Expert consensus promotes evidence-based orthodontic care for adult patients

Alveolar bone defects and prominent facial 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 offers strategies to improve adult orthodontic care.

How do orthodontists plan treatment for adults with reduced bone support, periodontal concerns, or complex skeletal discrepancies?

As more adults seek orthodontic treatment, answering these questions becomes increasingly difficult. Beyond creating straighter smiles, clinicians balance facial aesthetics, skeletal relationships, periodontal health, and rapidly evolving digital technologies while striving to provide safe, predictable, and personalized treatment.

“The increasing demand for adult orthodontic treatment has presented critical challenges.” says Dr. Li Su, one of the lead authors.

To help address these challenges, international experts developed three complementary consensus articles published in International Journal of Oral Science. These include the “Expert Consensus on Orthodontic-Related Alveolar Ridge Augmentation for Adult Patients” published in International Journal of Oral Science on March 25, 2026, “Expert Consensus on Clinical Strategies for Orthodontic Treatment with Clear Aligners” posted on International Journal of Oral Science on March 13, 2025, and “Expert Agreement on the Orthodontic Treatment of Protruding Facial Deformities” published in International Journal of Oral Science on February 1, 2025. Based on systematic reviews of evidence and multidisciplinary expert consensus, researchers establish a new evidence-based framework for the diagnosis and delivery of adult orthodontic care.

Looking beyond the smile

Correcting prominent facial deformities involves much more than straightening the teeth. Adult patients often present with complex skeletal, dental, and soft tissue features, making diagnosis and treatment planning much more difficult than correcting alignment alone.

“Diagnosis of protruding facial deformities should follow the principle of diagnosis of total elements.” says Dr. Chenchen Zhu. The approach encourages clinicians to look beyond the teeth and assess the patient as a whole before deciding on treatment.

Rather than focusing primarily on the teeth, jaws, and facial profile, the consensus recommends considering multiple dimensions—including sagittal, vertical, and transverse relationships, developmental potential, and broader clinical factors—to understand the underlying causes of deformity and establish realistic treatment goals.

Multidimensional analysis refers to the overall assessment of sagittal, vertical, and horizontal dimensions as well as growth potential in the diagnostic and decision-making process of orthodontic cases.
By integrating facial, skeletal, and dental evaluations with functional and periodontal assessments, orthodontists can establish realistic treatment goals before selecting the most appropriate treatment approach.

With treatment goals clearly defined, the next challenge is to determine how these goals can be achieved safely and predictably.

Planning every move

Setting the destination is only the beginning. Providing predictable tooth movement requires meticulous planning, where each stage is mapped out before active treatment begins. Successful planning also depends on selecting an appropriate treatment strategy based on case complexity and biomechanical requirements, ensuring that digital technology complements sound clinical judgment.

“Accurate initial tooth position requires complete and accurate patient data.” says doctor Wenli Lai. Facial and intraoral photographs, radiographic examinations, cone beam computed tomography (CBCT) scans and digital dental models provide the information needed to develop an accurate digital treatment strategy.

Consensus emphasizes that planning must extend well beyond the desired end result. Thus, the initial, intermediate and final positions are the three keys to the success of clean alignment therapy.
By carefully planning each transition, orthodontists can guide tooth movement in a predictable sequence while respecting biomechanical principles, helping to achieve effective results with greater control.

Working 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 preexisting defects that increase the risk of periodontal complications during orthodontic treatment. Thorough assessment of periodontal health and alveolar bone therefore becomes an essential part of treatment delivery.

The consensus also states that CBCT imaging for comprehensive assessment of alveolar bone status is strongly recommended, particularly when extensive tooth movement is anticipated. Together, these assessments help clinicians identify anatomical limitations before treatment begins and plan for safer tooth movement.

Where additional bone support is required, the consensus outlines evidence-based strategies—including orthodontic-related alveolar ridge augmentation—to reduce periodontal complications and expand treatment options in appropriately selected patients. By incorporating biological assessment into clinical decision making, the recommendations reinforce that successful adult orthodontic care depends not only on accurate tooth movement, but also on maintaining the health of the surrounding tissues.

Future efforts

The authors note that the recommendations are expected to evolve as new evidence emerges, with future large-scale clinical studies, technological advances, and interdisciplinary research helping to refine and strengthen current guidance.

“As our understanding deepens, as clinical research continues to evolve, and as better research methods are applied to clinical practice, it will undoubtedly lead to more optimized treatment outcomes and improved long-term patient stability.” concludes Dr. Chenchen Zhu.