Correcting Lower Anterior Crowding

How often have you had patients come in and ask if you could just straighten one tooth to give them a better-looking smile? It’s a fact that most adults are unwilling to undergo complete orthodontic care. Yet, many of them would love you to do something to improve the way their teeth look. Fortunately, there are many minor tooth movement procedures that you can do that will give your patients the esthetic result they are looking to achieve. In this, and succeeding issues of Aurum Ceramic/Classic News, we will explore some of the more common orthodontic procedures used every day to help you give your patients the beautiful smile they want.

One of the most common complaints that adult patients ask their dentist about is crowding of the lower anteriors. Correcting this problem can often be easy if you take the time to carefully evaluate the severity of the crowding and the relationship of the upper and lower anteriors to each other in occlusion.

In the clinical case shown here, a minimum amount of lower anterior crowding occurred because the patient did not wear his final retainers after completing his orthodontic treatment. Although this crowding may not appear serious, once the interproximal contact points have been broken, the drifting and crowding will only get worse over time if it is left untreated.

When crowding of the lower anteriors is 11/2 mm or less, it can usually be corrected by recontouring the interproximal enamel of each tooth from cuspid to cuspid and placing a retainer called a Spring Hawley retainer. To accomplish this, you must first send an accurate set of upper and lower dental casts to the lab. The lab will then reset the lower anteriors aligning them into their ideal position. The
Spring Hawley retainer is then made to this pre-set ideal position. On the day of delivery of the appliance, and not before, the enamel re-contouring is done. This will allow the teeth to be guided into the ideal position pre-set by the appliance. If the patient’s bite relationship is too deep and the lower anteriors already make contact with the upper anteriors, you will not be able to move them, regardless of the amount of re-contouring performed or force exerted by the appliance. So it is critical that you evaluate the relationship of the upper and lower anteriors to each other prior to selecting this treatment approach.

In this case, however, there was enough clearance with the opposing arch to allow the teeth to move back into alignment. Once this was accomplished, an indirect matrix was used to bond a retention wire to each individual tooth. This retainer is called an E-Z Bond.

Lower anterior crowding often re-occurs after orthodontic treatment.		Lab resets the lower anterior teeth in their orthodontic treatment.
The Spring Hawley Retainer made to ideal anterior position.		Occlusal view of the Spring Hawley retainer in place.
Post treatment - lower anteriors re-aligned and etched for placement of EZ Bond.		Placement of a final retainer called the EZ Bond.