Treatment of Crowded Cases Using Physiologically Adaptive Mechanics

The following cases demonstrate how facial treatment planning should be the primary focus. These patients are obviously very crowded. Are the bones of the mid-face and body of the mandible smaller than normal or has there been an adaptation of the alveolar process to abnormal muscle forces impacting arch development?

Several years ago, extractions would have been the treatment plan without hesitation. But with improvements in technique and technology, patients can now be treatment planned and evaluated with the long-term implications on both profile (lateral view) and arch width and facial support (frontal view).

In viewing these cases, please note that great care has been given to using treatment forces that are just high enough to stimulate cellular activity without overpowering the periodontium and orofacial muscular complex. If the optimal forces are maintained, the alveolar bone and tissue can be moved with teeth.

• Class I Nonextraction Youth
  Patient with severe crowding and flat profile.

• Class I Nonextraction Adult
  Patient with severe crowding and flat profile with tissue-grafting indication.

• Class I Nonextraction Youth
  Patient with severe crowding and very flat profile.

• Class I Nonextraction Adult
  Patient with open bite, posterior crossbite and deep, narrow palate.

• Class I Nonextraction Youth
  Patient with open bite, posterior crossbite and narrow palate.

• Class I, Class II Youth
  Tooth guidance case with severe crowding and unilateral crossbite.