Dental Crowding – Overview
Dental crowding is one of the common problems that can be intercepted. In this article there is an overview of dental crowding. Read on to know more.
Crowding is a common problem encountered at various stages of development and in varying degrees of severity. Crowding in the mandibular region may be seen in the early mixed dentition and is a finding of importance for the pedodontist.
In the pre-eruption stage of the incisors, crowding is seen to be present. There exists a situation called ‘incisor liability’where the permanent incisors being larger than their deciduous counterparts, may have an impact on the crowding.
In the maxillary arch, the lateral are more palatally placed.
In the mandibular arch, the teeth may be lingually placed accompanied by some amount of rotation.
Will crowding resolve on its own?
This is dependent on several factors such as the following:
The eruption of the permanent incisors brings about the lateral shift of the deciduous canines so as to align them. Should interdental spacing be absent, this shift is not possible an may decrease the chances of a better alignment. Thus, Leighton’s prediction of permanent teeth crowding based on presence or absence of interdental spacing can be a good predictor.
Intercanine arch width:
The intercanine arch width increase can also helps in resolving the incisal crowding. The intercanine width increases to about 6mm in maxilla and about 4mm in mandible from 2 years of age to maturity. Hagberg (1994) has used this measurement and predicted that an intercanine distance of 28 mm or more shows little risk of crowding, while that less than 26 mm may be associated with some crowding up to 10 years of age at least.
Inclinations of the permanent incisors:
The more forward inclination of the permanent incisors may help increase the arch circumference.
The ratio of the size between the permanent and primary teeth will give an indication as to whether adequate space will be available or not.
Considering the above factors and keeping in mind goals of interceptive orthodontics being to make adequate space available at the right time, observation or intervention may be required.
Options in the management of crowding:
The various options that exist in the management of crowding are:
- Disk primary teeth
- Extraction of teeth
Incases where spacing exists in the primary dentition with the incisor position having an additional space creating effect, crowding (less than 2 mm) will in most cases correct themselves with normal dentition and occlusion establishment (apart from late incisor crowding). Concomitantly, if a space analysis coupled with the measurement of intercanine width shows a favorable situation, the patient should be kept under observation.
Disking of primary teeth:
The primary teeth may sometimes prevent the incisors from aligning themselves. If the space required is not more than 3-4 mm, the grinding disking the mesial surfaces of the canines will help to align the incisors.
Disking may either be carried out either by means of a 169 L bur or a disking strip. In cases, where minimal disking is required, the strip may be preferred for better control. The disked surfaces need to be protected with a fluoride application.
Once space is made available, the teeth may spontaneously correct themselves by tongue pressure. Should the lateral be locked behind the centrals, however, modification of the lingual arch (with auxiliary springs) may be used to align the incisors. Should an adequate space not be provided by disking the canines, the primary molars may be disked later.
Extraction of teeth:
The extraction of teeth in order to create space is a well established procedure. The most recognized of these include the so-called serial extraction, timely extraction and Wilkinson’s extraction.
The above article discusses about the
dental crowding -a brief overview