Excessive crowding

Crowding of teeth occurs when there is not enough space in the mouth to accommodate all of the adult teeth.

Causes of Crowding

Crowding can result from various factors, including the size and shape of teeth, the anatomy of the dental arches, the skeletal structure of the jaw, and harmful personal habits. Properly identifying the specific cause of malocclusion in each case is critical for effective diagnosis, treatment planning, and prognosis. Common causes of crowding include the presence of extra teeth, lost teeth, impacted teeth, or teeth that are abnormally shaped.

Solutions

If you have particular treatment preferences for a patient, please communicate these when you submit your case. We strive to tailor our clear aligners to implement the treatment you prescribe as accurately as possible. Should you require something not listed on our form, do not hesitate to provide additional instructions.

For severe crowding, employing a combination of techniques often yields the best results. Techniques such as proclination and expansion are generally more effective together than separately. For less severe cases, achieving treatment goals might be possible with just one of the four main techniques: procline, expand, distalize, or IPR.

Techniques for Managing Crowded Cases

Procline

Proclining teeth can enhance the fullness of a patient's lips or side profile, often beneficial for older patients with less firm lips. This method might also suit individuals with a flat facial profile. To assess the need for proclination, draw a line from the nose tip to the chin tip on a profile photo of the patient. Ideally, the upper lip should nearly touch this line, and the lower lip should slightly overlap it. If both lips fall significantly behind this line, proclination may be beneficial. Conversely, if the lips extend well beyond the line, moving the teeth lingually might improve the profile. You can request this modification in the "other instructions" section if needed.

Expand

Expansion is commonly used to create space in the mouth. It is appropriate when there is a noticeable gap between the back teeth and the cheeks when the patient smiles. Expanding the smile can dramatically enhance its appearance, giving the patient a brighter, more engaging smile.

Distalize

We often recommend distalizing the front teeth and premolars by 1-3 mm to achieve a Class I bite and improve chewing functionality. However, we advise against distalizing molars due to the difficulty in moving them effectively. Keeping movements under 4 mm per quadrant helps maintain predictability and minimizes the risk of disrupting other teeth. If greater movement is desired, it can be requested.

IPR (Interproximal Reduction)

While we generally avoid IPR, it is sometimes necessary to create space in highly crowded cases. IPR can facilitate quick alignment by maintaining the current tooth positions while rotating them into correct alignment. It is typically recommended when aligning both dental arches is necessary, and reducing the width of the teeth on one arch is required to achieve proper overjet. IPR may be needed only on one arch and can also be used to achieve a Class I relationship for premolars or canines or to correct a midline misalignment.