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Correcting crowding of teeth

We tell you which treatments can help correct crowded teeth
We use the most effective devices and advanced bite correction techniques
Treatment time — from 8 months

Teeth crowding in orthodontic practice is very common – most patients come to the orthodontist with this very problem.

crowding is a lack of space in the tooth row. The more space is lacking, the more crowding can occur (teeth tilt and turn to take up less space).

Not only does crowding disrupt the aesthetics of the smile, but it also leads to the formation of malocclusion and other dental problems.

Causes of crowding

  • Small jaw size (micrognathia)
    If the upper or lower jaw does not grow large enough during a child's development, the permanent teeth (which are much larger than the baby teeth) do not have enough room to erupt properly. Micrognathia can be genetically determined, or it can form as a result of bad habits during the period of active growth. Mouth breathing, finger sucking, and improper tongue function can cause delayed jaw growth and the formation of an improper bite and crowding.

  • Large Teeth (Macrodentia)
    Space deficiency can also occur in properly formed jaws when teeth are significantly larger than normal in size.

  • Early Removal of Baby Teeth
    Baby teeth hold space for permanent teeth. If a baby tooth is extracted earlier than six months before it is due to change, the space for the permanent tooth to erupt may be lost. Neighboring teeth will move into the area of the missing tooth and «take» the wrong place.
    If it is necessary to extract baby teeth as a result of decay and its complications, a consultation with an orthodontist is necessary. If it is necessary to hold the space after extraction, the doctor will make removable plates or special appliances to prevent crowding.

  • Wisdom teeth eruption

    Lower jaw incisor crowding can occur in adulthood. Most patients and doctors associate the appearance of crowding on the lower jaw with the eruption of third molars – wisdom teeth.

In reality, this is not such a clear-cut fact – most current research does not prove, or even disprove, the relationship between erupting third molars and crowding.

Sources:
Presence and Maturation Dynamics of Mandibular Third Molars and Their Influence on Late Mandibular Incisor Crowding: A Longitudinal Study. Int J Environ Res Public Health. 2021 Sep 25;18(19):10070. doi: 10.3390/ijerph181910070. PMID: 34639372; PMCID: PMC8508372.
Does mandibular third molar have an impact on dental mandibular anterior crowding? A literature review. J Stomatol Oral Maxillofac Surg. 2018 Jun;119(3):204-207. doi: 10.1016/j.jormas.2018.03.005. Epub 2018 Mar 21. PMID: 29571816.

Consequences of overcrowding

  • Bite abnormalities
    In many clinical cases, crowding hides a more serious orthodontic problem – underdevelopment and narrowing of the jaw, distal or other types of bite. In this case, the orthodontist has a more important mission – to correct the bite, and the correction of crowding becomes the default «default» task, because without straight teeth, it is impossible to achieve proper alignment of the teeth.

  • Deterioration of oral hygiene and higher risk of dental caries
    With severe crowding, proper oral hygiene becomes impossible. The constant presence of soft and hard plaque leads to the development of caries and inflammatory periodontal diseases (gingivitis and periodontitis).

  • Periodontal disease and recession formation
    Irregular positioning of the teeth leads to an impaired redistribution of the chewing load on the teeth. In this case, the tooth retention apparatus – periodontium will suffer. Bone loss, recession and increased tooth mobility will occur.

  • Pathological abrasion, chipping and cracking of enamel.
    The increased load on the teeth leads to a violation of the integrity of its hard tissues – the enamel is destroyed, eroded and chipped. There is increased abrasion not only of crowded teeth, but also those with which they are interlocked. Stable restoration of such teeth is not possible, as the dental restorations will chip and lead to even more tooth destruction as a result of misalignment and hypercontacts.

Treatment of crowding

Orthodontic treatment tactics will depend on the degree of space deficiency, dental health, bite, and bone volume. To create a customized treatment plan, the orthodontist will perform a diagnostic – analyzing photographs, skull CT scans, tooth tilts, and more.

The main task to solve crowding – is to create space in the tooth row. How does an orthodontist create space?

  • Increases the inclination of the teeth
    As the inclination is increased, the length of the tooth row is increased. This method has great limitations: bone volume, initial inclination of the teeth.

  • Widens the teeth
    The largest expansion to create space can be performed by an orthodontist in childhood during the period of active bone growth (6-8 years of age) using special expansion appliances. In adolescence and adulthood, expansion can occur with the help of braces or eliners, but already in a much smaller volume. In a permanent bite with pronounced crowding, expansion can be achieved with special devices with miniscrews or surgically. This method is optimal when, in addition to crowding, there is a skeletally pronounced narrowing of the jaw.

    • Distalizes (moves teeth backward)
      Moving the side teeth backward causes the tooth row to lengthen and create space in the tooth row. The distalization treatment option may be considered if it will not only solve the crowding issue, but also improve the bite.

  • Grinds teeth
    Separation – is the grinding of the lateral surfaces of the tooth to correct their shape and create space. The grinding is done during orthodontic treatment in a volume that is harmless to the enamel (0.1-0.2 mm per surface), but allows for the creation of precious space to correct crowding.

Studies show that tooth grinding is harmless to enamel and does not increase the risk of tooth decay, even many years after separation.

Sources:
Dental health assessed more than 10 years after interproximal enamel reduction of mandibular anterior teeth. Am J Orthod Dentofacial Orthop. 2007 Feb;131(2):162-9. doi: 10.1016/j.ajodo.2006.10.001. PMID: 17276856.
Dental health assessed after interproximal enamel reduction: caries risk in posterior teeth. Am J Orthod Dentofacial Orthop. 2011 Jan;139(1):90-8. doi: 10.1016/j.ajodo.2010.09.002. PMID: 21195282.
  • Removing teeth
    In cases of severe crowding, sometimes the decision may be made to remove a tooth. This decision is made when other options for creating space are impossible or insufficient, and tooth extraction will also lead to a correction of the bite.

Teeth crowding — one of the most common reasons to visit an orthodontist. For some patients, the goal of treatment is aesthetics – straight teeth and a beautiful smile, and for others, preserving the future health of the teeth comes first. The orthodontist's arsenal of treatment options for crowding can be combined and combined to create an effective and predictable treatment plan.

Regardless of the patient's initial treatment request, it is always rewarding to see how their smile – becomes wider and more confident as their teeth align, which can be visually appreciated by the patient themselves.

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08.10.2022
Updated 31.12.2023