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ADULT ORTHODONTICS

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

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ADULT ORTHODONTICS

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  1. ADULT ORTHODONTICS DR. FITRI OCTAVIANTI DEPARTMENT OF ORTHODONTICS USIM

  2. WHAT WILL YOU LEARN? • 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

  3. 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

  4. 6% of adults have OJ > 7mm • 9% have OB complete to palate • 25% orthodontics patient in USA are adult patient • > 70% are female

  5. Why seek ortho treatment? • Desire to improve dental appearance • Treatment of relapse cases • To facilitate restorative or periodontal treatment • For surgical correction of jaw discrepancy • To use intraoral mandibular advancement appliances for obstructive sleep apnoea

  6. No age limit • Aesthetics • Functional • Adjunct to other treatment INDICATIONS OF ADULT ORTHODONTICS

  7. Medical problem-allergies • Poor oral hygiene • Short root CONTRAINDICATIONS OF ADULT ORHODONTICS

  8. SPECIFIC PROBLEMS IN ADULT 1. Lack of growth 2. Periodontal disease 3. Missing or heavily restored teeth 4. Physiological factors affecting tooth movement 5. Adult motivation and attitude towards treatment

  9. 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

  10. Micro-implant used for anchorage for intrusion the anterior teeth

  11. 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.

  12. 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

  13. Atrophy of alveolus after tooth loss

  14. Bonding bracket to restoration teeth is more difficult than to the enamel

  15. 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

  16. 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

  17. DIFFERENCES BETWEEN ADULTS AND CHILDREN • Medical history- medications and medical condition • Psychological- very demanding • Growth- unsuitable for functional appliances • Previous disease- caries and periodontal • Stability- reduce cell turnover • Cell biology- slower cell response

  18. AESTHETIC ORTHODONTICS APPLIANCES Aesthetic orthodontics brackets Lingual orthodontics Clear plastic appliances

  19. Aesthetics orthodontics brackets • Made from clear or tooth colored material 2 types Polycarbonate (plastic bracket) Ceramic material

  20. Plastic brackets 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

  21. Plastic brackets Plastic brackets Plastic brackets with metal slot

  22. Ceramic brackets Ceramic brackets • made from polycrystalline or monocrystalline • More aesthetic than plastic brackets

  23. 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

  24. Ceramic brackets Ceramic brackets

  25. Lingual orthodontics Brackets are bonded in the lingual aspect of the teeth • Advantages: • Aesthetics • Less risk to labial enamel • through decalcification • Position of the tooth can be • seen more accutarely • Bite plane effect

  26. Disadvantages: • Speech difficulties • Tongue discomfort • Masticatory difficulties • Technical demanding for • operator • Bonding and rebonding were • not easily implemented • Cost

  27. Lingual appliances

  28. Lingual appliances

  29. Clear plastic appliances • The “invisalign” • Similar to plastic retainer • Mild cases • Patient have to wear a series of plastic appliances to move teeth

  30. Clear plastic appliances Disadvantages Advantages • Excellent aesthetics • Comfort for patients • Ease of care and oral • hygiene • Limited control over • root movement • Limited • intermaxillary • correction • Cost

  31. Aligner is worn for 20 hours per day It is changed every 2 weeks It is only removed for eating, drinking and brushing teeth Each aligner will be move the teeth 0.25-0.3 mm

  32. 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

  33. 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.

  34. Clinical symtom: Nocturnal symtom: • Snoring • Witnessed apnoea • Choking/gasping • Nocturia • Reslessness • Daytime symtom: • Excessive daytime sleepiness • Depression • Impared quality life

  35. The sympton can be worsened by certain aggravating factors: • Alcohol consumption • Obesity • Supine position

  36. 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

  37. Treatment: • Conservative treatment: removal of aggravating factors • Non surgical treatment -Continuous Positive Airway Pressure -Mandibular Advancement Splints

  38. Monoblock appliance for treatment of sleep apnoea

  39. First generation vacuum-formed mandibular advancement splint

  40. Second generation Herbst removable mandibular advancement splint

  41. Third generation medical dental sleep appliance

  42. Seft-adjustment is possible anteroposteriorly , right and left lateral movement

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