Adult Orthodontics

List of Contributors xi

Introduction:: More than a Century of Progress in Adult Orthodontic Treatment xiii

1 Potential Adult Orthodontic Patients – Who Are They? 1
Birte Melsen

Introduction 1

Who are the patients? 1

How do the patients express their needs? 6

The first visit 7

Communicating with the patient 9

Summary 10

References 10

2 Diagnosis:: Chief Complaint and Problem List 12
Birte Melsen, Marco A Masioli

Introduction 12

Work-up of a problem list – the interview – chief complaint 12

General health 14

Clinical examination 16

Extraoral examination 16

Extraoral photographs 19

Function of the masticatory system 23

Intraoral analysis – oral health 23

Evaluation of dental casts – arch form 24

Occlusal analysis 24

Space analysis 26

Cephalometric analysis 26

Final problem list 27

Indication for treatment 28

The presentation of the problem list – the tip of the iceberg 29

Concluding remarks 33

References 33

3 Aetiology 35
Birte Melsen

Introduction 35

Biological background 35

Aetiology of malocclusions in adults 41

Age-related changes in the skeleton 42

Age-related changes in the craniofacial skeleton 46

Age-related changes in the local environment 46

Consequences of deterioration of the dentition 48

Case reports 49

Conclusion 50

References 52

4 Interdisciplinary Versus Multidisciplinary Treatments 54
Birte Melsen

Interdisciplinary or multidisciplinary treatments 54

Establishment of an interdisciplinary team 56

Treatment sequence 58

Essential and optional treatment procedures 59

Interaction during treatment 61

Post-orthodontic treatment 62

Patient satisfaction 62

Examples of interdisciplinary cases 63

References 63

5 Treatment Planning:: The 3D VTO 64
Birte Melsen, Giorgio Fiorelli

Determining the treatment goal 64

Producing an occlusogram 64

Combining the occlusogram with the head fi lm 69

The computerized occlusogram 72

Responding to patients’ needs 73

Orthodontic treatment:: Art or science? 73

References 76

6 Tissue Reaction 77
Carlalberta Verna, Birte Melsen

Orthopaedic effects 77

Orthodontic effects in adult patients 78

References 95

7 Appliance Design 99
Birte Melsen, Giorgio Fiorelli, Delfi no Allais, Dimitrios Mavreas

Introduction 99

Defi nition of the necessary force system 100

Anchorage evaluation 101

Sequencing the treatment into phases 103

Appliance selection and design 105

Sliding mechanics 108

Segmented mechanics 112

Conclusion 128

References 129

8 Anchorage Problems 132
Birte Melsen, Carlalberta Verna

Introduction 132

Definition 132

Classification of anchorage 132

Intramaxillary anchorage 133

Soft tissue anchorage 136

Free anchorage 137

Intermaxillary anchorage 142

Occlusion 143

Differential timing of force application 144

Extraoral anchorage 144

Skeletal anchorage 145

References 160

9 Bonding Problems Related to Adult Rehabilitated Dentitions 163
Vittorio Cacciafesta, M Francesca Sfondrini, Carmen Giudice

Introduction 163

Brackets 163

Basics of bonding 168

Bonding to crowns and restorations 178

Debonding 179

Reconditioning of stainless steel attachments 180

Banding 181

Auxiliary attachments 185

References 185

10 Material-related Adverse Reactions in Orthodontics 188
Dorthe Arenholt Bindslev

Introduction 188

Fixed appliances 188

Bonding and banding materials 194

Removable appliances 197

Miscellaneous materials 199

Concluding remarks 200

References 200

11 Patients with Periodontal Problems 205
Birte Melsen

Prevalence of periodontal disease 205

Malocclusion and periodontal disease 205

Orthodontics and periodontal disease 206

Indications for orthodontic treatment in periodontally involved patients 209

Treatment of patients with flared and extruded upper incisors 212

Tissue reaction to intrusion of teeth with horizontal bone loss 214

Treatment of patients with vertical bone defects 220

What are the periodontal limits for orthodontic tooth movement? 221

Sequence of treatment in periodontally involved patients 227

Conclusion regarding Infl uence of orthodontic treatment on periodontal status 227

References 231

12 A Systematic Approach to the Orthodontic Treatment of Periodontally Involved Anterior Teeth 234
Jaume Janer

Single tooth gingival recession 234

Progressive spacing of incisors 238

Case reports 241

Management of periodontally involved teeth 245

References 258

13 Interdisciplinary Collaboration Between Orthodontics and Periodontics 261
Francesco Milano, Laura Guerra Milano

Introduction 261

Periodontal diagnosis 262

History taking, clinical and radiographic examination 262

Screening for periodontal disease 262

Local factors predisposing to periodontal therapy 264

Timing of ortho-perio treatment 264

Periodontal therapy 265

Surgical therapy 271

Mucogingival and aesthetic surgery 272

Regenerative surgical therapy 281

Supportive periodontal treatment 282

Ortho-perio and multidisciplinary clinical cases 282

Conclusion 284

Acknowledgements 284

References 288

14 The Link Between Orthodontics and Prosthetics 291
Yves Samama

Introduction 291

Edentulousness and space management:: the mesiodistal dimension 291

The vertical dimension 301

Orthodontics, periodontal disease and prosthetic splinting 303

Conclusion 307

Acknowledgements 308

References 308

15 Patients with Temporomandibular Joint (TMJ) Problems 310
Birte Melsen

Orthodontics and dysfunction 310

Controversy in the literature regarding TMD and occlusion 312

Treatment and TMD 313

Treatment of clicking joints 314

Orthodontic treatment of patients with TMD 314

Organization of the treatment 320

Conclusion 320

References 323

16 Patients with Temporomandibular Disorders 324
Peter Svensson

Introduction 324

Classification and epidemiology 324

Diagnostic procedures 326

Risk factors and etiology 329

Pathophysiology 329

Management 332

Summary 335

References 335

17 Invisalign®:: as Many Answers as Questions 339
Rainer-Reginald Miethke

Is Invisalign® new? 339

How does Invisalign work? 339

What are the pre-treatment considerations? 340

How does the Invisalign System differ from conventional orthodontics? 341

What characterizes patients seeking Invisalign treatment? 341

What is the most favourable approach to resolving crowding in Invisalign patients? 341

How can the alternatives to IER be evaluated? 342

What are the problems related to resolution of crowding? 342

When are extractions indicated? 342

Does an Invisalign treatment plan differ from a regular orthodontic treatment plan? 344

How does one take an adequate impression for the Invisalign System? 344

What is required to be evaluated in ClinCheck®? 345

What material are aligners made of? 347

What are aligner attachments? 347

How are attachments fabricated on the teeth? 348

What has to be controlled after insertion of aligners? 348

What are the consequences of good or poor aligner fi t? 349

What if an aligner is lost? 350

What can be done if a severe discrepancy between ClinCheck® and the clinical situation

becomes evident during treatment? 350

What can be done if a slight discrepancy between ClinCheck® and the clinical situation becomes evident at the end of treatment? 350

How can complications during treatment with the Invisalign system be avoided? 350

References 353

18 Progressive Slenderizing Technique 354
Pablo Echarri

Definition and objectives 354

Anthropological justification of slenderizing 354

Influence of slenderizing on dental plaque, caries and periodontal disease 355

Indications 355

Contraindications 360

Advantages of slenderizing 360

How much enamel can be stripped? 361

Special considerations 362

Instrumentation for slenderizing 362

Progressive slenderizing technique 366

Case reports 369

References 369

19 Post-treatment Maintenance 370
Birte Melsen, Sonil Kalia

Stability? 370

Biological maintenance 371

Mechanical maintenance – retention 372

Intermaxillary retention 378

Active retention plates 380

Conclusion 380

References 380

20 What are the Limits of Orthodontic Treatment? 382
Birte Melsen

What determines the limits? 382

Reference 383

Index 385