Treatment Options for Management of Mandibular Anterior Crowding in Mixed Dentition

Abstract

An abundance of published reports deal with incisor crowding and post orthodontic relapse. While the causes of incisor crowding seem multifactorial, one viewpoint of reducing post incisor relapse involves early intervention. Fixed orthodontic treatment begun with well-aligned incisors can yield more stable results than cases beginning with crowded or rotated teeth, The assessment of mandibular crowding following the eruption of lateral incisors is an important time in the early mixed dentition. It is the time when space-crowding for the entire dentition is predicted. It is also a time when some lower incisors can be guided into more favorable positions. Since pediatric dentists see most children in the 6 to 8 year age group, by giving thoughtful attention to the early mixed dentition stage, it is possible to improve dental health and assist good orthodontic outcomes for many children. This paper provides a brief review of treatment options for management of mandibular anterior crowding in mixed dentition KEYWORDS: Mandibular anterior crowding, Mixed dentition, early intervention. INTRODUCTION: The nomenclature committee of the American Association of Orthodontics in 1950 has defined "Ideal occlusion" as "Basically a Myth and a Figment of the imagination". Ideal occlusion does not always occur, and variations from an idealized occlusal scheme are quite compatible with normal function and esthetics. It has been noted by Tweed that children with the loveliest faces had lower incisors upright over the basal bone and those with facial imbalances that ranged from mild to moderate had procumbent or crowded lower incisors. Fixed orthodontic treatment begun with well-aligned incisors can yield more stable results than cases beginning with crowded or rotated teeth. Crowding may be primary, secondary or tertiary crowding. 1 The need for correction is both aesthetics and functional. The eruption of teeth into a crowded environment predisposes to premature loss of attachment on the adjacent teeth as well as downward progression of sub gingival plaque that causes more damage. 2 Much misunderstanding of preventive and interceptive orthodontics stems from the implication, that "early" treatment of malocclusion in children precludes the need for later orthodontic treatment. As facial and dental development continues throughout childhood and adolescence the long-term impact of early treatment may not be predicted. Yet early intervention may help develop a normal occlusion and facial harmony. 3 The late mixed dentition stage of development is a favorable time to start treatment to resolve crowding. The clinical implication of this is that if extraction treatment is indicated, the first premolars are available. If non-extraction treatment is preferable, arch length preservation can provide space for alignment in approximate 75% of all patients with crowding. 4