Teeth Crowding Treatment

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Crowding or the syndrome of tight teeth alignment refers to the incorrect positioning of front and, less frequently, side teeth.

This occurs when the combined width of the crowns is greater than the jaw length. Due to lack of space, teeth may tilt, rotate, or erupt outside the dental arch. Crowding always results in narrow interdental gaps. The shape of the dental arch flattens. Crowding is the most common bite disorder, diagnosed in 34% of teenagers and 68% of adults.

Orthodontic consultation
Metal braces
Ceramic braces
Sapphire braces
Aligners

Crowding is classified into four degrees of severity:

1. Mild. The space deficiency in the dental arch is no more than 3 mm. All crowns are straight but closely packed.
2. Moderate. The space deficiency reaches or exceeds 3 mm. One tooth, typically an incisor, or less commonly a canine, is misaligned.
3. Severe. The space deficiency is up to 5 mm. Two teeth are displaced, rotated, or erupt outside the dental arch, leading to pathological changes in the alveolar process and dental arch.
4. Very Severe. The space deficiency exceeds 5 mm. Two teeth are pushed outside the dental arch, while others shift or rotate. The dental arch flattens.

Crowding occurs due to insufficient space in the jaw. It develops as a result of:

• Small jaw size or micrognathia. This is due to hereditary factors or improper jaw development during childhood.
• Narrowing of the dental arch caused by soft tissue dysfunction. These changes arise from hormonal and metabolic imbalances, injuries, or defects in jaw closure (occlusion).
• Abnormally large teeth (macrodontia). Oversized crowns take up more space in the dental arch than normal.
• Supernumerary teeth (hyperdontia). A rare case where one or more extra teeth grow. These teeth erupt outside the dental arch, displacing the other crowns.
• Bite abnormalities. Crowding often accompanies deep overbites but can occur with any occlusion pathology.
• Abnormal frenulum attachment. This anomaly interferes with proper lip and jaw closure, inevitably leading to occlusion defects and crowding.
• Early loss of baby teeth. Baby teeth are always smaller than permanent ones. If a permanent tooth erupts too early, there may not be enough space for it due to an underdeveloped jaw.
• Loss of baby or permanent teeth. If missing teeth are not replaced with prosthetics, the remaining teeth may tilt into the gap.
• Harmful childhood habits. Sucking on fingers, toys, biting pencils, and lips can lead to crowding. Late pacifier weaning, lack of solid food in the child’s diet, and infantile swallowing (when the tongue is placed between the lower gum ridge) also contribute.
• ENT diseases in children. These cause mouth breathing, altering the shape of the facial skeleton, dental arches, and palate.

Not all factors need to be present. A few causes are enough for malocclusion to develop, requiring orthodontic correction during adolescence or adulthood.

The primary signs of crowding are oral. Patients typically experience:

• Narrow interdental spaces;
• Misalignment of incisors, canines, and premolars;
• Overlapping of crowns;
• Rotation of teeth along their axis;
• Teeth positioned outside the dental arch;
• Bite abnormalities.

Facial distortion and functional impairments are often present. Patients may have altered facial features, speech problems, and difficulty biting and chewing food.

Signs of crowding can also be detected in children with baby teeth. If the gaps between the teeth are too narrow or non-existent, there won’t be enough room for the permanent teeth to erupt properly.

To determine the nature and causes of tooth crowding, we conduct:

1. History Taking. The doctor interviews the patient, noting complaints and cosmetic concerns about the smile. They examine the oral cavity, assess crown size and position, and determine the bite type.
2. X-rays. Orthopantomograms (panoramic X-rays) and CT scans are performed to identify root positioning, the presence of wisdom teeth, and supernumerary teeth. Bone tissue health is also evaluated.
3. Biometric Methods: Spee, Pon, Corkhaus, Snagina methods are used to determine the degree of the defect, its causes, and the dental arch length. These methods help select the best orthodontic treatment.

The correction method depends on the degree of crowding, jaw size, and available space in the jaw. The causes of crowding and associated dental problems are also considered.

The orthodontist selects several optimal methods for correcting tooth crowding, offering aligners or braces and explaining the advantages and disadvantages of each option.

Aligners

Aligners are a popular choice for correcting crowding. These transparent rigid orthodontic trays are virtually invisible. They gently and comfortably shift the crowns into the correct position.

Treatment with aligners is fully planned and predictable. Patients can see their perfect smile before treatment begins. A set of trays is created to correct crowded teeth, typically between 5 and 32 trays. These are changed every two weeks at home.

Aligners work well for mild to severe crowding but are not suitable for very severe cases. They are not used when jaw expansion is required or when there is significant dental arch flattening or complex occlusion issues.

Braces

Braces are suitable for correcting any degree of crowding, from mild to very severe. Braces position all teeth with precision, ensuring proper alignment. When combined with other orthodontic appliances, they can expand the jaw.

Patients with crowded teeth at the "Kiadent" clinic have the option to choose from several types of braces:

• Metal—most effective and affordable;
• Ceramic—highly aesthetic;
• Sapphire—clear braces.

For patients who want a discreet orthodontic treatment but have a limited budget, we offer combined braces. The part that attaches to the front teeth is made from ceramic or sapphire, while the side sections are metal. These models combine high aesthetics for the smile zone with reliability in the chewing teeth area.

To address crowding, additional space must be created to align all teeth in a straight row. This can be done in three ways:

• Jaw expansion. This is done using retractors, intermaxillary elastics, and wires.
• Tooth extraction. Teeth that do not contribute to chewing, such as wisdom teeth or premolars (fourth and fifth teeth), are extracted.
• Separation. Up to 0.5 mm of enamel is removed from the sides of the teeth without affecting the inner tooth structure (dentin). This creates up to 4 mm of extra space on one jaw.

Patients with crowded teeth primarily worry about aesthetics. They often feel self-conscious when smiling or eating in public and cover their mouths when speaking.

Crowding can also cause more serious issues:

• Occlusion defects. Crowding is typically the result of a pathological bite. Patients often have an underdeveloped or narrow jaw, deep bite, distal, traumatic, or crossbite.
• Damage to crowns and periodontium. Crowded teeth make it difficult to bite and chew food properly. Excessive chewing pressure is placed on the crowded and adjacent teeth, leading to chips, cracks, and enamel wear. Periodontal ligaments, which support the roots, weaken, leading to gum recession. Tooth necks become exposed.
• Cavities and gum inflammation. The gaps between crowded teeth cannot be cleaned thoroughly, leading to food particles, bacteria, and plaque buildup. The risk of cavities and pulpitis increases. The gingival pockets enlarge and become inflamed, resulting in gingivitis or periodontitis.
• Tooth loss. Detecting cavities or gum disease is difficult in patients with crowded teeth. By the time these issues are diagnosed, the teeth are often significantly damaged, and their roots are loosened. These teeth may be impossible to restore and require extraction.
• Temporomandibular joint dysfunction (TMJ). Uneven pressure on the teeth can lead to pain and clicking in the jaw joint. The joint may become inflamed or dislocated. Learn more about TMJ treatment.
• Chronic pain. Dysfunction in the masticatory system affects not only the TMJ but also causes pain in the jaw muscles, neck, back of the head, and temples.
• Digestive issues. Poor chewing leads to large food particles entering the stomach, causing indigestion, fermentation, and bloating. Digestive organ function worsens.

• How long will crowding treatment take?

  It depends on the degree of misalignment. Mild cases are corrected within six months, moderate cases in 1-1.5 years, and severe cases may take up to 2 years.

• What is the retention period? Is it necessary for crowding treatment?

  Retention is the process of maintaining the results of orthodontic treatment. The ligaments around newly aligned teeth have not yet fully formed, so the teeth can easily shift back to their crowded position.

  Retention follows the main treatment stage and lasts 1.5-2 times longer than the straightening phase with aligners or braces. During this time, you will need to wear a retainer, which can be a removable tray or a fixed wire attached to the inner side of the crowns.

• Can crowded teeth be straightened with crowns or veneers?

  Correcting crowding with highly aesthetic ceramic or zirconium restorations is a quick and easy method. However, prosthetic treatment only masks the defects. It does not address the underlying problems of a narrow jaw and the improper alignment of the roots. Uneven pressure on the teeth and TMJ remains, causing the restorations to chip and break over time.

• Do braces or aligners need to be placed on both jaws if only one jaw is crowded?

  Orthodontic treatment usually involves both jaws. During tooth alignment, the positioning of the teeth changes, affecting the contact between upper and lower teeth.

  Braces or aligners can be placed on one jaw only in cases of minimal crowding, where the contact between the upper and lower canines and molars remains intact. Such cases are rare.

• Is orthodontic treatment necessary if only one tooth is crowded?

  Yes. Visually, the patient may only notice one crooked tooth. However, there are often narrow gaps between teeth, slight tilting and shifting of adjacent teeth, and minor occlusion abnormalities.

  Such mild cases can be treated in a few months. If the positioning and alignment of the side teeth are not affected, the single crooked tooth can be corrected using:

  • Aligners;
  • Braces on one jaw;
  • Partial braces that only target the misaligned tooth and a few surrounding teeth.