Orthodontics for adults may just mean that YOU are paying for the treatment, not your parents.
Maybe you were lucky enough to have parents that paid for your teeth to be “straightened” before your teens. But even so, in later years the ravages of time may bring you back to tidy things up for that nice smile again. Maybe you never had the need to have braces as a kid, or just didn’t get it done, but feel you would relate better socially or professionally now to have it done.
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Orthodontics for Adults: Introduction
In this chapter will be discussed primarily orthodontics for adults, with some discussion of what types of things can be accomplished for the typical teenager as well.
While this chapter does not claim to be anything like a complete guide to orthodontia, as I am not an orthodontist or expert in the field, I am just passing on what has made sense to me over my years of practice, with the hope that you will do further research on your particular needs.
The American Association of Orthodontics, on their site, may answer a lot of your basic questions. And Wikipedia offers some detailed information with many references to the primary literature that you may explore in more depth.
I hope the following will give you some overview and guidance, however.
Orthodontia For Adults
Sometimes people make it to adulthood and they have really crooked teeth, largely because their parents didn’t want to invest in orthodontia. It is not cheap, but can certainly have a big impact on self-respect.
You might reach the age of 40 or so and decide that you’re tired of looking the way you do, and you have a good job and are making serious money, and it seems to be the time to get things done. If you are a professional or in a managerial position, this could be important in your job effectiveness as well.
Of course, by this age you might have some missing teeth as well, and that actually might be helpful – for it makes a little more room that could be filled by moving a tooth or two into that space.
The first thing that the orthodontist will do is obtain a complete scan of your jaws and teeth, so that there will be no uncertainties about what is in the bone and how the roots are aligned relative to each other. Also, study models will be obtained that show where you are now, and then these models can be sectioned and rearranged to get an idea of how things CAN be. Of course, these days this can be done digitally.
Once it is determined what needs to be done, there are two orthodontic approaches that might be chosen. Many dentists have taken courses so that they can do InvisAlign or another plastic aligner system. This is where the dentist sends all of the information to a specific laboratory that will return a series of alignment stents that are placed in your mouth, each slightly moving the teeth in the desired direction. These guides are all computer generated and as they are inserted they are made to force the teeth into a slightly different position each time, until with a long enough series of guides, the teeth end up where they should be.
InvisAlign is a very useful technique, but it has limitations as to HOW it moves the teeth and the nature of the forces that are applied to the crown of each tooth. But the guides are transparent and hardly noticeable when the patient wears them, and most dentists can do some limited orthodontic treatment in this way.
Conventional Orthodontia is another thing entirely. When brackets or bands are cemented to the teeth and wires are placed through them, a wide variety of forces can be applied. The orthodontist uses wire of different cross-sections, even rectangular, to exert very specific forces, even forces that would push the tooth DOWN into the bone, while tipping it backward. These more complex movements are frequently required to accomplish the goals of the case, and are only possible with full arch wiring of the teeth.
Now, bear in mind that I am NOT an orthodontist, and to go any more deeply into this subject would not be appropriate for me, as I have done few orthodontic cases. But I will describe a couple of adult situations that I have done that are pretty typical.
This is where a tooth is missing for some time, and the tooth behind it in the arch tips into the space. It may even happen if the adjacent tooth is there but so decayed in the area where they contact, that there is NO solid contact and the adjacent tooth tips.
In order to restore a patient’s missing area it may be required to tip the tooth behind, back out of the way – whether it is being restored with a conventional three-unit bridge, or with an implant.
Brackets and arch wire will be installed over most of the arch and specific wires bent to put pressure on the tipped tooth so that it will upright, BUT at the same time NOT rise above the level of the occlusal plane. This is tricky and requires someone who knows what they are doing to get the forces right. Otherwise, the tooth comes up as it tips and hits the opposing arch when you bite down.
But it can be done and it a great advantage in many restorative procedures.
An example of this may be seen in the Chapter on Collapsed Bite, where two second molars were uprighted to make it possible to fabricate the bridges.
Anterior Tooth Flaring
In this scenario the patient has upper front teeth that become tipped outward more than desired. These teeth are typically somewhat tipped outward, but when it gets to be too much, spaces open between the adjacent teeth and they may no longer be in occlusion.
This situation could be caused by tongue thrusting or because the teeth are somewhat periodontally involved, and when the patient eats or shifts their lower jaw forward, the upper teeth are somewhat pushed out. It’s not a very good look.
In this case, if when the patient bites down in their normal, centered bite, the front teeth are not touching, then they can be brought back in orthodontically. This could either be done by conventional orthodontia or by InvisAlign. The forces that need to be applied are probably not too complex, so either method may be used.
When teeth are repositioned in the mouth, they seem to have an innate desire to return to their original place. Once the repositioning is done the orthodontist will supply the patient with a retainer – familiar to many people. This retainer is designed to fit tightly to the teeth, but only IN the final configuration. If it is worn regularly, the teeth will anchor themselves better in place, but if left out for some period of time, the teeth will move.
It is common for people, even adults, to wear the retainer religiously for some months, and then a little less regularly for a while, and then go a couple weeks without wearing it and at the end of that time it WON’T fit back in. Teeth have a will of their own.
But, the longer the retainer is worn, the more the teeth will stay roughly in position after the retainer is abandoned.
In the case I described above with the flaring incisors, I made the patient a retainer that was really a removable partial denture, replacing a couple of back teeth, but with a plate that covered the inside surface of the anterior teeth. I made little hooks on the anterior teeth that the denture would fit and HOLD the teeth in place and not let them flare out again.
Orthodontics for Teenagers
One of the biggest advantages to orthodontics at this age is the correction of mal-erupted teeth. Often the permanent teeth erupt in strange places. It could be because of premature loss of primary teeth, which are supposed to guide the permanent teeth into place, but it could be that the permanent tooth is WAY off.
When I was a young teenager my upper canine on the right side erupted ABOVE the premolars, which were already in place. There was NO room for the canine at all – and when I smiled it couldn’t even be seen because it was so far up under the upper lip.
The dentist extracted the first premolar to make room for the canine, cemented a bracket on the canine and pulled it down to the level of the other teeth with a rubber band connected to an arch wire running from the other premolar to the incisors. This worked well and the canine is still in the same place today.
This last example is NOT a case where active retention needs to be done to keep the canine from going back up, there is no drive for it to do so. Rotated teeth and tipped teeth are much more likely to return to the original positions.
Often over crowding is the major drive for doing orthodontics – and some extractions followed by rearranging the teeth into the open spaces often solves the problem.
Why are teeth sometimes overcrowded? Since you inherit your bone structure, tooth shapes and tooth positions largely from your parents, the problem comes when you get something from each parent, and what you get doesn’t fit well into your mouth. Father’s teeth and mother’s bone structure can be a problem.
Palatal Expansion – facilitating orthodontia during the teens
One of the things that is becoming very common these days is to actually CHANGE the bone structure while you are young. Palatal expansion is done when the bones are still forming so that orthodontia in the teenage years is far more successful.
The hard palate, or roof of the mouth, consists of two bones which have a suture between them running from front to back. This suture line is the line where bone deposition increases the size of the palate along with the other bones as a person ages.
When this palatal suture is still actively making bone, if there is any pressure tending to expand the suture, it will make more bone and increase in size more than it otherwise would.
It may seem like torture to put one of these palatal expansion devices in a kids mouth, but, strangely, most kids don’t seem to mind. Even when the orthodontist occasionally screws the expander tighter against the molars, pushing the arch wider, it seems to be taken well by the kids.
But, this approach makes a huge difference in the capacity in later years to get the upper and lower teeth in the correct relationship to each other – with normal overlap horizontally. And it is also very helpful in shaping the child’s face – making the face a little wider toward the area of the cheekbones – which is a socially approved look.
Orthodontics for Adults: Bottom Line
It is best to get your teeth arranged correctly in youth, but if that was not done, or has relapsed, or you have become more sensitive to your appearance in your adult years, you can certainly do something about that.
With todays porcelain brackets, the appearance of braces will not necessarily detract from your appearance while you are under treatment – so, if you have the money and even a professional need, now is the time. And there is now the possibility in many instances of using plastic alignment stents to move your teeth – expensive, but perhaps more socially tolerated.