Could “Age” be a potential decelerating factor in clinical orthodontics?

Assistant professor,Department of Orthodontics and Dentofacial Orthopedics, Update Dental College & Hospital, Dhaka, Bangladesh. Assistant professor , Department of Dentistry, Sher-E-Bangla Medical College & Hospital, Barisal, Bangladesh. Assistant professor , Department of Prosthodontics, Update Dental College & Hospital, Dhaka, Bangladesh. Assistant professor, Department of Oral Anatomy& Physiology, Update Dental College & Hospital, Dhaka, Bangladesh.


Introductions:
"What is the perfect age to start orthodontic treatment?"-That is one of the most frequent queries that any clinicians have to face in their orthodontic practice.The American Associations of Orthodontist (AAO) recommends that every child first visit an orthodontist by age seven or earlier if a problem is detected by parents, the family dentist or physician.Obviously that raises the second question to be face by orthodontist is that -"what is the maximum age limit to start orthodontic treatment"?That's the million dollar question any clinician have to face to motivate his elderly patients with orthodontic complain.There is probably no other area of health care that requires patient cooperation to the extent that orthodontics does.
The first condition required for carrying out a successful orthodontic treatment involves patient cooperation by ensuring its treatment goal and success.Frequently, the uncooperative patient is labeled as having a poor or defiant attitude toward orthodontic treatment 1 .Communication between the orthodontist and the patient, and general information about orthodontic treatment are two important factors in orthodontic patients' compliance 2 .So to ensure better patient compliance the maximum age limit of orthodontic treatment should be answered.However no definitive border line of age is found to start an orthodontic lately.Treatment approach, management protocol and finishing goal will be change with a same orthodontic problem according to age.Adult orthodontics requires a different approach to the treatment than treatment for growing adolescent individuals due to varied reasons.Lack of growth potential makes growth modification procedures not applicable to adults and imposes limitations to certain tooth movements.Periorestorative problems, multiple extractions, other oral diseases, systemic problems, aging of thetissues, different psychosocial factors need to be considered while formulating appropriate individualized treatment plan.The complex interaction of these factors leads to a much different approach for adult orthodontics 3 .In this article we have describe two of such adult orthodontic cases (from both gender) where treatment were started in their fourth decade of life, with some modification of conventional treatment approach to gain the finishing goal.

Report of Cases 2:
A 42-years-of age female house wife reported with a chief complains of poor smile appearance due to excessive protruded front teeth and multiple gaps among them.There was no history of spacing or proclination of teeth in her adolescent age[Fig: 4(A,C&D)].Those problems appear in last 10-12 years and they are gradually deteriorating over the past years.According to her this ill appearance of smile creates a negative influence in her personal life.However her personal history reveals that her husband is a businessman and they are suffering from infertility.

Discussions:
The only limitation found in adult orthodontic treatment is in initiating tooth movement 4 .This may take a few more weeks than in an adolescent.But once treatment has begun, progress can be as fast or faster in the adult patient due to the excellent cooperation received from the adult patients.The finishing phase of treatment needs greatest attention so as to attain the highest degree of stability of tooth position and occlusion, and the greatest benefits in terms of esthetics and dental health.Adults who seek orthodontic treatment fall into 2quite different groups 5 comprehensive treatmentand adjunctive treatment.None of this group reported to be slowing down or cessation of orthodontic tooth movement.However, treatment modality and goal could be vary with that of adolescents one.
Our study did not observe any decelerating factor related to age while managing these two adult orthodontic cases.Similar result has been reported by the retrospective study done in 2002 by Von Bremen and Pancherz 6 where 204 patients record were evaluated those were treated with functional, functional/fixed combinations, Herbst/fixed appliance combination, and fixed appliances alone, in both adult and adolescents group.The mean treatment duration was 37months and the duration decreased with dental development.Moreover, similar type of study by Robb et al. 7 with 72 cases reveals did not find any significant treatment duration differences between adult and adolescents group.Considering all other factor that might affect the duration of orthodontic treatment, age is not the factor that might slowdown the tooth movement or influencing the orthodontic treatment 8 .However healthy tooth and surrounding structure might be maintained with age.

Conclusions:
Our study and the literature review of similar study clearly reveal that age is not a bar on orthodontic treatment.Adult patient are more co-operative than that of adolescent, that ensure more rapid success, however their tooth and surrounding structure's integrity should be ensured before initiation of orthodontic treatment.

Figure 1 :
Figure 1: Extra oral photograph pretreatment front view (A), right lateral view (B), showing ill smile and post treatment front view (C) showing improvement.