List of Contributors xiii About the Companion Website xv Introduction xvii Introduction: More than a Century of Progress in Adult Orthodontic Treatment xix 1 Potential Adult Orthodontic Patients - Who Are They? 1 Birte Melsen Introduction 1 Who are the patients? 1 How do the patients express their needs? 6 The first visit 7 Communicating with the patient 9 Summary 10 References 10 2 Diagnosis: Chief Complaint and Problem List 12 Birte Melsen, Marco A. Masioli Introduction 12 Workup of a problem list - the interview and chief complaint 12 General health 15 Clinical examination 16 Extraoral examination 17 Extraoral photographs 19 Function of the masticatory system 22 Intraoral analysis - oral health 23 Evaluation of dental casts - arch form 24 Occlusal analysis 24 Space analysis 26 Cephalometric analysis 26 Final problem list 27 Indication for treatment 28 The presentation of the problem list - the tip of the iceberg 29 Concluding remarks 33 References 33 3 Aetiology 35 Birte Melsen Introduction 35 Biological background 35 Aetiology of malocclusions in adults 41 Age-related changes in the skeleton 42 Age-related changes in the craniofacial skeleton 46 Age-related changes in the local environment 47 Consequences of deterioration of the dentition 48 Case reports 49 Conclusion 52 References 52 4 Interdisciplinary versus Multidisciplinary Treatments 54 Birte Melsen Interdisciplinary or multidisciplinary treatments 54 Establishment of an interdisciplinary team 56 Treatment sequence 59 Essential and optional treatment procedures 59 Interaction during treatment 62 Post-orthodontic treatment 62 Patient satisfaction 62 Examples of interdisciplinary cases 63 References 63 5 Treatment Planning: The 3D VTO 65 Birte Melsen, Giorgio Fiorelli Determining the treatment goal using the occlusogram 65 Production of an occlusogram: manual procedure and general concepts 66 Responding to patients'' needs 76 Orthodontic treatment: art or science? 78 References 78 6 Tissue Reaction 79 Carlalberta Verna, Birte Melsen Orthopaedic effects 79 Orthodontic effects in adult patients 80 References 97 7 Appliance Design 101 Birte Melsen, Delfino Allais, Giorgio Fiorelli Introduction 101 Treatment goal definition 101 Anchorage evaluation 110 Sequencing the treatment into phases 110 Appliance selection and design 112 Conclusion 138 References 138 8 Anchorage Problems 141 Birte Melsen, Carlalberta Verna Introduction 141 Definition 142 Classification of anchorage 142 Intramaxillary anchorage 142 Differential anchorage 146 Soft-tissue anchorage 147 Free anchorage 147 Intermaxillary anchorage 151 Occlusion 155 Differential timing of force application 156 Conclusion 156 Extraoral anchorage 156 Skeletal anchorage 156 Prosthodontic implants 157 Temporary anchorage devices 157 Palatal implants 159 Palatal mini-implants with abutments, optimal insertion sites and possible mechanics 159 Implant placement and adaption of the mechanics 159 Clinical applications for palatal mini-implants 163 Conclusion 163 Onplant 163 Retromolar implants 163 Immediately loadable devices 164 Zygoma ligature 164 Miniplates 164 Mini-implants 164 Material 166 Design of the intraosseous parts 166 Design of the transmucosal parts 168 Design of the head of the mini-implant 168 The screwdriver 168 Insertion site 168 Insertion 170 Antibiotics 171 Load transfer 171 Tissue reaction to loading 172 Loading 173 Orthodontic mechanics 173 Alternative application of TADs used as anchorage 173 Indications 174 Complications 175 What happens if the screw touches a root? 175 Failures 176 Problems related to the mini-implant and solutions 176 Problems related to the insertion procedure 176 Problems related to the patient 176 Future of TADs 176 References 177 9 Bonding Problems Related to Adult Reconstructed Dentitions 181 Vittorio Cacciafesta Introduction 181 Brackets 182 The Basis of the Bonding Clinical Procedure 189 Banding 205 Auxiliary Attachments and Aesthetic Buttons 209 Anchorage Needs and Reinforcement 210 Bonded Retainers 211 References 212 10 Material-Related Adverse Reactions in Orthodontics 216 Dorthe Arenholt Bindslev, Gottfried Schmalz Introduction 216 Fixed appliances 216 Removable appliances 227 Miscellaneous materials 230 Concluding remarks 230 References 231 11 Patients with Periodontal Problems 235 Birte Melsen Prevalence of periodontal disease 235 Malocclusion and periodontal disease 235 Orthodontics and periodontal disease 236 Indications for orthodontic treatment in periodontally involved patients 239 Treatment of patients with flared and extruded upper incisors 242 Tissue reaction to intrusion of teeth with horizontal bone loss 247 Treatment of patients with vertical bone defects 250 What are the periodontal limits for orthodontic tooth movement? 254 Sequence of treatment in periodontally involved patients 258 Conclusion regarding influence of orthodontic treatment on periodontal status 260 References 262 12 A Systematic Approach to the Orthodontic Treatment of Periodontally Involved Anterior Teeth 265 Jaume Janer Single tooth gingival recession 265 Progressive spacing of incisors 269 Case reports 275 Management of periodontally involved teeth 276 References 290 13 Interdisciplinary Collaboration between Orthodontics and Periodontics 293 Francesco Milano, Laura Guerra Milano Introduction 293 Periodontal diagnosis 294 History taking and clinical and radiographic examination 294 Screening for periodontal disease 294 Local factors predisposing to periodontal therapy 296 Timing of ortho-perio treatment 297 Periodontal therapy 298 Surgical therapy 298 Mucogingival and aesthetic surgery 300 Regenerative surgical therapy 312 Supportive periodontal treatment 312 Ortho-perio and multidisciplinary clinical cases 313 Conclusion 319 Acknowledgements 319 References 321 14 Prosthetically Guided Orthodontic Strategies 323 Arturo Imbelloni, Cesare Luzi Introduction 323 Interdisciplinary treatment planning: orthodontics in periodontal prosthesis 324 Prosthodontic indications for orthodontic therapy 325 Pre-prosthodontic orthodontics 325 Role of temporisation in interdisciplinary treatment 343 Prosthodontic finalisation 345 References 346 15 Patients with Temporomandibular Joint (TMJ) Problems 348 Birte Melsen Orthodontics and dysfunction 348 Controversy in the literature regarding TMD and occlusion 350 Treatment and TMD 351 Treatment of clicking joints 352 Orthodontic treatment of patients with TMD 352 Organisation of the treatment 358 Conclusion 358 References 360 16 Patients with Temporomandibular Disorders 362 Peter Svensson, Fernando G. Exposto Introduction 362 Classification and epidemiology 362 Diagnostic procedures 363 Risk factors and aetiology 367 Pathophysiology 368 Management 371 Summary 373 References 374 17 Clear Aligners and Their Role in Orthodontics 379 Sonil Kalia, Reginald Mietke, Birte Melsen History of aligners 379 Difference between aligner treatments and conventional orthodontic treatments 380 What types of patients are seeking aligner treatments? 380 Pre-treatment considerations 380 What has to be evaluated before the aligners are produced? 381 Force-driven or displacement-driven aligners? 381 Invisalign® 381 Orthocaps® 385 Studies on treatment efficacy and efficiency of aligner 389 What role will the aligners play in the future? 390 Conclusion 391 References 391 18 Progressive Slenderising Technique 392 Dr Pablo Echarri, Emma Vila Mancho Definition and objectives 392 Anthropological justification of slenderising 393 Influence of slenderising on dental plaque, caries and periodontal disease 393 Indications 394 Contraindications 397 Advantages of slenderising 399 How much enamel can be stripped? 399 Special considerations 401 Instrumentation for slenderising 401 Progressive slenderising technique 404 Slenderising with aligners 407 The design and planning of the slenderising and preventing risks in slenderising 411 Stripping and Bolton index 412 How much enamel can be worn out? 417 Facial and dental midlines 418 Teeth size 418 Design and planning of the stripping 418 Progressive stripp.