adult orthodontics
DESCRIPTION
ADULT ORTHODONTICS . DR. FITRI OCTAVIANTI DEPARTMENT OF ORTHODONTICS USIM. WHAT WILL YOU LEARN?. Indications and contraindications Specific problems in adult orthodontic treatment Differences between adults and children Aesthetics orthodontics appliances - PowerPoint PPT PresentationTRANSCRIPT
ADULT ORTHODONTICS
DR. FITRI OCTAVIANTI
DEPARTMENT OF ORTHODONTICS USIM
•Indications and contraindications•Specific problems in adult orthodontic treatment
•Differences between adults and children
•Aesthetics orthodontics appliances•Mandibular advancement splints in treatment of obstructive sleep apnoea
WHAT WILL YOU LEARN?
Introduction
•The demand for orthodontics for adults is increasing
Two groups of adults that request orthodontic treatment
Looking for comprehensive treatment
Looking for adjunctive orthodontic treatment
•6% of adults have OJ > 7mm•9% have OB complete to palate•25% orthodontics patient in USA are adult patient
•> 70% are female
Why seek ortho treatment?1. Desire to improve dental appearance2. Treatment of relapse cases3. To facilitate restorative or periodontal
treatment4. For surgical correction of jaw
discrepancy 5. To use intraoral mandibular
advancement appliances for obstructive sleep apnoea
No age limitAestheticsFunctionalAdjunct to other treatment
INDICATIONS OF ADULT ORTHODONTICS
Medical problem-allergiesPoor oral hygieneShort root
CONTRAINDICATIONS OF ADULT ORHODONTICS
SPECIFIC PROBLEMS IN ADULT1. Lack of growth2. Periodontal disease3. Missing or heavily restored teeth4. Physiological factors affecting tooth movement5. Adult motivation and attitude towards treatment
LACK OF GROWTH
•The majority of growth changes have occurred by the end of puberty
•No scope for growth modification•Skeletal discrepancies can only be treated with orthodontic camouflage or combine orthognathic-orthodontic
•Can be difficult to reduce overbite •Extruding the molars are prone to relapse
Micro-implant used for anchorage for intrusion the anterior teeth
PERIODONTAL DISEASE
•Adults are more likely to be suffering, or have suffered from periodontal diseases
•Active periodontal disease should be treated and stabilized before orthodontic treatment begin.
MISSING OR HEAVILY RESTORED TEETH
•Tooth loss may lead to drifting and tilting of adjacent teeth and over eruption of opposing teeth into the space
•Atrophy of the alveolar bone can occur•Heavily restored teeth are more common in adults and may complicate orthodontic treatment.
•Bonding to restoration material is difficult
Atrophy of alveolus after tooth loss
Bonding bracket to restoration teeth is more difficult than to the enamel
PHYSIOLOGICAL FACTORS AFFECTING TOOTH MOVEMENT
•There is a reduced tissue blood supply and decreased cell turnover in adults
•Initial tooth movement is slower in adults •May be more painful•Lighter initial forces are advisable
ADULT MOTIVATION AND ATTITUDE TOWARDS TREATMENT
•Usually adults are well-motivated patients•Increase co-operation may compensate for slower initial tooth movement
•Adults tend to be more conscious of the appearance
•More drive towards aesthetic orthodontics•More reluctant to wear extra oral appliances
DIFFERENCES BETWEEN ADULTS AND CHILDREN
1. Medical history- medications and medical condition
2. Psychological- very demanding3. Growth- unsuitable for functional
appliances4. Previous disease- caries and periodontal5. Stability- reduce cell turnover6. Cell biology- slower cell response
AESTHETIC ORTHODONTICS APPLIANCES
Aesthetic orthodontics brackets
Lingual orthodonticsClear plastic appliances
Aesthetics orthodontics brackets
•Made from clear or tooth colored material
2 types Ceramic material
Polycarbonate (plastic bracket)
Plastic brackets
•Plastic brackets showed problems with staining and lack of stiffness, which led to deformation of brackets
•Some newer version have metal slot incorporated with plastic brackets
Plastic brackets
Plastic brackets Plastic brackets with metal slot
Plastic brackets
Ceramic bracketsmade from polycrystalline or monocrystalline
More aesthetic than plastic brackets
Ceramic brackets
•The disadvantages: •The bond strength is too strong that could cause enamel fracture
•Too much friction that reduce sliding of archwire
•Bracket breakage especially at the tie-wings•Iatrogenic enamel damage: enamel wear if teeth contacted ceramic brackets
•Problem when debonding brackets
Ceramic brackets
Ceramic brackets
Ceramic brackets
Lingual orthodontics
•Advantages:
AestheticsLess risk to labial enamel
through decalcificationPosition of the tooth can be
seen more accutarelyBite plane effect
Brackets are bonded in the lingual aspect of the teeth
•Disadvantages:Speech difficultiesTongue discomfortMasticatory difficultiesTechnical demanding for
operatorBonding and rebonding were
not easily implementedCost
Lingual appliances
Lingual appliances
Clear plastic appliances
•The “invisalign”•Similar to plastic retainer•Mild cases•Patient have to wear a series of plastic appliances to move teeth
Clear plastic appliances
Advantages Disadvantages
Excellent aestheticsComfort for patientsEase of care and oral hygiene
Limited control over root movementLimited intermaxillary correctionCost
Aligner is worn for 20 hours per
day
It is changed every 2 weeks
Each aligner will be move
the teeth 0.25-0.3
mm
It is only removed for
eating, drinking and
brushing teeth
OBSTRUCTIVE SLEEP APNOE AND MANDIBULAR ADVANCEMENT SPLINTS
Obstructive sleep apnae (OSA) is a sleep-related breathing disorder, characterised by reapeted collapse of the upper airway during sleep, with cessation of breathing
Etiology OSA:Combination of anatomical and pathophysiological factors.
Combination of retropositioned facial skeleton and reduced oro-pharyngeal dimensions at one or more site between soft palate, tongue and pharyngeal wall.
Functional impairment of upper airway dilatory muscles.
Nocturnal symtom:•Snoring•Witnessed apnoea•Choking/gasping•Nocturia•Reslessness
Daytime symtom:•Excessive daytime sleepiness
•Depression• Impared quality life
Clinical symtom:
The sympton can be worsened by certain aggravating factors:
•Alcohol consumption•Obesity•Supine position
OSA is typically classified:•Mild OSA- AHI 5-15 episodes per hour of sleep•Moderate OSA- AHI 16-30 episodes per hour of sleep
•Severe OSA- AHI >30 episodes per hour of sleep
AHI=apnoea-hypopnoea index
Treatment:•Conservative treatment: removal of aggravating factors
•Non surgical treatment -Continuous Positive Airway Pressure -Mandibular Advancement Splints
Monoblock appliance for treatment of sleep apnoea
First generation vacuum-formed mandibular advancement splint
Second generation Herbst removable mandibular advancement splint
Third generation medical dental sleep appliance
Seft-adjustment is possible anteroposteriorly , right and left lateral movement
