Chapter 21

Adult orthodontics

Orthodontic treatment is not confined to children and adolescents.

Many adult patients seek an orthodontic solution to improve their function and appearance.

These patients may have discussed their concerns with their dentist (GDP). Often, they may have:

• been denied access to orthodontic treatment as children
• been offered it but they refused to take it up
• had orthodontics with a treatment plan that was incorrect or unsuccessful
• failed to complete treatment or to wear their retainers and the teethrelapsed

Often, patients have been considering an orthodontic treatment option for some time before they actually speak with their dentist.

The dentist will know where it is appropriate to refer the patient, i.e. the severity of the malocclusion.

If it is a relatively mild malocclusion involving:

• mild rotations
• crowding
• spacing

the patient may be referred to a Specialist Practitioner, who has qualified as a dentist and then gone on with post-graduate training in order to achieve a post-graduate qualification in orthodontics.

If it is a more challenging malocclusion involving:

• an underlying skeletal asymmetry
• a complex occlusal problem
• a severe degree of crowding
• a number of congenitally missing teeth
• any untreated ectopic teeth
• signs of bone loss or a periodontal condition

The patient may then be referred to a Consultant Orthodontist, who:

• has qualified as a dentist
• has gone on to achieve further orthodontic qualifications
• has worked in the hospital service as a Senior or Specialist Registrar
• ultimately, be appointed as a Consultant

The treatment plan that they provide will help decide where best to treat the patient.

Adult patients have some advantages over children.

They:

• are compliant and keen
• know what they want
• can have interproximal enamel reduction
• have good oral hygiene

They also have some disadvantages. They may have:

• missing teeth
• fractured teeth which are sometimes non-vital
• root-treated teeth
• periodontal disease with resultant gum recession
• implants
• loss of alveolar ridge due to earlier extraction of teeth
• tooth surface loss
• underlying medical health problems
• they have finished facial growth
• teeth which have suffered trauma and have become ankylosed, i.e. fused to the surrounding tissue; these teeth cannot be moved orthodontically
• bridgework; so in some areas, movement and space is compromised
• root resorption and low bone levels
• Temporo-mandibular-joint problems, e.g. pain on opening, clicking, etc.
• para functional habits, e.g. bruxism
• effects on periodontal health if the patient is a smoker

For adult patients, a more socially acceptable and discreet option may include:

• fixed appliances using aesthetic brackets (these can be upper anteriors only) (Figure 21.1)
• bond full upper and lower ceramic brackets (Figure 21.2)
• removable appliances, i.e. they can be removed for critical business or social meetings
• aligners
• lingual fixed appliances (Figure 21.3)

Adult patients come to seek advice and information for a variety of reasons.

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