How to straighten teeth, the complete patient's guide

By Dr. George Ghidrai

Crowded teeth are one of the most common orthodontic problems.

Read this complete patient's guide on how to straighten teeth and find out which treatment option might work for you.

Most often, when your teeth become crowded, it’s due to lack of space for all of the teeth to properly fit. This condition is also known as teeth overcrowding.

What are the causes of teeth overcrowding ?

Usually, teeth overcrowding occurs when your teeth and jaw size do not have a harmonious relationship. If your teeth are too large compared to the size of your jaw, they will not be able to fit in the space available. These are generally inherited traits just as the color of your eyes or the size of your hands.

crowded teeth on the upper arch

Another important cause can be the early (or late) loss of primary teeth, which can result in an improper eruption of definitive teeth. For example, if a baby tooth is lost prematurely, teeth around the gap tend to move into the empty space, causing the permanent tooth to erupt in a crooked position. In such cases, space maintainers are good solutions for holding adjacent teeth in place.

What problems come with crowded teeth ?

Crowded teeth make teeth cleaning more of a challenge, as it is hard to properly eliminate all of the plaque on and between the teeth. Consequently, the risk of tooth decay, gingivitis, and periodontal disease increases.

Moreover, it makes people feel self-conscious about their appearance and affect their self-esteem.

Treatment options for crowded teeth

Correcting your crowded teeth is critical for a healthy mouth. A proper treatment will give you straighter teeth, a better bite, a more attractive smile, and healthier teeth and gums.

In most cases, you will be referred to a specialized orthodontist, although most dentists are trained to treat minor orthodontic problems. Your dentist and orthodontist will guide you in making the best choice of orthodontic treatment based on your unique situation and needs.

Types of orthodontic correction for overcrowded teeth

• Dental braces

  Braces are the most common type of orthodontic correction. Traditional dental braces are used to straighten teeth affected by crowding, protrusions, alignment issues, irregular spacing and/or crookedness.

  Braces can be fixed or removable:

  • Fixed braces are worn all the time and can only be removed by your dentist.
  • Removable braces can be taken out of your mouth; however, orthodontists will advise against repeated, long-term removal of the appliance for optimal results.

  Braces consist of brackets and arch-wires placed across the teeth, with elastic ties used to secure them. Brackets are attached to the teeth with light-cured dental cement, which can be color-matched to the shade of the teeth.

  dental braces

  The flexible arch wires that are attached to the brackets apply constant pressure, which helps to reposition the teeth based on the treatment plan. The brackets can be metal, ceramic, or composite:

  • metal braces are the strongest and work best for severe crowding or complex bite problems
  • ceramic brackets are slightly weaker, but the fact they are tooth-colored makes them more attractive to many patients
  • in some cases, patients can have metal brackets attached to the back of the teeth in order to appear less noticeable

  braces with ceramic brackets

  
  

  Who is a candidate for dental braces ?

  Dental braces are generally used for people who need to correct teeth that are crowded, crooked, protruding or out of alignment. Children younger than eight typically are not candidates for dental braces because their permanent teeth have not had long enough to develop.

  A very important factor is general oral health. People with dental conditions such as tooth decay, gum disease or periodontal disease need to correct these issues before orthodontics can be considered. Proper oral hygiene measures are also required.

  Treatment procedure

  If the overcrowding is severe, the removal of one or more teeth may be required to create additional space. However, most practitioners agree that the ideal way to correct crowded teeth is without pulling any teeth.

  During the first appointment, impressions, photos, and X-rays of the teeth are taken and a proper treatment plan is devised. The actual placement of brackets and arch wires can take 10 to 20 minutes.

  Regular appointments are needed to replace the elastic bands and adjust the braces. Patients may experience tightness and mild discomfort after adjustments.

  The length of time a patient will have to wear orthodontic braces depends on the initial condition and treatment plan. The more severe the overcrowding, and the older the patient, the longer the treatment period. Normally, treatment duration is between one and three years.

  After the treatment is over, patients need to wear a retainer to hold the teeth in their new positions. A typical length to wear a retainer is one year, but this can vary from case to case.

  
  

• Invisalign

  Invisalign is a popular brand of clear aligners and alternative to traditional dental braces. Invisalign was introduced by Align Technologies in 1999 and has attracted a large number of orthodontic patients ever since.

  Invisalign consists of a series of clear (invisible), customized removable aligners. Each set of aligners is worn for approximately two weeks and then replaced with the next set. As patients progress through the series of aligners, teeth will begin moving, little by little, gradually towards the projected final position.

  Invisalign

  The clear aligners are computer-manufactured plastic appliances that straighten the teeth without compromising smile aesthetics. Invisalign is removable and custom-made for every patient. The aligners must be removed in order to eat, drink, brush and floss, but should be in place a minimum of 20 hours per day.

  Who is a candidate ?

  Currently, Invisalign is approved for use in adults and teenagers with fully erupted permanent teeth. For teenagers, there are specially designed aligners called Invisalign Teen.

  Although Invisalign is more limited in terms of treating serious orthodontic cases, it generally works well for overcrowding if the condition is not extremely severe.

  As with dental braces, general oral health concerns like gum disease and tooth decay must first be managed before treatment can be considered.

  Treatment procedure

  During an initial consultation, impressions and photos are taken of the teeth. These are sent to Align’s dental lab where CAD/CAM technology is used to fabricate the aligners.

  New aligners are provided over the course of treatment to continually move the teeth to the desired position. Aligners are replaced during checkup visits that are spaced between two and four weeks apart.

  The duration of treatment varies: typically, 20 to 30 aligner variations are needed to accommodate most cases. Most adults complete treatment within one year.

  After the treatment, patients should wear retainers for 8 to 12 months; otherwise, the newly aligned teeth can gradually revert back towards their initial position. Align Technologies also provides Vivera retainers that are made with the same technology as Invisalign aligners.

Dental veneers and crowding

Porcelain veneers can be another option to treat crowded teeth. Dental veneers offer highly aesthetic results, but pre-planning is very important. Here are some issues about this treatment option:

• Veneers work best in case of moderate crowding and might not be a good option when younger patients are involved.

• When treating crowded teeth, there is a need to prepare some of the teeth more in order to aesthetically align all veneers. This means removing a variable amount of the tooth's original healthy structure.

• When the crowding is more severe, you may need 8 or 10 veneers to achieve a beautiful complete result. The procedure may take multiple office visits and entail a higher cost.

• In some cases, dental veneers can work very well in combination with other techniques. For example, an ideal treatment might be Invisalign (or dental braces) followed by veneers. Of course, each case will be evaluated based on the clinical situation and patient's needs.

Dentofacial Orthopedics

If you have extreme crowding, bone structure may be inadequate to hold a great final result. Orthodontics focuses on the alignment of the teeth; however, the teeth are not the only part of the face and mouth that can cause trouble and unwanted misalignments.

Dentofacial Orthopedics helps to guide facial bone growth through the use of orthopedic appliances for the jaw and face. Most orthodontists are also specialized in Dentofacial Orthopedics.

Conclusions

Orthodontic treatments have greatly improved over the last years with a wave of new products and technologies. A proper orthodontic treatment should address both dental arches and the bite. The bite, or the way your teeth meet together, is critical for a comfortable and stable situation.

Therefore, when you want to straighten teeth affected by overcrowding on the upper arch, you should consider that there may be some need for treatment to correct the lower arch and the bite as well.