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 Table of Contents  
Year : 2012  |  Volume : 4  |  Issue : 6  |  Page : 270-274  

Adult interdisciplinary therapy

1 Department of Orthodontics, Vivekananda Dental College for Women, Thiruchengode, India
2 Department of Orthodontics, Meenakshiammal Dental College, Chennai, India

Date of Submission01-Dec-2011
Date of Decision02-Jan-2012
Date of Acceptance26-Jan-2012
Date of Web Publication28-Aug-2012

Correspondence Address:
Bala Krishnan Rajkumar
Department of Orthodontics, Vivekananda Dental College for Women, Thiruchengode
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-7406.100248

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Adult patients have many preexisting conditions like tooth loss, severe skeletal dysplasia, periodontal disease, and various temporomandibular dysfunctions. In such adult patients, an interdisciplinary treatment approach is followed by customizing orthodontic treatment for the individual patient. This article shows a case that is managed in an interdisciplinary method of treatment approach.

Keywords: Metal ceramic bridge, nance button, pendulum appliance, preadjusted edgewise appliance, transpalatal arch

How to cite this article:
Rajkumar BK, Janarthanam P. Adult interdisciplinary therapy. J Pharm Bioall Sci 2012;4, Suppl S2:270-4

How to cite this URL:
Rajkumar BK, Janarthanam P. Adult interdisciplinary therapy. J Pharm Bioall Sci [serial online] 2012 [cited 2022 Aug 14];4, Suppl S2:270-4. Available from:

In the past three decades, a major reorientation of orthodontic thinking has occurred regarding adult patients. With recent improvements in treatment techniques and changes in treatment philosophies, orthodontists are more involved in the management of adult patients. [1] Adult patients desire treatment efficiency, convenience in appointments, and good communication with oral health care providers. Unlike the typical adolescent, an adult may exhibit rapid periodontal breakdown and bone loss. Therefore, adult therapy requires the establishment of goals and efficient mechanotherapy so that completion occurs as expeditiously as possible. In this article, we have shown a case treated in an interdisciplinary approach.

   Case Report Top

A 23-year-old patient presented with a class 1 malocclusion on a class 2 skeletal base with average mandibular plane angle and proclination of upper and lower incisors with normal facial pattern, incompetent lips, convex profile, and acute nasolabial angle [Figure 1]a-c.
Figure 1: (a-c) Extraoral view of the patient

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Intraoral evaluation revealed spacing in upper and lower arches, missing left upper first molar, mesiolingual rotation, and mesial tipping of left upper second molar [Figure 2]a-e.
Figure 2: (a-e) Intraoral view of the patient

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   Treatment Plan Top

We decided on a non-extraction treatment plan and the treatment plan was divided into three stages:

Stage 1: Derotation of 27 with transpalatal arch and distalization of 27 with pendulum appliance. [2],[3]

Stage 2: Incisor retraction in the upper arch, finishing and detailing with preadjusted edgewise appliance.

Stage 3: Replacement of 26.

Stage 1

Derotation of 27 was done with removable transpalatal arch in the upper arch and removable biteplane in the lower arch [Figure 3]a-b. Derotation was done in 3 months. After derotation of 27 [Figure 4], distalization of the molar was carried out with pendulum appliance [2] [Figure 5]. With the pendulum appliance, anchorage was derived from the premolars, anterior portion of the hard palate, and from the opposite side first molar. Activation of the spring was done for only one side where distalization was required. Post-distalization orthopantomogram (OPG) showed bodily distalization of upper left second molar [Figure 6].
Figure 3: (a and b) Before derotation of 27 with transpalatal arch

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Figure 4: After derotation of 27

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Figure 5: Distalization with pendulum appliance

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Figure 6: OPG showing the bodily distalization of upper left second molar

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Stage 2

Preadjusted edgewise appliance therapy was started during distalization and Nance button was placed after distalization of 27 to maintain the regained space [Figure 7]. Incisor retraction was done with frictionless mechanics for anchorage considerations [Figure 8]a-e. Space closure was done in 5 months. After incisor retraction, the patient was given settling elastics for 1 week [Figure 9]a-e. Then, debonding of fixed appliance was done [Figure 10]a-e and post-treatment radiographs were taken [Figure 11]. Post-treatment radiographs displayed parallelism of roots and ideal incisor position was achieved.
Figure 7: (a-e) Nance button to maintain the regained space

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Figure 8: (a-e) Retraction with tear drop loop for incisor retraction

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Figure 9: (a-e) After incisor retraction and during settling

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Figure 10: (a-e) Intraoral view after appliance removal

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Figure 11: Post-treatment radiographs

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Stage 3

After appliance removal, a metal ceramic bridge for replacement of the left upper first molar was done [Figure 12]a-e. In lower arch fixed spiral wire retainer was done and in the upper arch a Begg's wraparound retainer was given for retention.
Figure 12: (a-e) Intraoral views after replacement of left upper first molars

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   Discussion Top

The orthodontist frequently is placed in the position of treatment plan director. Decisions regarding extraction or nonextraction and surgery to correct or tooth movement to camouflage skeletal problems are the key orthodontic responsibilities. Along with this, the orthodontist must establish the sequence of implementing the treatment plan: Who does what, when, and how does the orthodontist communicate the sequence and the rationale of the sequence to the patient and to the providers for their input and modification. Patients under dual provider and multiple provider care must be educated to plateaus of treatment progress and how these relate to their well-being. [4]

   Conclusion Top

Technical improvements and teamwork among dental specialists has made interdisciplinary therapy more available and predictable for a large group of adults. Also important is that not all providers have the patience or desire to spend time and energy with interdisciplinary adult and not all patients can afford the full spectrum of services for stomatognathic system rehabilitation.

   References Top

1.Gorman JC. Treatment with lingual appliances: The alternatives for adult patients. Int J Adult Orthodon Orthognath Surg 1987;3:331.  Back to cited text no. 1
2.Hilgers J. The pendulum appliance for class II non-compliant therapy. J Clin Orthod 1992;26:706.  Back to cited text no. 2
3.Byloff FK, Darendeliler MA. Distal molar movement using the pendulum appliance.1. Clinical and radiological evaluation. Angle Orthod 1997;67:249.  Back to cited text no. 3
4.Musich DR. Assessment and description of the treatment needs of adult patients evaluated for orthodontic therapy, parts I-III. Int J Adult Orthodon Orthognath Surg 1986;1:55.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]


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