Khan RS, Horrocks EN. A study of adult orthodontic patients and their treatment. Br J. 1991; 18:183-194
McKiernan EX, McKiernan F, Jones ML. Psychological profiles and motives of adults seeking orthodontic treatment. Int J Adult Orthod Orthognath Surg. 1992; 7:187-198
Steele J, Treasure E, O'Sullivan I, Morris J, Murray J. Adult Dental Health Survey 2009: transformations in British oral health 1968–2009. Br Dent J. 2012; 213:523-527
Löe H, Anerud A, Boysen H, Smith M. The natural history of periodontal disease in man. The rate of periodontal destruction before 40 years of age. J Periodont. 1978; 49:607-620
Socransky SS, Haffajee AD. Microbial mechanisms in the pathogenesis of destructive periodontal diseases: a critical assessment. J Periodontal Res. 1991;; 26:195-212
Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. J Periodont. 2000; 14:216-248
Taylor C, Roudsari RV, Jawad S, Ashley MP, Darcey J. The aetiology and management of labial and vertical migration of maxillary incisors: ‘Do you catch my drift?’. Br Dent J. 2014; 216:117-123
Johal A, Ide M. Orthodontics in the adult patient, with special reference to the periodontally compromised patient. Dent Update. 1999; 26:101-108
Darcey J, Ashley M. See you in three months! The rationale for the three monthly periodontal recall interval: a risk based approach. Br Dent J. 2011; 211:379-385
Lang N, Joss A, Orsanic T, Gusberti F, Siegrist B. Bleeding on probing. A predictor for the progression of periodontal disease?. J Clin Periodontol. 1986; 6:590-596
Lindhe J, Socransky SS, Nyman S, Haffajee A, Westfelt E. Critical probing depths in periodontal therapy. J Periodontol. 1982; 9:323-336
Ainamo J, Nordblad A, Kallio P. Use of the CPITN in populations under 20 years of age. Int Dent J. 1985; 34:285-291
Consultant in Orthodontics, University of Manchester Dental Hospital, Higher Cambridge Street, Manchester, M15 6FH, Salford Royal NHS Foundation Trust, Stott Lane, Manchester and Northenden House Orthodontics, Sale Road, Manchester, M23 0DF
Adult patients are increasingly seeking orthodontic treatment. It is essential to establish optimal periodontal health in these patients before embarking on such treatment, which demands the interaction between the general dental practitioner (GDP) and orthodontist for effective management. This article focuses on the management of periodontal disease in orthodontic patients, orthodontic considerations, retention and complications that may arise. This is demonstrated throughout a series of clinical cases treated within a multidisciplinary team. The management of patients with periodontal disease is often challenging; the clinical issues that require consideration are discussed throughout this article.
CPD/Clinical Relevance: This article provides a summary of the orthodontic and periodontal implications of different treatment techniques and management for the general practitioner.
Article
Adult patients are increasingly requesting orthodontic treatment. An epidemiological study at the Eastman Dental Hospital revealed that the number of adults undertaking orthodontic treatment has increased significantly, especially since 1985.1 This may be due to social acceptability of appliance therapy, with the main motivation of adult patients being the desire to improve their dental appearance.2
Adults can be excellent candidates for orthodontic treatment. They are motivated and co-operative, however, consideration must be given to the periodontal condition in this group of patients. Periodontitis is a common problem in adults. It has been found that 72% of adult patients have at least one site with clinical attachment loss (CAL) equal to or more than 3 mm.3 Furthermore, the cumulative impact of periodontal challenges over a lifetime may result in older patients having more CAL.
Though plaque has a significant role in the aetiology of periodontal disease, the seminal work of Löe and colleagues4 demonstrated that plaque alone is not the critical factor in disease progression. There is a complex interaction in the subgingival environment between disease-causing bacteria, their numbers and virulence within the biofilm and the host inflammatory response.5 It is this inflammatory response that results in the collateral damage of tissue breakdown.6 Many risk factors have been identified that may influence periodontal disease progression which are listed in Table 1.
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