The major differences between adult and young orthodontic patients

1. ‫الرحيم‬‫الرحمن‬‫هللا‬‫بسم‬
Ibn Sina University
Faculty of Dentistry
Department of Orthodontics
Adult Orthodontics
Mohanad Elsherif
BDS (U of K), MFD RCSI, MFDS RCPS(Glasg), MSc (Orthodontics), M.Orth. RCSEd

2. Introduction
 Who are adults?
those over age 18 at the start of treatment.
 Adult orthodontics has been the fastest-growing
type of orthodontic treatment in recent years.
 In the United States, adults now comprise about
30% of all patients receiving comprehensive
orthodontic treatment.

3. Introduction
Adults who seek orthodontic treatment fall into two quite different
groups:
(1) Younger adults:
 Typically under 35, often in their 20s.
 They desired but did not receive comprehensive orthodontic treatment
as youths and now seek it as they become financially independent.
 They usually seek the maximum improvement that is possible.
 They may or may not need extensive treatment by other dental
specialists but frequently need interdisciplinary consultation.

4. Introduction
(2) older group:
 Typically in their 40s or 50s,….
 They have other dental problems and need orthodontics as part of a larger
treatment plan.
 They seek to maintain what they have, not necessarily to achieve as ideal an
orthodontic result as possible.
 For them, orthodontic treatment is needed to:
 Control dental disease
 Making restoration of missing teeth easier and more effective
 So the orthodontics is an adjunctive procedure to the larger periodontal and
restorative goals.

5. Young
patients
Adults
patient
s

6. Adult patients
 More likely to have relevant medical
history:
 Diabetes
 Hypertension
 Relevant medications
 Therefore medical consultation and referral
is important before and during treatment.

7. Adult patients
 Higher chances of caries and periodontal
problems:
 Therefore other types of dental treatment almost always are
required.
 Treatment planning must involve all the dentists who will
play a role in the treatment.
 Who will be the leader?
 Deep caries, RCT and periodontitis affect extraction choice.
 Heavy restoration affect bonding.

8. Adult patients
 Absence of growth
 Growth modification is not a treatment option.
 Therefore everything has to be done with either
orthodontic tooth movement, restorative dentistry, or
orthognathic surgery.
 Planning orthodontic treatment and/or Surgery for
adults can be easier because there are no uncertainties
related to the amount and direction of growth.

9. Adult patients
 Tooth movement is more difficult
 The initial response to orthodontic force is slower
in adults because the delayed cellular response
 However once tooth movement start the
movement proceed at approximately the same rate
as for adolescence.

10. Adult patients
 Anchorage control
 Multiple missing teeth
 Periodontal involvement of
anchorage unit teeth
 Extraoral appliances are not
tolerated
 Temporary anchorage devices

11. Adult patients
Treatment mechanics
 Extrusion of teeth should be avoided as there are
no compensating growth at the ramus.
 Therefore open bite and deep bite are corrected
either by active intrusion and/or Orthognatheic
surgery.

12. Adult patients
 Psychological considerations:
 Adults react to being orthodontic patients differently from children and
adolescents in three ways:
 Almost always they are intensely interested in their treatment and want to
understand what is happening and why, so they require more clinical time in
explanations.
 They experience more pain than younger patients or they are less tolerant of
it— so medication for pain control is more important for them.
 They desire esthetic appliance, ceramic brackets, lingual appliance and clear
aligners are options

13. Treatment for adults
 Treatment of adults fall into two categories
 Adjunctive orthodontic treatment
 Comprehensive orthodontic treatment

14. Treatment of adults
1. Adjunctive orthodontic treatment:
 Adjunctive orthodontic treatment for adults is, by definition,
tooth movement carried out to facilitate other dental procedures
necessary to control disease, restore function, and/or enhance
appearance.
 Simpler procedures, often can and should be carried out within
the context of general dental practice
 This discussion does not require familiarity with the principles of
comprehensive orthodontic treatment, but it does presume an
understanding of orthodontic diagnosis and treatment planning.

15. Treatment for adults
2. Comprehensive orthodontic treatment
 The goal of comprehensive orthodontics for adults is the
same as for adolescents: to produce the best combination
of dental and facial appearance, dental occlusion, and
stability of the result to maximize benefit to the patient.
 Comprehensive orthodontics for adults tends to be
difficult and technically demanding.

16. Adjunctive Orthodontic
treatment
 Typically, adjunctive orthodontic treatment will involve any or all of several
procedures:
(1) repositioning teeth that have drifted after extractions or bone loss so that
more ideal fixed or removable partial dentures can be fabricated or so that
implants can be placed

17. Adjunctive Orthodontic
treatment
 Typically, adjunctive
orthodontic treatment
will involve any or all of
several procedures:
(2) alignment of anterior
teeth to allow more
esthetic restorations or
successful splinting,
while maintaining good
interproximal bone
contour and embrasure
form.

18. Adjunctive Orthodontic
treatment
 Typically, adjunctive
orthodontic treatment will
involve any or all of several
procedures:
(3) correction of crossbite if this
compromises jaw function (not
all crossbites do).

19. Adjunctive Orthodontic
treatment
 Typically, adjunctive orthodontic treatment will involve any or all of several
procedures:
(4) forced eruption of badly broken down teeth to expose sound root structure
on which to place crowns or to level/regenerate alveolar bone.

20. Declaration
 The author wish to declare that; these presentations are his original work, all
materials and pictures collection, typing and slide design has been done by the
author.
 Most of these materials has been done for undergraduate students, although
postgraduate students may find some useful basic and advanced information.
 The universities title at the front page indicate where the lecture was first
presented. The author was working as a lecturer of orthodontics at Ibn Sina
University, Sudan International University, and as a Master student in Orthodontics at
University of Khartoum.
 The author declare that all materials and photos in these presentations has been
collected from different textbooks, papers and online websites. These pictures are
presented here for education and demonstration purposes only. The author are not
attempting to plagiarize or reproduced unauthorized material, and the intellectual
properties of these photos belong to their original authors.

21. Declaration
 As the authors reviews several textbooks, papers and other references during
preparation of these materials, it was impossible to cite every textbook and journal
article, the main textbooks that has been reviewed during preparation of these
presentations were:
Contemporary Orthodontics 5th edition; Proffit, William R, Henry W. Fields, and
David M. Sarver.
Handbook of Orthodontics. 1st edition; Cobourne, Martyn T, and Andrew T. DiBiase.
 Clinical cases in orthodontics. Martyn T. Cobourne, Padhraig S. Fleming, Andrew T.
DiBiase, Sofia Ahmad
Essentials of orthodontics: Diagnosis and Treatment; Robert N. Staley, Neil T. Reske
Orthodontics: Current Principles & Techniques 5th edition; Graber, Lee W, Robert L.
Vanarsdall, and Katherine W. L. Vig
Orthodontics: The Art and Science. 3rd Edition. Bhalajhi, S.I.

22. Declaration
 For the purposes of dissemination and sharing of knowledge, these
lectures were given to several colleagues and students. It were also
uploaded to SlideShare website by the author. Colleagues and students
may download, use, and modify these materials as they see fit for non-
profit purposes. The author retain the copyright of the original work.
 The author wish to thank his family, teachers, colleagues and students
for their love and support throughout his career. I also wish to express
my sincere gratitude to all orthodontic pillars for their tremendous
contribution to our specialty.
 Finally, the author welcome any advices and enquires through his
email address: Mohanad-07@hotmail.com

23. Thank You