Resolving severe tooth crowding.

It seems increasingly that our virtual smile makeovers involve simulating the out come of orthodontic treatment. With this case, it's the use of braces to resolve severe crowding of both the patient's upper and lower teeth.

Case issues and concerns:

Severe tooth crowding.

When looking at this case's "before" picture, it's easy enough to imagine what the underlying problem is.

The collective width of this person's teeth is substantially wider than the amount of jawbone space that's available. As a result, as some of the teeth have come in they've had to do so way forward (upper lateral incisors) or backward (upper and lower eyeteeth) from their expected (normal) location.

Tooth length vs. gum line level.

Another issue that's noticeable in this "before" picture is one of tooth size.

With most smiles, the person's upper central incisors (upper center teeth) are both wider and longer than their neighboring lateral incisors. With this smile, it seems both types of teeth are the same length.

While we only have a picture to examine, we'd anticipate that the crown portion (the enamel-covered part of teeth that typically lies above the gum line) of these centrals is substantially larger (longer) than what it seems. It's as if the teeth have not been able to fully erupt out of the gums.

 
  • A case displaying severe tooth crowding.
    A case displaying severe tooth crowding. A case displaying severe tooth crowding.
  • After having orthodontic treatment.
    After having orthodontic treatment. After having orthodontic treatment.
 

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Treatment solutions:

Simulating orthodontic treatment.

Our "after" picture is our attempt at showing the type of changes that having orthodontic treatment could make.

In a nutshell, what the treating orthodontist must do is find enough jaw space that they are able to realign the teeth. They'll likely have several plans of attack in accomplishing this goal.

  • They may remove one back tooth (premolar) on each side (top and bottom, a total of 4 teeth), and gain the additional space they need that way. Or, as an alternative, push the back teeth back further along the jaw so there is more available space in front where it's needed.

    Another technique is to "strip" the teeth. This simply means the teeth are trimmed down so they are slightly narrower (thus reducing their collective width). Obviously, only the treating dentist can make a decision about which of these methods (possibly used collectively) will work best.

  • They'll also try to "expand" each arch as much as possible. This refers to bringing the teeth out to a position along the jawbone where its overall curvature (length) is longer.

    Actually, our "after" picture illustrates this, although to a much larger degree than is realistic. In real life, the upper eyeteeth won't end up being so prominent. (What we've shown in our "after" picture reflects our shortcomings. We're only so talented in trying to simulate orthodontic transformations.)

a) The gum line issue.

As mentioned above, we anticipate that this person's upper central incisors are larger than they appear in the "before" image. Our "after" picture suggests the size we think they actually are.

It's not uncommon that the act of moving teeth tends to resolve gum issues such as these. If not, and if it is a concern, "gum sculpting" can be performed. Either way, this is simply a topic that needs to be discussed with the treating dentist.

b) Straightening off the edges of the teeth.

When teeth are crooked, it's not uncommon that the edges of some of them don't get worn down straight the way they naturally would. And then others get worn more so than normal.

It's very common that a dentist will straighten off irregular edges of teeth by buffing them slightly with a dental drill. That's the look we've tried to simulate in our "after" picture.

c) What orthodontic method should be used?

A decision about what type of orthodontic system should be used to treat this case can only be made by this person and their orthodontist. Having said that, removable aligner systems often have difficulty treating complex cases (like this one). For that reason, some type of traditional (wire and brackets) system would probably make the most predictable choice.

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