Treatment of crowding in permanent dentition

Treatment of crowding in permanent dentition
Copyright (c) Department of Orthodontics
University of Dental Medicine, Yangon

1. TreaTmenT TreaTmenT
of of
Crowding Crowding
in PermanenT denTiTionin PermanenT denTiTion
Dr.Hla Hla Yee

2. CausesCauses

Generalized crowdingGeneralized crowding
(Jaw size tooth size discrepancy )(Jaw size tooth size discrepancy )

Localized crowdingLocalized crowding
•Supernumerary teethSupernumerary teeth
•Retained deciduousRetained deciduous
•Early loss of primary teeth Early loss of primary teeth
•MacrodontiaMacrodontia
•Tooth size discrepancyTooth size discrepancy

3. DiagonsisDiagonsis
Space analysisSpace analysis
Tooth size analysisTooth size analysis
Radiographic examinationRadiographic examination

4. TreatmentTreatment
depend on severity of crowdingdepend on severity of crowding
Space Space
discrepanciesdiscrepancies
Up to 4mmUp to 4mm
5mm to 9mm5mm to 9mm
Treatment ProtocolTreatment Protocol
Non-extractionNon-extraction

Disking Disking

ExpansionExpansion
(except for third molar)(except for third molar)
Non-extraction Non-extraction

Expansion Expansion
or or
Extractionof some teeth Extractionof some teeth
other than third molarother than third molar

5. 10mm or more10mm or more Extraction regardless Extraction regardless
of what happen to of what happen to
third molar at later third molar at later
statestate

6. Treatment Planning Treatment Planning
for Crowdingfor Crowding
Based on lower archBased on lower arch
If crowding in lower arch is minimal and If crowding in lower arch is minimal and
incisors are in correct position, accept incisors are in correct position, accept
lower incisor crowding.lower incisor crowding.
If crowding in lower arch is moderate or If crowding in lower arch is moderate or
severe , correct lower incisor crowding. severe , correct lower incisor crowding.

7. Treatment Planning Cont’dTreatment Planning Cont’d
Correction of crowding in permanent Correction of crowding in permanent
dentition requires extraction or expansiondentition requires extraction or expansion
Diagnosis set upDiagnosis set up
Type of tooth movement requiredType of tooth movement required
Choice of appliance and mechanotherapyChoice of appliance and mechanotherapy

8. Treatment of Treatment of
Orthodontic problems associated Orthodontic problems associated
with Supernumerary teethwith Supernumerary teeth
Extra teeth in addition to the normal number of teeth in a given
dentition.
It is rare to see extra teeth in the deciduous dentition.
Types
-Supplementary teeth
-Conical supernumerary teeth
-Tuberculate supernumerary teeth

14. Orthodontic problems associated Orthodontic problems associated
with supernumerary teethwith supernumerary teeth
Deviation of the eruption path of permanent Deviation of the eruption path of permanent
succedaneous teeth .succedaneous teeth .
eg. Proclination, rotation, displacementeg. Proclination, rotation, displacement
Median diastemaMedian diastema
Delayed eruption of permanent succedaneous teethDelayed eruption of permanent succedaneous teeth
Dilaceration or abnormal root development of Dilaceration or abnormal root development of
permanent teeth.permanent teeth.

15. DiagnosisDiagnosis
Clinical examinationClinical examination

Count the teethCount the teeth

Palpation should be carried out up into the Palpation should be carried out up into the
labial sulcus and in some cases the outline of labial sulcus and in some cases the outline of
the tooth may be felt in this situation.the tooth may be felt in this situation.

16. Radiographic examinationRadiographic examination

Standard occlusal viewStandard occlusal view

PA viewPA view

Parallax view ( to determine the bucco-palatal Parallax view ( to determine the bucco-palatal
relation )relation )

18. Treatment OptionsTreatment Options
( 1 ) No treatment( 1 ) No treatment
( 2 ) Extraction of the erupted supernumerary( 2 ) Extraction of the erupted supernumerary
( 3 ) Surgical removal of unerupted ( 3 ) Surgical removal of unerupted
supernumerarysupernumerary

to permit the proper eruption of normal to permit the proper eruption of normal
dentitiondentition

to prevent malposition of teethto prevent malposition of teeth

19. Early surgical removal of supernumerary teeth Early surgical removal of supernumerary teeth
AdvantagesAdvantages

Spontaneous eruptive potential of permanent Spontaneous eruptive potential of permanent
incisors.incisors.

To prevent anterior space closure and midline To prevent anterior space closure and midline
shift shift
- Therefore,- Therefore,Early detection and removal of Early detection and removal of
supernumerary teeth are important for interception or supernumerary teeth are important for interception or
prevention of malocclusionprevention of malocclusion

Supernumerary teeth should be removed Supernumerary teeth should be removed
immediately before complicated orthodontic immediately before complicated orthodontic
problem occur.problem occur.

20. DisadvantagesDisadvantages

Potential damage to adjacent teeth resulting in Potential damage to adjacent teeth resulting in
deviatalization and/or root malformation.deviatalization and/or root malformation.

Inability of a young child to psychologically Inability of a young child to psychologically
tolerate the surgical procedure.tolerate the surgical procedure.

21. Delayed intervention denotes observation Delayed intervention denotes observation
until adjacent root formation is complete until adjacent root formation is complete
which is generally between 8 and 10 years which is generally between 8 and 10 years
of age.of age.
AdvantageAdvantage

Less danger of damaging the growing Less danger of damaging the growing
mesenchymal portion of the permanent teeth.mesenchymal portion of the permanent teeth.

22. DisadvantagesDisadvantages

1 )Less of eruptive potential of the central 1 )Less of eruptive potential of the central
incisorsincisors

2 )Loss of anterior arch space or midline shift2 )Loss of anterior arch space or midline shift

3 )More extensive surgical and orthodontic 3 )More extensive surgical and orthodontic
treatment for correctiontreatment for correction

4 )Increased in vertical height of the premaxilla 4 )Increased in vertical height of the premaxilla
will accentuate the difficulty of surgical access will accentuate the difficulty of surgical access
to unerupted supernumeraryto unerupted supernumerary

23. Treat the orthodontic problemsTreat the orthodontic problems
Space analysisSpace analysis

If adequate space exist - treat the conditionIf adequate space exist - treat the condition
•( 1 )Realignment of adjacent permanent teeth( 1 )Realignment of adjacent permanent teeth
•Correction of proclinationCorrection of proclination
•Correction of rotation Correction of rotation
•Correction of displacementCorrection of displacement
•( 3 ) orthodontic extrusion of permanent teeth( 3 ) orthodontic extrusion of permanent teeth
•( 2 ) Approximation of adjacent teeth( 2 ) Approximation of adjacent teeth

24. 
If space deficiency is present If space deficiency is present
•Create the space for correction of orthodontic Create the space for correction of orthodontic
problems depend on severity of crowdingproblems depend on severity of crowding

( disking, expansion or extraction of permanent teeth )( disking, expansion or extraction of permanent teeth )

Type of tooth movement Type of tooth movement

Choice of applianceChoice of appliance

MechanotherapyMechanotherapy

25. Rotation of IncisorsRotation of Incisors

26. CausesCauses
Retained primary teethRetained primary teeth
Supernumerary teethSupernumerary teeth
CrowdingCrowding
Habits – nail bitingHabits – nail biting

27. ManagementManagement
Investigate, identify and remove the causeInvestigate, identify and remove the cause
Correct rotation earlyCorrect rotation early

28. ApplianceAppliance
Use a removable appliance to apply force Use a removable appliance to apply force
couplecouple
Fixed – removable appliance Fixed – removable appliance
( Whip spring )( Whip spring )
Fixed applianceFixed appliance