Adult orthodontics 2

ADULT ORTHODONTICS
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education

-What is adult?
- history of adult orthodontics.
- Reasons for increase interest of adults
in orthodontic treatment.
- Indication
- Contraindications.
- Difference between adult and
adolescent patients.

Adult is defined as one who is fully
grown,most males 18 and above and
most females of 16 and above can be
considered to be adult,although residual
growth is left. It is however quite
impractical to determine the exact time
when adulthood begins.

HISTORY:
- Kingsley, in 1880,indicated an early
awareness regarding orthodontic
potential in adult patient.
- He stated, “It may be regarded as
settled fact that there are hardly any
limits to the age when movement of teeth
might not succeed.”

Acc. To MacDowell(1901),
after the age of 16 years, a complete and
permanent change in transition of the
occlusion is almost impossible owing to
the development of,
- adult glenoid fossa,
- density of the bones ,
- muscles of mastication.

In 1921 Calvin Case demonstrated the
value of orthodontic therapy for the
patient with pyorrhea in the lower
anterior area.

Adult orthodontics:-
Acc. To Ackerman, “adult orthodontics
is concerned with striking a balance
between achieving optimal proximal and
occlusal contact of the teeth,acceptable
dentofacial aesthetics, normal function
and reasonable stability.”

Reasons for the increased interest by
orthodontists in the adult as a patient and
vice versa.
1) Improved appliance placement
techniques.

2) Better management of joint
dysfunction.
3) More effective management of
skeletal jaw dysplasias with advanced
orthognathic surgical techniques.

4) Increased desire of patients and
restorative dentists for treatment of
dental mutilation problems using tooth
movement and fixed restorations rather
than removable prostheses.
5) Reduced vulnerability to periodontal
breakdown as a result of improved tooth
relationships and occlusal functions.

6) Role of media, visual as well as print
articles in magazines ,news paper as
well as community programs have
increased patient awareness.
7) A broader understanding of the
biology of the tooth movement,esp. with
regard to age changes.
8) Ingenious approaches to anchorage
management such as implants.

INDICATIONS: (BY RAVINS)
1) Improvement of tooth-periodontal
tissue relationship.
2) Establishing an improved plane of
occlusion to distribute the forces of
occlusion better.
3) Balancing the existing space for better
prosthetic replacement.
4) Improve occlusion and coordination
between the muscle and TMJ.
5) improve patient esthetic.www.indiandentalacademy.com

CONTRAINDICATIONS: (BY
BARRER)
1) Severe skeletal discrepancies.
2) Advanced local or systemic disease.
3) Excessive alveolar bone loss.
4) Poor stability prognosis.
5) Lack of patient motivation.

But mark and cosrn disagree with this
list except for systemic disease and lack
of patient motivation.

DIFFERENCE B/W ADOLESCENT
AND ADULT ORTHODONTIC
PATIENT.
Acc to levitt, “ in adult patient there is no
growth and only tooth movement”.
Acc to Barrer “ adult, unlike the child is
a relentless patient, who will not cover
our deficiencies in skills or our errors in
the use of mechanical procedures by
helpful settling in post-treatment.”www.indiandentalacademy.com

Acc to Ackerman. “ In a child ,one
occasionally calls on another specialist.
On the other hand it is rare adult whom
one treats orthodontically without
finding it necessary to collaborate with
another specialist.”

FOUR MAJOR CATEGORIES IN
WHICH ADULT PATIENT
SIGNIFICANTLY DIFFER FROM
THEIR ADOLESCENT
COUNTERPART:
1) The diagnostic process.
2) Treatment plan selection.
3) Acceptance of recommended therapy.
4) Achievement of treatment objectives.

1) THE DIAGNOSTIC PROCESS.
Problem oriented dental record aides
in making the appropriate
diagnosis, for it requires that the
patient’s problems be listed and a
plan be developed to manage each
problem.

DIAGNOSTIC STEPS:-
1) Collect data accurately.
2) Analyze data base.
3) Develop problem list.
4)Prepare tentative treatment plan.
5) Interact with those who are involved;
discus plans and options; clarify
sequence, acquire patient acceptance.
6) Create final treatment plan.www.indiandentalacademy.com

Before starting the treatment, the
orthodontist needs to be prepared to do
the following:-
1) Diagnose different stages of pdl
disease and their associated risk factors.
2) Diagnose TMJ dysfunction before,
during or after tooth movement.

3) Determine which cases require
surgical management and which one
require incisor reangulation to
camouflage the skeletal base
discrepancy.
4)Work cooperatively with team of other
specialists to give the patient the best
outcome.

ADULT ORTHODONTIC
TREATMENT OBJECTIVES:
1) Dentofacial aesthetics.
2) stomatognathic function.
3) Stability.
4) Achieving class 1 occlusion.

ADDITIONAL ORTHODONTIC
TREATMENT OBJECTIVES:-
1) Parallelism of abutment teeth:-
- Restoration will have better
prognosis.
- Allows for a better pdl response.
- Allows for better retention.

2) MOST FAVORABLE
DISTRIBTION OF TEETH:-
- Teeth should be positioned in such a
way that occlusion of natural teeth can
be established bilaterally between the
arches.

3) REDISTRIBUTION OF OCCLUSAL
AND INCISAL FORCES:-
- helpful in case of significant bone
loss.
4) ADEQUATE EMBRESURE SPACE
AND PROPRE ROOT POSITION:-
- Allows for better pdl health.

5) ACCEPTABLE OCCLUSAL PLANE
AND POTENTIAL FOR INCISAL
GUIDENCE AT SATISFACTORY
VERTICAL DIMENSION.

6) ADEQUATE OCCLUSAL
LANDMARK RELATIONSHIP.
7) BETTER LIP COMPETECY AND
SUPPORT:-
- Inadequate support may create change
in anteroposterior and vertical position of
upper lip and increse wrinkling.

8) IMPROVED CROWN/ROOT
RATIO:-
In case of individual teeth bone loss
we can improve the crown to root ratio
by decreasing length of clinical crowns
tooth is erupted orthodontically.

9) IMPROVEMENT OF
MUCOGINGIVAL AND OSSEOUS
DEFECTS:-
- Proper positioning of teeth in arch will
improve gingival topography.
10) BETTER SELF MAINTEINANCE
OF PDL HEALTH:-
- For better periodontal health tooth
should be positioned properly over their
basal bone support.

11) ESTHETICS AND FNCTIONAL
IMPROVEMENT.

2) TREATMENT PLAN SELECTION:
Factor affecting treatment plan
selection:-
1) Existing oral pathology:
- dental caries
- periodontal disease
- faulty restoration
- TMJ.
2) Skeletal relationship.

3) Biological consideration:
- neuromuscular maturity.
- periodontal susceptibility.
- rate of tooth movement.
- growth.
4) Therapeutic approach available:
- functional appliances.
- orthognathic surgery.
- restorative dentistry.

5) Extraction/nonextraction.
6) Anchorage requirement.
7) Missing teeth.

FACTOR AFFECTING THE
PATIENT’S ACCEPTANCE OF THE
TREATMENT PLAN:-
1) Sociobehavioral interaction:
- Office environment
- Staff training and selection
- Team coordination
2) Duration of treatment.

3) Cost of treatment.
4) Perceived risk/benefit ratio.
5) Appliance selection.
6) perceived value orthodontic treatment
to dental providers consulted.
7) Negative condition.
8) Positive conditions.

FACTOR AFFECTING THE
ACHIVEMENTS OF TREATMENT
OBJECTIVES:-
1) Psychosocial behavioral orientation.
2) Previous medical history
3) Dental history.
4) Ability of the orthodontist to interface
the treatment plan with those of other
dental specialist.
5) skills and knowledge of orthodontist
and staff. www.indiandentalacademy.com

1) Psychosocial behavioral orientation:
- patient cooperation with the
prescribed therapy.
- patient’s adaptation to orthodontic
appliance.
- Patient acceptance of the duration
of the treatment.(fatigue factor)
- Cost of the treatment.

2) Previous medical history:-
- Minimize force at TMJ in arthritis
patient.
- Patient with ulcerative colitis and
psoriasis may be taking steroids.
- Uncontrolled diabetic patient.
- Patient receiving anticoagulant
therapy.
- Patient with hyperacidity can
develop root caries during
treatment.
- Bacterial and hormonal changeswww.indiandentalacademy.com

- Patient with hyperacidity can
develop root caries during treatment.
- Bacterial and hormonal changes
during 2nd trimester of pregnancy
-Bacterial and hormonal changes
during 2nd trimester of pregnancy
can cause severe inflammation.

* Etiology of adult malocclusion.
* Types of adult orthodontic patients.
* Types of adult orthodontic treatment.
* Adjunctive treatment:
- Goals
- Biomechanical considerations.
- Timing and sequence.
- Procedures carried out.

ETIOLOGY OF ADULT TOOTH
MALPOSITION:-
1) DENTAL ORIGIN
2) SKELETAL ORIGIN

1) DENTAL ORIGIN:-
a) Faulty eruption from the normal
functional position.
b) Insufficient arch length.
c) Excessive arch length.
d) Prolonged retention of primary
teeth.
e) Ectopic eruption.

g) Prolonged finger and thumb sucking
habits.
h) Clenching and grinding.
i) Improper swallow pattern with tongue
thrusting.
j) Effects of tongue pressure on the
anterior teeth.

k) Macroglossia.
l) Premature loss of deciduous teeth.
m) Loss of permanent teeth.

2) SKELETAL ORIGIN:-
a) Cleft palate.
b) Gross mediolateral disharmony of the
craniofacial skeleton.

ADULT PATIENTS WHO NEED
ORTHODONTIC TREATMENT CAN
BE DIVIDED IN TO 2 GROUPS:-
1) YOUNGER ADULTS.( UNDER 35
OFTEN IN THEIR 20’S)
2) OLDER PATIENT IN THEIR 40’S
AND 50’S.

1) YOUNGER GROUP:-
Goal:-
Improve quality of life.

Reasons for not receiving orthodontic
treatment early:-
1) Reluctant about treatment.
2) Were not aware of orthodontic
treatment.
3) Parents could not afford.
4) Were not given proper advise by
family dentist.
5) No orthodontist located in the vicinity.

6) Improper ortho treatment when young
or were uncooperative.
7) Had ortho treatment but relapse
occurred.
8) More conscious of appearance with
age.
9) Anterior teeth started to crowd or
minor crowding becomes worse.

2) OLDER PATIENTS:-
Goal:-
- Maintain proper dental health.
- For the restorative purpose.

 Older patient mainly need treatment
for:-
1) Malposed teeth contributing to pdl
disease.
2) Increased difficulties in mastication.
3) Anterior space enlarging or
developing.
4) For better tooth positioning prior to
prosthetic preparation.
5) Tooth interference that may causes
TMJ problems.www.indiandentalacademy.com

ACCORDING TO PROFFIT ADULT
ORTHODONTIC TREATMENT IS
DIVIDED IN TO 3 PARTS:-
1) ADJUNCTIVE TREATMENT.
2) COMPREHENSIVE TREATMENT
FOR ADULTS.
3) SURGICAL TREATMENT.

DIFFERENCE BETWEEN
ADJUNCTIVE TREATMENT AND
COMPREHENSIVE TREAMTMENT
IS INDISTINCT,AS ANY TREAMENT
WHICH REQUIRE MORE THAN 6
MONTHS IS CALLED AS
COMPREHENSIVE TREATMENT.

1) ADJUNCTIVE TREATMENT:-
“ Tooth movement carried out to
facilitate other dental procedures
necessary to control disease and
restore function.”

GOALS :-
1) Facilitates restorative treatment by
positioning the teeth.
2) Improve periodontal health by
removing plaque harboring areas .
3) Establishing favourable crown to root
ratio and position of the teeth.

BIOMECHANICAL
CONSIDERATIONS:-
- Control of anchorage requires that
anchor teeth should not be allowed to tip.
- Fixed appliance is necessary.

-Adult patients demand for removable
appliance but they are not useful in
adjunctive treatment.
- But in case of multiple missing teeth
removable appliance is useful.

Placement of brackets

- In case of reduce periodontal support
and bone loss , lighter forces and
relatively larger movements are needed.

TIMING AND SEQUENCE OF
TREATMENT:-
- Before any type of tooth movement any
caries or pulpal pathology should be
eliminated.
- Larger restoration require detail
occlusal anatomy should be carried out
after orthodontic treatment is over.

- Periodontal disease should be
controlled before any tooth movement.
- Scaling, curettage and gingival graft
should be carried out before treatment.
- Surgical pocket elimination and
osseous surgery should be carried out
after orthodontic treatment.

 PROCEDURES CARRIED OUT IN
ADJUNCTIVE TREATMENT : -
1) UPRIGHTING POSTERIOR TEETH.
2) FORCED ERUPTION.
3) ALIGNMENT OF ANTERIOR
TEETH.
4) CROSSBITE CORRECTION.

UPRIGHTING POSTERIOR
TEETH:-

1) If third molar is present , whether
both second and third molar should
be uprighted.
2) Whether to upright tipped teeth
by distal crown tipping or by mesial
root movement.

3) Whether we need slight extrusion or
maintain occlusal height during
uprighting.
4) Whether premolar should be
repositioned or not.

APPLIANCE FOR MOLAR
UPRIGHTING:-
- Partial fixed appliance.
- Anchorage.
- Placement of brackets on canine and
premolars.

UPRIGHTING A SINGLE MOLAR:-
Moderately tipped
molar:-
- 17x25 braided s.s
- 17x25 Ni-Ti
 Severely tipped
molar:-
-19x25 s.s
- Uprighting spring
( 17x25 beta- Ti)

• “ T-loop”
- 17x25 s.s
- 19x25 beta-Ti
• Activation of T-loop.

• Severely tipped teeth:-
- Use of modified T-
loop.

• Final position of
molars and premolars.
• Use of open coil
spring - steel
- A Ni-Ti
• Occlusion should be
checked carefully.

RETENTION
• For shorter period
• For a longer period.
- Intracoronal wire
splint

FORCED ERUPTION:-
Indications:-
- Defects in cervical third .

TREATMENT PLANING:-
- Periapical radiograph.
- Single tapering and flared and
divergent root morphology.
- Endodontic therapy.

How much tooth should be extruded can
be determine by 3 factors:-
1) Location of the defect.(fracture line)
2) Space to place margin of the
restoration.(1 mm)
3) An allowance for the biological width
of the gingival attachment.(2 mm)www.indiandentalacademy.com

 Duration:-
- 1mm/week without damaging pdl.
- 3 to 6 week.

TECHANIQUE
• Continuous flexible
wire is
contraindicated.

2 METHODS
• With orthodontic
bracket.
• Without
orthodontic bracket.

• Brackets are placed
more occlusally on
anchor teeth than its
ideal position.
• T-loop,
- 17x25 s.s
- 19x25 beta-Ti

RETENTION:-
- By passively fitting rectangular arch
wire.(3 to 6 week).

ALIGNMENT OF ANTERIOR TEETH
Indications:-
1) To improve access and permit
placement of well contoured restorations.
2) To permit placement of crowns and
pontics .

3) To reposition closely approximated
roots and to improve the amount of
interradicular bone.
4) To position teeth so that implants can
be placed to support restorations.

* Alignment of crowed, rotated and
displaced incisors.
* Separation of approximated teeth.

• Position teeth for single tooth implant:-
- Minimum 6mm of space is require.
- Apices of adjacent teeth.

Anterior diastema closure and
space redistribution:-
Causes:-
- Loss of posterior teeth.
- Small teeth.
.- Loss of bone support.

TREATMENT:-
- With Removable appliance.
- With fixed appliance.

CROSSBITE CORRECTION:-
- It can cause functional problem and
occlusal trauma.
- Single tooth crossbite.
- Group of teeth in crossbite.(part of
skeletal problem).

- Correction with removable
appliances.(anterior segment)
- Correction with the “through the bite”
elastics.(posterior segment).

SUMMARY:-
There is wide variety of
etiology that can cause an adult
malocclusion. Also each patient’s need
for treatment are different so treatment
should be carried out taking his/her
needs in consideration.
Adjunctive treatment helps by
facilitating other dental procedures to
control disease and restore function.

PERIODONTAL ASPECT OF ADULT
TREATMENT:-
1) Minimal periodontal involvement.
2) Moderate periodontal involvement.
3) Severe periodontal involvement.

1) MINIMAL PERIODONTAL
INVOVEMENT: -
CHILDREN AND ADOLESCENT
ARE LESS SUSEPTIBLE TO
PERIODONTAL DISEASE THAN
ADULTS.

2) MODERATE PERIODONTAL
INVOVEMENT: -
All periodontal disease should be
controlled before tooth movement.
Fully bonded orthodontic appliance is
preferred in periodontally involve adult
patient.

Steel ligatures or self legating brackets
are preferred.
Periodontal maintenance therapy at 2-4
month interval.

3) SEVERE PERIODONTAL
INVOVEMENT: -
Periodontal maintenance should be
scheduled at more frequent intervals.
Orthodontic goals and mechnics should
be modified to keep force value
minimum.

SPACE CLOSURE VS. PROSTHETIC
REPLACEMENT: -
Old extraction site: -
Space closure is difficult in adult.
The involvement of cortical bone tend to
produce reciprocal space closure.
Implant in the ramus can be use to
provide necessary anchorage.www.indiandentalacademy.com

TOOTH LOST DUE TO
PERIODONTAL DISEASE: -
Unwise to move a teeth in area where
bone is destroyed because of periodontal
disease.

SURGICAL TREATMENT: -
- orthognathic basically involves planned
fracturing of the facial skeletal parts and
reposition them as desired.
- Moderate to severe skeletal
discrepancy.
- Patient education.

SURGICAL PROCEDURES: -
1) Correction of anteroposterior
relationship: -
both maxilla and mandible can be moved
forward or backward for correction of
jaw discrepancy.

A) MAXILLARY SURGERY: -
The LeFort 1 downfracture
procedure is used to reposition the
maxilla.

B) MANDIBULAR
ADVANCEMENT:-
- Bilateral saggital split
osteotomy(BSSO) of the mandibular
ramus.
- stretching and retraction of the inferior
alveolar nerve.

C) MANDIBULAR SETBACK: -
- BSSO.
- The transoral vertical oblique ramus
osteotomy(TOVRO).

2) CORRECTION IN VERTICAL
PLANE: -
a) Maxillary surgery: -
- LeFort 1 downfracture of the maxilla,
with superior reposition of the maxilla.
- In downward movement of the maxilla
rigid fixation are used.(synthetic
hydroxyapatite)

b) Mandibular surgery: -
mandibular ramus surgery in open bite
cases avoided.
Short face(skeletal deep bite) best treated
by saggital split mandibular ramus
surgery.

3) CORRECTION OF TRANSVERSE
RELATIONSHIP: -
easy to move maxilla in transverse
direction then mandible.

A) MAXILLARY EXPANTION: -
Constriction or expantion done
during course of Lefort 1
downfracture procedure.

GENIOPLASTY

RETENTION: -
- More difficult in adult then in
adolescent patient ,
- slower tissue turn over rate.
- Normal functional adaptation occurs
more when growth has been completed.
- Reduce height of periodontium.

-Hawley retainer.
- Hawley retained with tongue cribs.
- fixed bonded retainer(max. and mand.
Anterior segments)

Restorative retainers: -
- composite restoration.
- amalgam, inlay or onlay.
- pontics (fixed/removable).

Periodontal surgical retention procedure:
- Fibrotomy.
- gingivectomy.

TREATMENT
CONSIDERATIONS IN
PATIENTS WITH
TEMPOROMANDIBULAR
DYSFUNTION

TMD as motivating factor for adult
patient.
Orthodontic treatment helps patient
with TMD problems.

TMD symptoms can be divided in 2
groups: -
- Internal joint pathology.(Arthritis)
- Symptoms of muscle origin caused
by spasm and fatigue of the muscle.

TEMPOROMANDIBULAR JOINT
DISORDERS: -
- Deviation in form.
- Disk displacement.
- TMJ hypermobility.
- Dislocation.
- Synovitis.
- Capsulitis.

- Osteoarthritis.
- Ankylosis.

ETIOLOGY
Normal function + An event >
Physiologic tolerance
TMD symptoms

EVENTS: -
1) Local events: -
- History of bruxism.
- Trauma
- Poorly aligned teeth.
- Placement of improperly occluding
crown.
- Loss of posterior teeth.www.indiandentalacademy.com

Systemic events: -
- Emotional stress.
- Acc. To Han Selye “ Stress is a
non specific response of the body to
any demand made upon it.”
Physiologic tolerance.

Clinical presentation: -
- Pain at preauricular area or temple
area or at ear when chewing or
opening the mouth.
- Pain may radiate to head, face or
eye.

Behavioral changes like,
- Avoiding wide opening of the
mouth.
- Patient prefers softer food.

OCCLUSAL STABILITY

HISTORY AND EXAMINATION
FOR TMD
- Questionnaire.
- Orofacial pain history.

CLINICAL EXAMINATION
• Nonmasticatory examination.
• Masticatory examination.

Nonmasticatory examination
• Cranial nerve examination.
• Eye examination.
• Ear examination.
• Cervical examination.

Examination of optic nerve and
oculomotor, trochlear and abducent
nerve.

CERVICAL EXAMINATION

Masticatory examination
• Muscle examination.
• TMJ examination.
• Dental examination.

MUSCLE EXAMINATION

MASSETER MUSCLE
EXAMINATION

STERNOCLIEDOMASTOID
MUSCLE

PALPATION OF TMJ

• Maximum interincisal distance.
• Lateral and protrusive movement.
• Opening pathway of mandible.

TREATMENT OF TMD
• Control of myofacial pain.
• Treatment of TMJ.

Three approaches to control
myofascial pain: -
1) Reducing the amount of stress.
2) Reducing the patient’s reaction to
the stress.
3) Improving the occlusal
relationship.www.indiandentalacademy.com

Treatment of TMJ disorders: -
1) Definitive treatment.
2) Supportive treatment.

Definitive treatment: -
1) Occlusal therapy: -
- Reversible occlusal therapy.
- Irreversible occlusal therapy.
2) Emotional stress therapy.

2) Supportive therapy: -
a) Pharmacological therapy: -
- Analgesics
- NSAIDs
- Corticosteroids
- Muscle relaxants
- Local anesthetics.

b) Physical therapy: -
- Thermotherapy.
- Coolant therapy.
- Ultrasound therapy.
- Iontophoresis.
- Electrogalvenic stimulation
therapy.

-Transcuteneous electrical nerve
stimulation.
- Acupuncture.

OCCLUSAL APPLIANCE
THERAPY
• It is a removable device, usually
made up of hard acrylic that fits
over the occlusal and incisal
surfaces of the teeth in one arch
, creating precise occlusal contact
with the teeth of the opposing arch.

TYPE OF OCCLUSAL
APPLIANCES
• STABILIZATION APPLIANCE
• ANTERIOR POSITIONING
APPLIANCE
• ANTERIOR BITE PLANE
• POSTERIOR BITE PLANE
• PIVOTING APPLIANCE
• SOFT OR RESILIENT APPLIANCE

STABILIZATION APPLIANCE
• Muscle relaxation appliance
• Fabricated on maxillary arch
• Indicated in patient with muscle
hyperactivity.
e.g. bruxism

- Fabrication of appliance.
- Locating the musculoskeletally stable
position.
- Developing occlusion.

FINAL CRITERIA FOR
STABILIZATION APPLIANCE
• Appliance must accurately fit the maxillary
teeth.
• In centric relation all posterior mandibular
buccal cusp must contact on flat surface
with even force.
• In any lateral movement only mandibular
canines should exhibit contact on the
appliance.
• It should polished.www.indiandentalacademy.com

ANTERIOR REPOSITIONING
APPLIANCE
• It is an interocclusal devise that
encourages the mandible to assume a
position more anterior then the
intercuspal position.
• Mainly used to treat disc derangement
disorders.

Locating the correct anterior position
• Anterior stop is constructed.
• Joint symptoms are evaluated.

Sometime orthodontic treatment
becomes more complicated by
previous splint therapy for TMD
problems.

The moment of truth for TMD
symptoms comes after orthodontic
treatment is completed, when
clenching and grinding that
originally caused the problem tend to
recur.

LIMITATION IN ADULT
ORTHODONTIC TREATMENT: -
1) INTRINSIC.
2) EXTRNSIC.

1) INRINSIC: -
- Adults are no longer growing.
- PDL status.

ACCORDING TO CHASENS,
ORTHODONTIC TREATMENT
SHOULD BE AVOIDED IN
FOLLOWING CLINICAL
SITUATIONS: -
1) Incontrolled inefection and
inflammation.
2) Inadequate retention is present.

3) Lack of patient motivation and
cooperation.
4) Systemic problems which cannot be
treated or difficult to control.

TMD serves as one of the motivating
factors for adult patient to visit
orthodontist. Relief of pain by providing
adequate TMJ therapy motivates patient
to undergo the remaining restorative or
orthodontic treatment.

THANK YOU
For more details please visit

Adult orthodontics 2

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