How does adult orthodontics differ from orthodontics for children?

Because growth is complete in adults, it is no longer possible to guide the jaw relationship through growth; corrections are made through tooth movement and, where necessary, skeletal anchorage (mini-screws) or orthognathic surgery. In addition, adult patients more often have missing teeth, old fillings, crowns, wear and, most importantly, a history of gum disease.

In the orthodontic literature, adult treatment is divided into two groups:

• Adjunctive orthodontics: correcting the position of a few teeth before an implant, bridge or crown; it usually takes a few months.
• Comprehensive orthodontics: aligning all the teeth and the bite; it usually takes more than a year, and aesthetic appliances (clear aligners, ceramic brackets, lingual brackets) are most often chosen in this group.

Why is gum health so important?

Orthodontic tooth movement happens through the remodelling of the periodontal ligament and alveolar bone surrounding the tooth. In healthy supporting tissue this process proceeds safely. But if force is applied to the teeth while there is active inflammation caused by bacterial plaque, bone loss can accelerate.

While appliance-related gum inflammation rarely turns into periodontitis in children and adolescents, in adults this is not acceptable; even if the gums look healthy at the start, they must be closely monitored throughout treatment. Bleeding on probing at the examination is one of the most important signs of active disease.

Can someone who has had gum disease have orthodontic treatment?

Yes. Bone loss is no barrier to orthodontic treatment in adults, provided the disease has first been brought under control. The typical sequence is:

1. Periodontal examination and X-rays: pocket depths, bleeding, bone level and gum thickness are recorded.
2. Gum treatment: scaling, root planing and, if needed, surgical approaches.
3. Healing and observation period: a waiting period to make sure the disease has stopped.
4. Orthodontic treatment: lighter forces are used on teeth with reduced bone support.
5. Supportive periodontal therapy: professional cleaning and check-ups usually every 2–4 months throughout treatment.

Teeth that need root canal treatment should also be treated before orthodontics; root-canal-treated teeth can be moved orthodontically.

Are gum recession and “black triangles” a risk?

In areas with a thin gum biotype and narrow bone, the risk of gum recession increases, especially when teeth are moved towards the lip or the arch is expanded. According to current thinking, recession develops when the thin bone in front of the tooth opens up and the tissue over it is put under strain. For this reason, in adults with insufficient attached gingiva or very thin tissue, a gum graft may be considered before treatment; preventing recession is easier than correcting it afterwards.

When crowded teeth are aligned, especially in adults with bone loss, small spaces that the gum papilla cannot fill (“black triangles”) can become visible between the teeth. This should be anticipated and discussed with the patient before treatment. The appearance can be improved by slightly reshaping the tooth contact points (interproximal reduction), correcting the tooth’s angulation or cosmetic bonding.

Braces or clear aligners: is there a difference for the gums?

Which appliance is chosen depends not only on gum condition but also on the type of tooth movement required. A safer plan emerges when the decision is made jointly by the orthodontic specialist and the specialist in periodontology. At our clinic, this collaboration takes place under one roof.

What should you pay attention to after treatment?

• For teeth with reduced bone support, retention is usually planned long-term, often as a fixed wire.
• Gum-improving surgery (for example, covering areas of recession) is usually done after the final position of the teeth has been established.
• Supportive periodontal therapy should continue for life, even after orthodontics is finished.

How should you care for your mouth at home during treatment?

In adult orthodontic patients, much of the success depends on home care. Brackets and wires increase plaque retention; clear aligners keep the teeth away from saliva while they are worn, so if cleaning after meals is neglected, the risk of decay and gum inflammation can rise.

• Brush at least twice a day with a soft-bristled brush and fluoride toothpaste; pay extra attention to the upper and lower edges of the brackets.
• Clean between your teeth with interdental brushes, a floss threader or a water flosser.
• If you use clear aligners, do not put them back in after eating or sugary drinks without brushing your teeth first.
• Smoking harms gum healing and the response to periodontal treatment; the treatment period is a good opportunity to quit.
• If you have a systemic condition that affects the gums, such as diabetes, keeping it under control is important.

If you notice bleeding gums, gum swelling, bad breath or increasing tooth mobility, it is advisable to contact the clinic without waiting for your next appointment.

Can orthodontics benefit gum health?

Crowded and overlapping teeth can create plaque traps that a toothbrush and floss cannot reach. Aligning the teeth can reduce these areas and make daily cleaning easier. In addition, front teeth that have flared or spread apart because of gum disease can be repositioned and splinted once the disease is under control. Uprighting tipped teeth in gaps also creates a better foundation for restorations such as implants or bridges. These benefits are only meaningful while gum disease is under control and regular maintenance is kept up.

Frequently asked questions

Related pages

Medically reviewed by: Dr. Dt. Mehmet Fuat BozabaSpecialist in periodontology · September 2026

For appointments and information: message us on WhatsApp or call us on 0544 289 66 33.

Sources: Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics, 5th ed., Elsevier Mosby, 2013; Bishara SE (ed.). Textbook of Orthodontics, W.B. Saunders, 2001.

This article is for information only; diagnosis and treatment planning can only be carried out by a dentist after an examination.