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Crowding and Spacing

Crowding and Spacing. Lecture 7 Ingrid Reed DDS, MS Department of Orthodontics & Dentofacial Orthopedics. Spacing. Primary Generalized – a good thing Primate spaces Maxillary –mesial of canine Mandibular – distal of canine Mixed dentition Permanent dentition. Primary Dentition.

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Crowding and Spacing

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  1. Crowding and Spacing Lecture 7 Ingrid Reed DDS, MS Department of Orthodontics & Dentofacial Orthopedics

  2. Spacing • Primary • Generalized – a good thing • Primate spaces • Maxillary –mesial of canine • Mandibular – distal of canine • Mixed dentition • Permanent dentition

  3. Primary Dentition

  4. Maxillary primate spaces

  5. Primate spaces

  6. Causes of spacing • Normal developmental stage • Mesiodens • Tooth size to arch perimeter discrepancy • Missing teeth (especially maxillary lateral incisors) • Microdontia or peg laterals • Excessively protruded teeth • Large frenum • Habits- thumb sucking

  7. Primary picsdigger.com

  8. Mesiodens Primary Permanent 4.bp.blogspot.com dentistry4kids.net

  9. Mixed dentition

  10. Mesiodens

  11. Spacing

  12. Early mixed dentition • Normal eruption pattern of incisors is in a smooth arc • Erupting canines should close small spaces • 2 mm or less • > 2 mm or if not enough space for laterals may want to close with 2 x 4 • Must know what movements you are making since could cause resorption of the lateral roots against the unerupted canines

  13. Ugly Duckling Stage

  14. initial KW 6-15-05 Initial

  15. Excessive anterior space >2 mm • Assess teeth present • Radiograph – check mesiodens, missing teeth • Occlusal radiograph – determine patency of the suture • Large frenum • Protruded incisors • Bolton tooth size discrepancy - small maxillary lateral and/or central incisors

  16. Mesiodens

  17. History of trauma

  18. Unerupted Central Incisors

  19. DR DOB 3/28/98 7/19/07 age 9 years 4 mo

  20. DR pano 9/10/08 age 10 y 6 mo

  21. 6/11/09 age 11y 3 mo 2 years later

  22. (9-23-2010) 12 years 6 months

  23. Patient G DOB 7-15-2000 (Pano 12-2-08) Age 8 years 5 mo

  24. 12-03-2009

  25. 12/03/2009

  26. 7/20/2010

  27. 7/20/2010

  28. 7/20/2010

  29. Incisor Protrusion

  30. Permanent dentition

  31. MB

  32. MB

  33. MB

  34. PW

  35. PW

  36. RH

  37. RH

  38. The smile tells it all!

  39. Comparison

  40. Previous thumb habit

  41. Frenum

  42. Missing laterals

  43. Treatment of generalized spacing Teeth are too small for arches • Increase tooth mass – crowns, implants • Decrease arch perimeter • Consolidate spaces • Tip teeth lingually • Distribute space distal to the canines

  44. Crowding

  45. Crowding

  46. Crowding • Tooth – jaw size discrepancy • Too large a tooth mass to align in smooth arc in supporting bone • Protrusion of teeth must be included in analysis of crowding • Curve of Spee • Take into consideration using Leeway space to correct molar relationship

  47. Age related crowding • Primary dentition • Rare to have crowding • Correction not proved to correct permanent crowding • Lack of space • Predictor of severe crowding of permanent dentition

  48. Mixed dentition • Small amount (1-2 mm) of mandibular anterior crowding • Common because of incisor liability • Does Leeway space take care of it? • Look at radiographs – are 2nd premolars smaller 2nd primary molar • Must hold space (LLA) close to the time the 2nd primary molars exfoliate • Can’t use that space to correct molar relationship

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