Dental Crowding

Dental crowding
Normal Occlusion
 Tooth size Arch length discrepancy (TSALD) that results in malposition
and/or rotation of teeth
 one of the most common malocclusions with a frequncey of 25%.
 crowding is much more prevalent in modern populations
 Classification of Crowding
TSALD = Tooth Size-Arch Length Descrepancy
1. According to Proffit
 If TSALD <5 mm → Mild Crowding
 If TSALD >5 mm but <8 mm → moderate crowding
 If TSALD >8 mm → severe Crowding
2. According to the location of crowding
• Anterior crowding
• Posterior crowding
 Classification of Crowding

2. According to the etiology

a. Primary crowding (Hereditary).
b. Secondary crowding (Aquired)
c. Tertiary Crowding (Due to Mandibular growth and third molars)
d. Transient (in early eruption)
 Etiology of Crowding
Hereditary Crowding
1. Macrodontia and/or Micrognathia
2. Supernumerary Teeth
 Etiology of Crowding
 Environmental Crowding:
1. Premature loss of primary tooth
2. Rotation of tooth
3. Prolonged retention of primary
tooth
4.Abnormal pressure habits
5. Proximal caries
 Space Analysis
1. In Permenant Dentition
a. Carey’s Analysis
• Space Availabe = arch perimeter from the mesial of one first molar to the other.
• Space Required = mesiodistal width of each erupted tooth from contact point
to contact point
Space analysis = Space Available – Space required
 Space Analysis
2. In Mixed Dentiton
b. Moyers analysis (probability tables)

• Tanaka–Johnston’s Prediction Method (probability equation)

• Radiographic Method
 Space Creation
1. Extraction ( Mostly first premolar is extracted to relieve severe crowding )
2. Distal movement of molars (To relieve crowding and increased overjet)
3. Uprighting of molars (In the case of tipped molar, space gained is 1-1.5mm)
 Space Creation

4. Interproximal reduction

space gained from each

anterior tooth → 0.5 mm

5. Derotation of posteriors
 Space Creation
• 6. Proclination of incisors (Incisors are retroclined or their proclination will not
affect the soft-tissue profile)
• 7. Expansion (for narrowed arch and mild to moderate crowding)
 Treatment of Crowding
• In Mixed Dentition
1. slight anterior crowding (2–3 mm) → No
Treatment.
2. moderate anterior crowding (3–4 mm) →
Proximal reduction the mesial surface of the
deciduous canine.
3. When crowding is severe → Serial Extraction.
Treatment of Crowding
• In permenant dentiton

1. Expansion of the dental arch to gain space

2. Reduction of tooth material

a. Extraction
b. Proximal Stripping
 Retention and Relapse
• Relapse is defined as the tendency of treated teeth to return to their original
position, to prevent Relapse we need to use Retention appliances.

Retention appliances are of 2 types: 1. Fixed 2. Removable

• Thank you for listening….