Treatment of Crowding in Adults

Different treatment options for treatment of crooked teeth in adults are based on many factors including:

  • Severity of space deficiency (mild, moderate or severe).
  • Biologic age of the patient.
  • Other limitations such as quality of gum tissues.
  • Lip form and facial harmony.
  • Body response to orthodontic forces.

Severity of Space Deficiency

Space deficiency has been categorized in three levels of mild, moderate and severe. Mild crowding cases could be treated without any permanent teeth extraction while severe crowding cases most probably need extraction.

In moderate cases, the orthodontist/ dentist may start treatment trying to open up space using different techniques such as expansion (RME: Rapid Maxillary Expansion), IPR (Inter-Proximal Reduction) and monitoring the body response. After about 6 months, the Orthodontist / dentist reevaluates the treatment progress and will have another discussion with patient/patient’s parents in order to finalize the treatment plan. At this point, extraction of 1-4 permanent teeth might be considered. This conservative approach to treatment planning is called “Therapeutic Diagnosis” which is standard of care.

Biologic Age

Biologic or developmental age of the patient is another decisive factor in treatment planning. As we discussed in previous section many well-treated crowding in childhood could be managed without extraction in their second treatment phase after the age of 12. The younger the patient is when they start the treatment, the better while it never means that orthodontic treatment is not possible in older ages. My oldest patient, Anne- Marie, was 79 year old!

Gum Tissues

Healthy gum tissues allow your orthodontist / dentist to consider non-extraction treatment. Poor oral hygiene and severe gum recession might reduce the chance of successful non-extraction treatments.

Lip Form and Facial Harmony

Between age 7 to 12 years kids have both baby and adult teeth in (mixed dentition) and monitoring the eruption pattern of adult permanent is crucial. At the same ages many skeletal deformities of jaws could be managed with a range orthodontic treatments called growth modification, which will be discussed under “overbite”, “underbite” and “overjet” treatments.