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Case report 
Orthodontic treatment of mandibular anterior crowding 

MK Alam  
Abstract 
This paper concerns orthodontic treatment of a 17 years old Bangladeshi female with a class I 
malocclusion along with anterior crowding in the mandibular arch. Orthodontic treatment 
carried out with preadjusted Roth type (018 slot) fixed brackets with labial flaring of the 
mandibular incisors to accomplish the treatment. The esthetics and occlusion were 
maintained after retention. 
 
Key words: Crowding, malocclusion, labial flaring.
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Introduction  
Crowding is a quantitative discrepancy 
between the clinical length of the dental 
arch and the sum of the mesiodistal widths 
of the teeth1. While crowding may occur in 
the anterior or posterior areas of either 
arch, adults are most likely to have 
crowding in the mandibular anterior area2. 
Crowding is the lack of space for all the 
teeth to fit normally within the jaws. The 
teeth may be twisted or displaced3. 
Crowding occurs when there is 
disharmony in the tooth to jaw size 
relationship or when the teeth are larger 
than the available space1-2. Crowding can 
be caused by improper eruption of teeth 
and early or late loss of primary teeth. 
 

 
Crowding should be corrected because it can:  

a. prevent proper cleaning of all the 
surfaces of your teeth  
b. cause dental decay increase  
c. the chances of gum disease prevent 
proper functioning of teeth 
d. prevent proper functioning of teeth  
e. make your smile less attractive 
 
Treatment object 
Braces are a simple yet effective form of 
orthodontic treatment and can generally be 
used to remedy crowding of the teeth. 
While many people are hesitant to get 
braces because of their cosmetic nature 
and effect on social life, the results 
generally outweigh the temporary effect.

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Corresponds to: 

Dr. Mohammad Khursheed Alam, Assistant Professor and Head, Department of Orthodontics, 

Bangladesh Dental College. Road 14 A (New) Dhanmondi Residential Area, Dhaka, Bangladesh 

Email: dralam@gmail.com

BANGLADESH JOURNAL OF MEDICAL SCIENCE Volume-8 No. 1-2; January-March 2009 

 33



Alam MK 

Treatment objectives were to: 
1. Level and align the arches. 
2. Correct mandibular arch length 

discrepancies. 
3. Maintain Class I canine and 

molar relationships. 
4. Maintain dental and facial 

midline. 
5. Normalize the overbite and 

overjet. 
6. Improve the gingival condition. 
7. Maintain the profile. 
8. Achieve long-term stability.  

 
Treatment progress 
The mandibular arch needed to be 
leveled to correct misalignments, 
considering that the patient had 
completed growth. The mandibular arch 
had 3.5 mm arch length discrepancy 
(Fig-1) and overjet was 4 mm. To 
normalize the overjet and 
misalignments, the best treatment 
option is 1.75 mm labial flaring of 
mandibular incisors. Treatment was 
started in the mandibular arch with 
preadjusted Roth type (018 slot) 
brackets. A 0.014 and 0.016 inch nitinol 
arch was used for leveling and labial 
flaring of the mandibular incisors. After 
labial flaring and leveling of the 
mandibular incisors, a 0.016 × 0.022 
inch nitinol arch was inserted for the 
final alignment and detailing. Lastly a 
0.016 × 0.022 inch stainless steel arch 
wire was used for the alignment 
stabilization.            

An ideal occlusion was obtained after 5 
months active fixed orthodontic 
treatment, and all the appliances were 
removed. Fixed lingual type retainer 
was set on the lingual surface of the 
mandibular anteriors prepared by 
coaxial wire and set by light cure 
composite (Fig-1). 
 
Discussion  
Tooth crowding is a common 
orthodontic problem1-2. It is basically 
what it sounds like, the teeth are too 
crowded together, and become crooked. 
Peck and Peck4 reported a clear 
relationship between the shape of 
mandibular incisors and their 
irregularity, Smith5 found little 
correlation between the shape of 
mandibular incisors and the degree of 
the teeth. There is some disagreement 
regarding the role of incisor crowding 
in periodontal disease, but there is no 
dispute about the improvement in oral 
esthetics that can be achieved by 
alignment of the teeth. Although 
treatment of mandibular anterior 
crowding must be individualized, 
clinicians should always keep in mind 
the high potential for relapse as they 
consider esthetics, treatment mechanics, 
periodontal conditions, and ultimate 
retention. Crooked teeth are generally 
not considered attractive and it is not an 
optimal occlusion so orthodontic 
treatment    is    required   to    fix    this  
orthodontic problem1-2. 

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Orthodontic treatment of mandibular anterior crowding

Treatment will not only help create a 
beautiful smile but will help oral health as 
well. There are a number of different 
possibilities for dental treatment of tooth 
crowding depending on the severity of the 
case; different situations should be treated 
differently. Extra space can be created by 
expansion of the arches or extraction of 
teeth or stripping or labial flaring. Every 

treatment option has its own merits and 
demerits. On orthodontist’s point of view, 
present case was treated best by labial 
flaring. Once space is created, braces will 
eliminate crowding and align the teeth. 
Correction of crowding can help to prevent 
dental decay and periodontal disease by 
improving the ability to remove plaque 
from the teeth1-2.

 

Figure 1. Pre and post treatment (photographs published with permission).  

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Conclusion 
The treatment goals set in the pretreatment 
planning were all attained and were 
successful. Solid intercuspation of the 
teeth was maintained with class I molar 

relationship. The mandibular teeth were 
found to be esthetically satisfactory in the 
line of occlusion. The over jet become 
near ideal and normal overbite was found.

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References 

1. Bishara SE. An approach to the 
diagnosis of different malocclusion. 
Textbook of orthodontics. Philadelphia, 
WB Saunders 2001:146-184. 
 
2. Proffit WR and Fields, Jr. HW. 
Orthodontic treatment planning: from 
problem list to specific plan. In Proffit 
WR. Ed. Contemporary Orthodontics. 2nd 
ed. North Carolina, Mosbi 1992: 186-224. 
 
3. Bhuiyan MM and Islam KR. 
Orthodontic treatment of severe crowding  
 
 

of male preadolescent by fixed braces. City 
Dental College J 2007; 4 (1):19-22. 
 
4. Peck H and Peck S. An index for 
assessing tooth shape deviations as applied 
to the mandibular incissors. Am J Orthod 
1972; 61 (4):384-401. 
 
5. Smith RJ, Davidson WM, Gipe DP. 
Incisor shape and incisor crowding: A 
reevaluation of the Peck and Peck ratio. 
Am J Orthod 1982; 82 (3):231-235. 
 
 

 
 
 
 
 
 
 
 
 
  
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The Prophet (S) said, “Whoever is offered some perfume should not refuse it because it is 

light to wear and has a good scent” [Abu Dawud, An-Nasai] 

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