The tilt of one of your teeth can have various causes. The two most common causes are lack of space and periodontitis, an inflammation of the jaw bone and the gums. Before you can start treating a crooked tooth, you must first know what caused you to be skewed. That depends on which treatment can be started. How do you recognize the difference? If you have a lack of space, you will usually know that already, your dentist may have told you. Maybe you should have had braces in the past and you didn’t want that then, or you wanted braces and you couldn’t. In any case, your jaw is too narrow to accommodate the teeth and molars that belong to it. Your gums are firm, light pink and do not bleed. If your tooth is crooked due to periodontitis, then it is a different story. The tooth probably stood up earlier and changed position later in life. The tooth is also a little loose and occasionally your gums will bleed when brushing. You may also have a bad breath.
The treatment options for a crooked tooth due to lack of space are described below; the development and treatment of periodontitis in the chapter of ”Gaps between teeth – Problems and their solutions”.
Treatment options for the crooked tooth due to lack of space
You have a crooked front tooth or a fang that is far outside the line.
Both cases occur quite often and have to do with lack of space in your jaw. Your jaw is too narrow in your case to accommodate all your teeth neatly next to each other. This also immediately indicates the difficulty of the treatment, there will have to be room. A second point of attention for treatment is that your teeth will have to remain more or less symmetrical, so it is not always possible to treat only one tooth. If you have one crooked tooth, and your teeth and gums are otherwise healthy, the treatment options are:
- Change shape with filling material;
- Pulling, with or without after-treatment;
- Place a facing;
- Place a crown;
Only grind the tooth
Sharpening is by far the least invasive treatment, with often great results. Small amounts of enamel are ground off from the respective element to change the shape so that the element fits nicely into the tooth row.
This only has a good result if the stand deviation is not too large and if the element has a good color.
Change the shape of the tooth with filling material
The current composites, the most commonly used white filler, have almost become a panacea in dentistry. These materials used to be subject to discoloration and wear, but nowadays they are extremely durable and colourfast and also available in many colors. Larger shape and position changes can be achieved with composite, often in combination with grinding.
Pull the tooth
Sometimes pulling is a good option if the tooth is positioned so far outside or inside the dental arch that there is only a small gap between its two neighboring elements.
This is often the case with lower teeth. In the lower teeth it even regularly happens that after pulling the crooked tooth, the gap between the neighboring teeth closes automatically in a few weeks. Your dentist will determine in advance whether this will not affect the position of your upper teeth. All teeth and molars in the upper and lower jaw exert influence on each other. Of course, it is not the intention that after a while an upper tooth becomes crooked because you have pulled a crooked lower tooth! However, whether this will happen can already be properly estimated before treatment.
If, after pulling the crooked tooth, a gap still exists, it can be filled by making both neighboring elements a little wider. This can be with composite or by means of a porcelain facing. Pulling a tooth that is very out of line is usually done quickly. The tooth has less grip in the bone, because it is in a different place. In general, you will experience few additional objections, often not even a painkiller is needed. Your dentist will of course anesthetize you, the anesthetic works for three to four hours. Once the anesthesia has been worked out, the wound will still feel a little bit fair, but this too will disappear quickly. Wounds in the mouth heal very quickly unless you smoke. Smoking slows wound healing. So do not smoke in any case during the wound healing period. Sometimes the wound is sutured, usually a soluble suture is used for this, which disappears automatically after about a week. If a follow-up treatment has been agreed, for example to make the neighboring elements wider, it can already take place after a few days.
Pull and place an etching bridge
Pull and placing an etching bridge requires a somewhat more extensive treatment. This is because the tooth that is tilted is pulled and it has already been estimated in advance that the gap that remains between the neighboring elements will not close automatically. Making an etching bridge is a good option if the space that remains after drawing has approximately the width of one tooth and the neighboring elements are more or less intact. An etching bridge is a porcelain counterfeit tooth (dummy) that is glued to the rear of the neighboring teeth by means of two wings. It is a nice restoration to replace a missing element and a restoration that also does little damage to the rest of your teeth. For securing to the neighboring elements, these sometimes need to be ground slightly at the rear, but this is minimal. Fixing is done with a special “tooth glue”, a material that attaches to enamel and to porcelain and metal.
Pull and place a bridge
Pulling and placing a bridge is an extensive treatment, whereby a lot of tooth material has to be sacrificed from the neighboring elements. This treatment is therefore only advisable if the neighboring elements of the crooked tooth are in poor condition and actually already had to be crowned. Because that happens with the placing of a bridge, the two neighboring elements are provided with a crown and a fake tooth (dummy) is fixed in between. A three-part bridge in this case is needed to complete one missing element. A bridge is a restoration of porcelain, or porcelain on a metal surface, to replace a missing element.
A three-part bridge consists of two crowns and a dummy. The dummy replaces your missing tooth or molar, the crowns provide a hold for the dummy on the pillars. The pillars are the teeth or molars that are on either side of the hole, they are ground into a stump that the crown fits over.
Pulling and crooked teeth with braces
The tooth that is tilted is pulled and it has already been estimated in advance that the gap that remains between the neighboring elements will not close automatically. If the neighboring element or the other elements are not exactly as you want, then a follow-up treatment with a brace is a good option. A removable bracket is rarely possible. With this, only a few position changes can be achieved. It is therefore probably a fixed bracket, also known as a locking bracket. You cannot get it out of your mouth and you have to count on one or two years of treatment time. It may seem like a long time, but in practice it appears that most clients find it difficult.
Straighten the tooth by grinding and applying a porcelain facing
Instead of plastic, a tooth can also be built with porcelain. This is more expensive than plastic and the treatment takes longer, but the end result is beautiful and the restoration will not discolor. First of all, the crooked tooth will have to be sharpened into shape. This time, not only are the corners protruding from the row of teeth removed, but also a thin layer of enamel is ground away from the front of the tooth to accommodate the porcelain that will be glued on later. Placing the porcelain facing made by a dental technician requires a follow-up consultation. This means that in the time between the two consultations you walk with a tooth, from which some enamel has been ground. Usually no emergency restoration is made over it. The intervening time is too short to damage the ground tooth. Moreover, in practice it appears that nobody sees that something has been done to your teeth. However, the tooth may be somewhat sensitive to cold after the first treatment. Brushing with a toothpaste against sensitive teeth helps.
The tooth with a crown
The tooth with a crown is an extensive treatment. For this, quite a lot of your own tooth needs to be ground. This treatment is eligible if the tooth is not only skewed, but is also very filled or discolored, for example. A crown is stronger than a porcelain facing, this can also be a reason to make a crown. For example if you are very creaky or bite nails. Placing a crown made by a dental technician requires a follow-up consultation. This means that in the time between the two consultations you walk with a tooth that has been polished with a lot of enamel. To ensure that the buffed tooth stump is not damaged in the meantime, you will receive an emergency crown. So you walk for about a week with a less beautiful tooth. With an emergency crown you are certainly not embarrassed, but it is always a little less beautiful and a little less pleasant than a real porcelain crown.
Straighten the tooth through orthodontics
Straightening the tooth by means of orthodontics is a good option if the crooked tooth is completely intact and you find it a pity if a restoration is made on it. Usually the orthodontic treatment will be preceded by some grinding work on the tooth, since you have a lack of space.
Orthodontics is generally applied to fit the entire upper teeth to the entire lower teeth, especially if the braces are placed during puberty. This can be deviated from for adults with specific wishes; the treatment can be aimed only at straightening the front (the front teeth). Not every dentist is involved in this type of orthodontic treatment, but it is certainly possible. A choice will be made between a removable or a fixed bracket. This choice depends on the position of your teeth. Clients often prefer a removable bracket, because it can then be taken off occasionally. Keep in mind, however, that a removable bracket is only possible in very few cases, and that it must still be worn 24 hours a day.