Lower Anterior Crowding Research Articles

One year treatment effects of the eruption guidance appliance in 7- to 8-year-old children: a randomized clinical trial.

The eruption guidance appliance (EGA) aims to correct sagittal and vertical occlusal relations concomitantly with alignment of the incisors. Few reports have been published on treatment effects with the EGA but no randomized studies have been available. The aim was to find out if 1 year active treatment time with EGA was sufficient for achieving normal occlusal relationships and dental alignment in 7- to 8-year-old children. Eligibility criteria for participants were: fully erupted upper central incisors, and Angle's Class I or Class II molar relationship combined with any of the following traits: deep bite, increased overjet ≥5mm, moderate anterior crowding with overjet ≥4mm. After screening of 148 children, 48 7- to 8-year-old children were recruited in the study. The participants were randomly assigned into a treatment group (N = 25) and a control group (N = 23). Children in the treatment group received treatment with the EGA for 1 year. The controls had no orthodontic treatment. Changes in overjet, overbite, Angle's Class, and crowding were used as primary outcome measures. Occlusal assessments were performed on dental casts obtained from all subjects at start of the study (T1) and after 1 year (T2). Lateral cephalograms were obtained from all subjects at T1 and from the treatment group at T2. All measurements on dental casts and cephalograms were carried out blinded. Forty-six children completed the study. Mean overjet and overbite decreased significantly in the treated subjects during 1 year, in contrast to a slight increase in the controls. Class II molar relationship decreased from 46 to 4 per cent in the treatment group, with no significant change in the control group. Mandibular anterior crowding decreased significantly in the treated subjects, while the controls showed a slight increase. In short term, the EGA seems to be effective in correcting increased overjet and overbite, Class II malocclusion, and lower anterior crowding in the early mixed dentition. Follow-up data are needed to assess long-term effects of this treatment. This study was not registered.

Technique tips--active lingual retainer.

It is believed that, because dental arch length decreases and lower anterior crowding increases throughout life, the only way to maintain ideal alignment after orthodontic treatment is by means of some form of permanent retention. Bonded lingual retainers are often placed after fixed orthodontic treatment and can serve in-mouth for decades.

Mandibular incisor extraction in orthodontics: A systematic review

Objectives: Our objective was to evaluate the use of mandibular incisor extraction in relieving the lower anterior crowding and its advantages and disadvantages. Materials and Methods: A systematic review of the literature by using several electronic databases (PubMed, Medline, Cochrane library, Medline in progress, Web of science) was performed with the help of a senior health sciences librarian. The electronic search was followed up with hand searches. After applying our inclusion and exclusion criteria, the search yielded 30 articles that were then scored, based on their methodological validity. Results: Mandibular single incisor extraction proved to be an effective way of relieving the lower anterior crowding with good long-term stability. However, a proper case selection, lower inter-canine width, tooth size arch length discrepancy are some of the factors that influence the achievement of stable results. Conclusion: Mandibular incisor extraction, as discussed in this article is a good choice when all the conditions with regard to its indications are satisfied by a patient. Incisor extraction is a better choice to opt for, as the mechanics becomes simpler and good results are achievable.

Angle Class I malocclusion treated with lower incisor extraction

In planning orthodontic cases that include extractions as an alternative to solve the problem of negative space discrepancy, the critical decision is to determine which teeth will be extracted. Several aspects must be considered, such as periodontal health, orthodontic mechanics, functional and esthetic alterations, and treatment stability. Despite controversies, extraction of teeth to solve dental crowding is a therapy that has been used for decades. Premolar extractions are the most common, but there are situations in which atypical extractions facilitate mechanics, preserve periodontal health and favor maintenance of the facial profile, which tends to unfavorably change due to facial changes with age. The extraction of a lower incisor, in selected cases, is an effective approach, and literature describes greater post-treatment stability when compared with premolar extractions. This article reports the clinical case of a patient with Angle Class I malocclusion and upper and lower anterior crowding, a balanced face and harmonious facial profile. The presence of gingival and bone recession limited large orthodontic movements. The molars and premolars were well occluded, and the discrepancy was mainly concentrated in the anterior region of the lower dental arch. The extraction of a lower incisor in the most ectopic position and with compromised periodontium, associated with interproximal stripping in the upper and lower arches, was the alternative of choice for this treatment, which restored function, providing improved periodontal health, maintained facial esthetics and allowed finishing with a stable and balanced occlusion. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

Dentoalveolar class III treatment using retromolar miniscrew anchorage

In this article, we report the successful use of miniscrews in the distalization of the lower dentition to correct an Angle class III malocclusion with lower anterior crowding in a dolichofacial adult patient. Conventional intraoral and extraoral appliances have many disadvantages, including the need for patient cooperation, potential for anchorage loss, and vertical extrusion of upper molars and lower incisors. Extrusion should be prevented or minimized when treating long-faced patients with reduced overbite. After third molar extractions, miniscrews were placed in the retromolar area. A sliding jig was applied to distalize the lower molars, while the anterior teeth were bonded and retracted secondarily to avoid round tripping. After 18 months of treatment, molar and canine class I relationship with normal overjet and overbite were achieved. In addition, there was an esthetic improvement in the profile with only a small increase of the lower anterior facial height. These results remained stable at a 12-month follow-up.

The Trikki lingual appliance

Lower anterior crowding is a frequent finding in early mixed dentition. Left untreated, it may lead to extractions of permanent teeth or even to impactions. The Trikki lingual appliance is a fixed device that aids in lower arch expansion and space gaining, especially in the lower anterior region, without the need for brackets. Patients with a deep-bite tendency, retroclined lower incisors, and/or lower anterior crowding are good candidates. The Trikki appliance may be used to shift the lower midline in cases of premature unilateral loss of a primary canine or to gain space and align ectopically erupted lower incisors. It requires no patient compliance, is effective, is easy for the clinician to adjust, and can be incorporated into any early treatment protocol.

ISW for the Treatment of Adult Facial Asymmetry and Tooth Crowding

ABSTRACT Improved superelastic Ti-Ni alloy wire (ISW) was used for the management of a 24-year-old patient presenting with facial asymmetry and maxillary and mandibular anterior dental crowding. After the extraction of teeth #14, #24, #34, #45, ISW leveling was performed to relieve upper and lower anterior crowding. Elastic chain and intermaxillary elastics (IME) were then used to correct the mandibular shift. The correction of facial asymmetry was successfully achieved within 31 months. The outcome was the accomplishment of an esthetic smiling arc that achieved patient satisfaction after the completion of orthodontic treatment. How to cite this article Yuan-Chieh C, Jian-Hong YU, Ya-Yu T, Chien-Chih YU. ISW for the Treatment of Adult Facial Asymmetry and Tooth Crowding. Int J Experiment Dent Sci 2013;2(2):134-138.

Modified serial extraction in a case with missing mandibular second premolars and a brief review of related treatment modalities

This article discusses a case of an 8-year-old female child who presented with severe lower anterior crowding and congenitally missing lower second premolars. A conventional serial extraction procedure could not be performed due to the congenital absence of teeth. Instead, planned extraction of a few primary teeth was done to relieve the lower anterior crowding, the results of which were near satisfactory.

ISW Treatment for the Skeletal Class III with Anterior Crossbite and Minor Facial Asymmetry

ABSTRACT Skeletal class III with anterior crossbite is a very common orthodontic problem in Taiwan. Early diagnosis and treatment are very important to achieve effective correction. This article reports the treatment outcomes using improved superelastic TiNi alloy wire (ISW; developed by Tokyo Medical and Dental University) for a case of skeletal class III malocclusion with anterior crossbite and lower anterior crowding combined minor facial asymmetry. ISW allowed relief of crowding to facilitate correction for this case. In comparison with the traditional treatment with SSW multiple L loops of class III patient, ISW multiloop edgewise archwire (MEAW) can provide a more efficient and easier way for the patient. After 16 months of treatment, a desirable outcome was achieved and patient was satisfied with the treatment procedure and result. How to cite this article Tseng CH, Jian-Hong YU. ISW Treatment for the Skeletal Class III with Anterior Crossbite and Minor Facial Asymmetry. Int J Experiment Dent Sci 2013;2(1):53-59.

Invisalign® treatment in the anterior region

Based on our previous pilot study, the objective of this extended study was to compare (a) casts to their corresponding digital ClinCheck® models at baseline and (b) the tooth movement achieved at the end of aligner therapy (Invisalign®) to the predicted movement in the anterior region. Pre- and post-treatment casts as well as initial and final ClinChecks® models of 50 patients (15-63 years of age) were analyzed. All patients were treated with Invisalign® (Align Technology, Santa Clara, CA, USA). Evaluated parameters were: upper/lower anterior arch length and intercanine distance, overjet, overbite, dental midline shift, and the irregularity index according to Little. The comparison achieved/predicted tooth movement was tested for equivalence [adjusted 98.57% confidence interval (- 1.00; + 1.00)]. Before treatment the anterior crowding, according to Little, was on average 5.39 mm (minimum 1.50 mm, maximum 14.50 mm) in the upper dentition and 5.96 mm (minimum 2.00 mm, maximum 11.50 mm) in the lower dentition. After treatment the values were reduced to 1.57 mm (minimum 0 mm, maximum 4.5 mm) in the maxilla and 0.82 mm (minimum 0 mm, maximum 2.50 mm) in the mandible. We found slight deviations between pretreatment casts and initialClinCheck® ranging on average from -0.08 mm (SD ± 0.29) for the overjet and up to -0.28 mm (SD ± 0.46) for the upper anterior arch length. The difference between achieved/predicted tooth movements ranged on average from 0.01 mm (SD ± 0.48) for the lower anterior arch length, up to 0.7 mm (SD ± 0.87) for the overbite. All parameters were significantly equivalent except for the overbite (-1.02; -0.39). Performed with aligners (Invisalign®), the resolvement of the partly severe anterior crowding was successfully accomplished. Resolving lower anterior crowding by protrusion of the anterior teeth (i.e., enlargement of the anterior arch length) seems well predictable. The initial ClinCheck® models provided high accuracy compared to the initial casts. The achieved tooth movement was in concordance with the predicted movement for all parameters, except for the overbite.

Lower Anterior Crowding Correction by a Convenient Lingual Method

In recent years, the increased esthetic demands of patients seeking orthodontic treatment have led to the development of various esthetic appliances and techniques. Lingual orthodontics is a major expression of this necessity. Several techniques and appliances have been introduced during the years, but they usually require special equipment and manipulation to be applied to patients. In this report, we present an easy, convenient, and effective lingual method for the management of specific simple cases with mild-to-moderate lower anterior crowding using conventional orthodontic means. In selected cases, the presented method may provide a viable simple solution for correcting a common orthodontic problem, the lower anterior crowding, while satisfying patients' increased esthetic requirements.

Commentary: Lower Anterior Crowding Correction by a Convenient Lingual Method1

Commentary: Lower Anterior Crowding Correction by a Convenient Lingual Method¹

Influence of palatoplasty on occlusion of patients with isolated cleft palate

Methods: Cast models of 77 patients, 30 males and 47 females, with an average age of 21 years and no syndromes were taken. They were in the permanent dentition and had not undergone orthodontic treatment. The sample was divided into non-operated and operated patients, the latter having been submitted to palatoplasty at a mean age of 2.2 years. Results: Almost 80% of the sample exhibited sagittal discrepancies in the inter-arch relationship, with a Class II malocclusion prevailing (59.74%) followed by Class III (20,78%), regardless of palatoplasty. Transverse analysis showed a 23% incidence of posterior crossbite also not influenced by palatoplasty. Intra-arch relationship indicated that constriction and crowding on the upper arch were more frequent in the operated group (p=0.0238 and p=0.0002, respectively), showing an influence of palatoplasty on its morphology. The predominant morphological characteristics in patients with isolated cleft palate were a Class II malocclusion, upper dental arch constriction and upper and lower anterior crowding. Conclusion: The influence of palatoplasty was restricted to constriction and crowding of the upper dental arch, with no interference from the extension of the cleft, except for the upper crowding, which occurred more in patients with complete cleft palates.

Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding

To clinically evaluate the alignment efficiency of 0.016-inch coaxial superelastic nickel-titanium (NiTi) and 0.016-inch superelastic NiTi in the lower anterior region over a period of 12 weeks. A sample of 24 patients requiring lower anterior alignment were included in this single-center, single-operator, double-blind clinical trial and were randomly allocated into two groups of 12 patients. The type of wire selected for each patient was not disclosed to the provider or to the patient. Comparison of pretreatment characteristics of the archwire groups revealed no discrimination between two samples, thus verifying the random allocation of the intervention. An initial alginate impression of the lower arch was followed by impressions at 4-, 8-, and 12-week intervals. Casts were measured using the coordinate measuring machine to denote the degree of alignment. Duplicate readings of the cast series were taken to assess measurement variation. A statistically significant difference (P < .05) in the mean values of tooth movement demonstrated the superior aligning efficiency of coaxial superelastic NiTi over single-stranded superelastic NiTi in relieving lower anterior crowding. The measurement error recorded was within acceptable limits, with range values within 95% limits of agreement. Coaxial superelastic NiTi wire proved superior to single-stranded NiTi in its efficiency in relieving lower anterior crowding over a 12-week period.

The nance lingual arch: an auxiliary device in solving lower anterior crowding

After exfoliation of the primary incisors and eruption of the permanent incisors, the dentist has the opportunity of observing closely the beginning of occlusal changes. In several cases, alterations, such as lower anterior crowding, can be prevented and treated with proper follow-up. In the mixed dentition, one of the mechanisms for maintaining space and favoring dental alignment is to preserve leeway space before permanent second molar irruption. Among the devices with this function, the Nance lingual arch helps maintaining the position of the permanent mandibular molars and incisors after a premature loss of the primary canines. This paper describes the applicability of Nance lingual arch for preserving leeway space, thus contributing for correction of lower anterior crowding.

Oral Health Status and Treatment Needs of the Inmates in Hindalga Central Prison, Belgavi-Karnataka

A specific study has been undertaken on the inmates of the central prison Belgaum (Karnataka) to assess their oral health status of treatment requirements. In total 630 male inmates have been examined with WHO Performa. In general it has been found that most percentage of people had bad oral hygiene, added with high percentage of dental decay. Many of them had various harmful tobacco habits which were causing sub mucous fibrosis added with severe attrition. Interestingly quite a good number of people had lower anterior crowding along with anterior fractured teeth. This phenomenon seems to be more than normal population when compared.

Influence of shovel-shaped incisors on the dental arch crowding in Mongolian females

The aim of this study was to investigate the influences of shovel-shaped incisors on the dental arch crowding in the samples of modern young female adult Mongolians (belonging to the Khalkha-Mogol grouping) ranged between 18.5 and 25.0 years, with a mean age of 20.7 years. Materials in this study comprised of 33 dental casts. Plaster replicas of the A.S.U. system plaques were used to facilitate standardization in scoring and classify shoveling regarding both upper central and lateral incisors. Dimensions of the dental arch namely, overjet, overbite, arch depth, arch width and irregularity index were measured. The correlation between the shovel shape of the central incisor and the lateral incisor was highly significant. Significantly relations were found between the grades of shoveling and the mesiodistal diameters of upper first molars and lower incisors. Positive correlation was admitted between the shoveling and upper arch depth anterior, and upper arch depth. It may be considered that the grades of shoveling are indirectly related with upper and/or lower anterior crowding. Although crowding is looks like an expression of disharmony between teeth and alveolar arch, it may be caused by multiple etiologic factors interacted directly and/or indirectly.

Unusual Extraction Treatment in Class II division 1 Using C-Orthodontic Mini-Implants

This paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants(R) were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding.

Mandibular symphyseal distraction osteogenesis with stepwise osteotomy in adult skeletal class III patient

This technical note reports the use of symphyseal distraction with stepwise osteotomy in a case of lower anterior crowding and rotation in the incisor area. This technique allows for easy dental decompensation and reduced presurgical orthodontic time in skeletal class III cases.

A study of occlusion in elderly Japanese over 80 years with at least 20 teeth

The purpose of this study was to identify the occlusal status of elderly Japanese over 80 years with at least 20 teeth. The study enrolled 76 elderly Japanese (44 male, 32 female) with a mean age of 82 years and an average of 25.7 remaining teeth. The study consisted of intra-oral examination, intra-oral and facial photographs, radiographs and impressions for study casts. No gender difference was observed in age or number of remaining teeth. Anteroposterior occlusal relationship was characterised by maxillary protrusion in 67.6%, acceptable overjet in 31.0%, and anterior crossbite in 1.4%. Vertically, deep bite was noted in 33.8%, acceptable overbite in 64.8%, and open bite in 1.4%. Most of the subjects had either Angle class I (68.4%) or class II (25.7%) canine relationship. Only 3.9% of the subjects had upper anterior crowding. Lower anterior crowding was observed in 23.7%, but tended not to be severe. These results indicate that Japanese who attained the goal of '8020' have a relatively good occlusion.