The misalignment of teeth or an improper bite relationship is known as malocclusion, a condition affecting a significant portion of the adult population. Contrary to the belief that orthodontic correction is limited to adolescence, achieving a proper bite and straight teeth is highly feasible for adults. Modern advancements provide a range of effective treatment options for adults seeking to improve their dental health and smile aesthetics. Correction often involves specialized techniques tailored to the unique anatomy and goals of the adult patient.
Understanding the Impact of Malocclusion
Fixing a misaligned bite is driven by more than just appearance, as malocclusion contributes to several functional and oral health problems. Misalignment causes abnormal wear on enamel surfaces, leading to chipped, fractured, or excessively worn teeth that may require restorative procedures.
Functional issues include difficulty chewing and biting, which can affect digestion and cause discomfort. A poor bite relationship can also place stress on the temporomandibular joints (TMJ), potentially causing chronic jaw pain, headaches, or muscle tension. Malocclusion complicates routine oral hygiene because crowded or overlapping teeth create difficult-to-clean spaces. These areas accumulate plaque and bacteria, increasing the risk of cavities and gum disease.
Non-Invasive Orthodontic Solutions
Most adult malocclusion cases involving primarily tooth positioning, rather than severe jawbone discrepancy, can be corrected through non-invasive orthodontic methods. Traditional fixed appliances, such as metal or ceramic braces, use brackets and wires to apply continuous, controlled force. The orthodontist periodically adjusts the archwire to gradually guide the teeth into alignment. Ceramic brackets offer a less visible alternative to metal, appealing to adults concerned about aesthetics, and both types are effective for complex movements.
A popular option is clear aligner therapy, which uses a series of custom-made, transparent plastic trays to incrementally shift the teeth. Patients switch to a new set of aligners every one to two weeks, requiring wear for approximately 20 to 22 hours per day. Clear aligners are discreet and removable for eating, drinking, and oral hygiene, making them convenient for many adult lifestyles. This method is generally most suitable for mild to moderate crowding, spacing, and bite issues, and requires strict patient compliance.
In cases requiring complex tooth movement without surgery, accessory appliances may be used with braces or aligners. Temporary Anchorage Devices (TADs) are small, titanium mini-screws temporarily placed into the jawbone to act as a fixed anchor point. This rigid anchorage allows the orthodontist to move specific teeth, such as intruding teeth to correct a deep bite or closing large gaps. TADs can also support specialized appliances, like a Maxillary Skeletal Expander (MARPE), which helps widen a narrow upper jaw in non-growing adult patients by gently separating the palatal bones. This technique can reduce the need for more invasive jaw surgery.
Addressing Severe Skeletal Issues
When malocclusion stems from a significant mismatch in the size or position of the upper and lower jaws, it is classified as a skeletal malocclusion. Examples include severe overbites, underbites, or crossbites that cannot be corrected by moving the teeth alone. In these instances, orthognathic surgery, often called corrective jaw surgery, is the definitive treatment to reposition the jawbones into proper alignment.
The process is a combined effort between an orthodontist and an oral and maxillofacial surgeon, spanning several years. The first phase involves pre-surgical orthodontics, where fixed braces align the teeth within their respective jaws. This pre-alignment ensures the teeth will interdigitate correctly once the jawbones are surgically moved. The surgery involves the surgeon making precise cuts in the jawbone, such as a Le Fort I osteotomy for the upper jaw or a Bilateral Sagittal Split Osteotomy for the lower jaw, to move the bone segments to the planned position.
The newly positioned jaw is secured using small titanium plates and screws, which remain permanently in place. Following recovery, post-surgical orthodontics fine-tunes the final bite relationship and stabilizes the result. This comprehensive approach is reserved for severe skeletal discrepancies and improves bite function, facial balance, and profile.
Post-Treatment Care and Long-Term Stability
The active phase of orthodontic treatment is followed by the retention phase, which is necessary to maintain the results. Teeth have a natural tendency to shift back toward their original positions (relapse) because the surrounding bone and ligament fibers need time to stabilize around the new alignment. Retainers are custom-made devices designed to hold the teeth firmly in their corrected positions while supporting structures remodel.
Removable retainers are a common option, including the clear plastic (Essix) type or the traditional Hawley retainer, which uses an acrylic base and a wire. These devices must be worn full-time for an initial period, typically several months, and then transitioned to nighttime wear indefinitely. The other main type is the fixed or bonded retainer, a thin wire cemented directly to the tongue-side surface of the front teeth, usually the lower six.
Fixed retainers offer continuous, non-removable stability, virtually eliminating the risk of relapse for the teeth they cover. Many orthodontists recommend a combination of both fixed and removable retainers to maximize long-term stability. The commitment to wearing a retainer, particularly at night, is considered a lifetime commitment to ensure the teeth do not drift out of alignment.