|Year : 2017 | Volume
| Issue : 4 | Page : 679-682
Taking a glance at anterior crossbite in children: Case series
Derya Ceyhan, Canan Akdik
Department of Paediatric Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
|Date of Web Publication||12-Dec-2017|
Dr. Derya Ceyhan
Department of Paediatric Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Anterior crossbite is a malocclusion that takes place for various reasons, leads to major problems and may be fixed using various methods. This study aimed to provide an update regarding the methods used for anterior crossbite treatment presenting treatments of the removable active acrylic appliance with bite plane. Clinical examination of aged 9–15, seven healthy children who visited our clinic due to crowding and esthetic displeasure in anterior teeth indicated that one or more permanent maxillar incisor teeth were positioned behind of permanent mandibular incisor teeth. After clinical-radiographical examinations, removable active acrylic appliances with bite plane were decided to apply. Patients with adapted-activated appliances were called to follow-ups once a week. Treatments continued 4–6 weeks in mixed dentition, 7–8 weeks in permanent dentition. In choosing the method, advantages-disadvantages, indications-contraindications of methods should be discussed. Correct indication and suitable motivation are important for the success of anterior crossbite treatment.
Keywords: Anterior crossbite, pediatric patients, removable appliance, treatment
|How to cite this article:|
Ceyhan D, Akdik C. Taking a glance at anterior crossbite in children: Case series. Contemp Clin Dent 2017;8:679-82
| Introduction|| |
Anterior crossbite is defined as the malocclusion that results in maxillar anterior teeth being positioned behind of mandibular anterior teeth. Its prevalance in different countries around the world varies between 2.2% and 36%.,,, It was expressed that the appearance of anterior crossbite intensifies with the eruption of permanent teeth. It is known that anterior crossbite is caused by conditions such as supernumerary teeth, odontomas, persistent primary teeth, traumatized primary incisor teeth, lip biting habit, and lack of space.,,
Early diagnosis and treatment of anterior crossbite cases are recommended to prevent tooth wear, anterior tooth fractures, gum problems, and temporomandibular joint disorders and to achieve a better functional occlusion and esthetics., Therefore, to diagnose and treat the malocclusion early and to supervise the patient properly are important for healthy physiological and psychological development.
The treatment is performed by fixed or removable approaches that practice the movement of mandibular anterior teeth toward the lingual, the movement of maxillar anterior teeth towards the labial, or a combination of these.
From the past to the day, the methods used for anterior crossbite treatment included tongue blade, reversed prefabricated stainless steel crowns, composite inclined plane, fixed orthodontic treatment, and removable active acrylic appliances with bite plane.,, Although it has been reported that factors such as child's age, number of teeth to be repositioned, total number of teeth, status of occlusion, and motivation of child and parents should be considered in deciding which of these methods to be used, clinicians occasionally experience dilemmas in choosing the method.,
In the present study, it was aimed to present the treatment of children with anterior crossbite by removable active acrylic appliance with bite plane and provide an update regarding the methods used for anterior crossbite treatment.
| Case Report|| |
In the clinical examination of aged 9–15 years, 7 healthy children who visited our clinic due to crowding and esthetic displeasure in their anterior teeth, it was examined that one or more permanent maxillary incisor teeth were positioned behind of permanent mandibular incisor teeth [Figure 1]a, [Figure 1]c, [Figure 2]a, [Figure 2]c, [Figure 3]a, [Figure 4]a and [Figure 4]c. It was first checked whether the mesiodistal distance to allow the labial movement of maxillary permanent anterior teeth was sufficient in children, and it was confirmed that there were no skeletal abnormalities. After these examinations, it was decided to apply a removable active acrylic appliance with bite plane. Written informed consent forms were obtained from the each of parents and patients. The appliance planning was made on the working models obtained by pouring hard plaster to the dental impressions taken using the irreversible hydrocolloid impression material, alginate (Zetalgin, Zhermack Group, Rovigo, Italy), and the models were sent to the laboratory as soon as possible. The prepared appliances were adapted to the mouth of the patients and activated. The patients were informed about taking care of their oral hygiene, using the appliance regularly, removing it during meals, and putting it on and off. The patients were called to follow-ups once a week and were evaluated on the account of oral hygiene, usage of the appliance and movement of the teeth. Durations of the treatments were 4–6 weeks in the mixed dentition period [Figure 1]b, [Figure 1]d, [Figure 2]b, [Figure 2]d and [Figure 3]b and 7–8 weeks in the permanent dentition period [Figure 4]b and [Figure 4]d. At the end of these durations, it was observed that maxillary permanent incisor teeth were placed in the position they needed to be and esthetics was achieved.
|Figure 1: (a) A 9-year-old male patient with crossbite of 11 numbered tooth. (b) After 4 weeks, intraoral view of the patient following the treatment. (c) A 9-year-old female patient with crossbite of 11 numbered tooth. (d) After 5 weeks, intraoral view of the patient following the treatment|
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|Figure 2: (a) A 9-year-old female patient with crossbite of 11 and 21 numbered teeth. (b) After 6 weeks of treatment, intraoral view of the patient when she was at the age of 14 years old. (c) A 10-year-old male patient with crossbite of 11 numbered tooth. (d) After 6 weeks of treatment, intraoral view of the patient when he was at the age of 15 years old|
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|Figure 3: (a) A 10-year-old male patient with crossbite of 11 and 21 numbered teeth. (b) After 6 weeks, intraoral view of the patient following the treatment|
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|Figure 4: (a) A 12-year-old male patient with crossbite of 11 numbered tooth. (b) After 8 weeks, intraoral view of the patient following the treatment. (c) A 15-year-old female patient with crossbite of 11 numbered tooth. (d) After 7 weeks, intraoral view of the patient following the treatment|
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| Discussion|| |
One of the main purposes of pediatric dentistry is to prevent malocclusions by facilitating the correct positioning of teeth and healthy development of jaw arcs through tooth eruption guidance. For children at the growth and development period, solving problems with minor interventions affects their social life positively. Therefore, anterior crossbite treatment is a highly conservative approach for pediatric patients when it is diagnosed correctly and treated appropriately.
In choosing the method, discussion related to the advantages-disadvantages and indications-contraindications of the approaches used in anterior crossbite treatment should be carried out.
It was reported for the tongue blade method, which is considered simple and economical, that it may be used in the early period of tooth eruption, it is not sufficient to repose more than one tooth, and it is difficult to provide the patient's compliance to the treatment., In addition, it has been reported that there is no accurate control of the amount and direction of force applied. McEvoy  applied the tongue blade method in an 8-year-old child with anterior crossbite, and she stated that this method is a suitable approach for cooperative children whose teeth are in the early period of eruption. This method was not used for our patients because two patients had crossbite at more than one tooth, three patients would experience difficulty in applying this method correctly, and two patients were in the late period of tooth eruption.
For reversed prefabricated stainless steel crown, which is resistant and has low cost and does not require an effort by patients, it was reported that application of the crown onto the teeth with crossbite is difficult, the duration patients spend on dental unit is long, and it is generally not preferred by patients and their parents as it is unesthetic. It was not chosen for our patients due to these disadvantages.
Composite inclined plane, which does not require laboratory procedures, does not cause pain in patients and is esthetically acceptable, was not preferred in our patients because it is costly, the duration patients spend on dental unit may be long, it may affect patient's psychology negatively, it cannot be used in cases where the anterior crossbite involves more than one-third of the crown height, and it may lead to gum problems, as well as tooth structure loss while removing from teeth at the end of the treatment. However, due to the disadvantages of other treatment methods, Bayrak and Tunc  preferred composite inclined plane treatment in 7–9 aged 3 pediatric patients and reported that the teeth with crossbite were positioned to normal position in 1 or 2 weeks, and this treatment is an effective and simple method resulting in a short time. It is seen that the observation of clinicians on patients and their indication decisions are important in choosing the method.
Fixed orthodontic treatments, which are costly and time-consuming, require comprehensive planning and clinician's effort and have risk of causing gum problems, dental caries, and pain, are preferred generally in patients who cannot show suitable compliance to the treatment. This treatment method was not preferred as our patients showed suitable compliance to the treatment. On the other hand, Wiedel and Bondemark  compared the fixed orthodontic treatment with the removable active appliance with bite plane treatment used in anterior crossbite and reported that fixed orthodontic treatment may provide shorter treatment duration but both methods are highly effective.
The removable active acrylic appliance with bite plane is reported to be an easily applicable and a reliable method. Its advantages include that the duration patients spend on dental unit is short as it is prepared in a laboratory, the patient can remove it unsuitable social settings, it is easy to clean and achieve oral hygiene, it does not harm soft tissues, and it is economical.,, In addition, with this appliance, it is possible to control the amount of movement of tooth or teeth with crossbite. On the other hand, the requirement of patient cooperation and laboratory procedures, uncomfortableness and intolerableness are considered as its disadvantages. Ulusoy and Bodrumlu  applied removable active acrylic appliance with bite plane treatment on a patient at the age of 8 years and reported that teeth with crossbite were correctly positioned after 4 months, and it is a highly effective, manageable, easily usable method that does not harm soft tissues and may be applied to children of early ages. Compared to our treatment durations, longer duration of their treatment may have been caused by the occlusion problem that included in more than one tooth and was more complicated. Furthermore, it was reported that the production of organic matrix in the periodontal ligament, mitotic activities and soluble collagen levels of cells, and osteoblastic and osteoclastic activities are decreased as patients get older., The duration of the treatments may have differed among our patients due to these factors.
Due to limitations of working time on pediatric patients and potential psychological problems that may arise from a fixed system placed into the mouth, the removable active appliances with bite plane were preferred in our patients. Its preferability increased by advantages such as its economical, harmless, and easily applicable nature. Our patients did not complain about its uncomfortableness and intolerableness, which are known as disadvantages of this appliance. In our study, the patients showed good cooperation, they did not experience difficulty in using the appliance and achieving oral hygiene, the teeth were correctly positioned after the treatment, esthetics was provided, and gums were healthy.
| Conclusion|| |
When correct indication is established, and suitable motivation is achieved, the removable active acrylic appliance with bite plane is considered as a method that can be easily applied by clinicians, tolerated by patients, and resulted in a short time in anterior crossbite treatment in pediatric patients of different ages.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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