A BASIC LESSON ON THE ROLE OF AGE IN ORTHODONTIC TREATMENT PLANNING.

1. Age Factor in Orthodontics
DR. VIGNESH R, BDS

2. Adult Patients
• Adult: Is defined as one who is fully grown, or a
person who ceases to grow
• The exact time when a person reaches adulthood
cannot be predicted
• Biologically, males above 18 years, and females
above 16 years can be considered adults
• Orthodontically, adult patients are classified as:
– Group I :- 18 – 25 years (Post -Adolescent patients)
– Group II:- 26 – 35 years
– Group III :- Above 35 years
• Another classification is:
– Younger adults: Under 35 years
– Older adults: Above 35 years

3. • From 1970 to 1990, there has been an 800% increase in
adult patients
• The reason for this increase can be attributed due to the
following reasons:
1. Innovations in appliance placement techniques:Newer
approaches such as direct bonding, invisible/lingual
orthodontics
2. Innovations in material research:Such as ceramic
brackets and tooth colored wires
3. Role of a family dentist
4. Role of media, visual as well as print
5. Role of insurance companies
6. Affluence: Due to improving socio economic standards
7. Greater awareness: Of health and esthetic standards

4. CHARACTERISTIC ADOLESCENT PATIENT ADULT PATIENT
Growth Potential: Growth Modifn. possible Growth Modifn. Not
possible; Only tooth
correction possible
TMJ: Adaptable Signs of TMJ dysfunction
Periodontal problems: Periodontal diseases are
rare
Frequent periodontitis
General health: Rarely a problem Usually a major
concern,esp. at event of
surgery
Appliance esthetics: Rarely of concern Major concern to the patient
Retention planning: Short-term with removable
appl.
Long term & usually fixed
Appliance Tolerance: Will tolerate better More time required to adapt
Speech: Adjusts quickly Takes more time and effort
to adjust
Motivation & cooperation: Poor to excellent Usually good
Treatment appreciation: Ranges from hardly
concerned to very
appreciative
Usually very appreciative

9. Indications for Adult Orthodontics
The Indications are:
• Prosthodontic
• Periodontal
• Temperomandibular joint
• Esthetic

10. Prosthodontic Indications:
These are:
* Parallelism of abutment teeth
* Uprighting of tilted teeth
* Regaining lost extraction spaces
* Derotation of rotated teeth
* Intrusion of supraerupted teeth
* Distribution of extraction space more
favorably

11. Periodontal Indications
• Crowding of teeth:
– Crowding Plaque accumulation
Periodontitis
• Spacing between teeth:
– Spacing between teeth Food lodging
Periodontal Pocket formation

12. Temperomandibular Dysfunction
• Usually caused due to early loss of posterior
teeth, leading to over closure, and loss of
vertical height
• Orthodontist can relieve the symptoms using
splints before embarking on prosthetic
rehabilitation

13. Esthetics
• This is the most motivating factor behind
seeking treatment
• Usual causes of esthetic concern are:
– Crowding
– Rotations
– Migrations, etc
All owing to periodontal problems

14. Contraindications for Adult Orthodontics
• Medical: Bone formation is compromised in certain diseases
such as Diabetes. Also treating medically compromised
individuals is difficult
• Periodontitis: Patients with poor oral hygiene, mobile teeth, and
periodontitis are poor orthodontics patients
• Skeletal malocclusions: These require surgical intervention, and
thus may not be taken up, owing to the physical and medical
status of the patient
• Under motivated patients: It is advised not to start the treatment
unless the patient is determined to see the therapy through to
completion
• Poor stability prognosis

15. Diagnosis and age
• Normalcy in dentofacial region differs with age
• Transient malocclusions/self-correcting malocclusions: These are features
of the developing dentofacial complex, which are normal in a child, but if
present in an adult would constitute a malocclusion. These are self
correcting as age advances.
• Some transient malocclusions are:
– Open bite seen in gum pads - Flush terminal plane
– Primary spacing ( Deciduous dentition) - First deep bite
– Ugly duckling stage
• For maximum success of myofunctional and orthopedic appliances, the
dental and skeletal age of the young patient has to be assessed
– Skeletal age: Usually assessed using Hand Wrist radiographs, cervical
vertebrae etc
– Dental age: Determined by assessing the stage of root development and
calcification
– Skeletal and dental ages don’t always coincide with the Chronologic age

16. Treatment and age
Advantages of treating at an early age are:
– Scope for growth modification: Offers growth
modification procedures such as myofunctional and
orthopedic correction
– Scope for preventive and interceptive orthodontics
– Helps harnessing natural growth forces: Enables the
dentist to guide erupting teeth into more favorable
positions utilizing the natural guidance of erupting teeth,
in a mesio-occlusal direction
– Minimizes psychological distress:Treating at an early age
minimizes psychological distress that can develop due to
a full fledged malocclusion

17. Late treatment
• Role of growth:
– Cases decided for orthognathic surgery should be treated only
after growth completion, to avoid recurrent growth changes
with continuation of abnormal growth pattern.
• Limited treatment option:
– Since the growth is complete, the orthodontist`s treatment
option will be narrowed to moving teeth, and surgery, if needed,
and not on growth modulation, guidance of eruption etc
• Compromise on treatment objectives:
– Since growth is over, objectives for ideal dentition such as,
proper function, aesthetics, and stability may not be achieved.
The treatment may have to be compromised

18. Tooth Movement & Age
• Vitality of tissues:
– Orthodontic tooth movt. is less responsive in adult patients, owing
to decreased vascularity and cellularity, of their periodontal
membrane and bone. Hence tooth movt. requires more time
• Role of growth:
– Orthopedic correction cannot be achieved after growth completion,
and orthodontic correction in an adult, is done by altering the force
magnitude and duration

19. Role of apical foramen
• For adults, the apical foramen is narrower,
in contrast to younger individuals, hence
force application on the tooth can pose a
greater chance for non-vitality, root
resorption, and ankylosis of teeth to
occur.

20. Density of Bone:
• Since the bone density if higher for adults,
tooth movement is slower.

21. • An adult patient may have additional problems
such as:
– Periodontitis
– Faulty restorations
– Attrition
– Loss of teeth, etc
• The diagnosis for an adult should consider
these factors, for the success of the orthodontic
treatment.
Diagnosis

22. Appliance selection:
• Myofunctional and orthopedic appliances
cannot be used for adults, owing to growth
cessation
• Since esthetics is their prime concern,
removable appliances, fixed appliances (for
e.g.Lingual orthodontics),orthognathic
surgery etc, are the treatments options
available

23. Periodontal problems
• Periodontitis is more common in adults.
Periodontally involved teeth move more
readily and offer poor anchorage

24. Patient motivation and cooperation
• More cooperation is usually achieved from
an adult, rather than from a child

25. Tissue vitality
• The tissue vitality and responsiveness is
much lower in an adult, owing to lesser
vascularity and cellularity, hence it delays
tooth movement.

26. Treatment objectives:
• Since adult treatment most often needs
to be compromised, the orthodontist has
to strike the best balance between the
three objectives of orthodontic treatment
namely; function, esthetics and balance.

27. Treatment appreciation
• Adult patients appreciate treatment results
better than children.