Moderate Crowding: How do you make space?

Moderate crowding can happen with upper teeth, lower teeth, or both. It can also happen in conjunction with a good bite, or with a bad bite (overbite or underbite). When it comes to crowding, something needs to be done to make space for the remaining permanent teeth to grow in to a healthy position in the jaw bones. There are two options to address moderate crowding as a young, growing person: expanding the dental arches or serial extraction.


Expanding the dental arches

Expanding the dental arches is accomplished with an upper expander, limited upper braces, and a lower expander. The treatment time is typically 9-12 months. This treatment usually takes place between the ages of 8 and 10. Interceptive orthodontic treatment expanding the dental arches is called phase I orthodontic treatment. At the end of this treatment typically several baby teeth are still present and upper and lower retainers are worn at nighttime to maintain the correction. Because the goal of this treatment is only to make the appropriate amount of space for the remaining permanent teeth to erupt, most patients benefit from full upper and lower braces when all of their permanent teeth have erupted (usually around age 12 or 13) to make both the esthetics and function of the smile ideal.


Prior to orthodontic treatment.

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Following phase I orthodontic treatment with upper and lower expanders and limited upper braces

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All permanent teeth have erupted and ready for full upper and lower braces.

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Serial extraction

Serial extraction involves sequential removal of all baby canines and baby first molars (8 baby teeth total) followed by subsequent removal of four premolars (permanent teeth). This treatment modality can be used for bottom teeth, top teeth, or both, depending upon the severity of the crowding and the bite. With this treatment method, there are no orthodontic appliances (no expanders or braces) worn by the patient until all of the patient’s permanent teeth have erupted, usually around age 12 or 13. Once all permanent teeth have erupted, most patients benefit from full braces to make both esthetics and function ideal.


Prior to full upper and lower braces. Two upper permanent teeth have already been extracted due to the severity of the upper crowding. After these pictures two lower teeth were also extracted due to the severity of the lower crowding and need to make the bite of the upper and lower teeth match.

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Following full upper and lower braces and elastics.

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Conclusions

There is not a right or wrong decision regarding which choice is more appropriate for your child. Dr. Eberle believes in keeping as many permanent teeth as possible for a lifetime and therefore leans towards the phase I treatment with expanders. She was also treated with upper and lower expanders as a child and knows that the long-term results are stable. Sometimes extracting the baby teeth followed by extracting the permanent teeth is the more realistic option. Although most young kids find braces and expanders exciting, as adults we know there is responsibility and maintenance that comes with such appliances. In any age group, the orthodontic result is a reflection of the participation of the patient and patient compliance is key to success. As you can see from the above photos, esthetically pleasing and functional results can be achieved with either treatment method.