[Orthodontic treatment in adults with compromised periodontium: biomechanical principles and clinical applications]

In recent years, there has been a dramatic increase in the number of adults receiving comprehensive orthodontic treatment. In clinical practice, management of adults may be somewhat different than for most adolescents. Adults are more likely than adolescents to have dentitions that have undergone some degree of mutilation over time, which may necessitate alterations in the treatment strategy. Excessive wear, missing and compromised teeth are some of the differences observed. For adult patients who have experienced bone and attachment loss as a consequence of periodontal disease, a new set of biomechanical requirements exists for producing the tooth movements desired during the orthodontic therapy. Proper planning and appliance design for adults presenting with multiple missing teeth may require some degree of creativity to adapt to unique malocclusions and deliver the proper biomechanical force system. In this article, current clinical application of biomechanical principles will be presented with emphasis on clinical orthodontic management of severely mutilated dentitions.