Aging of the Occlusion- What Should We Know? Daniela Garib. AAO June 2021. Episode 88

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Farooq Ahmed

Aging of the Occlusion: What Should We Know? Daniela Garib


Life expectancy most countries 75-90


Long term changes in adults

·      Males forward rotation, females backwards rotation Behrents 1984

·      Arch length decreases

·      Increase in crowding

·      Limited study follow up


Study by Daniela to investigate up to the age of 60, not previously done in orthodontic literature Massaro 2018 AJODO


·      Initial sample age 13 -17 second sample age 60

·      Study sample 22


·      Increase in crown height 0.5-3mm, due to passive eruption and gingival migration

·      M-D tooth size decreased 0.3mm

·      Mandibular incisor crowding increased 2.5mm

o   Due to reduction in arclength, direct relationship

o   Possible boned retainer in normal occlusion

·      Maxillary incisors crowding of 1mm (small)

o   Arch length reduction of 3.5mm

o   Explanation, upper incisors upright to resolve the reduction in arch length

·      Overbite reduction

o   Due to late mandibular growth

·      Upper 7s upright, age 13 distally tipped, age 60 upright

·      Patient satisfaction age 60 – satisfied

o   Concerns relate to colour

o   No desire for orthodontics




3d superimposition on aging models  Garib 2021 AJODO

·      Lower arch 13 landmarks of the gingival aspect

o   Incisors retract

o   Molars medialise

o   Premolars lingually tip

·      Maxillary arch Garib Orthodontics and craniofacial research

o   6 landmarks investigated , including 2nd, 3rd palatal rugae

o   Reliable in 5 year interval

o   Unreliable in 40 year intervals – likely due to changes in palatal rugae


Cephalometric soft tissue changes

·      Decreased in NLA

·      Upper and lower lip retrusion

·      Reduction in upper lip thickness

·      Soft tissue nose and chin increased

·      Upper incisor show decreased 4mm in total, 1 mm per decade




·      Occlusion is the most stable component when compared to skeletal and soft tissues


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