Adult orthodontia is the practice of straightening teeth and correcting bite discrepancies in patients whose facial growth and skeletal development are complete. While traditionally associated with adolescents, modern advancements have made treatment accessible and increasingly popular for older patients. Today, about one in four orthodontic patients is an adult, seeking treatment for various reasons beyond simple aesthetics. This process involves applying controlled forces to the teeth, which gradually move them into a more favorable position within the jawbone, improving both appearance and long-term health and function of the bite.
Common Reasons Adults Choose Orthodontics
One primary motivation for adult treatment is orthodontic relapse, where teeth shift back toward their original positions after earlier childhood treatment. This shifting often occurs because of a failure to wear retainers consistently. Many adults also seek care for issues that were never treated in youth, such as worsening crowding, excessive spacing, or an improper bite alignment known as malocclusion.
Addressing functional problems is another significant driver for adult patients. A misaligned bite can contribute to excessive wear on certain teeth, making them vulnerable to chipping or breakdown. Correcting the bite can alleviate excessive stress on the jaw joints, potentially improving symptoms related to the temporomandibular joint (TMJ). Furthermore, orthodontics is frequently used in a pre-restorative capacity to properly position teeth for subsequent dental work, creating the necessary space for crowns, bridges, or dental implants.
Modern Treatment Options
Traditional and Aesthetic Braces
Adult patients benefit from a range of discreet and highly effective appliances. Conventional metal braces are still used, often reserved for complex cases that require precise tooth movement. Ceramic braces offer a less noticeable alternative, functioning identically to their metal counterparts but utilizing tooth-colored or clear brackets that blend in with the teeth.
Clear Aligners and Lingual Options
Clear aligner therapy, popularized by systems like Invisalign, is highly favored by adults due to its aesthetic qualities. This treatment involves wearing a series of custom-made, transparent plastic trays that progressively move the teeth. A significant advantage is their removability, allowing for easier eating and oral hygiene maintenance, though they require strict compliance of being worn for 20 to 22 hours per day. Lingual braces offer the most aesthetically hidden option, as the brackets and wires are bonded to the back surfaces of the teeth. While completely invisible when smiling, they can be more challenging to adjust to initially and may affect speech and tongue comfort.
How Adult Orthodontics Differs From Childhood Care
The fundamental difference between adult and childhood orthodontics lies in the maturity of the patient’s skeletal structure. Since facial growth is complete, the bone surrounding the teeth is denser and less pliable than in a growing child. Tooth movement relies entirely on bone remodeling, a process that is slower in mature bone, often leading to a longer overall treatment duration.
Adults frequently present with existing dental work, such as crowns, bridges, large fillings, or missing teeth, which complicates treatment planning. Brackets cannot be bonded directly to certain restorative materials, and the presence of implants or fixed prosthetics limits the available options for tooth movement. Managing periodontal health is another major consideration, as adults have a higher risk of gum disease or marginal bone loss. Any existing gum inflammation or bone support issues must be controlled by a periodontist before and throughout treatment to ensure healthy tooth movement.
When a severe skeletal discrepancy exists, growth modification techniques used in children are not applicable. Achieving a proper functional bite often requires orthognathic (jaw) surgery, performed in conjunction with orthodontic treatment. This surgical path is necessary because the jawbones cannot be repositioned non-surgically once growth has stopped. Treatment often requires a multidisciplinary approach, involving the orthodontist coordinating care with general dentists, periodontists, and oral surgeons to manage these complexities.
The Treatment Timeline and Retention
The patient journey begins with a comprehensive initial assessment, which includes digital X-rays, photographs, and three-dimensional scans of the teeth and jaws. This diagnostic information is used to create a precise, customized treatment plan, predicting the exact movements required. The active phase of treatment, where the teeth are moved with braces or aligners, can range widely depending on the complexity of the case.
For mild alignment corrections, treatment might last as little as 12 to 18 months. For more severe bite problems or significant crowding, the active phase commonly spans 18 to 36 months. Regular check-ups are scheduled every four to ten weeks to monitor progress and adjust the appliances or switch to the next set of aligners. Once active tooth movement is complete, the crucial retention phase begins. Retention is a non-negotiable, lifelong commitment because the teeth retain a natural tendency to drift back toward their original positions. This phase involves wearing custom-made retainers, which can be removable or fixed, to stabilize the teeth in their newly corrected alignment.