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CATEGORY LINICAL

Benefits of adolescent orthodontic treatment

Dr Geoff Hall

By Dr Geoffrey Hall

T he majority of orthodontic treatment is carried out in the late mixed or permanent dentition. is allows for comprehensive treatment within a nite and realistic time frame, whilst optimizing adolescent growth and compliance. More malocclusions are probably treated in adolescence than any other period, not because it is always the best time for therapy, but rather because this is the time at which patient and parent often become aware of the problem. Furthermore, the treatment of many malocclusions has been traditionally postponed until the permanent teeth have erupted. R. Shah et al (EJO 2019) conducted a qualitative study and explored parental perceptions of treatment outcomes in their child during the adolescent period and reported three main bene ts of their child’s orthodontic treatment: health-related behavioural change, dental health and psychosocial in uences. General characteristics of adolescent malocciusion u Dentition and occlusal relationships are established. u Skeletal growth may be mostly over and decelerating. u Muscle function is matured. u Functional malocclusions are less frequent since they have largely been accommodated by dentoalveolar, skeletal and/or mandibular joint adaptations. u Temporomandibular dysfunction is more frequent since dental, skeletal and joint adaptability have diminished. u Psychological aspects are more signi cant than at younger ages. erefore, with the eruption of the canines and premolars, permanent dentition is established. During this time, the adolescent growth spurt and onset of puberty occur. e skeletal discrepancy becomes accentuated and facial appearance and occlusal relationships deteriorate. ese changes occur at a time when individuals are most self-conscious about their body image and facial appearance.

Defining goals in adolescent treatment

is not related to chronological age. u Physical maturity can be assessed by the skeletal maturity or skeletal age. u e bones mature at di erent rates and follow a reasonable sequence.

Since precise tooth positioning is the principal strategy in adolescent treatment, cephalometric analysis for treatment planning is essential and many analyses have been designed solely to determine the placement of teeth within particular skeletal morphologic patterns. e treatment goals for planning are as follows:

u Skeletal u Dental u Occlusal and functional u Soft-tissue and facial aesthetics u Compromises.

1. Skeletal A primary aim is to predict the time of the adolescent growth spurt to utilize it in the planned orthodontic correction. A number of maturity indicators, particularly the hand-wrist radiograph and cervical vertebrae have been used in such predictions. What is Skeletal maturity? Also termed Skeletal age; it is determined by accessing the development of bones in the hand and wrist or by evaluating the development of cervical vertebrae on lateral cephalograms. It provides a most useful means of assessing biologic maturity and is useful through the postnatal growth period. u Assessing the skeletal maturity status of an individual helps in knowing whether the patient will grow appreciably in the treatment period which has important implications in the treatment planning and response to treatment. u e position of the patient in the facial growth curve is important while planning orthopaedic therapy, functional appliance therapy and orthognathic surgery. u e orthopaedic or functional appli ance treatment during the periods of accelerated growth can contribute sig ni cantly to correction of dentofacial deviations leading to an improvement in facial appearance. u e physical maturity of an individual

Growth velocity curve – Growth per unit of time for measuring skeletal growth

Variation in rates of growth during maturation Assessments of maturation provide critical information about the growth of craniofacial structures and length of time growth will continue, or whether growth has been completed. is is important because patients’ maturational and chronologic ages should be expected to di er, often by more than 1 to 2 years, which confounds growth assess ments necessary for orthodontic diagnosis and treatment planning. During adolescence, hormonally mediated growth typically occurs to bring about a spurt in skeletal growth called PHV (peak height velocity). e pubertal growth spurt is characterised by considerable variability in onset and duration among individuals and according to gender. Two episodes of relatively rapid growth, or growth spurts, have been documented for both general somatic and craniofacial growth.

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