Crowding, or tooth size arch length deficiency, is one of the most common reasons that people seek orthodontic treatment for themselves or their children.
As permanent mandibular anterior teeth erupt a primary tooth may become over-retained leading to a double row of “shark teeth”, causing parents a great deal of concern.
While this may be easily remedied with removal of the over-retained primary tooth, some other space management issues are not as straightforward.
What about crowding that is more significant? Should you treat all of these patients with early interceptive orthodontic treatment or do you wait until the permanent dentition? If you are to treat them at an early stage, what is the treatment? What happens if you wait?
It is important to understand the pattern of growth and development of the untreated arch as it transitions from the primary to the permanent dentition.
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In a normal maxillary and mandibular arch there are primate spaces.
It is well established that 1-2 mm of lower incisor crowding is normal before closure of the canine primate space, otherwise known as the incisor liability.
by Bruno L. Vendittelli, DDS, D. ORTHO, FRCD(C); Tracey J. Hendler, DDS, D. Ortho, MSD, FRCD(C)