Crowding Treatments

Mild crowding before and after Invisalign

Mild crowding corrected with Invisalign in 18 months. Actual patient of Dr. Viechnicki.

Crowding is a lack of space for all of the teeth to fit normally in the mouth.

Crowding tends to get worse with age if left untreated beyond age 11. It occurs because of genetic and environmental reasons resulting in one or several of the following:

  • Small jaw size
  • Large tooth size
  • Extra teeth

(For a summary of what causes crowding, read this guide.)

Treatment options range from increasing the size of the jaws, reducing the size of the teeth and reducing the number of teeth.

1. Palatal Expander

Severe crowding before and after braces and expander

Severe crowding corrected with a palatal expander followed by full braces for 26 months. Actual patient of Dr. Viechnicki.

Advantages:

  • Increases width of upper jaw
  • Increases width of smile

Disadvantages:

  • Does not affect lower jaw size
  • Additional appliance
  • Requires nightly activation
  • Requires jaw surgery in ages 13+

2. Maintain Space

Severe crowding before and after space maintainer

Severe crowding corrected with a space maintainer before all the baby teeth fell out. Note 10 teeth before vs. 12 teeth after. Actual patient of Dr. Viechnicki.

Advantages:

  • Restricts forward movement of back teeth
  • Best option for 80% of children with crowding

Disadvantages:

  • Requires starting prior to all permanent teeth erupting
  • Adds 6 to 18 months of treatment before braces

3. Broaden Arches

Mild crowding before and after braces

Mild crowding corrected with full braces for 24 months. Actual patient of Dr. Viechnicki.

Advantages:

  • Increases width of smile

Disadvantages:

  • Lips may not close around teeth
  • Gum recession if teeth moved outside of bone
  • High level of cooperation with retainers

Additional examples:

Mild crowding before and after braces

Mild crowding corrected with upper braces in 7 months. Actual patient of Dr. Viechnicki.

4. Reduce Tooth Size

Moderate crowding before and after braces

Moderate crowding corrected with full braces in 24 months. Actual patient of Dr. Viechnicki.

“Slenderizing” can give teeth the space they need to align.

Advantages:

  • Compensate for mismatched tooth sizes

Disadvantages:

  • Removal of up to 0.3mm of enamel on the sides of teeth
  • Sensitivity of teeth possible

Example:

5. Remove Teeth

Severe crowding before and after braces

Severe crowding corrected with full braces and removal of teeth in 24 months. Actual patient of Dr. Viechnicki.

Advantages:

  • Better result than broadening arches in severe crowding

Disadvantages:

  • Requires removal of teeth
  • Face may look “ditched in” if front teeth pulled too far back

Examples: