Journal of International Oral Health

CASE REPORT
Year
: 2017  |  Volume : 9  |  Issue : 2  |  Page : 88--90

Early orthodontic interception of anterior crossbite in mixed dentition


MM Sunil, MA Zareena, MS Ratheesh, G Anjana 
 Department of Pedodontics and Preventive Dentistry, Royal Dental College, Palghat, Kerala, India

Correspondence Address:
M S Ratheesh
Department of Pedodontics and Preventive Dentistry, Royal Dental College, Iron Hills, Chalissery, Palghat - 679 536, Kerala
India

Abstract

Single tooth anterior crossbite is commonly seen in the early mixed dentition period. Once identified, the treatment should ideally involve any method which is simple, noninvasive, involves little chair side time, requires minimal patient cooperation, and gives rapid correction of the crossbite without affecting the surrounding structures. In young children, compliance with a removable appliance can often be an issue. Here, we present a fixed appliance for the correction of single tooth anterior crossbite in mixed dentition using a simple appliance.



How to cite this article:
Sunil M M, Zareena M A, Ratheesh M S, Anjana G. Early orthodontic interception of anterior crossbite in mixed dentition.J Int Oral Health 2017;9:88-90


How to cite this URL:
Sunil M M, Zareena M A, Ratheesh M S, Anjana G. Early orthodontic interception of anterior crossbite in mixed dentition. J Int Oral Health [serial online] 2017 [cited 2019 Sep 22 ];9:88-90
Available from: http://www.jioh.org/text.asp?2017/9/2/88/202706


Full Text



 Introduction



Single tooth anterior crossbite during the mixed dentition stage has been a very common finding. This can either be due to a skeletal deficiency or dental which can be determined from the profile analysis and intraoral findings.[1] Moyers has defined a simple anterior tooth crossbite as a dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth.[2] The incidence of anterior dental crossbite has been reported to be 4%-5%.[3]

The best time to intercept and treat a patient with dental crossbite is at its inception so that minor orthodontic problems progressing into major dentofacial anomaly can be prevented. An old orthodontic maxim states “the best time to treat a cross bite is the first time it is seen.”[4]

Different techniques have been used for anterior dental crossbite corrections. Most of the techniques for such corrections involve a removable appliance which requires good cooperation between the dentist and the patient for the success. This cooperation is sometimes difficult to obtain in pediatric patients.[3]

Here, we present a simple appliance for the correction of a single tooth anterior crossbite where the patient compliance required is minimal.

 Case Report



An 8-year-old female patient reported to the Department of Pedodontics and Preventive Dentistry with the chief complaint of improperly aligned upper front teeth. The parent noticed it around 21 months back as the tooth erupted into the oral cavity. The patient had a history of abscess and early loss of deciduous maxillary anteriors about 2 years back.

Medical history was found to be noncontributory.

Intraoral examination revealed that the patient had a mixed dentition. Crowding was noted in both the upper and lower arches. The permanent maxillary left central incisor (21) was palatally placed and in crossbite relation [Figure 1]. Gingival stripping was noticed in relation to permanent mandibular left central incisor (31). Crowding was present in relation to both the upper and lower arches.{Figure 1}

Space analysis was done using the Moyer's mixed dentition analysis. The interpretation revealed marked space deficiency in relation to both the upper and lower arches.

A multi-stage treatment was planned with the first priority in correcting the crossbite in relation to 21. Considering the age and compliance of the patient, an anterior sectional twin bracket appliance was selected for the correction of the crossbite.

After thorough oral prophylaxis, preadjusted edgewise bracket with 0.022” slot was selected and bonded on 11 and 21.

0.014” nickel titanium (NiTi) wire was selected and cut symmetrically by 10 mm from the midline marking [Figure 2]. The wire was placed into the brackets and stabilized using ligature ties. To raise the bite, glass ionomer cement (GIC) of 2 mm thickness was placed on the occlusal aspect of 36 and 46 [Figure 3].{Figure 2}{Figure 3}

On recall of the patient after 1 week, marked tooth movement was noted in relation to 21. After 2 weeks, the crossbite was completely corrected. The GIC placed on 36 and 46 were removed using an ultrasonic scaler. The wire was then changed to 0.017 × 0.022” NiTi [Figure 4] and retained for another 2 weeks followed by debonding [Figure 5]. The patient was further recalled after 1 week for follow-up and further treatments.{Figure 4}{Figure 5}

 Discussion



It is one of the major responsibilities of pediatric dentist or orthodontist to guide the developing dentition to a state of normalcy in line with the stage of oralfacial growth and development. The period of mixed dentition offers the greatest opportunity for occlusal guidance and interception of malocclusion.[2]

Lee [5] outlined four factors to consider before selecting a treatment approach:

Adequate space in the dental arch to reposition the toothSufficient overbite to hold the tooth in position following correctionAn apical position of the tooth in crossbite that is the same as it would be in normal occlusionA Class I occlusion.

The mode of treatment selected should be comfortable to the patient, should not damage associated tissues, should give rapid crossbite correction, and should require minimal patient cooperation.[6]

Anterior dental crossbite should be treated immediately to prevent abnormal enamel abrasion, involved anterior teeth mobility and fracture, periodontal pathosis, and temporomandibular joint disturbances.

The main aim of early treatment is to tip the affected maxillary tooth or teeth labially to a point where a stable overbite relationship exists. The achieved normal overjet or overbite relationship prevents relapse.[7]

Different treatment approaches that used in the early mixed dentition period for single tooth anterior dental crossbite corrections include tongue blade therapy, reverse stainless steel crowns, removable Hawley's retainer with anterior Z-springs and bonded resin composite slope. The use of removable acrylic appliances with posterior bite opening platforms and anterior finger springs for labial tipping of maxillary teeth requires patient cooperation.[8]

Dental anterior crossbite involving one or more teeth can be corrected by means of fixed orthodontic appliance as they have a greater power of action and liberates more continuous forces when compared to removable ones, reduces the need for patient cooperation, and allows for three dimensional control of the tooth to be moved.[9]

Skeggs and Sandler [10] stated that the use of fixed appliances was correctly used for the treatment of anterior dental crossbite and it is completed more rapidly than would have occurred with conventional removable technique and also agreed with Asher et al.[6] who stated that the using of fixed appliances will utilize light continuous force to correct the crossbite.

The innovative approach of using twin bracket appliance was preferred in this case as all other removable appliances require more patient cooperation and treatment time. Anterior bite plane is recommended to prevent the unwanted movement of the incisors.[11] However, the patient compliance and considering the oral hygiene maintenance, GIC was placed over the occlusal surface of 36 and 46 to open the bite for proceeding with the correction. The drawback of using GIC as bite block includes wearing away of the cement, chance of supra-eruption or intrusion of the molars.[9] But in this case, no marked tooth movement was noted. This may be due to the minimal time of placement of the bite block.

 Conclusion



There are numerous interceptive orthodontic strategies for the correction of single tooth anterior crossbite. However, the anterior sectional twin bracket appliance was found to be reliable and effective. The treatment duration was short and patient compliance was found better when compared to a removable appliance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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