Alveolar bone defects and facial protrusion deformities affect a significant portion of the population and may increase the risk of other complications. The proposed expert consensus aims to provide evidence-based recommendations for the treatment of these complications and provide strategies to improve orthodontic treatment in adults.
How do orthodontists plan to treat adults with reduced bone support, periodontal concerns, or complex skeletal discrepancies?
As more adults seek orthodontic treatment, these questions become increasingly difficult to answer. In addition to creating straighter smiles, our clinicians strive to provide safe, predictable, and personalized treatment while balancing facial aesthetics, skeletal relationships, periodontal health, and rapidly evolving digital technology.
“The growing demand for adult orthodontic treatment presents significant challenges.” said Dr. Li Shu, one of the lead authors.
To address these challenges, international experts have produced three complementary consensus articles, International Journal of Oral Sciences. These include “Expert Consensus on Orthodontics-Related Alveolar Ridge Augmentation for Adult Patients.” International Journal of Oral Sciences March 25, 2026, “Expert Consensus on Clinical Strategies for Orthodontic Treatment Using Clear Aligners” International Journal of Oral Sciences “Expert consensus on orthodontic treatment of facial protrusion deformities” published on March 13, 2025 International Journal of Oral Sciences Researchers established a new evidence-based framework for diagnosing and delivering orthodontic treatment in adults based on a systematic evidence review and multidisciplinary expert consensus.
Look beyond the smile
Correcting facial protrusion deformities requires more than just straightening the teeth. Adult patients often exhibit complex skeletal, dental, and soft tissue features, making diagnosis and treatment planning much more difficult than correcting alignment alone.
“Diagnosis of facial protrusion deformity should follow the principles of all-component diagnosis.” Dr. Chengchen Zhou says: This approach allows clinicians to look beyond the teeth and assess the whole patient before making treatment decisions.
Rather than focusing primarily on teeth, jaws, and facial contours, the consensus recommends considering multiple aspects, including sagittal, vertical, and lateral relationships, growth potential, and broader clinical factors, to understand the underlying causes of deformity and establish realistic treatment goals.
Multidimensional analysis refers to the comprehensive evaluation of sagittal, vertical, horizontal dimensions, and growth potential in the diagnosis and decision-making process of orthodontic cases.
By integrating facial, skeletal, and dental assessments with functional and periodontal considerations, orthodontists can establish realistic treatment goals before selecting the most appropriate treatment approach.
Now that treatment goals are clearly established, the next challenge is to determine how to achieve those goals safely and predictably.
plan every move
Defining your destination is just the beginning. Achieving predictable tooth movement requires careful planning that maps out all stages before starting active treatment. Successful planning also depends on selecting the appropriate treatment strategy based on the complexity and biomechanical demands of the case and ensuring that digital technology complements sound clinical judgment.
“Accurate initial position of teeth requires complete and accurate patient data.” Dr. Lai Wenli says: Facial and intraoral photographs, x-rays, cone beam computed tomography (CBCT) scans, and digital dental models provide the information you need to develop an accurate digital treatment strategy.
Consensus emphasizes that planning should extend far beyond the desired end result. Therefore, the initial position, intermediate position, and final position are the three keys to the success of clear aligner treatment.
By carefully designing each transition, orthodontists can guide tooth movement in a predictable sequence while respecting biomechanical principles, helping to achieve efficient results with greater control.
deal with biology
Even the most carefully planned tooth movement must respect the biological limits of the supporting tissues. Adult patients often have reduced alveolar bone support or pre-existing defects, which increases the risk of periodontal complications during orthodontic treatment. Therefore, a thorough assessment of periodontal health and alveolar bone is an essential part of treatment.
The consensus also states that CBCT imaging is strongly recommended to comprehensively assess the condition of the alveolar bone, especially when extensive tooth movement is anticipated. Combining these assessments allows clinicians to identify anatomical limitations and plan safer tooth movement before treatment begins.
When additional bone support is required, the consensus outlines evidence-based strategies, including orthodontically-related alveolar ridge augmentation, to reduce periodontal complications and expand treatment possibilities in appropriately selected patients. By integrating biological assessment into clinical decision-making, this recommendation emphasizes that the success of adult orthodontic treatment depends not only on accurately moving teeth, but also on maintaining the health of the surrounding tissues.
Future initiatives
The authors state that future large-scale clinical studies, technological advances, and multidisciplinary research will help refine and strengthen current guidance, and that recommendations are expected to evolve as new evidence emerges.
“As our understanding deepens, clinical research continues to evolve, and better research methods are applied to clinical practice, this will undoubtedly lead to more optimized treatment outcomes and improved long-term patient stability.” Dr. Chechen Zhou concludes:
sauce:
International Journal of Oral Sciences
Reference magazines:
Original paper title: Expert consensus on orthodontics-related alveolar ridge augmentation for adult patients
journal: International Journal of Oral Sciences
DOI: https://doi.org/10.1038/s41368-026-00430-x
Original paper title: Expert consensus on clinical strategies for orthodontic treatment using transparent aligners
journal: International Journal of Oral Sciences
DOI: https://doi.org/10.1038/s41368-025-00350-2
Original paper title: Expert consensus on orthodontic treatment of facial protrusion deformity
journal: International Journal of Oral Sciences
DOI: https://doi.org/10.1038/s41368-024-00338-4 https://doi.org/10.1038/s41368-026-00430-x
