TREATMENT OF CROWDING: EXPANSION, INTERPROXIMAL REDUCTION OR EXTRACTION?
Aesthetics and social aspects are the primary factors motivating the adult patient to seek orthodontic treatment. Crowding is a frequent reason for patients not being confident with their smile. Three main strategies are available to gain space in the dental arch: 1) expansion, 2) interproximal reduction and 3) extraction. Not only the severity of crowding determines the treatment approach, as the intervention aims at harmonious facial aesthetics, normal oro-facial function, and periodontal health. The clinician bases the individualized treatment plan on full orthodontic records. Space conditions are assessed especially in relation to bucco-lingual inclination of the teeth, facial physiognomy, occlusion, lip and tongue function, and periodontal biotype. Expansion, extraction, or interproximal reduction are complementary strategies and can be combined according to individual needs. Various fixed and removable types of appliances have different properties. The appliance design depends on the treatment goal and the planned tooth movements.