Adult Orthodontics Research Articles

Adult orthodontics: a quality assessment of Internet information.

This study evaluated the quality, reliability and readability of information on the Internet on adult orthodontics. A quality assessment of adult orthodontic websites. Postgraduate Orthodontic Unit, Cork University Dental School and Hospital, Cork, Ireland. An Internet search using three search engines (Google, Yahoo and Bing) was conducted using the terms ('adult orthodontics' and 'adult braces'). The first 50 websites from each engine and under each search term were screened and exclusion criteria applied. Included websites were then assessed for quality using four methods: the HON seal, JAMA benchmarks, the DISCERN instrument and the LIDA tool. Readability of included websites was assessed using the Flesch Reading Ease Score (FRES). Only 13 websites met the inclusion criteria. Most were of US origin (n = 8; 61%). The authors of the websites were dentists (n = 5; 39%), professional organizations (n = 2; 15%), past patients (n = 2; 15%) and unspecified (n = 4; 31%). Only 1 website displayed the HON seal and three websites contained all JAMA benchmarks. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/144. The average FRES score was 63.1/100. The number of informative websites on adult orthodontics is low and these are of moderate quality. More accurate, high-quality Internet resources are required on adult orthodontics. Recommendations are made as to how this may be achieved.

Adult orthodontics: a quality assessment of Internet information.

S.M. McMorrow, D.T. MillettLaypeople are increasingly turning to the Internet for sourcing health information, owing to the volume of resources, ease of access, and the convenience of ‘surfing the ...

A discerning approach to simple aesthetic orthodontics.

There is currently considerable interest from general dental practitioners (GDPs) in the use of simple orthodontics to treat adult malocclusions. There is controversy in this, particularly in relation to 'quick fixes', simple orthodontics and 'straight teeth in six months' as opposed to more conventional treatment where the whole malocclusion is treated. This article will present a case for the use of simple aesthetic adult orthodontics in a measured and planned way. It will discuss the processes, planning and the importance of consent. It will also highlight how digital technology is used to preview, consent and execute an aesthetic result. Many of the recent systems emerging, have been as a result of the demand and supply of cosmetic dentistry. This, to a degree, has not helped since the implication of a 'quick-fix' is associated with this field. There has also been discussion on what the limits of GDP orthodontics should be. There is variability in how GDPs approach orthodontics, their experience, skill and ability to treat to an acceptable standard. Short courses may be one way of delivering orthodontic training but some of these courses are not regulated and the amount of internal mentoring is variable. This article highlights some of the systems in use, and potential upsides and downsides of this approach.

Adults seeking orthodontic treatment: expectations, periodontal and TMD issues.

The growth in adult orthodontics presents new challenges to both the general dental practitioner and the orthodontist. Although many of the main objectives of orthodontic treatment are similar for adults, young adults and children, adult patients frequently bring significant challenges in several areas not often seen in the younger patient group. In areas such as planning realistic treatment outcomes, it is paramount that the patient's expectations are identified, respected and managed where appropriate. The adult patient's dental health often dictates deviation from the ideal treatment plan and periodontal problems are a common example. Based on current evidence, this paper presents an overview of some of the difficulties in the management of these issues, as well as highlighting developments with regard to pain conditions and their relevance to orthodontic treatment and its effects on temporomandibular joint disorders (TMD) management.

Screening and Prevalence of the Novel Cariogenic Pathogen Scardovia wiggsiae among Adult Orthodontic and Non-Orthodontic Patient Saliva Samples

Orthodontic therapy in the United States has become routine among teenagers and increasing among adults. Despite these positive developments, orthodontic treatment has often been associated with changes to the oral environment, which may increase disease risk. Although numerous studies have demonstrated the causal link between Streptococcus mutans and carious lesions, more recent evidence suggest that it only constitutes part of a much larger oral microbial community. Several recent studies have demonstrated the presence of newly characterized cariogenic pathogen, the anaerobic Gram-positive bacillus Scardovia wiggsiae. This retrospective study of previously collected saliva samples originated with a convenience sample of pediatric and adult patients, previously recruited from the University of Nevada Las Vegas-School of Dental Medicine (UNLV-SDM) clinics. More than one hundred saliva samples from adult orthodontic (n=49) and non-orthodontic (n=52) patients were selected for inclusion in this study. All DNA extracted from these samples was subsequently screened using PCR, which revealed the presence of S. mutans (SM), P. gingivalis (PG), and S. wiggsiae (SW), which differed in prevalence among non-Orthodontic and Orthodontic patients. In non-orthodontic patients nearly all of the PG-positive and SW-positive samples were also SM-positive samples. However, among orthodontic patients, none of the SW-positive samples were either SM- or PG-positive. In addition, further analysis of demographic variables revealed decayed-missing-filled teeth (DMFT) score, periodontal pocket depth (PPD), age, gender, and BMI did not vary between groups, which suggest continued research in this area will be needed to elucidate these findings.

Adult orthodontics part 2: advances in treatment

Advances in orthodontic technology, especially those that address the aesthetic problem of metal or visible braces, have boosted the demand for adult orthodontics. Dental clinicians should be familiar with the advantages and limitations of the new aesthetic appliances coming onto the market. Clinical Relevance: Understanding the advances and different treatment modalities is the responsibility of both the GDP and the specialist orthodontist so that they can convey the relevant information to patients.

Transparent magnesium aluminate spinel: a prospective biomaterial for esthetic orthodontic brackets.

Adult orthodontics is recently gaining popularity due to its importance in esthetics, oral and general health. However, none of the currently available alumina or zirconia based ceramic orthodontic brackets meet the esthetic demands of adult patients. Inherent hexagonal lattice structure and associated birefringence limits the visible light transmission in polycrystalline alumina and make them appear white and non transparent. Hence focus of the present study was to assess the feasibility of using magnesium aluminate (MgAl2O4) spinel; a member of the transparent ceramic family for esthetic orthodontic brackets. Transparent spinel specimens were developed from commercially available white spinel powder through colloidal shaping followed by pressureless sintering and hot isostatic pressing at optimum conditions of temperature and pressure. Samples were characterized for chemical composition, phases, density, hardness, flexural strength, fracture toughness and optical transmission. Biocompatibility was evaluated with in-vitro cell line experiments for cytotoxicity, apoptosis and genotoxicity. Results showed that transparent spinel samples had requisite physico-chemical, mechanical, optical and excellent biocompatibility for fabricating orthodontic brackets. Transparent spinel developed through this method demonstrated its possibility as a prospective biomaterial for developing esthetic orthodontic brackets.

Adult orthodontics part 1: special considerations in treatment

Adult orthodontic demand in the UK has increased significantly in both private and National Health Service sectors, the reason being improvement in the availability of orthodontic services and an increased patient awareness towards orthodontics; in particular the desire for adults to have an aesthetic smile. There is also the role of orthodontics as an adjunct to restorative, periodontal and orthognathic treatment. Clinical Relevance: Successful orthodontic treatment of adults depends on an understanding of the biological, mechanical, psychological and aesthetic needs of adult patients.

Treatment of Osteochondroma in the Mandibular Condyle and Secondary Dentofacial Deformities Using Surgery Combined With Orthodontics in Adults

Osteochondroma is a benign tumor that is rare in the craniofacial region. When it does occur, the condyle and coronoid process have been the most commonly affected sites. The secondary progressive malocclusion and facial asymmetry will be common physical signs in most cases. The traditional surgical treatment of osteochondroma of the mandibular condyle has been condylectomy, with or without reconstruction of the condyle. We believe more attention should be paid to restoring joint function, improving the facial appearance, correcting malocclusion, and re-establishing harmony among them. From January 2000 to March 2013, 27 patients (17 women and 10 men) who had been diagnosed with osteochondroma of a unilateral mandibular condyle underwent condylectomy and condylar reconstruction using a pedicled posterior mandibular border obtained by ramus osteotomy. The secondary dentofacial deformities were simultaneously corrected using orthognathic and facial contouring procedures, followed by orthodontic treatment, when necessary. Occlusion and temporomandibular joint pain and function, including the maximal mouth opening and maximal protrusion, were recorded preoperatively and postoperatively. The patients were followed for an average of 13 months (range 24 to 48). The outcomes of, and feedback information from the patients showed apparent improved joint function, with no cases of osteochondroma recurrence. The secondary dentofacial deformities were corrected significantly. Satisfactory occlusion was achieved with orthognathic and orthodontic treatment. Our data suggest that condylectomy and condylar reconstruction, with simultaneous correction of the secondary dentofacial deformities using orthognathic procedures, might be a better approach to manage osteochondroma accompanied by dentofacial deformities. In addition to facial contouring procedures, orthodontic treatment should be considered for better improvement in facial esthetics and occlusion.

Think Mathematic, Gain Orthodontic. Innovative modification of Tonn formula to calculate mesiodistal width of missing lower incisors

The incidence of congenital absence of lower incisors though is statistically low but still is area of concern for orthodontists. Also, chances of losing lower anteriors due to periodontal pathology are high due to its location, which is a concern in adult orthodontics. For the achievement of an ideal occlusion and a good intercuspation, we need to identify the interarch tooth size discrepancy calculated using the individual tooth size. Thereby, in cases with missing lower incisors, considering the tooth size of the missing tooth is questionable. Therefore, we have proposed an innovative mathematical modification of Tonn formula for the prediction of the mesiodistal width of the missing lower anterior tooth. The use of this method in our department is a testimony of its usefulness.

Management of bimaxillary dento alveolar protrusion with lingual appliance

Adult orthodontics in today's contemporary world is focused mainly on esthetics. Lingual orthodontics has evolved as an adjunct while exploring esthetics. Assuring esthetics and functional balance is the current concept of invisible orthodontics. It is almost as successful as labial orthodontics and has good three-dimensional control over the dentition. As the brackets are placed near to the center of resistance of the tooth, anchorage value is higher in lingual orthodontics than labial orthodontics. With the appliance in mouth, the patient overcomes the social barriers of appearing in public and augments his own level of confidence. Proper knowledge on biomechanics ensures success with lingual appliance. The following case report presents the usage of lingual technique in closing generalized spaces by following proper biomechanics in achieving ideal occlusion and thus enhancing esthetics.

"Periodontal care in the sequence of adult orthodontics: How to avoid periodontal complication during orthodontic treatment"

"Periodontal care in the sequence of adult orthodontics: How to avoid periodontal complication during orthodontic treatment"

Adult Orthodontics (2012)

Adult Orthodontics (2012) Author: Birte Melsen Publisher: Wiley-Blackwell, Hoboken, NJ, USA Price: £99.99 ISBN: 781405136198 Pages: 408 Increasing numbers of adult patients are seeking orthodontic treatment. This book fulfils the need for an orthodontic text exploring the specific problems associated with management of the adult dentition. The book is divided into 20 chapters with additional supporting information relating to chapters 4, 7, 8, 12, and 18 available on the companion website for the book at www.wiley.com/go/melsen. This is a very comprehensive text looking at the complete management …

Mandibular Symphysis Transverse Widening

The most common orthodontic methods of treating mandibular transverse deficiencies is extractions, interdental stripping, and other dento-alveolar compensation but it can not addressesd about skeletal problem This study assessed the treatment outcomes after surgically assisted rapid tooth orthodontics using the symphysis osteotomy and dentoalveolar distraction osteogenesis technique. The applications of distraction osteogenesis in mandibular widening, by symphysis osteotomy, has emerged as a definitive, predictable and better stability. The most important factors in mandibular widening is performed with simple surgical technique and devices. As a results, these techniques are very useful and effective in cases of difficult tooth movement in adult orthodontics transverse problems There were few intraoperative or postoperative complications and were not clinically significant.

Restoring esthetics using adjunctive orthodontics – Case reports

Pre-restorative orthodontic alignment has definite advantages especially in patients with mal-aligned dentition seeking prosthetic rehabilitation. As adult orthodontics has gained popularity, orthodontic practices have seen a change in the patient population they encounter on a day-to-day basis. From completely dentulous adolescents, this population has widened to encompass adult dentitions with worn or abraded teeth, peg-shaped lateral incisors, fractured teeth, gummy smiles, multiple edentulous spaces, or other restorative needs that often require tooth positioning that is slightly different from non restored, nonabraded, adolescent teeth. In such instances, an interdisciplinary approach is necessary to evaluate, diagnose, and resolve esthetic problems using a combination of orthodontic, periodontic, endodontic and prosthodontic treatments. The aim of the article is to emphasize the importance of adjunctive orthodontics in such interdisciplinary treatment protocols, through two case reports.

Orthodontic-Periodontic Interdisciplinary Approach

AbstractIn the last years, a significant development has taken place in the orthodontic treatment of adult Patients. Adult orthodontics is different than that for children because in adults there is virtual no more growth and because there are changes in the tooth supporting structures: the periodontium. The orthodontic treatment is carried out through the medium of periodontium so a healthy tooth supporting system is the essential prerequisite for carrying out the orthodontic treatment. At the same time, as the tooth is moving under the effect of orthodontic force, various changes occur in the periodontium under the effect of force. So, it is important that the orthodontic treatment is periodontally compromised patient be considered separately as they are more prone to further bone loss; the reduced periodontium cannot sustain further loss without the potential loss of teeth. The reduced periodontal support dictates altered treatment design, mechanics and retention. At the same time it is important to consider the limits of periodontium while carrying out orthodontic treatment so that there is no damage due to inadvertent intervention.

Shear bond strength of stainless steel brackets bonded to porcelain surface treated with 1.23% acidulated phosphate fluoride gel compared to hydro fluoric acid with silane coupling agent (In vitro comparative study)

With the increasing demands for adult orthodontics, a growing need arises to bond attachments to porcelain surfaces. Optimal adhesion to porcelain surface should allow orthodontic treatment without bond failure but not jeopardize porcelain integrity after debonding.The present study was carried out to compare the shear bond strength of metal bracket bonded to porcelain surface prepared by two mechanical treatments and by using different etching systems (Hydrofluoric acid 9% and acidulated phosphate fluoride 1.23%). Materials and Methods: The samples were comprised of 60 models (28mm *15mm*28mm) of metal fused to porcelain (feldspathic porcelain). They were divided as the following: group I (control): the porcelain surface left untreated and glazed, group II (Diamond bur group): the porcelain surface was treated with fine diamond bur at speed of 350000 rpm for 20 seconds, group III (Red stone bur): the porcelain surface was treated with coarse red stone bur at speed of 8500 rpm for 20 seconds. Each group consists of 20 samples, then each group subdivided into two subgroups; one treated with acidulated phosphate fluoride 1.23% and the other subgroup treated with Hydrofluoric acid 9 % with silane coupling agent. Results: The result of this study revealed that there was very high significant difference among all tested groups and the highest shear bond strength was for diamond bur group with HFA and Silane (8.67 MPa), the 2nd highest strength was for control group with HFA and Silane (7.52 MPa), the 3rd was (7.38 MPa) in red stone bur with HFA and Silane, the least shear bond strength values were obtained for subgroups treated with acidulated phosphate fluoride gel 1.23%. Conclusions: The most reliable procedure for bonding orthodontic brackets to the porcelain surfaces is through the surface treatment combinations of mechanical roughening by using diamond bur, 9% Hydrofluoric acid and Silane coupling agent application.

Adult orthodontics in the absence of orthognathic treatment: a hospital perspective

To examine adult orthodontic treatment within two hospital settings and ascertain whether any factors have a statistically significant effect on treatment outcomes. A retrospective observational study. Through the analysis of hospital case notes, variables relating to adult patients undergoing orthodontic treatment that did not involve orthognathic surgery between 1991 and 2008 at the Eastman Dental and Croydon University Hospitals, were studied. In addition, a proportion of study models were Peer Assessment Rating (PAR) scored to determine treatment outcome. Females accounted for 76·2% of the adults studied, with a mean age of 31·24 years. The most commonly presenting malocclusion was a class II division 1 incisor relationship on a class II skeletal base, with over half of all patients studied having missing teeth upon presentation. The mean treatment length was 2·29 years. Only the type of orthodontic treatment (orthodontic-only or multidisciplinary) and/or the presence of a crowded upper labial segment had a statistically significant effect on treatment outcomes, as measured by PAR scores. This study has highlighted demographical and treatment trends from a cohort of adult patients studied within two hospital orthodontic departments. It also illustrates that a crowded upper labial segment and the type of treatment provided has a statistically significant effect on post-treatment PAR scores.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Gingival recession and adult orthodontics: A clinical evidence-based treatment proposal

The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.