Title: Distalization in lower anterior crowding.  Early and less, classic approach or late and more, modern approach?

Abstract:

Lower frontal crowding, mild or medium, is an anomaly that becomes evident around the age of 7-8 years, once the temporary incisors are replaced by the permanent ones.

Unlike the upper arch which can be expanded, the conservative treatment of crowding in the lower arch is more limited to procedures such as: grinding the proximal dental surfaces, protrusion of the retruded incisors or distalization of the lateral teeth. The distalization methods chosen depend on the moment of establishing the diagnosis and starting the treatment.

In the mixed dentition, creating space can be done by keeping the E- space or acquiring an additional space by distalizing the permanent first molars with a lip-bumper. It is a simple, short-term, evidence-based, inexpensive approach, capable of solving moderate crowding. The disadvantage is the risk of posterior crowding at the level of the second and third molars, therefore cases must be selected according to the position of the bud of the second molar and the degree of formation of its roots.

In the permanent dentition, lower frontal crowding becomes a reality without the possibility of self-improvement, despite the growth of the jaws during puberty. Distalization of lateral teeth is a modern approach that requires skeletal anchorage associated with a fixed appliance. The method requires in advance a CBCT examination, a surgical intervention for the application of mini implants, respectively the extraction of the third molars and presents the risk of complications during the surgical procedure or later, around the mini implant; and last but not least, it is expensive.

Therefore, whenever possible, early diagnosis and early treatment of crowding in the lower frontal area are preferable.