Current controversies in late incisor crowding.

Although the terminology is mildly controversial, late incisor crowding (tertiary crowding, late secondary crowding, post-adolescent crowding) is widely regarded as a normal maturation event which is likely to affect most individuals to some extent. Disagreement arises when attempts are made to quantify the change and to predict the timing of the crowding. Most young adults experience some degree of loss of incisor alignment, usually near the anticipated emergence time for the third molars, and almost characteristically it is the lower anterior teeth which best demonstrate the phenomenon. Unfortunately, the physiological crowding changes are frequently confused with orthodontic treatment relapse. Greater controversy surrounds the aetiology of the undesirable crowding changes and despite many attempts we are still not in the enlightened position of explaining, predicting or preventing the problem (except by permanent retention). It is illogical to assume a single cause as the beguilingly simple observation of crowding belies the complexity of possible interacting factors. Perhaps it is a capricious combination of: tooth size and arch form; facial growth pattern (differential soft tissue and skeletal maturation); continuing late growth rotations; cumulative effects of resting, functional and parafunctional soft tissue pressures; lack of compensating attrition; and an ill-defined, mesially acting force emanating from the back of the dental arch. Many theories have attempted to resolve the mystery of the mesially acting force, including: pressure from erupting third molars; an inherent mesial migration; continuing mesial and occlusal dental drifting; maturation and contraction of periodontal soft tissues (particularly the transseptal fibres); the anterior component of occlusal forces; and the lower anterior arch contracting influence of the incisor overbite.(ABSTRACT TRUNCATED AT 250 WORDS)