I want to straighten my crooked front teeth <Orthodontic case>

Hello.

I'm Dr. Son Su-min, an orthodontic specialist at Guardians Dental Myeongdong, who has been practicing for 20 years.

I want to straighten my crooked front teeth

The front teeth are the most visible area when talking or laughing.

Even a difference in the arrangement and angle of one tooth can be a long-standing concern for oneself.

The patient I'm introducing this time also mentioned that the arrangement of their front teeth was a concern during the initial consultation.

The examination revealed that the arrangement of the front teeth was uneven and some teeth were tilted.

In such cases, it's necessary to check not only the arrangement of the teeth but also the direction and degree of tilt of the front teeth.

Today, I'll explain what to check and the principles of treatment planning for front teeth orthodontics based on this case.

Photos of the patient at the time of visit

Can crooked front teeth be corrected without extraction?

To align overlapping teeth, space is needed for the teeth to fit.

In non-extraction orthodontics, it's crucial to determine how to secure this space.

If the space is insufficient and the front teeth are only expanded outward, the arrangement may be improved, but the front teeth may appear more protruded than before.

If the teeth are already tilted forward, this aspect needs to be examined more carefully.

Therefore, it's necessary to check whether non-extraction orthodontics is possible and to what extent the desired change can be achieved.

At this time, the important thing is the control of the front teeth's torque.

Low-torque bracket design is used to reduce the tendency of the front teeth to tilt forward.

However, the bracket alone does not determine the angle of the front teeth, and the selection of wires and space securing methods must be considered together to adjust the angle of the front teeth.

*When using low-torque brackets, individual differences may cause tooth movement pain, oral ulcers, or bracket detachment.

Why Orthodontic Treatment Was Needed

1. Misalignment of Upper and Lower Dental Arches The upper and lower teeth were not evenly aligned.

Especially in the front tooth area, the teeth overlapped or were crooked, resulting in an irregular arrangement that was noticeable when smiling.

1. Lower tooth #47 (second largest molar on the right side) tilted inward. Molars play an important role in chewing and breaking down food.

If the lower molars are tilted inward, it is difficult for them to properly interlock with the upper molars,

and the chewing force may not be evenly distributed.

Additionally, the tilted area may be difficult to clean with a toothbrush, making it harder to maintain oral hygiene. Therefore, it was necessary to correct both the front tooth arrangement and the tilt of the molars.

A lateral X-ray allows visualization of the angle of the upper and lower front teeth, lip position, and relationship of the jawbone.

A panoramic X-ray was used to examine the total number of teeth, the direction of the tooth roots, presence of wisdom teeth, and the condition of the alveolar bone.

Additionally, since it is difficult to determine the thickness of the alveolar bone on the side of the mouth or the possibility of outward movement using panoramic imaging, a CT scan was performed for further evaluation.

Orthodontic treatment involves moving teeth, so it is necessary to check not only the visible teeth but also the condition of the roots and surrounding tissues.

According to the examination results, the patient had slightly protruding upper and lower lips, and the front teeth were irregularly arranged.

However, it was not impossible to perform non-extraction orthodontics, considering the degree of overlapping teeth.

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When there is lip protrusion, non-extraction orthodontics may have limited changes in the lip profile because there is less space to move the front teeth backward compared to extraction orthodontics.

Therefore, we thoroughly explained how much improvement in lip protrusion could be expected along with tooth alignment before making a decision.

Treatment Process for Crooked Front Teeth

① Space Creation Plan First, confirm whether there is sufficient space behind the molars

Non-extraction orthodontics starts with identifying where space can be created for overlapping front teeth. If there is space behind the molars, it may be possible to move the entire dental arch backward to arrange the front teeth.

To move the dental arch backward, orthodontic appliances such as mini screws may be used.

If there is concern that the wisdom tooth may hinder posterior movement, removal of the wisdom tooth may also be considered.

However, there are limitations to how much the dental arch can be moved backward, and the actual amount of movement depends on the patient's oral condition, including the space behind the molars and the structure of the gum bone.

Whether the lip protrusion improves also depends on the amount the teeth move backward, as the change in tooth position does not always directly translate to lip changes. Therefore, it is necessary to consider the pre-treatment lip position, the angle of the front teeth, and the characteristics of the soft tissues together.

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② Adjusting the Angle of the Front Teeth Selecting brackets is part of the treatment planning

The front teeth are important not only for alignment but also for their angle.

Because the lips were slightly protruding,

the angle was adjusted during the alignment process to prevent the front teeth from tilting forward, and a plan was made to move them to a stable position considering the root direction.

③ Improving Molar Tilt In this patient, the second largest molar on the right side (tooth #47) was tilted toward the tongue, so it was necessary to examine both the tilt of this tooth and its occlusion with the upper molars.

If the molars are tilted inward, the contact relationship with the opposing teeth may change, potentially affecting the chewing function.

Using orthodontic wires, we adjusted the angle of the inwardly tilted molars and improved the position of the teeth, considering the occlusion with the upper molars.

In this process, we not only aligned the teeth but also examined the occlusal relationship between the upper and lower molars.

After Treatment

Before treatment, the upper front teeth were facing different directions, making the tooth line uneven.

After treatment, the irregular arrangement was corrected, and the front teeth are now naturally connected to the surrounding teeth.

After removing the orthodontic appliance, maintenance continues.

Since teeth can change position even after treatment, it is essential to use the retainer as instructed and regularly check the condition.

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Especially in cases like this patient, where the teeth were overlapping or rotated, there is a relatively strong tendency for the teeth to return to their original position after treatment.

Therefore, we instructed the patient to use both a fixed retainer attached to the inside of the front teeth and a removable retainer.

I believe it is essential to explain not only the changed arrangement but also how to maintain it after treatment.

If the retainer comes off or does not fit properly, please do not leave it as it is, but have it checked at the dental clinic.

In Conclusion

The desire to "make crooked front teeth straight" contains the expectation of wanting to change naturally, along with the concern about the appearance of the teeth when smiling.

I try to listen to these expectations concretely and connect them to the treatment direction, considering the conditions confirmed during the examination.

From those concerned about the arrangement of their front teeth to those with multiple problems such as protrusion, narrow dental arch, or open bite, the necessary diagnosis and treatment plan differ.

Looking at the clinical cases recorded on the Guardians Dental Myeongdong blog, you can see what problems existed initially and what was considered when planning the treatment.

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If you are considering non-extraction orthodontic treatment while looking for a dental clinic near Myeongdong Station, please make sure to receive a thorough explanation of the space needed for your teeth, the expected position of your front teeth, and the reason for the proposed treatment.

I hope today's story has been helpful to those who are concerned about crooked front teeth, and I conclude this article.

• Dr. Soo-min Son -

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NAutomatically translated from the Korean post on our Naver blog. Read the original ↗