«It's too late now, isn't it?» We hear this often, usually said with a half-smile. The answer is no: orthodontic movement relies on remodelling of the bone around the root, a biological process that stays active throughout life.
What changes in adulthood is not the possibility. It is the prerequisites.
What we assess before starting
In a teenager we work on a growing, generally healthy mouth. In an adult the picture is more layered, and before moving a single tooth we want to know:
- the state of the gums and bone. This is the most important point. Moving teeth on an inflamed periodontium makes things worse: if there is periodontitis, it is treated and stabilised first, then orthodontics is considered.
- the presence of fillings, crowns, implants. Implants do not move: they are ankylosed in the bone. They must be treated as fixed points in the plan.
- function and bite, not only aesthetics: how you close, whether there are premature contacts, whether you have habits such as night-time clenching.
- any missing teeth, which may have let neighbours drift over the years.
Why adults ask for orthodontics
It is not always an aesthetic request. Functional motivations are common: crowded teeth that are impossible to clean (and therefore permanently inflamed gums), a bite that has started to wear enamel down, the need to upright a tooth so that a proper prosthesis can be made.
In these cases orthodontics is not a whim: it is the prerequisite for the rest of the work to last.
Timing
It is generally longer than in adolescents, because bone remodelling is slower and because adult cases are often more complex. Actual duration can only be stated after the case study, never by eye at a first visit.
The tools
Clear aligners and fixed appliances are not «better/worse» alternatives: they are tools with different indications. Aligners are discreet and removable, and in many adult cases they are an excellent choice — but they must be worn consistently, and not every movement is achieved with the same efficiency. The choice is made on the case, not on fashion.
Afterwards: retention
It applies to everyone, but to adults even more: once alignment is complete a retainer is needed, and it must be maintained over time. Without it, teeth tend to drift back towards their starting position.
Sources
- WHO — Oral health fact sheet — overview of oral diseases and the importance of periodontal health.
- European Federation of Periodontology — patients area — periodontal health as a prerequisite for treatment.
- Italian Ministry of Health — Dental health — general guidance on assessment and check-ups.