Edentulous sites, periodontal breakdown, prosthetics bridges or dental implant restorations and severe abrasion with loss of vertical dimension are common clinical conditions accompanied with malocclusion in middle-aged adults. With these complex situations, hopeless teeth or preexisting restorations can be extracted or removed instead of healthy premolars, and accordingly, asymmetric anchorage control and additional detailed managements to overcome the differences in tooth shape and size maybe necessary. Orthodontic treatment can also be a part of a multi-disciplinary or a full mouth rehabilitation protocol with additional application of adult dentofacial orthopedic protocols such as palatal expansion, clockwise and counterclockwise rotation of the mandible.

As an orthodontist, we do our best to “customize” our treatment protocol to overcome the compromised clinical situations and to provide the most functional as well as esthetic treatment outcome regardless of age. However, in reality adult comprehensive treatment is classified by definition, “camouflage” or “limited” treatment unless surgery is accompanied to improve the skeletal discrepancies. This seems like an unfair definition in the era of 3D tooth movement of all ages. This lecture will provide an overview of customize orthodontics for the middle-aged adults, which should not be defined as camouflage treatment. Clinical decisions to overcome the uneven/ asymmetric extraction scheme, clinical management to control 3-dimensional tooth movement and anchorage as well as to overcome the esthetic limitations will be shared with treatment outcome and long-term prognosis.