Adult Orthodontics

The Editors Birte Melsen 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. Cesare Luzi 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 xiiiAbout the Companion Website xvIntroduction xviiIntroduction: More than a Century of Progress in Adult Orthodontic Treatment xix1 Potential Adult Orthodontic Patients – Who Are They? 1Birte MelsenIntroduction 1Who are the patients? 1How do the patients express their needs? 6The first visit 7Communicating with the patient 9Summary 10References 102 Diagnosis: Chief Complaint and Problem List 12Birte Melsen, Marco A. MasioliIntroduction 12Workup of a problem list – the interview and chief complaint 12General health 15Clinical examination 16Extraoral examination 17Extraoral photographs 19Function of the masticatory system 22Intraoral analysis – oral health 23Evaluation of dental casts – arch form 24Occlusal analysis 24Space analysis 26Cephalometric analysis 26Final problem list 27Indication for treatment 28The presentation of the problem list – the tip of the iceberg 29Concluding remarks 33References 333 Aetiology 35Birte MelsenIntroduction 35Biological background 35Aetiology of malocclusions in adults 41Age-related changes in the skeleton 42Age-related changes in the craniofacial skeleton 46Age-related changes in the local environment 47Consequences of deterioration of the dentition 48Case reports 49Conclusion 52References 524 Interdisciplinary versus Multidisciplinary Treatments 54Birte MelsenInterdisciplinary or multidisciplinary treatments 54Establishment of an interdisciplinary team 56Treatment sequence 59Essential and optional treatment procedures 59Interaction during treatment 62Post-orthodontic treatment 62Patient satisfaction 62Examples of interdisciplinary cases 63References 635 Treatment Planning: The 3D VTO 65Birte Melsen, Giorgio FiorelliDetermining the treatment goal using the occlusogram 65Production of an occlusogram: manual procedure and general concepts 66Responding to patients’ needs 76Orthodontic treatment: art or science? 78References 786 Tissue Reaction 79Carlalberta Verna, Birte MelsenOrthopaedic effects 79Orthodontic effects in adult patients 80References 977 Appliance Design 101Birte Melsen, Delfino Allais, Giorgio FiorelliIntroduction 101Treatment goal definition 101Anchorage evaluation 110Sequencing the treatment into phases 110Appliance selection and design 112Conclusion 138References 1388 Anchorage Problems 141Birte Melsen, Carlalberta VernaIntroduction 141Definition 142Classification of anchorage 142Intramaxillary anchorage 142Differential anchorage 146Soft-tissue anchorage 147Free anchorage 147Intermaxillary anchorage 151Occlusion 155Differential timing of force application 156Conclusion 156Extraoral anchorage 156Skeletal anchorage 156Prosthodontic implants 157Temporary anchorage devices 157Palatal implants 159Palatal mini-implants with abutments, optimal insertion sites and possible mechanics 159Implant placement and adaption of the mechanics 159Clinical applications for palatal mini-implants 163Conclusion 163Onplant 163Retromolar implants 163Immediately loadable devices 164Zygoma ligature 164Miniplates 164Mini-implants 164Material 166Design of the intraosseous parts 166Design of the transmucosal parts 168Design of the head of the mini-implant 168The screwdriver 168Insertion site 168Insertion 170Antibiotics 171Load transfer 171Tissue reaction to loading 172Loading 173Orthodontic mechanics 173Alternative application of TADs used as anchorage 173Indications 174Complications 175What happens if the screw touches a root? 175Failures 176Problems related to the mini-implant and solutions 176Problems related to the insertion procedure 176Problems related to the patient 176Future of TADs 176References 1779 Bonding Problems Related to Adult Reconstructed Dentitions 181Vittorio CacciafestaIntroduction 181Brackets 182The Basis of the Bonding Clinical Procedure 189Banding 205Auxiliary Attachments and Aesthetic Buttons 209Anchorage Needs and Reinforcement 210Bonded Retainers 211References 21210 Material-Related Adverse Reactions in Orthodontics 216Dorthe Arenholt Bindslev, Gottfried SchmalzIntroduction 216Fixed appliances 216Removable appliances 227Miscellaneous materials 230Concluding remarks 230References 23111 Patients with Periodontal Problems 235Birte MelsenPrevalence of periodontal disease 235Malocclusion and periodontal disease 235Orthodontics and periodontal disease 236Indications for orthodontic treatment in periodontally involved patients 239Treatment of patients with flared and extruded upper incisors 242Tissue reaction to intrusion of teeth with horizontal bone loss 247Treatment of patients with vertical bone defects 250What are the periodontal limits for orthodontic tooth movement? 254Sequence of treatment in periodontally involved patients 258Conclusion regarding influence of orthodontic treatment on periodontal status 260References 26212 A Systematic Approach to the Orthodontic Treatment of Periodontally Involved Anterior Teeth 265Jaume JanerSingle tooth gingival recession 265Progressive spacing of incisors 269Case reports 275Management of periodontally involved teeth 276References 29013 Interdisciplinary Collaboration between Orthodontics and Periodontics 293Francesco Milano, Laura Guerra MilanoIntroduction 293Periodontal diagnosis 294History taking and clinical and radiographic examination 294Screening for periodontal disease 294Local factors predisposing to periodontal therapy 296Timing of ortho–perio treatment 297Periodontal therapy 298Surgical therapy 298Mucogingival and aesthetic surgery 300Regenerative surgical therapy 312Supportive periodontal treatment 312Ortho–perio and multidisciplinary clinical cases 313Conclusion 319Acknowledgements 319References 32114 Prosthetically Guided Orthodontic Strategies 323Arturo Imbelloni, Cesare LuziIntroduction 323Interdisciplinary treatment planning: orthodontics in periodontal prosthesis 324Prosthodontic indications for orthodontic therapy 325Pre-prosthodontic orthodontics 325Role of temporisation in interdisciplinary treatment 343Prosthodontic finalisation 345References 34615 Patients with Temporomandibular Joint (TMJ) Problems 348Birte MelsenOrthodontics and dysfunction 348Controversy in the literature regarding TMD and occlusion 350Treatment and TMD 351Treatment of clicking joints 352Orthodontic treatment of patients with TMD 352Organisation of the treatment 358Conclusion 358References 36016 Patients with Temporomandibular Disorders 362Peter Svensson, Fernando G. ExpostoIntroduction 362Classification and epidemiology 362Diagnostic procedures 363Risk factors and aetiology 367Pathophysiology 368Management 371Summary 373References 37417 Clear Aligners and Their Role in Orthodontics 379Sonil Kalia, Reginald Mietke, Birte MelsenHistory of aligners 379Difference between aligner treatments and conventional orthodontic treatments 380What types of patients are seeking aligner treatments? 380Pre-treatment considerations 380What has to be evaluated before the aligners are produced? 381Force-driven or displacement-driven aligners? 381Invisalign® 381Orthocaps® 385Studies on treatment efficacy and efficiency of aligner 389What role will the aligners play in the future? 390Conclusion 391References 39118 Progressive Slenderising Technique 392Dr Pablo Echarri, Emma Vila ManchoDefinition and objectives 392Anthropological justification of slenderising 393Influence of slenderising on dental plaque, caries and periodontal disease 393Indications 394Contraindications 397Advantages of slenderising 399How much enamel can be stripped? 399Special considerations 401Instrumentation for slenderising 401Progressive slenderising technique 404Slenderising with aligners 407The design and planning of the slenderising and preventing risks in slenderising 411Stripping and Bolton index 412How much enamel can be worn out? 417Facial and dental midlines 418Teeth size 418Design and planning of the stripping 418Progressive stripping technique 419Case reports 421References 42119 Post-Treatment Maintenance 423Birte Melsen, Sonil KaliaStability 423Biological maintenance 424Mechanical maintenance – retention 426Intermaxillary retention 431Active retention plates 434Latest technology in retainers fabrication (bonded and vacuum-formed) 434Virtual removal of fixed appliances and or attachments to fabricate retainers 434Retention after aligner orthodontic treatments 435Future developments 435Conclusion 435References 43620 Treatment Duration: Can It be Shortened? 438Sabarinath Prasad, Mauro Farella, Birte MelsenIntroduction 438Adjuncts to accelerate tooth movements 438Treatment-related factors 441Conclusions 444References 44421 What are the Limits of Orthodontic Treatment? 446Birte MelsenWhat determines the limits? 446Reference 447Index 448

"The contents are clear, concise and well structured. In total, there are 21 chapters, which cover the full scope of adult orthodontic treatment, with a particular focus on clinical challenges which are unique for the adult patient. Each chapter is succinct and well written, with a structured flow which allows the reader to digest the subjects being discussed. The fundamental areas of adult orthodontics covered include diagnosis, aetiology, interdisciplinary versus multidisciplinary treatments, anchorage, treatment planning and post-treatment maintenance."- Zohaib S. Khan, Specialist in Orthdontics, St Helens, UK, Published in British Dental Journal (Nov 23)"... this newly updated and expanded edition of Adult Orthodontics is an authoritative resource on the subject of adult orthodontics, blending together clinical guidance with a thorough evaluation of the evidence base.... An invaluable and comprehensive instructional and informational resource for professionals providing orthodontic treatment to adults and those dealing with orthodontics as part of the interdisciplinary management of the adult dentition, Adult Orthodontics is especially recommended as a core addition to personal, professional, and academic library Dentistry/Orthodontics collections."—Library Bookwatch, January 2023, Midwest Book Reviews"Adult Orthodontics is an authoritative resource, written and edited by experts in the field, combining clinical guidance with a thorough evaluation of the evidence base. Diagnostic issues and problems are clearly defined, and solutions and limitations elucidated using case studies...an invaluable reference for professionals providing orthodontic treatment to adults"- Peter Folly, British Dental Association, Published in BDJ Team (July 22)