Special Considerations in Treatment for Adults

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. Almost always, it involves only a part of the dentition, and the primary goal usually is to make it easier or more effective to replace missing or damaged teeth. Making it easier for the patient to control periodontal problems is a frequent secondary goal, and sometimes is the primary goal. The treatment duration tends to be a few months, rarely more than a year, and longterm retention usually is supplied by the restorations. With the distinction made in this way, most of the adjunctive treatment discussed in this chapter can be carried out within the context of general dental practice. Whether one or several practitioners are involved, adjunctive orthodontics must be coordinated carefully with the periodontal and restorative treatment. In contrast, the goal of comprehensive orthodontics for adults is the same as for adolescents: to produce the best combination of dental occlusion, dental and facial appearance, and stability of the result to maximize benefit to the patient. Typically, comprehensive orthodontics requires a complete fixed orthodontic appliance, intrusion of some teeth is likely to required, orthognathic surgery may be considered to improve jaw relationships, and the duration of treatment from braces on to braces off exceeds 1 year. Adults receiving comprehensive treatment are the main candidates for esthetically-enhanced appliances, the prime examples being clear aligners, lingual appliances, and ceramic facial brackets. The complexity of the treatment procedures means that an orthodontic specialist is likely to be significantly more efficient in delivering the care. The first part of this chapter is devoted to adjunctive treatment, carried out in large part with fixed appliances that involve only selected areas of the dental arches. The second part covers non-surgical comprehensive adult treatment. The integration of orthodontics and orthognathic surgery is discussed in Chapter 19.