Correction of Crowding using Conservative Treatment Approach

Crowding being the most common chief complaint of the patients seeking orthodontic treatment has multiple treatment options. Thus the orthodontist has to choose wisely amongst the options according to the individual patient need. The present case report is about the correction of crowding using the combination of extraction and non-extraction modality. The upper arch was treated by expansion and the lower arch was treated using extraction of a single incisor.


IntroductIon
In the plethora of orthodontic chief complaints, crowding The radiographic examination presented with skeletal Class I (Figure 3a-3b) with average growth pattern and proclined upper and lower incisors (Table 1).Bolton's model analysis showed mandibular teeth excess in both overall and anterior ratio calculations and Pont's index showed the requirement of expansion in both premolar and molar regions.After the initial wire, 0.016×0.022"NiTi wire followed by 019×25" NiTi were placed for the sequential leveling (Fig. 6a-6e).Stainless steel wire of 019×025" in upper and lower arch was used for final leveling.During the leveling phase, canines moved distal with the lace back force and the space available in the anterior region was utilized for the intrusion of the upper incisors.The upper arch was segmented into anterior and posterior segments and 019×025" sectional stainless steel wires were placed in both the segments.
Connecticut Intrusion Arch (CIA) wire was tied to the anterior segment for the intrusion of the upper incisor (Fig. 7a-7c).NiTI palatal expander was retained until the heavy stainless steel wire was used.Then the canine intrusion was done using utility arch (Fig. 8).
In the lower anterior region the space obtained by the expansion was not sufficient to bring about the alignment of lower incisors so it was decided to extract lower right central incisor as it was periodontally compromised too..014"auxiliary NiTi wire was placed and the left lateral incisor was aligned (Fig. 6f).Although lower incisor extraction for the orthodontic purpose is rarity, certain cases can sustain the loss of a lower incisor and still can produce a good occlusion and pleasing facial esthetics. 2,3,5,6The present case is a good example of such treatment modality.The extracted lower incisor was periodontally compromised since the beginning, the etiology of which was probably the deep bite with constant occlusal trauma and poor oral hygiene.OJN and proclination have etched their importance by being in the top of the list.Diagnosis and treatment planning in such cases are challenging as well as demanding.Diagnosis in the form of model analysis, radiographic analysis, soft tissue analysis; all have their share of contribution in deciding the treatment plan.However, the most valid treatment option is at the discretion of the patient's choice and orthodontist can merely guide them in the direction of what is good for them.One of the most popular non-extraction treatment modalities is the arch expansion and by utilizing the expansion space one can correct the crowding.With the advent of temperature activated wires, we are equipped with efficient appliance like NiTi palatal expander, which can produce the efficient physiological expansion. 1Apart from the conventional extraction protocol, one can think of single lower incisor extraction to bring about the correction without compromising the ideal occlusion. 2,3The present article is a case report of one such case of crowding treated using the combination of extraction and non-extraction treatment modality.were moderately crowded and the lower anterior teeth were severely crowded with a lingually erupted lateral incisor on left side.Transverse asymmetry was seen in upper arch and the arch was narrow in the premolar region.Lower dental midline was shifted to left by 3 mm.Gingival recession was seen in the lower left central incisor region.The oral hygiene status was poor.It was a typical case of arch length-arch width-tooth material discrepancy.The upper incisors were traumatized.

diagnosis
Angle's Class I dental malocclusion with increased overjet and overbite with severe lower anterior crowding based on skeletal Class I jaw bases, with average growth pattern and proclined upper incisors.
To treat traumatic upper incisors 2. To relieve crowding of upper and lower arches 3. To expand constricted arches 4. To establish normal overjet and overbite relation 5. To establish proper inclination of upper incisors.

Figure
Figure 16a-16b: comparison of pre-treatment and post-expansion maxillary occlusal view