5: Severe crowding

5 Severe crowding

History

Medical history

Amy’s mother reports that her daughter had a heart murmur as a baby and attended a cardiologist at the local hospital. She fractured her right wrist in a fall from her mountain bike 4 months ago and has been attending for physiotherapy at the local hospital since the cast was removed. Mobility is almost back to normal now but she has difficulty with some procedures such as toothbrushing. Otherwise she is fit and well.

Examination

Intraoral

image The intraoral views are shown in Figures 5.1 and 5.2. Describe what you see.

image What factors influence the rate of space loss following early loss of a primary molar? What are the effects of early loss of a primary molar?

These are given in Table 5.1.

Table 5.1 Factors affecting the rate of space loss following early loss of a primary molar

Factor Effect*
Age at loss The younger the age at loss, the greater the potential for space loss
Degree of crowding The more crowded the arch, the more space that will be lost
Tooth extracted Early loss of an e, rather than of a d, is likely to lead to more space loss (see below regarding arch). 5’s may erupt and be excluded palatally/lingually or be impacted; 5 may be in crossbite; centreline shift if asymmetrical extraction and in case of e, if early loss before age 7
Arch from which tooth is lost Greater loss is likely in the upper, rather than in the lower arch, as mesial drift tendency is greater in the former
Type of occlusion Less space loss will occur where good buccal interdigitation exists

Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 5: Severe crowding
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