Effects of crowding in the lower anterior segment–a risk evaluation depending upon the degree of crowding. J Orofac Orthop. 2004 Jan;65(1):13-25.
Patients with greater than 3mm of crowding experience an increased risk of periodontal disease, and this tends to worsen as the patient gets older.
AIM: The aim of this study was to investigate the extent to which the anterior segment is at risk of developing disease under the influence of different types of anterior crowding and whether the degree of crowding correlates with a potential risk. PATIENTS AND METHOD: A clinical examination and cast analysis taking special account of the age and gender of 125 adult patients (63 women, 62 men) were used to determine the clinical degree of abrasion and the individual incidence of tooth infractions, tooth fractures, caries, gingivitis, periodontitis and gingival recessions (WHO-OHS method), with any correlation between the incidence of disease and the respectively calculated crowding being recorded. The diagnosis of crowding was based on the segmented arch analysis proposed by Lundstrom [29]. Besides evaluating the total collective, a separate evaluation was performed for the age groups 18-34 years (n = 63) and > or = 35 years (n = 62). RESULTS: No gender-related differences in crowding were determined. Patients > or = 35 years showed significantly more crowding. An age-related increase in disease was recorded. The degree of abrasion and the individual incidence of caries did not correlate with the degree of crowding. By contrast, differences in the degree of crowding were determined in the total collective for tooth infractions (p < 0.001), tooth fractures (p = 0.004), gingival bleeding (p = 0.022), shallow periodontal pockets (p < 0.001), and gingival recessions > 3.5 mm (p < 0.001). The degree of crowding was found to correlate in the younger patients with tooth infractions (p < 0.017) and tooth fractures (p = 0.036), and in the older patients with shallow periodontal pockets (p < 0.001) and gingival recessions > 3.5 mm (p < 0.001). The incidences of disease in virtually physiologic cases of crowding (crowding < or = 2 mm, n = 31) were compared with those recorded in extreme cases of crowding (crowding > or = 5 mm, n = 30). All cases of crowding > or = 5 mm were subject to gingivitis and tooth infractions, and shallow periodontal pockets occurred three times more often and gingival recession > 3.5 mm twelve times more often. The presence of deep periodontal pockets could not be attributed to the degree of crowding. CONCLUSION: With respect to the multifactorial etiology underlying the risk of disease of the dental hard tissue and the periodontal tissues, anterior crowding > 3 mm (threshold value) as an individual “host factor” represents a cumulative risk potential for chronic inflammatory processes whose consequences are manifest only at a higher age. This gives rise to a medical treatment indication within the framework of preventive treatment strategies.
Chung CH, Vanarsdall RL, Cavalcanti EA, Baldinger JS, Lai CH.
Comparison of microbial composition in the subgingival plaque of adult crowded versus non-crowded dental regions. Int J Adult Orthodon Orthognath Surg. 2000 Winter;15(4):321-30.
This study reveals that more plaque (organized colonies of bacteria) accumulated in crowded areas of the mouth; and more species of periodontopathogens (more nasty bugs) were present in the subgingival plaque of crowded regions.
It has been reported in the literature that certain species of bacteria (periodontopathogens) present in the subgingival plaque are associated with destructive periodontal disease. The purpose of this study was to investigate and compare the presence and proportional distribution of periodontopathogens in the subgingival plaque of adult crowded versus non-crowded dental regions. Thirty adult patients with anterior dental crowding were selected from the Orthodontic Clinic of the University of Pennsylvania. After orthodontic records were taken and the periodontal examination was performed, subgingival plaque samples were collected from crowded (experimental) and contralateral non-crowded regions (control) of each patient. The presence of 9 periodontopathic species, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, Campylobacter rectus, Capnocytophaga species, Fusobacterium species, Peptostreptococcus micros, Porphyromonas gingivalis, and Bacteroides forsythus, was determined using culture and immunofluorescence techniques. The bacterial morphotype was also determined by the use of dark-field microscopy. It was found that supragingival plaque accumulation in crowded regions was significantly greater than in non-crowded regions. Analysis of the bacteria showed that the samples from crowded regions consistently contained more species of periodontopathogens than the samples from non-crowded regions. Morphologically, more spirochetes and motile rods were present in the crowded-region samples. In terms of the presence of individual periodontopathogens, Fusobacterium species, Capnocytophaga species, C rectus, and P micros were significantly more common in the crowded samples than in the non-crowded samples. It was concluded that: (1) more plaque accumulated in crowded areas; (2) more species of periodontopathogens were present in the subgingival plaque of crowded regions; (3) morphologically, more spirochetes and motile rods were present in crowded areas; and (4) Fusobacterium species, Capnocytophaga species, C rectus, and P micros were present more often in crowded areas than in non-crowded areas (P < 0.05).
Periodontal relevance of anterior crowding. J Orofac Orthop. 2000;61(2):69-79.
The following positive periodontal effects can be expected from correction of orthodontic crowding: better access for oral hygiene, improved morphology of soft and hard periodontal tissues; simplified mechanical and surgical therapy that should improve the chances of healing.
The periodontal relevance of anterior and posterior crowding concerns 3 main aspects: 1. oral hygiene/plaque retention, 2. altered topography of gingiva, septum and orofacial alveolar bone and 3. periodontal therapy (scaling, root planing, regenerative approaches). These aspects are discussed with regard to the literature and to the author’s own clinical and histological findings. Present-day knowledge suggests that the following positive periodontal effects can be expected from correction of orthodontic crowding: better access for oral hygiene, improved morphology of soft and hard periodontal tissues; future research has to substantiate the value of this benefit, simplified mechanical and surgical therapy (scaling, root planing, curettage), more favorable conditions for periodontal regeneration.
Alveolar bone loss and crowding in adult periodontal patients. Community Dent Oral Epidemiol. 1989 Feb;17(1):47-51.
This indicates that in periodontal patients local crowding and tooth angulation predisposes to increased bone loss.
The present study aimed to examine whether local crowding and tooth angulation in the mandibular incisor region led to alveolar bone loss in patients with moderate periodontal disease. The sample comprised 27 patients from the Department of Periodontology aged 29-57 yr. Mesiodistal tooth angulation and crowding, defined as an overlap of 2 mm or more, were assessed from dental casts. Alveolar bone loss was assessed from intraoral standardized paralleling radiographs by two methods, the absolute bone level (ABL), recorded from the cementoenamel junction, and the relative bone level (RBL), a new measure, expressing the bone level relative to the two adjacent interradicular crests. Contralateral sites were used as controls. A significant difference in bone level was found between crowded and non-crowded sites by both methods (-1.7 mm, P less than 0.001). This indicates that in periodontal patients local crowding and tooth angulation predisposes to increased bone loss. Analysis of the correlations between tooth angulations and the two measures of bone loss indicated that the RBL value is a more sensitive measure of localized bone loss.
Ainamo, J.
Relationship between malalignment of the teeth and periodontal disease J. Periodontology, 45(1), 1974, 43-9.
Malalignment does not enhance periodontal breakdown but it does decrease the effect of average oral hygiene measures.
Aim: to compare the periodontal status of maxillary lateral incisors and mandibular second premolars, contrasting those that presented as being malaligned with those that were not. Sample: 154 army recruits age 19-22 years of age.
(4316 fully erupted teeth) In the maxillary anterior region, which had been fairly well brushed by the subjects, both the degree of oral cleanliness and the extent of periodontal disease were worse around the malaligned than around the aligned teeth. In the premolar areas, the difference was less marked and it became nonexistent in the molar regions. Malalignment does not enhance periodontal breakdown but it does decrease the effect of average oral hygiene measures. Interestingly, if the hygiene was either excellent or poor, there was no significant difference due to the malalignment.
de Oliveira CM, Sheiham A.
The relationship between normative orthodontic treatment need and oral health-related quality of life. Community Dent Oral Epidemiol. 2003 Dec;31(6):426-36.
A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents’ oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents’ perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.
The face–an orthodontic perspective. Aust Orthod J. 1991 Mar;12(1):13-22.
Orthodontic treatment has the capacity of effecting many changes to patients. For better or worse, our society places a high value on physical beauty, and straight teeth make a positive contribution to facial attractiveness. We must think of our patients more as human faces rather than a set of malaligned teeth. Along with our capability of improving facial features we have an equal responsibility to avoid a deterioration. Providing basic guidelines are followed in patient assessment, treatment planning and treatment execution, orthodontic services can provide an enhancement to the faces and lives of our patients.
Northway Orthodontics