Early intervention of anterior crossbite and unfavorable tongue posture with a prefabricated myofunctional appliance: A case report

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

The crowding of the permanent incisors with accompanying rotations or anterior cross bite is commonly seen during eruption of the permanent lateral incisors. When crowding is limited to a few millimeters, sufficient space may allow normal growth, but when the upper jaw is narrow and crowding exceeds this amount, rapid expansion of the hard palate may be an effective method. The purpose of this study was to study the method of cone beam computed tomography to evaluate the results of rapid palatal expansion in the narrowing of the upper dentition and the lack of space for incisors and the reaction of intact permanent molars, when fixing the apparatus on primary second molars in the absence of posterior cross bite. The study involved 20 children (age 7-10 years) who were treated with the Haas apparatus. The Haas apparatus was fixed on the upper second primary molars and on the primary canines. Cone beam computed tomography was performed before and after palatal suture rupture. A decrease in incisor crowding was found in all patients. The width between the permanent molars in the diameter has increased significantly, the distance between the tops of the roots of the upper permanent molars has increased more than between the crowns of the teeth. Application of the method shows the possibility of expanding the sky in the transverse direction. The use of a Haas apparatus attached to primary teeth in early mixed dentition in the absence of posterior cross bite is effective and provides a pronounced planned transverse growth of the jaw and can be indicated to expand the anterior part of the upper jaw to eliminate crowding of the upper incisors. With rapid expansion, there are favorable spontaneous changes in the palatal vertical position of the maxillary permanent molars in the opposite direction of expansion and there is the potential to mimic the expected natural transverse growth. Fixation of the apparatus used for this procedure on the primary molars and keeping the permanent molars unused means the prevention of periodontal damage, loss of attachment, demineralization and external resorption of the roots of permanent molars.

The aim of this study was to provide basic representative data on the prevalence of malocclusions involving space deficiency in both primary and early mixed dentition and to examine the relationship between these malocclusions and orofacial dysfunctions. The results should be viewed from an orthodontic prevention and early treatment perspective. Orthodontic findings in the maxilla and mandible as well as the myofunctional status of 766 children in primary dentition and 2,209 children in mixed dentition were examined clinically in a cross-sectional study. The following parameters from each jaw were subjected to orthodontic analysis: crowding in the anterior and posterior regions of the maxilla and mandible in primary and mixed dentitions, deviations from normal maxillary arch forms in the primary dentition, deviations from normal anterior maxillary arch width in mixed dentition and maxillary apical base morphology in mixed dentition. Static and dynamic orofacial dysfunctions were documented with reference to specific parameters and clinical tests. Crowding was observed in every tenth child in primary dentition (10.8%) and in every second child in mixed dentition (49.7%). Habitual open mouth posture, visceral swallowing, articulation disorders and oral habits were statistically significantly more frequent in children in primary dentition presenting a narrow maxillary arch. Reduced anterior maxillary arch width (compression) was statistically more frequent in children in early mixed dentitions with habitual open mouth posture. A narrow maxillary apical base correlated positively with all the orofacial dysfunctions analyzed. Deviations from a regular arch form become apparent very early during dentition development and coexist with specific orofacial dysfunctions. They are thus important indicators for the early detection of functional abnormalities, causing deviations from normal dentition development. In children with orofacial dysfunctions the development of a narrow maxillary dental arch should be prevented by myofunctional therapy and by educating the parents. Interceptive orthodontic measures to treat a narrow maxillary arch in primary and early mixed dentition should also focus on eliminating functional disturbing factors, such as orofacial dysfunctions. Interdisciplinary cooperation with specialists in other fields of medicine, e.g. otorhinolaryngology and speech therapy, is essential to achieve this goal.

: As a dentist, it is very important to know the occlusal relationship of primary dentition so that any malocclusion in permanent dentition can be predicted at early stages and corrected accordingly by orthodontic treatments. The ideal occlusion and spacing in primary dentition acts as a mirror for the prevalence of malocclusion in the permanent dentition.: The aim of the study was to assess the occlusal relationships between the primary canines and the primary molars and spacings in primary dentition among a group of 3-6-year-old children.: A total of 120 children, comprising of 60 boys and 60 girls aged between 3-6 years irrespective of the race and socioeconomic status were randomly selected. The examination was done using pen light and mouth mirror. The occlusal assessment will be done only on children who are healthy and free from extensive caries that would affect the mesiodistal or occluso-gingival dimension of a tooth and, therefore, influence the occlusal characteristics. The primary molar relationship and the canine relationship will be assessed using Foster and Hamilton criteria with the teeth in centric occlusion. Primate space will be measured between primary lateral incisor and canine in the upper and primary canine and deciduous first molar on the lower on both the arches using a digital caliper [0-4 mm]. The obtained data was entered into Microsoft excel and chi-square test will be used for statistical analysis.: The study showed that, on left side, mesial step molar relationship was found in 53.3% boys and 55% girls, whereas on right side, 55% of boys and 51.6% of girls showed mesial step molar relationship. On left side, 77% of boys and 70% of girls showed class I canine relationship. On right side, 73% of boys and 67% of girls showed class I canine relationship. Primate spacings were found in 77% of children in maxilla and 84.7% of mandible.: The in vivo study concluded that, 1. Mesial step molar relationship was the most common Occlusal relationship of primary molars. 2. Class I canine relationship was the most common canine relationship in primary dentition. 3. Maxillary arch showed more percentage of primate spacings than mandibular arch. The early identification of molar and canine relationships and spacing present will help in prediction of future permanent molar relationship and probable future malocclusion.

The eruption of permanent teeth in children is a complex physiological process that is important for the development of the dentoalveolar system. The timing of eruption is a key indicator of biological age and prenosological diagnosis of children’s health. The need to update research on this topic is due both to changes in society and the importance of modern data for pediatric dentistry and public health. The aim of the study was to determine the regional characteristics of the terms of eruption of permanent teeth in early mixed dentition among children of Odesa. Material and methods. Dental examination was performed on children aged 4 to 8 years of both sexes. The examination was performed according to the generally accepted methodology, using standard dental instruments included in the examination kit. The children were divided into groups according to age and sex. Patients were examined on the basis of age and period of teeth eruption.Results. The results of the study of the eruption of the permanent teeth of the upper and lower jaws in children aged 4.5-8.5 years in Odesa indicate an earlier eruption of the permanent teeth in girls. Thus, in girls the eruption of the first permanent molars began at the age of 4.5 years and ended at the age of 6 years. In boys, the age of onset of fi rst molar eruption was 5 years and the age of completion was 6.5 years. It was found that the timing of the beginning and the end of the eruption of the central permanent incisors of the upper jaw was the same in boys and girls (6 years), but the average duration of eruption was different. The timing of the beginning and end of eruption of the upper lateral incisors was identical in boys and girls. However,diff erences in the average terms of eruption of permanent upper lateral incisors were obtained. The analysis of the results of the terms of eruption of the central permanent incisors of the lower jaw in boys and girls shows the same terms of beginning of eruption and average terms of eruption of these teeth. However, there were diff erences in the time of the end of eruption. The beginning of the eruption of the permanent central incisors of the upper jaw was noted earlier (at the age of 6 years) than the data given in the modern dental manuals of Ukraine and was completed at the age of 8 years. The age of the beginning and the end of eruption was one year earlier than the generally accepted data. The data on the time of eruption of the fi rst permanent molarsand incisors obtained as a result of the study are necessary for planning programs for prevention of dental caries in children in the period of early replacement dentition. The data obtained as a result of the study indicate the need for further epidemiological studies in other regions of Ukraine in order to establish the current national norms for the eruption of permanent teeth in children. Conclusion. The discrepancy between the dates of eruption of permanent incisors and molars in Odesa children and the standard dates of eruption of teeth was revealed, which indicates the need to clarify them in each region. Gender diff erences were found – earlier eruption of permanent teeth in girls. The data of the conducted research substantiate the necessity to revise the terms of caries prophylaxis in Odessa children and the necessity to conduct in-depth examination of children with violation of the terms of teeth eruption.

Anterior crossbite is the term used to describe an abnormal labiolingual relationship between one or more maxillary and mandibular incisor teeth. Different techniques have been used to correct anterior crossbite. This paper describes the use of Modified Essix appliance for the management of anterior crossbite in children in early mixed dentition. The case presented here demonstrates an anterior dental crossbite which was corrected using a modified Essix appliance on the mandibular arch. Correction was achieved within 8 to 10 weeks with improved and healthy periodontium. The procedure is a simple, effective, and patient compliant method for treating anterior dental crossbite.

Objective To compare tongue positions at rest between normal occlusion people and patients with anterior cross-bite malocclusions,and to explore whether there is any abnormality in the tongue position of the anterior cross-bite malocclusions.Methods Twenty adults of normal bite (8 males and 12 females,with an average age of 23.8 years) and 20 adults of anterior cross-bite (1 1males and 9 females,with an average age of 24.6 years) were involved in this study.The position habits of tongue were investigated by a questionnaire.The tongue positions,which were enhanced by applying barium to tongue and palatal surface,were compared by cephalometric roentgenogram.Two groups were compared by t-test to determine the variation of anterior cross-bite. Results In normal occlusion group,the dorsum of tongues was sealed with all palatal surfaces except uvula site.In anterior cross bite group,tongues were far from palate,and were difficult to lift.The profile of tongue showed standing upright forward and up in normal occlusion group,while inclining back and low in anterior cross-bite group.The tops of tongue dorsum sites were at the border of soft and hard palate in normal occlusion group.While in anterior cross bite group,the tops of tongue dorsum sites were at the border of uvula and soft palate.In anterior cross-bite group,the tongue-to palate distance was bigger than that of normal occlusion group (P＜0.01).However,both length and height of the tongue had no significant differences between two groups (P＞0.05).Conclusions In anterior cross-bite patients,tongue positions were lower than that of normal occlusion people. Key words: Anterior cross bite; Tongue position; Rest position; Normal bite

Introduction: Anterior crossbite, a common malocclusion in early mixed dentition, is characterized by one or more lower incisors positioned anterior to the upper incisors. Early identification and management are essential to prevent progression to more severe malocclusion and associated complications. Description of Case: A 7-year-old female patient presented with a dental anterior crossbite involving the upper right permanent incisor. Clinical examination revealed a 1 mm reversed overjet and sufficient space for correction. A removable orthodontic appliance of Hawley's retainer with Z spring was utilized to treat crossbite after obtaining parental consent. The appliance was activated weekly, and the patient was instructed on proper use and oral hygiene. Positive overjet was achieved within four weeks, with complete alignment observed after an additional six weeks, despite a brief period of non-compliance. Discussion: Early interceptive treatment of anterior dental crossbite is crucial to restore normal occlusion and prevent more complex problems. Removable orthodontic appliances, such as the Hawley’s retainer with Z spring, are effective in cases with adequate space and active tooth eruption. These appliances offer advantages including ease of fabrication, maintenance of oral hygiene, and cost-effectiveness. However, patient compliance remains a key factor influencing treatment duration and success. Conclusion: Timely intervention using removable appliances with Z spring is an effective and practical approach for correcting dental anterior crossbite in young patients. Appliance selection should be tailored to individual patient factors, emphasizing the importance of early diagnosis and patient cooperation for optimal outcomes

To determine the incidence of malocclusion in a 5-year follow-up of school children and verify the hypothesis that individuals with previous malocclusion are more prone to maintain the same characteristics in the transition from primary to mixed dentition. School children, ages 8 to 11 years, participated. Inclusion criteria consisted of normal occlusion in primary dentition or subsequent malocclusions, anterior open bite and/or posterior crossbite and/or overjet measuring more than 3 mm, and that subjects had not submitted to orthodontic treatment and adenoidectomy. Data collection was based on evaluation of occlusion in school children in the actual stage of mixed dentition. Descriptive, Chi-square, and relative risk (RR) 95% confidence interval (CI) analyses were carried out. The greatest incidence of malocclusion was found in children with malocclusion (94.1%) when compared with those without malocclusion (67.7%) (RR = 1.4 [1.2-1.6]; P < .001). Anterior open bite (RR = 3.1 [1.7-5.8]), posterior crossbite (RR = 7.5 [4.9-11.5]), and overjet greater than 3 mm (RR = 5.2 [3.4-8.0]) in the primary dentition are risk factors for malocclusion in early mixed dentition. Spontaneous correction of the anterior open bite was confirmed in 70.1% of cases. Posterior crossbite and overjet greater than 3 mm were persistent in 87.8% and 72.9% of children. Malocclusion incidence was high. Individuals with previous anterior open bite, greater overjet, and posterior crossbite had greater risk of having the same characteristics in the mixed dentition.

Introduction: Anterior crossbite is a major aesthetic and functional concern to parents during the developmental stage of a child. Anterior crossbite is the lingual positioning of the maxillary anteri­or teeth in relationship to the mandibular anterior teeth. There are several methods for solving this problem. In this case report we present the treatment with a removable lingual plane. The aim of the following case report is to present the achieved good results after the early treatment of an anterior crossbite. Materials and Methods: This report describes the treatment of an 8-year-old girl in the Department of Orthodontics, Faculty of Dental medicine, Medical University - Varna. Diagnostic data was gathered from clinical photographs, cast models from intraoral impressions, cephalometric analysis based on lateral cephalograms and panoramic radiographs. Results: We established a crossbite of tooth 21 and laterodeviation. According to lateral cephalomet­ric analysis the patient has a retroclination of the upper central incisor on the left. There was suffi­cient mesiodistal width to achieve labial movement of the maxillary tooth. To align the maxillary an­terior central incisor and correct the crossbite, a removable acrylic appliance with posterior occlusal surfaces was used. A screw incorporated in the appliance was activated by 0.25 mm every 4 days for 12 days. After these 12 days the crossbite was corrected. Conclusion: There are many treatment options available for the correction of crossbites according to the number and site of the teeth/tooth involved, the stage of the dentition and its etiology. Based on the results presented here, a removable appliance with a screw may be considered the first choice of treatment to correct anterior dental crossbite of one incisor. This method is a safe, cost effective, rap­id and easy alternative for the treatment of an anterior crossbite.

OBJECTIVES To determine the frequency and pattern of anterior crossbite with primary and mixed dentition in School Children. METHODOLOGY A descriptive cross-sectional study was conducted at Sharif Medical and Dental College, Lahore. This study included 296 participants having either deciduous or mixed dentition, no history of orthodontic treatment, aged between 3-11 years, both genders and Pakistani nationals. Participants with a history of trauma, cleft lip/palate, or any craniofacial syndrome and systemic disease were excluded. Participant’s age, gender, skeletal class, and anterior crossbite (ACB) were recorded. The Chi-square/Fisher exact test was run to compare ACB and their pattern among gender, age group, and skeletal class. RESULTSThere is a relatively high rate of anterior crossbite in this population, which is about 10%. The females were 169(57.09%) and males were 127(42.91%). The mean age was 6.92 ± 1.68 years. Overall, the ACB was present in 31(10.47%). The most common pattern of ACB was single incisor involvement (n=11, 35.48%) followed by two incisors (n=9, 29.03%), and the least was four incisors (n=5, 16.13%). The difference for ACB was statistically significant among skeletal classes (p&lt;0.001). The frequency of ACB was higher in skeletal class 1 (n=17, 54.84%) and in skeletal class 3 (n=13, 41.94%) than in class 2 (n=1, 3.23%). CONCLUSION The frequency of anterior crossbite is about 10%, which is relatively higher than in other populations. Most anterior cross bites are dental due to one or two incisor involvement, which can be corrected easily at the mixed dentition stage.

Anterior crossbite or reverse overjet is the term used to describe an abnormal labiolingual relationship between one or more maxillary and mandibular incisor teeth. This may involve just a single tooth or up to all the upper incisors. Interceptive treatment is usually carried out in order to reduce the severity of this developing malocclusion in the mixed dentition. Different techniques have been used to correct anterior crossbite with variable effectiveness. This case report demonstrates a simple and cost-effective method for the correction of severe segmental anterior crossbite with a removable, lower Catalan's appliance initially and upper posterior biteplane with a z-spring later. Clinical Relevance: Anterior crossbite correction in the early mixed dentition is highly recommended as this kind of malocclusion does not diminish with age and could lead to further complications. Removable appliances are safe, cost-effective, rapid and an easy alternative for the treatment of crossbite cases requiring simple tipping, in contrast to a fixed appliance, which can be use in more complex conditions, is expensive, unaesthetic, difficult to maintain and needs a posterior bite platform incorporated.

BackgroundEpidemiological data on malocclusion among Chinese children are scant. The aim of this study was to provide detailed information on the prevalence of malocclusion in early mixed dentition children in Shanghai, China.MethodsA cross-sectional survey was conducted from September 2016 to April 2017, and 2,810 children aged 7- to 9- years were selected from 10 primary schools by cluster random sampling. Several occlusal parameters, including Angle molar relationship, overjet, overbite, open bite, anterior and posterior crossbite, midline displacement, scissors bite, and teeth crowding and spacing, were clinically registered by five calibrated orthodontic dentists.ResultsWe found that 79.4% children presented one or more occlusal anomalies. Angle Class I, Class II and Class III molar relationship were recorded in 42.3%, 50.9% and 5.9% of the sample, respectively. The proportion of Class III increased from 5.0% at age 7 to 7.8% at age 9. In the sagittal plane, increased overjet >3 mm was observed in 40.8% subjects, while the prevalence of severe overjet (>8 mm), anterior edge-to-edge (zero overjet) and anterior crossbite were 5.2%, 8.1% and 10.5%, respectively. Vertically, deep overbite >2/3 overlap was found in 6.2% of the children and open bite in 4.3%. Boys exhibited a higher rate of overbite than girls. For the transversal occlusal anomalies, 36.1% of the children had a midline displacement, which was followed by posterior crossbite (2.6%) and scissors bite (1.0%). Teeth space discrepancies were also common anomalies and anterior crowding (>2 mm) affecting 28.4% of the children, while anterior spacing (>4 mm) affecting 9.5%. Girls showed a higher prevalence of anterior crowding and a lower frequency of teeth spacing than boys.ConclusionsOur study demonstrated that malocclusion is prevalent among children in the early mixed dentition, and more health resources should be warranted to meet the challenge of prevention or early intervention of malocclusion.

Aim: As to the assessment of occlusal status pertaining to primary canines and molars, the latter is less within reach as it is difficult to guide jaws towards a centric occlusion while maintaining a vintage point in both direct and indirect observation. This study was originally intended to assess primary canine occlusion as a practical indicator in the evaluation of primary molar occlusion, which is otherwise less feasible in dental examination. Method and materials: A total of 281 healthy children (145 males and 136 females), with complete primary dentition and without erupted permanent teeth and serious caries were examined by a trained student of dentistry. Occlusal patterns of primary second molars were noted as flush terminal plane, distal step and mesial step and for primary canine as class I, class II and class III with regard to Angle’s classification. Results: Overall, Class II canine occlusion seemed to have coincided with more than half of the flush terminal molar occlusions (62%), whereas class I was largely associated with mesial step molars (61.2%). This was also found to be applied to cases undergoing unilateral assessment. (p<0.05). Conclusion: In the present study, a significant correlation between the primary canine and molar occlusal patterns (p<0.05) was found on both sides. Importance of study: the evaluation of primary canine occlusion can be used in preschool children as a simple practical method of predicting future discrepancies in the permanent dentition.

Introduction: Anterior crossbite, particularly during the mixed dentition stage, is a frequently encountered malocclusion affecting approximately 4–5% of the pediatric population. When left untreated, it may lead to complications in function, esthetics, and jaw development. Early intervention is essential to guide proper occlusal relationships. Case History: A 10-year-old patient presented with a chief complaint of reversed bite involving the upper front teeth, specifically teeth 11, 12, 21, and 22. The patient reported decreased self-confidence due to the appearance of the bite. A fixed Catlan’s inclined bite plane appliance had already been placed on the lower anterior teeth, and the patient came in for follow-up and monitoring. Discussion: Treatment of anterior crossbite can involve various removable or fixed appliances, with inclined bite planes offering the advantage of minimal dependence on patient compliance. Catlan’s appliance, a lower inclined bite plane, facilitates proper overjet and overbite relationships through a simple yet effective mechanism. In this case, its use allowed correction of a four-incisor anterior crossbite efficiently, without damaging dental or periodontal structures. Conclusion: Early correction of anterior crossbite using Catlan’s appliance can be a reliable, non-invasive, and quick solution, particularly when patient cooperation is limited. This case highlights the importance of timely diagnosis and the choice of an appropriate fixed appliance in supporting esthetic and functional rehabilitation.