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nasal morphology, recognition of aesthetic problems, and potential treatment.

Due to the tendency of the original growth pattern to re-establish itself following treatment, retention should be continued until the end of adolescent skeletal growth and incorporate a postural component to maintain the skeletal correction. Advantages of adolescent treatment u Control of all permanent teeth, except third molars, is possible. u It is bene cial to treat when bone turnover rates are still high even though adult dimensions are nearly achieved. u Repair and remodeling occur readily in response toorthodontic forces although the basic craniofacial morphology is largely established. u Motivation for treatment is high, especially when facial aesthetics are a ected. u Treatment-goals can be more surely de ned, as one does not have to counter the unpredictable dynamics of growth. u Since treatment is less dictated by developmental events, treatment options are lessened. u e best opportunities for control and manipulation of severe skeletal dysplasia are past. u Sportsandsocial activities, so important to adolescents, often compete with plans for orthodontic treatment. u e time necessary for treatment may be longer for certain malocclusions. u Tooth positioning is oftenmore di cult when the occlusion is fully established, and root formation is complete, than was tooth guidance during eruption. u For the young adolescent patient who completes orthodontic treatment, in case of any missing teeth, it is recommended to postpone implant Disadvantages in adolescent treatment

placement until the patient has completed both sagittal and vertical growth. u Orthognathic surgery should be delayed until all adolescent growth has ceased, which will be the late teens. of orthodontic problems to the adolescent age period is viewed as an advantage by some clinicians, others view it as a signi cant disadvantage. Many clinicians seek to intervene in the mixed dentition to eliminate or modify skeletal, muscular and dentoalveolar abnormalities before the eruption of permanent dentition occurs. Growth modi cation techniques allow the orthodontist to direct growth to achieve dramatic facial changes and these changes are an important part of patient motivation and satisfaction. On the surface, this concept seems reasonable because it appears more logical to prevent an abnormality from occurring than to wait until it has become fully developed. However, not all clinicians use the same treatment protocols, and the decision concerning whether to intervene before the eruption of the complete permanent dentition is based on a number of interactive factors. u References Graber, Vanarsdall – Orthodontic Current Principles and Techniques (6th edition) Moyers- Handbook of Orthodontics (4th edition) Samir E Bishara. Facial and dental changes in adolescents and their clinical implications. e Angle Orthodontist 2000;70(6):471-83. Sridhar Premkumar – Textbook of Craniofacial Growth (1st Edition) Conclusion Although deferring treatment

Habits In addition to certain facial features, patient habits that continue beyond early stages, such as mouth breathing or tongue placement habit (recognized by forward tongue placement during speech), should not be overlooked during treatment in the adolescent years. As patient habits have a great impact on social well-being and general health, they require special consideration for post-treatment stability. u Orthodontic camou age implies repo sitioning the teeth without correcting the skeletal problem. u eobjectiveoforthodonticcamou age is to correct the malocclusion which makes the underlying skeletal problem less apparent. u Class II malocclusions often can be camou aged. Indications for camouflage treatment: u Patients too old for growth modulation u Mild or moderate skeletal class II Timing of treatment e timing of treatment is a factor in the amount of change that can be produced. e amount of tooth movement that is possible is about the same in children as it is in adults. However, the growth modi cation range diminishes steadily as a childmatures and disappears after the adolescent growth spurt, so some Class II and Class III conditions that could have been treated in a growing child with growth modi cation and toothmovement would require surgery if treated later on. u Good alignment of teeth u Good vertical proportions. 5. Compromises Orthodontic camouflage

Dr Geoff Hall Specialist orthodontist and Director of the OrthoED Institute geoff@orthoed.com.au +61391080475

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