Adult Orthodontics

The complete reference work covering the increasingly prominent area of adult orthodontics

Written by renowned contributors from the orthodontic community and compiled by world-class editors, Adult Orthodontics, 2nd Edition is an authoritative resource on the subject of adult orthodontics, marrying together clinical guidance with a thorough evaluation of the evidence base. Sample topics discussed within the book include:

• Context for adult orthodontics, including patient demographics and aetiology
• Treatment planning considerations, including patient case profiles, initial outcomes and longer-term expectations
• Interdisciplinary and multidisciplinary approaches, including the links between adult orthodontics and periodontics, prosthetics, and temporomandibular disorders

This book is an invaluable resource for professionals providing orthodontic treatment to adults and those dealing with orthodontics as part of the interdisciplinary management of the adult dentition.

Dedications

To all of those who dedicated their spare time to finish this book
—Birte Melsen

To Emese, my equilibrium
To Birte, my inspiration
To my grandparents Liliana and Cesare, they know why
—Cesare Luzi

The Editors

Melsen Birte is the past President of European Orthodontic Society in 2004 and has made significant contributions to the field of orthodontics with her research, publishing around 350 papers in scientific journals on topics related to anchorage (orthodontics) and adult orthodontics. She is currently an orthodontist from Denmark.

Luzi Cesare is Founder and first President of the European Postgraduate Students Orthodontic Society (EPSOS). Past President of the Italian Society of Biomechanics (SIBOS) and of the Italian Association of Specialists in Orthodontics (ASIO). President AIDOR (Italian Academy of Orthodontics) 2022. Visiting Professor University of Ferrara and Rome Cattolica (Italy). He is currently in private orthodontics practice in Rome, Italy.

List of Contributors xiii

About the Companion Website xv

Introduction xvii

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

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

Workup of a problem list – the interview and chief complaint 12

General health 15

Clinical examination 16

Extraoral examination 17

Extraoral photographs 19

Function of the masticatory system 22

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 47

Consequences of deterioration of the dentition 48

Case reports 49

Conclusion 52

References 52

4 Interdisciplinary versus Multidisciplinary Treatments 54
Birte Melsen

Interdisciplinary or multidisciplinary treatments 54

Establishment of an interdisciplinary team 56

Treatment sequence 59

Essential and optional treatment procedures 59

Interaction during treatment 62

Post-orthodontic treatment 62

Patient satisfaction 62

Examples of interdisciplinary cases 63

References 63

5 Treatment Planning: The 3D VTO 65
Birte Melsen, Giorgio Fiorelli

Determining the treatment goal using the occlusogram 65

Production of an occlusogram: manual procedure and general concepts 66

Responding to patients’ needs 76

Orthodontic treatment: art or science? 78

References 78

6 Tissue Reaction 79
Carlalberta Verna, Birte Melsen

Orthopaedic effects 79

Orthodontic effects in adult patients 80

References 97

7 Appliance Design 101
Birte Melsen, Delfino Allais, Giorgio Fiorelli

Introduction 101

Treatment goal definition 101

Anchorage evaluation 110

Sequencing the treatment into phases 110

Appliance selection and design 112

Conclusion 138

References 138

8 Anchorage Problems 141
Birte Melsen, Carlalberta Verna

Introduction 141

Definition 142

Classification of anchorage 142

Intramaxillary anchorage 142

Differential anchorage 146

Soft-tissue anchorage 147

Free anchorage 147

Intermaxillary anchorage 151

Occlusion 155

Differential timing of force application 156

Conclusion 156

Extraoral anchorage 156

Skeletal anchorage 156

Prosthodontic implants 157

Temporary anchorage devices 157

Palatal implants 159

Palatal mini-implants with abutments, optimal insertion sites and possible mechanics 159

Implant placement and adaption of the mechanics 159

Clinical applications for palatal mini-implants 163

Conclusion 163

Onplant 163

Retromolar implants 163

Immediately loadable devices 164

Zygoma ligature 164

Miniplates 164

Mini-implants 164

Material 166

Design of the intraosseous parts 166

Design of the transmucosal parts 168

Design of the head of the mini-implant 168

The screwdriver 168

Insertion site 168

Insertion 170

Antibiotics 171

Load transfer 171

Tissue reaction to loading 172

Loading 173

Orthodontic mechanics 173

Alternative application of TADs used as anchorage 173

Indications 174

Complications 175

What happens if the screw touches a root? 175

Failures 176

Problems related to the mini-implant and solutions 176

Problems related to the insertion procedure 176

Problems related to the patient 176

Future of TADs 176

References 177

9 Bonding Problems Related to Adult Reconstructed Dentitions 181
Vittorio Cacciafesta

Introduction 181

Brackets 182

The Basis of the Bonding Clinical Procedure 189

Banding 205

Auxiliary Attachments and Aesthetic Buttons 209

Anchorage Needs and Reinforcement 210

Bonded Retainers 211

References 212

10 Material-Related Adverse Reactions in Orthodontics 216
Dorthe Arenholt Bindslev, Gottfried Schmalz

Introduction 216

Fixed appliances 216

Removable appliances 227

Miscellaneous materials 230

Concluding remarks 230

References 231

11 Patients with Periodontal Problems 235
Birte Melsen

Prevalence of periodontal disease 235

Malocclusion and periodontal disease 235

Orthodontics and periodontal disease 236

Indications for orthodontic treatment in periodontally involved patients 239

Treatment of patients with flared and extruded upper incisors 242

Tissue reaction to intrusion of teeth with horizontal bone loss 247

Treatment of patients with vertical bone defects 250

What are the periodontal limits for orthodontic tooth movement? 254

Sequence of treatment in periodontally involved patients 258

Conclusion regarding influence of orthodontic treatment on periodontal status 260

References 262

12 A Systematic Approach to the Orthodontic Treatment of Periodontally Involved Anterior Teeth 265
Jaume Janer

Single tooth gingival recession 265

Progressive spacing of incisors 269

Case reports 275

Management of periodontally involved teeth 276

References 290

13 Interdisciplinary Collaboration between Orthodontics and Periodontics 293
Francesco Milano, Laura Guerra Milano

Introduction 293

Periodontal diagnosis 294

History taking and clinical and radiographic examination 294

Screening for periodontal disease 294

Local factors predisposing to periodontal therapy 296

Timing of ortho–perio treatment 297

Periodontal therapy 298

Surgical therapy 298

Mucogingival and aesthetic surgery 300

Regenerative surgical therapy 312

Supportive periodontal treatment 312

Ortho–perio and multidisciplinary clinical cases 313

Conclusion 319

Acknowledgements 319

References 321

14 Prosthetically Guided Orthodontic Strategies 323
Arturo Imbelloni, Cesare Luzi

Introduction 323

Interdisciplinary treatment planning: orthodontics in periodontal prosthesis 324

Prosthodontic indications for orthodontic therapy 325

Pre-prosthodontic orthodontics 325

Role of temporisation in interdisciplinary treatment 343

Prosthodontic finalisation 345

References 346

15 Patients with Temporomandibular Joint (TMJ) Problems 348
Birte Melsen

Orthodontics and dysfunction 348

Controversy in the literature regarding TMD and occlusion 350

Treatment and TMD 351

Treatment of clicking joints 352

Orthodontic treatment of patients with TMD 352

Organisation of the treatment 358

Conclusion 358

References 360

16 Patients with Temporomandibular Disorders 362
Peter Svensson, Fernando G. Exposto

Introduction 362

Classification and epidemiology 362

Diagnostic procedures 363

Risk factors and aetiology 367

Pathophysiology 368

Management 371

Summary 373

References 374

17 Clear Aligners and Their Role in Orthodontics 379
Sonil Kalia, Reginald Mietke, Birte Melsen

History of aligners 379

Difference between aligner treatments and conventional orthodontic treatments 380

What types of patients are seeking aligner treatments? 380

Pre-treatment considerations 380

What has to be evaluated before the aligners are produced? 381

Force-driven or displacement-driven aligners? 381

Invisalign® 381

Orthocaps® 385

Studies on treatment efficacy and efficiency of aligner 389

What role will the aligners play in the future? 390

Conclusion 391

References 391

18 Progressive Slenderising Technique 392
Dr Pablo Echarri, Emma Vila Mancho

Definition and objectives 392

Anthropological justification of slenderising 393

Influence of slenderising on dental plaque, caries and periodontal disease 393

Indications 394

Contraindications 397

Advantages of slenderising 399

How much enamel can be stripped? 399

Special considerations 401

Instrumentation for slenderising 401

Progressive slenderising technique 404

Slenderising with aligners 407

The design and planning of the slenderising and preventing risks in slenderising 411

Stripping and Bolton index 412

How much enamel can be worn out? 417

Facial and dental midlines 418

Teeth size 418

Design and planning of the stripping 418

Progressive stripping technique 419

Case reports 421

References 421

19 Post-Treatment Maintenance 423
Birte Melsen, Sonil Kalia

Stability 423

Biological maintenance 424

Mechanical maintenance – retention 426

Intermaxillary retention 431

Active retention plates 434

Latest technology in retainers fabrication (bonded and vacuum-formed) 434

Virtual removal of fixed appliances and or attachments to fabricate retainers 434

Retention after aligner orthodontic treatments 435

Future developments 435

Conclusion 435

References 436

20 Treatment Duration: Can It be Shortened? 438
Sabarinath Prasad, Mauro Farella, Birte Melsen

Introduction 438

Adjuncts to accelerate tooth movements 438

Treatment-related factors 441

Conclusions 444

References 444

21 What are the Limits of Orthodontic Treatment? 446
Birte Melsen

What determines the limits? 446

Reference 447

Index 448

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