British Journal of Orthodontics

ISSN: 0301-228X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/yjor19

Adult Orthodontics—A Review

C. Nattrass B.D.S., F.D.S., R.C.S. (ENG.) & J. R. Sandy PH.D., M.ORTH., F.D.S.,
R.C.S. (ENG.), F.D.S.R.C.S. (EDIN.)

To cite this article: C. Nattrass B.D.S., F.D.S., R.C.S. (ENG.) & J. R. Sandy PH.D., M.ORTH., F.D.S.,
R.C.S. (ENG.), F.D.S.R.C.S. (EDIN.) (1995) Adult Orthodontics—A Review, British Journal of
Orthodontics, 22:4, 331-337, DOI: 10.1179/bjo.22.4.331

To link to this article: http://dx.doi.org/10.1179/bjo.22.4.331

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 British Journal of Orthodontics/Vo/. 22119951331-337

Adult Orthodontics- A Review

C. NATTRASS, B.D.S., F.D.S., R.C.S. (ENG.)
J, R. SANDY, PH.D., M.ORTH., F.D.S., R.C.S. (ENG.), F.D.S. R.C.S. (EDIN.)
Department of Child Dental Health, Bristol Dental School, Lower Maudlin Street, Bristol BS't 2LY, U.K.
Accepted for publication October 1994

Abstract. The increased demand for orthodontic treatment by adults suggests a review of the literature might be timely. In
this review we explore whether the increase in dem~nd is r~al and matc~ed by need. ~e also exami.ne the reasons for
treatment being sought and special considerations wh1ch are Important durmg orthodontiC treatment. Fmal/y, we compare
the orthodontic experience of adults and adole~c~nts: We conclude th~t adults seeking treatment ~an be excel/en~ p~tients
with high motivation and co-operation. The tu:zuatwns of orth?dont1c treatment must be explamed at the begmmng of
treatment since adult expectations of orthodontics can be very h1gh.
Index words: Adult Orthodontics, Review.

IntrOduction that adults comprised towards 25 per cent of the caseload

in American orthodontic practices. However, Fastlight in
Worldwide, it is thought that adults are becoming incre.as- 1982 found that only 15·3 per cent of his orthodontic
ingly more interested in orthodontic treatment (Gottlieb practice were adult patients. More recent data suggest that
eta/., 1991; Khan and Horrocks, 1991; Salonen eta/., adults do in fact form around 25 per cent (Gottlieb eta/.,
1992). This is probably because of improved .dental and 1991).
orthodontic awareness, as well as increased soc1al accepta- Some adult orthodontic patients have been assessed to
bility of appliance therapy (Breece ~nd Nieberg, 1986). see if they have any common epidemiological features.
There may also be dissatisfaction w1th the o~tcome of Khan and Horrocks, (1991) found that as many as 25 per
previous orthodontic treatment (BurgermodiJk et a/., cent of their adult patients were re-treatment cases, princi-
1991). Recent figures from the Dental Practic<: Board pally those with a Class II division 2 malocclusion. Women
showed that 23,431 adults completed orthodontic treat- are more aware of their malocclusion than men (Salonen
mentin 1992/1993, a 57 percent increase from the 1991/1992 eta/., 1992) and comprise a high (>70 per cent) propor-
figures of 14,868. However, adults still form only a small tion of adult orthodontic patients (Khan and Horrocks,
proportion of those who have orthodontic treatment on 1991; Tayer and Burek, 1981: Lew, 1993). The proportion
the National Health Service (3·5 per cent of completed of Class III malocclusions and skeletal 3 bases is greater
treatments in 1992/1993). That some adults would be.~efit amongst adult patients than in the general population
from orthodontic therapy is not in doubt. Burger~odljk et (Khan and Horrocks, 1991), which is not surprising since
a/., (1991) found an objective need for treatment tn 39 per these cases often need treatment to be delayed until after
cent of a Dutch population aged between 15 and 35 >'ears, the cessation of growth. It is generally agreed that adults
based on criteria listed by the W.H.O. and Dutch Zlek.en- commonly need an interdisciplinary approach to their care
fonds (the Dutch National Health Insurance orgamza- (Goldstein, 1953; Andreason, 1972; Chiappone, 1976;
tion), whilst Salonen eta/., (1992) found that 40 per cent Ackerman, 1978), principally restorative treatment, which
of a Swedish population aged 20 and over needed compre- can reduce the treatment time and need for adult ortho-
hensive orthodontic treatment. In the U.K., the Adult dontics.
Dental Health Survey (Todd and Lade~, 1988) provided
some statistics relating to the orthodontiC state of adults.
Whilst the objective need for treatment was not assessed, Motivation for and Attitudes of Adults Towards
the fact that 6 per cent have an overjet of 7 mm or more, Orthodontic Treatment
9 per cent have an overbite complete to the palat~, 56 per In general, adults are motivated by a desire to improve
cent have at )east one maxillary tooth out of alignment, the appearance of their teeth (Khan and Horrocks, 1991;
and 69 per cent have at least one mandibular tooth out of Breece and Nieberg, 1986), although some may present
alignment, suggests that some adults may benefit from hoping for the relief of temporomandibular joint dysfunc-
orthodontic treatment. tion (Andreason, 1972). Other motivating factors include
improving dental and psychological health, function, and
the affordability of treatment. Adults declining treatment
Need and Demand for Adult Orthodontics tend to be embarrassed (Lew, 1993), presumably by the
It is difficult to find convincing epidemiological data relat- unaesthetic appearance of the appliance or are dissuaded
ing to adult orthodontics alone, but as only 14 p~r cent of by the length of treatment time (Breece and Nieberg,
the Dutch population assessed b~ BurgermodiJ~ et a/., 1986).
(1991) expressed an interest in havmg treatme~t, 1t woul.d McKiernan et a/. (1992) examined the psychological
seem that the objective need for treatment tn adults IS profiles and motives of adults seeking orthodontic treat-
greater than subjective demand. Watson in 1979 estimated ment. The primary motivating factor was a desire to

0301-228X/951004000+00$02.00 © 1995 British Orthodontic Society

332 C. Nattrass and J. R. Sandy 810 Vol. 22 No.4

improve their dental appearance and often treatment had Tayer and Burek study, (1981), 100 per cent of the sample
been delayed until adulthood because it had never been (33 subjects) said they would have orthodontic treatment
previously recommended, 18·4 per cent were retreatment again.
cases. When the psychological assessment was examined,
it was found that nearly 50 per cent of the patients demon-
strated unstable or neurotic personality traits. This group Special Considerations in Adult Orthodontics
were in greater agreement with the clinicians' assessment Adults are likely to present with a different experience of
of their malocclusion, whereas the more 'normal' group oral disease than adolescents. Their teeth are likely to be
underestimated the severity of their malocclusion. The heavily restored, root-treated, or periodontally involved.
authors suggest that the atypical group may be less They may suffer from temporomandibular dysfunction
satisfied with the final outcome of orthodontic treatment. (TMD) and have increased occlusal awareness leading to
If these patients could be identified before treatment grinding and enamel wear (Vanarsdall and Musich, 1994).
begins they might benefit from counselling regarding Whilst similarities exist in the management of adult and
expectations from treatment and minimize the risks of adolescent orthodontic patients, adults bring with them a
dissatisfaction after treatment or of failure to complete. different set of problems which can pose a challenge for
However, this should not imply that all adults who seek the orthodontist.
orthodontic treatment are neurotic. Proffit, (1993) states
that ego-strength rather than weakness is typical of adult
orthodontic patients. There are psychological considera- Periodontal considerations
tions involved in the management of adults. Adults may
have high expectations of what orthodontic treatment can Whilst it is not within the scope of this review to consider
achieve for them and their true motives for seeking treat- the orthodontic-periodontal interface in great detail,
ment may be hidden. For example, straight teeth may adults are likely to have experienced periodontal disease
be expected to improve social and career opportunities. (the results of which may in fact be the motivation for
Unrealistic expectations should be avoided whenever treatment). It is important to consider the implications of
possible. Lew, (1993), however, did find that these parti- this. Pretreatment clinical examination should include a
cular expectations were fulfilled. Adolescents tend to full periodontal evaluation, and any active disease treated
accept their treatment passively, whereas adults are more and monitored prior to orthodontics. Proffit, (1993)
questioning. Unfortunately, interest does not imply com- recommends that a fully-bonded appliance is preferable
pliance and adults may require more detailed explanations for use in periodontal patients and that forces should be
as to why they are asked to co-operate with such accessories kept particularly light. It is imperative that orthodontic
as elastics and headgear. treatment should not further jeopardize periodontal
Tayer and Burek, (1981) assessed the attitudes of adult health. Consideration has been given to the effects of
orthodontic patients to their treatment. They found that orthodontic treatment on periodontal attachments. Boyd
the first 4 weeks were the most difficult period of adjust- et a/., (1989}, in their study of adults with reduced
ment, during which eating difficulties provoked anxiety periodontium, found that tooth movement did not lead to
and the most discomfort was experienced. Twenty per a significant further loss of attachment. However, tooth
cent felt that the appliances negatively affected their social loss due to periodontal abscesses did occur if the tooth was
life, although family and friends proved to be supportive. already severely compromised (pocket depth greater than
Headgear, removable appliances, and elastics were dis- 6 mm and/or furcal involvement). They suggest that
liked, and 60 per cent were surprised at the discomfort orthodontics may accelerate loss of attachment when
of treatment and by the unaesthetic appearance of the active disease is present and stressed the importance of
appliance. Discomfort of some degree would seem to be treating active disease prior to appliance therapy together
almost universal. Lew, (1993) found that 91 per cent of with regular maintenance visits throughout the course of
his sample of adult orthodontic patients suffered some orthodontics. Orthodontic treatment may be used in con-
discomfort during treatment, but only 24 per cent cited junction with periodontal therapy to increase the amount
this as the worst aspect of their experience. Forty-five per of new attachment of the periodontal ligament occurring
cent of the group found that the most unpleasant aspect following treatment of periodontal disease. Melsen eta/.
of treatment was it's duration. Espeland and Stenrik, (1988) examined the effects of orthodontic intrusion on
(1991) assessed whether professional treatment goals were periodontally involved teeth in Macaca fascisularis
meaningful to patients. 1t was found that both treated and monkeys and found that, whilst good oral hygiene was
untreated groups were able to provide a reasonably accur- the key to success, orthodontic intrusion with light forces
ate description of their own dentition and that 82 per cent increases the amount of new attachment forming when
of the treated group identified their own photograph at compared to teeth treated with periodontal treatment only.
the first attempt. It was concluded that young adults have The authors stress the importance of using light forces and
a high awareness of their own occlusion, irrespective of to avoid tipping teeth in order to limit hyalinization, root
whether they have had orthodontic treatment or not. It resorption, and pulpal necrosis. Indeed, tooth extrusion
was optimistically suggested that this dental awareness should be minimized, as this may reduce bone support
would translate to an appreciation of a good treatment (Williams et a/., 1982). Murakami et a/., ( 1989) assessed
result, implying that professional goals are meaningful the periodontal response around intruded teeth in Macaca
to most patients. However, patients were not directly fuscata monkeys and found that the gingivae moved in the
questioned as to their satisfaction with their course of same direction, and approximately 60 per cent of the
treatment. Despite the negative feelings expressed in the distance the teeth were intruded. The depth of the gingival
 Adult Orthodontics 333
BJO November /995

sulcus also increased, in some cases in excess of the 2 mm Zachrission and Buyuykyilmaz, (1993) described methods
considered to be the maximal depth which can be main- to aid bonding to gold. amalgam, and porcelain. firstly
tained in a healthy condition with simple oral hygiene. roughening the surface of the restoration using intra-oral
If tooth intrusion increases sulcus depth above 2 mm, sandblasting with 50-~J.m aluminium oxide. Intermediate
patients may need additional periodontal support to main- resins to improve bond strength and metal-bonding adhes-
tain their gingival health. ives may increase successful bonding to gold crowns,
The loss of alveolar bone in periodontally compromised whilst conventional composite is sufficient to bond to ena-
patients will result in different responses of the tooth to mel surrounding amalgam. Bond strengths to porcelain
orthodontic mechanics. The centre of resistance to the may be improved by etching with hydrofluoric acid (9·6
applied force will move apically and the teeth are more per cent) or acidulated phosphate fluoride gel (1·23 per
prone to tipping instead of bodily movement (Williams et cent) after sandblasting. together with silane primers and
al., 1982). Forces should therefore be very carefully con- highly-filled composite resin. The extraction pattern in
trolled. The loss of posterior teeth may cause difficulties adults may well differ from that in adolescents because of
with anchorage balance, opposing teeth may overupt. and teeth which are heavily restored or of poor prognosis. For
require orthodontic intrusion. Orthodontic/periodontal example, it may be preferable to remove a root-treated
patients need prolonged retention and monitoring once molar instead of a sound premolar. Alternatively. inter-
active treatment is completed. proximal stripping. particularly the debulking of large
Some evidence exists to suggest that alveolar bone amalgam restorations. may be utilized for provision of
reacts differently in adults compared to adolescents additional space.
(Reitan, 1954). After an initial delay in tissue reaction,
teeth probably move at a similar rate in adults and chil-
dren (Bond. 1972). Sound laboratory data is availa~le to Temporomandibular joint dysfunction
support the concept that juvenile bone is more reactive to
mechanical forces than adult bone (Liskova and Hert. Adults are likely to suffer from temporomandibular joint
1971). dysfunction at some stage. They may present for ortho-
dontic treatment hoping for relief of their symptoms or
develop symptoms during their treatment. Vanarsdall and
Musich. (1994) recommend that orthodontists be familiar
Lack of growth wi~h the diagnosis. and treatment of TMD and suggest
The treatment of non-growing patients will result in differ- usmg a TMD questionnaire as part of the initial evaluation.
ences in response to mechanotherapy. For example, It would seem prudent to warn patients that orthodontics
should teeth be extruded, vertical condylar growth and may not cure their joint dysfunction. Proffit, (1993)
alveolar bone changes are unlikely to occur to a sig~ificant suggests that symptoms of TMD tend to resolve during
degree. Therefore, the correction of a deep overbite and orthodontic treatment, possibly because the discomfort
arch levelling may need to be achie.ved b~ intrusion, associated with treatment halts grinding habits. However,
perhaps using segmental arch mechamcs. which may be symptoms tend to recur once the appliances are removed.
difficult.
As functional appliances utilize the p~bertal growth
spurt to achieve their results, they are not viable for adults Anchorage control
who will have ceased growing. Consequently, orthognathic
surgery may be needed to overcome a skeletal dispropor- Adults may he reluctant to wear headgear and it may be
tion untreatable by orthodontic camouflage. necessary to use other methods of anchorage control such
as palatal arches.

Aesthetic and restorative considerations

Closure of old extraction spaces
It is understandable that adults may be dissuaded from
treatment by the appearance of the appliance. The develop- Adults often present having lost permanent teeth, usually
ment of aesthetic brackets and lingual appliances attempts the first molars. with the extraction space remaining.
to overcome this problem. however. their use may well Commo~ly. there is reduced vertical bone height in these
compromise treatment and patients should be aware of ar~as which tends to be narrow buccolingually. Closure of
this before treatment commences. th1s space generally requires reshaping of the cortical bone
Ghafari. (1992) discussed problems arising during the which responds more slowly than cancellous bone. This is
use of ceramic brackets and suggested various solutions. considered difficult (Watson, 1979) and it may be prefer-
He advised against the use of ceramic brackets on structur- able to consider a prosthetic replacement. However. some
ally damaged. non-vital or heavily restored teeth, as orthodontists would aim to close this space as part of their
restorations may easily be damaged by the heavy dehond- treatment plan.
ing forces used. Ceramic brackets should not be used on Hom and Turley. (1984) examined models and radio-
mandibular incisors because of their potential to cause graphs to investigate the dental and periodontal changes
marked faceting on the incisal edges of the maxillary occurring when mandibular first molar areas were closed
teeth. in 14 adults. They found that five cases had complete
The presence of crowns and large amalgams can provide space closure and 12 had less than 1 mm of mesiodistal
an orthodontic challenge when assembling an appliance. spacing after treatment. The mean movement achieved
334 C. Nattrass and J. R. Sandy BJO Vol. 22 No.4

was 6·9 mm (range 2·9-11·5 mm), with mesial movement and finally from a clinical need. However, he did state
of the second molar being generally twice that of the distal that the 'real issue' of the decision relates to augmenting
movement of the second premolar. Root movement of the diagnosis and treatment planning.
second molar exceeded coronal movement, resulting in
uprighting and also eruption of this tooth. The bucco-
lingual width of the alveolar bone tended to increase ( 1· 2 Direct Comparisons of the Orthodontic Experience of
mm), but a similar amount (1·3 mm) of vertical bone loss Adults and Adolescents
was seen. Root resorption (mean = 1·3 mm) of the second
Psychological adjustment
molar occurred. The greatest amount of space closure and
least molar bone loss was witnessed when the initial space Brown and Moerenhout, (1991) used questionnaires to
measured equal to or less than 6 mm mesiodistally, 7 mm compare the psychological adjustment of pre-adolescents,
buccolingually, and the second molar had a mesial bone adolescents, and adults to fixed-appliance therapy. No
level 1 mm apical to the amelocemental junction. The significantly different responses were found between the
authors consider the use of previous extraction space a sexes, different malocclusions, or treatment mechanics.
viable alternative to either premolar extraction for the However, the adolescent group were consistently the most
relief of anterior crowding, or prosthetic replacement. negative respondents on all questions, i.e. they reported
Adult orthodontics need not necessarily be as compre- more pain, lower psychological well-being, and slight
hensive as is usually considered for adolescents. decrease in their social activity compared to adults and
Tulloch, (1993) discussed the adjunctive role of ortho- preadolescents. It was concluded that adults adapt psycho-
dontics in order to facilitate other dental procedures. The logically to fixed appliances more easily than adolescents.
orthodontic component of treatment should be simple and
of short duration ( < 6 months). This may include upright-
ing tipped teeth, the forced eruption of fractured teeth to Treatment mechanics
expose the root surface, and the alignment of irregular
drifting teeth. The ultimate restoration should be carefully Dyer eta/. (1991) investigated the differences in treatment
considered before treatment commences. mechanics between adolescents and adults. The principal
Much of the literature about adult orthodontics is anec- findings related to the differences in growth experience
dotal, based on clinical experience and personal opinions. between the groups. Adults required more precise treat-
Diagnosis has been suggested to be simpler for the adult ment mechanics to correct the molar relationship and
than the child (Ackerman, 1978)), but Chiappone, (1976) greater anchorage control. They wore Class II elastics four
recommends a more extensive regime. This includes a full times longer than adolescents with the resultant dental
series of temporomandibular joint (TMJ) radiographs and sequelae more apparent, despite attempts to counteract
muscle examination. Should a patient have pre-existing this. This is, adults had significant maxillary molar intru-
TMJ symptoms, a splint may be used to re-establish cen- sion, mandibular molar extrusion, and maxillary incisor
tric occlusion prior to orthodontic treatment. Stress and extrusion, together with uprighting and steepening of the
diet evaluation as well as a pantomographic tracing may occlusal plane compared to adolescents. The correction of
also be utilized for diagnostic purposes. molar relationship in adolescents was aided by forwards
Unlike most adolescent patients, adults are more likely movement of the mandibular molar to twice the extent of
to have a relevant medical history. Fastlight, (1982) also that in adults. Adults, however, experienced twice the
warns against over emphasizing pretreatment warnings as amount of intrusion of lower incisors relative to the man-
he considers that adults may be easily worried. However, dibular plane compared to adolescents, whilst the vertical
in the face of potential litigation, this may not be wise. molar movement was similar. Anchorage effects were
Is adult orthodontic treatment more difficult than that more notable in the adolescents and it was suggested that
of the adolescent? Barrer, (1977) found the management anchorage control was not achieved to the same extent in
of deep overbite, posterior crossbite, and tooth intrusion adults or that it was masked by the use of Class II elastics.
particularly difficult in adults, and he states that the final It was concluded that the skeletal discrepancy was signifi-
occlusion is rarely ideal. Ackerman, (1978) also found cantly reduced in both groups, but by different mechanisms.
adult treatment more difficult than adolescents, due to Both groups experienced posterior movement of A point,
their Jack of growth, high expectations and the involve- whilst adults also had a steepening of the occlusal plane.
ment of other disciplines. Chiappone, (1976) found that The vertical face height increased significantly for adoles-
the only difference in treatment mechanics was the slower cents, but was relatively unchanged for adults, demon-
initiation of tooth movement in adults compared to adoles- strating differences in growth. Interestingly, treatment
cents. Otherwise adult treatment was no more difficult. time was identical for both groups.
Machen, ( 1990, 1991) discussed the management of
orthodontic patients from a legal standpoint, with particular
reference to temporomandibular joint dysfunction, Periodontal health
periodontal disease, and facial-skeletal and dental dis-
crepancies. He emphasizes the need for a thorough hist~ry Boyd and Baumrind, ( 1992), and Boyd et al., ( 1989) inves-
(including previous trauma to head and neck) and examm- tigated the differences in the periodontal response during
ation before treatment, and of the importance of gaining orthodontic treatment between adolescents and adults. It
informed consent. Interestingly. he discussed the need for was found that adolescents had significantly more plaque
TMJ radiographic investigation firstly as a legal requ.ire- than adults at baseline and during the later stages of treat-
ment, secondly as a cost-benefit decision for the pattent ment, but both showed good plaque control once appliances
BJO November 1995
Adult Orthodontics 335

were removed. Pocket depths increased slightly in adults examined, the results present measurements for the maxil-
and increased significantly in the adolescent population as lary molar and the discussion refers to two molar sites.
treatment progressed. However, these measurements re- Therefore, conclusions relating to bony support may be
turned to baseline on completion of treatment for both invalid. In addition, no clinical examination of the perio-
groups and those of the adolescents matched those of dontal condition was made.
untreated adolescents with healthy periodontium. No
adult experienced significant loss of attachment, unlike
three of the adolescents. Not surprisingly, these three had Stability
the poorest plaque control throughout treatment.
A further study (Boyd and Baumrind, 1992) investi- Harris eta/. (1994) investigated the post-treatment stabil-
gated the use of molar bands and bonds, and their effects ity of adolescent and adult groups, presumably the same
on periodontal health. All received fixed Edgewise appli- population as previously assessed (Harris and Baker,
ance therapy, but some molars were banded and some 1990; Dyer eta/. 1991). Skeletal and dental changes were
bonded. The decision to band or bond was not made assessed using cephalometric analysis and it was found
randomly, but was dictated by clinical needs, i.e. if that whilst significant differences existed in absolute facial
headgear was to be used, maxillary molars were banded. dimensional change, due to the continued growth of the
Only two sites were examined for periodontal health. at adolescents, overall relapse of the molar relationship in
regular intervals throughout and after treatment. Agam, both groups was similar and minimal suggesting that by
adolescents proved to be less thorough at plaque removal these parameters, adults' occlusion remain as stable as
than. adults. Combined results demonstrated that banded adolescents' occlusion. Unfortunately, no discussion of
molars had worse periodontal indices t.han bon?e~ molars lower incisor crowding, or changes in overbite or overjet
and banded maxillary molars expenenced s1gmficantly were made, although the adult mandibular· incisors did
more loss of attachment (mean value 0·4 mm). Adoles- become more upright.
cents had worse periodontal indices on maxillary molars
than adults, but the study cohort was not well matched.
Adolescents had far more banded maxillary molars than Treatment discontinuation rates
adults, no doubt due to different clinical needs, i.e. ado-
lescents were often treated with headgear. Haynes, (1982) in an assessment of data taken from the
The authors attributed adults' better plaque control to Annual Reports of the Dental Estimates Board of England
their greater commitment to treatment (and finan~ial a~d Wales (1972-1979) suggested that patient ages were
responsibility) and to longer clinical crowns beanng duectly proportional to the discontinuation rate. Adoles-
attachments further from the gingival margin. They also cents aged 10-14 years had a discontinuation rate of 20·2
suggested that adolescents are more prone to gingi~al per cent whereas this increased to 42·7 per cent for adults
inflammation because of increased hormonal levels dunng (18 years and over). This is contradictory to the general
puberty. Increased levels of sex hormones are known to clinical impression that adults are more co-operative than
aggravate gingivitis during pregnancy (Hugoson, 1970); adolescents, and indeed a later publication by Murray,
therefore, this suggestion may be vahd. (1989) found that age was unrelated to discontinuation
Harris and Baker, ( 1990) assessed the effects of ortho- rates. Over 20 per cent of the patients studied in the latter
dontic treatment on dental supporting structures (root survey were aged over 16 at the start of treatment and
length and crestal bone height) between adults and adoles- their discontinuation rate was only 12·8 per cent. The
cents. The study groups were well-matched with respect Dental Practice Board have said it no longer records dis-
to their occlusion. Measurements, pre-and post-fixed continuation rates.
orthodontic therapy were made from panora~ic .and It is interesting that no great differences in the duration
cephalometric radiographs, corrected for magmficatiOn. of treatment have been found between adults and adoles-
The root morphology, and length of five teeth a.nd alveo- cents, despite the consensus of opinion that the reaction
lar bone crestal height at two sites in each patient were of teeth to an orthodontic force may be slower in adults
assessed. Adults had shorter roots than adolescents before (Watson, 1979; Tayer and Burek, 1981). Dyer et a/.,
and after treatments, but did not lose more absolute root (1991), Harris and Baker, (1990), and Chiappone, (1976)
length than the adolescents during treatment. Both groups have found that treatment times are similar, whereas
lost 1·0-1· 5 mm of root length and showed some blunting Boyd eta/ .• (1989) and Fastlight, (1982) found that adults
of the apex during treatment. Adults lost more crest~! completed their treatment earlier. The excellent coopera-
bone than adolescents, but it is unclear from the re~ults If tion of adults and their more consistent attendance have
this was significant. The authors co~~luded that, 1~ the been suggested as a possible explanation (Chiappone,
absence of compromising dental conditions, adult pat1ents 1976).
are not inherently more likely than adolescents to lose
dental support during treatment, but should be carefully
assessed before treatment commences. However, root Conclusion
morphology and length are difficult to assess from large
radiographs, and this study would have been more ~onclu­ Different approaches to the study of adult orthodontics
sive if peri-apical radiographs had been used. The s1tes for have been adopted. Earlier publications tend to comprise
measurement of alveolar crestal bone height were confused clinical opinion and case reports, whilst comparative
during presentation of the method, results, and discus- studies have been conducted more latterly. Some general
sion. The method states that the mandibular molar was findings appear to be consistent throughout. Adults tend
 336 C. Nattrass and J. R. Sandy 810 Vol. 22 No.4

to be excellent orthodontic patients, due to their high Espeland, L. V. and Stenrik, A. (1991)
motivation and co-operation. Since expectations may also Orthodontically treated young adults; awareness of their own dental
be high, the limitations of orthodontic treatment must be arrangement,
European Journal of Orthodontics, 13, 7-14.
made clear. Whilst tooth movement may be slow initially,
treatment is generally of the same duration as adolescents Fastlight, J. (1982)
Adult orthodontics,
and adults adapt well psychologically. Forces must be light
Journal of Clinical Orthodontics, 16, 606-618.
and periodontal disease under control before treatment
Ghafari, J. (1992)
begins. An interdisciplinary approach to treatment is com-
Problems associated with ceramic brackets suggest limiting use to
mon and orthodontists should be aware that a restorative selected teeth,
approach alone may offer quicker results. Finally, once Angle Orthodontics, 62, 145-152.
these demands have been met and treatment completed, Goldstein, M. C. (1953)
orthodontists are likely to be rewarded with a satisfied Adult orthodontics,
patient. American Journal of Orthodontics, 39, 400-424.
Gottlieb, E. L., Nelson, A. H. and Vogels, D. S. (1991)
1990 JCO study of orthodontic diagnosis and treatment procedures
I results and trends,
Acknowledgements Journal of Clinical Orthodontics, 25, 145-156.
We are grateful to Jane Western for cheerfully typing this Harris, E. F. and Baker, W. C. (1990)
manuscript. Loss of root length and crestal bone height before and during
treatment in adolescent and adult orthodontic patients,
American Journal of Orthodontics and Den tofacial Orthopaedics, 98,
463-469.
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Ackerman, J. K. (1978) 1 malocclusions,
The challenge of adult orthodontics. American Journal of Orthodontics and Dentofacial Orthopaedics,
Journal of Clinical Orthodontics. 12, 43-47. 105, 25-34.
Andreason, G. F. (1972) Haynes, S. (1982)
Treatment approaches for adult orthodontics. Discontinuation of orthodontic treatment in the general dental
American Journal of Orthodontics, 62, 166-175. services in England and Wales (1972-1979),
Barrer, H. G. (1977)
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