Resolving severe tooth crowding.

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.

Related Makeover Categories:

•  Virtual makeovers simulating orthodontic treatment.