16: Late lower incisor crowding

16 Late lower incisor crowding

Summary

Graham is almost 20 years old. He presents with crowding of his lower incisors (Fig. 16.1). What is the cause and how would you treat it?

image

Fig. 16.1 Lower occlusal view at presentation.

History

Complaint

Graham is concerned about the crowding of his lower front teeth and wonders if it will get worse.

History of complaint

His lower front teeth were straight until 18 months ago when he noticed crowding developing. He now finds it more difficult to keep his lower front teeth clean. Calculus build-up also seems to occur more easily on the inside of the lower teeth, which he finds annoying. He is also aware of the two wisdom teeth erupting at the back of his lower jaw for the past 18 months. These do not cause him any problems but he wonders if they are making his lower front teeth crooked.

Medical history

Graham is fit and well.

Dental history

Two years ago Graham had a course of fixed appliance therapy to close a large space between image followed by composite build-up of image.

Examination

Extraoral examination

Graham has a Class I skeletal pattern with average FMPA and no facial asymmetry. Lips are competent. There are no signs or symptoms associated with the temporomandibular joints.

Intraoral examination

The appearance of the teeth on presentation is shown in Figures 16.1 and 16.2.

image

Fig. 16.2 Left buccal occlusion.

image What do you notice?

Soft tissues appear healthy with the possible exception of mild gingival erythema related to image associated with slight plaque deposits; otherwise oral hygiene appears good; slight gingival recession on image.
All lower permanent teeth present; image visible in upper arch; (note image was erupted).
Lower labial segment crowding with image erupting; worst incisor contact point displacement was 2.5 mm.
Upper left quadrant appears aligned.
Class I incisor relationship, although it appears to be tending towards Class III.
Left buccal segment relationship Class III.

image Is development of lower incisor crowding common in the late teens?

In modern populations, there is a strong tendency for crowding of the mandibular incisor teeth to develop in the late teens. This occurs even if the teeth were well aligned or spaced initially, leading usually to mild crowding, whereas initial mild crowding tends to become worse. Lower labial segment crowding also occurs in patients in whom extractions for relief of crowding and fixed appliance therapy have been undertaken (unless a bonded lingual retainer has been placed).

image What are the possible causes of late lower incisor crowding?

The aetiology is multifactorial and the major theories proposed are as follows:

Late mandibular growth. Forward mandibular growth, especially if a growth rotation is also present, and where maxillary growth has stopped, aided by lip pressure, tends to reposition the lower incisors lingually, re/>

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 16: Late lower incisor crowding

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