Author(s): Timothy Foley DDS MCID, Gerald Z Wright DDS MSD, Sergio Weinberger DDS MCID
Journal: Journal of Dentistry for Children
Month, Year: May-June 1996
Major topic: discussion of different philosophies and techniques concerning lower incisor crowding
Type of Article: Literature Review
Findings: There is a strong correlation between crowding of the lower incisors and eventual crowding of the permanent mandibular dentition. Most commonly the lateral incisors erupt lingually, pushing the centrals labially and the canines posteriorly or not at all which can complicate eventual orthodontic treatment of the whole arch. By dental age 8.5 years, 85% and 100% of mandibualr intercanine distance is present in males and females respectively. It was noted that an intercanine distance of 28mm or more showed very little risk of crowding and no spontaneous resolution of crowding will occur after complete eruption of the laterals. The permanent teeth are typically 6mm larger than the primary teeth, this difference is called ‘incisor liability’. If there is less than 2 mm of crowding, it is recommended that you simply observe; these cases are usually self evident. With 3-4 mm of crowding, discing is recommended and is completed with or without local anesthesia using a 169L bur in a high speed handpiece, followed by a composite polisher. For 4-9mm of crowding, primary canine extraction is recommended to allow the incisors to unravel. This can also cause a decreased arch length and deepening of the bite, so the use of a horseshoe LHA is recommended. Crowding of greater than 10mm will typically require extraction and referral.
Key points/Summary: There are many ways to deal with lower incisor crowding in the mixed dentition and it is essential to determine the severity before deciding on a treatment plan. One should not perform extractions if you are unable to complete the patients treatment.
Assessment of article: Good stuff.
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