Crowding in orthodontics

Crowding

Discrepancy between tooth size and jaw size.

Arch length deficiency defined as a negative difference between

the space available in the dental arch and space required to
align the teeth.
 ….Crowding

Disproportion between arch length and tooth size:

 ….Crowding

Prolonged retention of deciduous teeth:

 ….Crowding

Periodontal diseases:

Bone loss as a result of aging or periodontal disease may

allow teeth to move under pressure.

They cause crowding in later life.

 ….Crowding

Premature loss of deciduous teeth:

Early loss of deciduous teeth

Mesial movement of distal tooth

Reduction in arch length

Crowding
 ….Crowding

Presence of supernumerary teeth:

 ….Crowding

Trauma:

Prenatal or birth injuries-

Foetus head tightly flexed on the chest
Forceps delivery
retard the growth of mandible
 ….Crowding

Localized abnormal size and shape of teeth:

 ….Crowding

Pressure from third molars:

Pressure from impacted third molars--- incisor crowding.

??
 ….Crowding

Late mandibular growth:

Growth of mandible in late teens—

a. Mandible displaced distally, with distortion of TMJ
b. Upper incisors flare forward
c. Lower incisors displace distally and become crowded
 Assessment of Crowding
a. Permanent dention space analysis :

• Carey’s and arch perimeter analysis :

 Lower arch - Carey’s analysis (C W CAREY – 1949)

 Upper arch - Arch perimeter analysis

 ….Assessment of Crowding
• Determination of arch length (AL)

• Determination of tooth size (TS):

 ….Assessment of Crowding
• Inference :
• Discrepancy = difference between the AL and TS.
b. Mixed dentition analysis :

i) Huckaba’s analysis :
Use of radiograph and the cast

True width of erupted primary molar = True width of unerupted premolar

Apparent width of erupted primary molar Apparent width of unerupted premolar

True width of unerupted = True width of erupted primary molar x

premolar Apparent width of primary molar

Apparent width of unerupted premolar

 ….Assessment of Crowding

ii) Moyer’s mixed dentition analysis :

• Use of the probability chart.

• Estimation of sum of lower incisors

• Estimation of available space for unerupted 3, 4 & 5.

 ….Assessment of Crowding

iii) Tanaka and Johnston mixed dentition analysis :

• Without using radiographs and probability charts.

• ½ MD width of LI + 10.5 = Width of 3,4& 5 in one lower quadrant.

• ½ MD width of LI + 11 = Width of 3,4 & 5 in one upper quadrant.
 ….Assessment of Crowding

3. Ratio analysis :

a. Peck and peck ratio :

Peck and peck ratio = Mesiodistal width of the lower incisor X 100
Faciolingual width of lower incisor

 Inference :
Normal ratio - CI is 88-92%
- LI is 90-95%
 ….Assessment of Crowding

BOLTON’S ANALYSIS :

• Importance has been recognized by Bennet and Mclaughin by

accepting it as 7th key to occlusion.

• Ratio between maxillary and mandibular teeth.

 ….Assessment of Crowding

• Estimation of overall ratio:

Overall ratio = Sum of mandibular 12 Sum X 100

of maxillary 12
• The ideal overall ratio is 91.3%.
 ….Assessment of Crowding

• Estimation of anterior ratio:

Anterior ratio = Sum of mandibular 6 Sum X 100

of maxillary 6
• The ideal overall ratio is 77.2%
 ….Assessment of Crowding

Ashley Howe’s analysis :

• Determination of total tooth material (TTM) :

 ….Assessment of Crowding

• Determination of premolar diameter (PMD):

• Determination of premolar basal arch width (PMBAW):

 ….Assessment of Crowding

Inferences :
• If PMBAW > PMD – Arch expansion is possible.
• If PMBAW < PMD – Arch expansion is not possible.

• Ideally, PMBAW% :
PMBAW% = PMBAW
X 100
TTM
PMBAW% is
37% or less – extraction
44% or more – no extraction.
Betn 37 & 44% – borderline case.
 ….Crowding

Treatment:

1. Space gaining – proximal stripping

-derotation
-extraction
-distalization
-uprighting
-expansion
-proclination of anteriors

2. Removal or fixed appliance

 ….Crowding

Treatment:
 ….Crowding

Treatment:
 ….Crowding

Treatment:
 ….Crowding

Treatment:

Correcting crowding by increase arch length can be done by

—

crimping a stop on the wire at the molar tube, so that it

holds the wire just in front of the incisors.
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