Bilateral Posterior Crossbite Research Articles

Rapid maxillary expansion for maxillary atresia and mandibular alignment: A mixed dentition case report

Introduction: Posterior crossbite is a common malocclusion in orthodontics. It often accompanies maxillary atresia, leading to unilateral or bilateral posterior crossbite. Rapid maxillary expansion (RME) is an approach to treat atresia, correct transverse discrepancies, and increase the perimeter of the maxillary arch. Objective: To present the case of an 8-year-old patient with maxillary atresia, skeletal Class I, dental Class I, and no space in the maxillary anterior and mandibular regions for the alignment of the incisors. Clinical procedures: RME was performed using a HYRAX type expander. After 20 days of daily activations, there was a change in the morphology of the palate, an increase in the arch perimeter, facilitating the eruption of incisors and canines. Final considerations: RME is an effective and efficient orthopedic treatment, recommended for correcting transverse deviations, normalizing structural and functional problems. As positive side effects, the indirect action on the mandibular molars and canines allowed the alignment of the incisors.

Functional treatment of bilateral posterior crossbite improves mandibular kinematics during chewing.

To evaluate the effects of treatment of bilateral posterior crossbite (BPXB) on mandibular kinematics by the percentage of reverse chewing cycles (RCCs) during soft and hard bolus chewing before and after the correction of the malocclusion with function-generating bite (FGB). This prospective study included 71 subjects: 19 patients with occlusally symmetric BPXB (M = 9; F = 10; mean age 9.3 ± 2.2[yr.mo]), 32 patients with occlusally asymmetric BPXB (19 with more teeth in crossbite on the right side (right prevalent side), M = 7; F = 12; mean age 8.2 ± 1.6 [yr.mo] and 13 on the left side, M = 7; F = 6; mean age 9.6 ± 1.9 [yr.mo]) and 20 controls without malocclusion (M = 8; F = 12; mean age 10.2 ± 1.7 [yr.mo]). Masticatory patterns were recorded before (T0) and after (T1) the correction of the malocclusion with FGB, with the K7-I® kinesiograph using standardized soft and hard boluses. BPXB was corrected in all included patients. At T0, the percentage of RCCs in BPXB was significantly increased compared to controls (P < .0001); symmetric BPXB showed no difference in RCCs between the sides, whereas asymmetric BPXB showed significantly more RCCs on the side with more teeth in crossbite (prevalent side). After treatment with FGB (T1), the percentage of RCCs was significantly reduced in both symmetric BPXB patients (soft bolus, P = .003; hard bolus, P < .001) and asymmetric BPXB patients (prevalent side: soft and hard bolus, P < .00001; non-prevalent side: soft bolus, P = .01 and hard bolus, P = .0002). Functional correction of BPXB with FGB significantly improved mandibular kinematics during chewing.

¿Qué papel tiene la ortodoncia en el tratamiento de cirugía ortognática?

Introduction: In orthognathic surgery treatment, orthodontics plays a fundamental role. By improving the inclination of the maxillary and mandibular incisors, as well as correcting bilateral posterior crossbite, it contributes significantly to the correction of facial and dental problems. Objective: To inform patients and the general population what the function of orthodontics is within orthognathic surgery. Design: Systematic review of studies published from 1998 to 2021. Data sources: PubMed. Study selection: A reviewer searched, selected and extracted information from the articles that were selected. All pooled articles were based on random effects models. Results: After collecting this information we can give results. Orthodontics helps in many factors in the process of orthognathic surgery to achieve an aesthetic result, orthodontics within orthognathic surgery fulfills the function of aligning the maxillary and mandibular dental arches; corrects crossbite; treats dentofacial deformities; achieves facial harmonization.

Influence of bad oral habits upon the development of posterior crossbite in a preschool population

BackgroundA study is made of posterior crossbite in deciduous dentition and its possible association to extrinsic factors (bad oral habits).MethodsA total of 1168 Spanish children between 3 and 6 years of age were included in the study. Exploration of the oral cavity was performed to assess the presence of crossbite (uni- or bilateral and/or functional), and a questionnaire was administered to the parents or caregivers to determine the presence of bad oral habits and their duration.ResultsIn occlusion, 19.7% of the cases (n = 230) presented uni- or bilateral posterior crossbite. On adopting centric relation confronting the midlines, crossbite persisted in 165 children, indicating that 65 cases were due to premature contacts (functional crossbite). The identified favoring factors were pacifier use, thumb sucking, oral breathing and tongue thrusting or immature swallowing.DiscussionMost studies in the literature report a relationship between posterior crossbite and bad oral habits. The proportion of posterior crossbites identified in our study (16.6%) is consistent with the data published by authors such as Kobayashi, Limeira or Paolantonio, among others, but differs from the results of Zhifei Zhou, Peres or Germa. In coincidence with most studies, we recorded a statistically significant association between posterior crossbite and bad oral habits.ConclusionsBad oral habits favor the appearance of posterior crossbite, and the duration of the habit, its intensity (in the case of thumb sucking) and type (in the case of pacifier use) act as influencing factors. Functional study characterized the types of posterior crossbites and identified those attributable to premature contacts. This aspect has not been addressed by previous studies, and we consider the findings to be very interesting for analyzing and identifying the features of true crossbites.

Etiology of narrow maxilla creating orthodontic and prosthetic treatment difficulties.

Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic factors are mostly related to upper airway pathologies that restrict breathing and cause negative pressure at the base of the nose and nasopharynx. The upper and lower airway is a whole unit. Regional anomalies or acquired problems affect the entire system. This can lead to developmental issues and permanent disorders in childhood, which will last their real life. This study was planned to investigate the incidence of nasopharyngeal obstruction originating from allergic rhinitis, turbinate hypertrophy, septum deviation, and adenoid vegetation in children scheduled for orthodontic treatment due to maxillary stenosis. Our study group consists of one hundred children aged 12-16 years who applied to the orthodontist due to dental malalignment and were found to have a narrowing of the maxilla. After the orthodontic evaluation, the patients were referred for an ENT examination to evaluate the etiological factors originating from the upper respiratory tract. In the study group, nasal congestion and allergic rhinitis were first investigated. All symptoms were evaluated and scored. Then, an ENT physical examination was performed in all cases, and nasal cavities, nasopharynx, and oropharynx were assessed with a fiberoptic endoscope. Regarding etiological factors, allergic rhinitis, turbinate hypertrophy, nasal septum deviation, and adenoid vegetation that would prevent breathing were carefully investigated. Firstly, deep palate, narrowed maxillary arch, V-shaped arch, adenoid face type, bilateral posterior crossbite, insufficient lip presence, maxillary incisor protrusion (upper forward thrust), skeletal class 2 division 1 malocclusion, and increased lower face height detected in patients primarily diagnoses were grouped according to their pathologies. Allergic rhinitis was found in 43 cases, turbinate hypertrophy in 30 instances, nasal septum deviation in 18 cases, and adenoid vegetation that prevented respiration in 61 patients. It is known that increased nasal airway resistance due to allergic rhinitis, septal deviation, turbinate hypertrophy, or adenoid vegetation in the upper respiratory tract may lead to permanent orthodontic disorders in children and adolescents. A multidisciplinary approach, early diagnosis, and treatment should be the first step to prevent this situation. Secondly, it should be planned to correct the anatomical disorders that have occurred with appliances and, if necessary, surgical approaches. Taking precautions before permanent problems arise in childhood is also crucial in prosthetic dentistry.

Evaluation of First Molar Buccolingual Angulations and Dental Arch Parameters in Adolescents with Bilateral Posterior Crossbite.

This study aimed to compare the maxillary and mandibular transverse dental arch widths and buccolingual inclinations of the molar teeth in patients with and without bilateral posterior crossbite (BPC) divided into different age groups. The study included dental models from 120 patients (age: 12-18 years), including 60 with BPC (32 boys and 28 girls) and 60 without BPC (controls; 30 boys and 30 girls), who were divided into three age groups (12-14, 14-16, and 16-18 years). The centroid and lingual transverse arch widths, dental arch perimeters, dental arch depths, and buccolingual angulation of the molar teeth in the maxillary and mandibular regions were evaluated using scanned three-dimensional dental models. Dental arch parameters and buccolingual molar angulation did not significantly differ between the different age groups in either the patients with BPC or the controls (p>0.05). However, several dental arch width parameters differed significantly between sexes in both groups, with higher values in boys than in girls (p<0.05). The difference in the upper and lower molar buccolingual angulation between patients with BPC and controls was greater at the age of 16-18 years than the age of 12-14 years (p<0.05). Patients with BPC have smaller maxillary dental arch widths and larger mandibular intermolar widths than those without BPC. The difference in the molar buccolingual angulation between them increases with advancing age.

Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update.

Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.

Cross-Bite and Oral-Health-Related Quality of Life (OHRQoL) in Preadolescents Aged 11 to 14 Years Old: A Pilot Case-Control Study.

Malocclusions have a negative impact on oral-health-related quality of life (OHRQoL). Posterior cross-bite is one of the most prevalent malocclusions in the preadolescent population. This study investigated the influence of posterior cross-bites (unilateral or bilateral) on OHRQoL in an 11- to 14-year-old population. A pilot case-control study was carried out at the Dental Clinic of the University of Salamanca between 2021 and 2023. A consecutive sample of 120 preadolescent patients aged 11 to 14 years old was recruited. Three groups were analyzed: a control group (no posterior cross-bite) (n = 40), a group with unilateral posterior cross-bite (n = 40), and a group with bilateral posterior cross-bite (n = 40). To analyze the OHRQoL, the Spanish version of the Child Perception Questionnaire (CPQ-Esp11-14) was used. The mean age of the sample was 12.2 years old (±0.96 years). The group of patients with a bilateral posterior cross-bite was shown to have higher scores in all dimensions of the CPQ-Esp11-14, as well as a higher total score. Sex only influenced the oral symptom dimension of the CPQ-Esp11-14 questionnaire; in this dimension, the girls described a greater impact. Age did not influence OHRQoL. The presence of a posterior cross-bite had a negative impact on OHRQoL in the preadolescent population that was studied.

Comparing Airway Analysis in Two-Time Points after Rapid Palatal Expansion: A CBCT Study.

The aim of this study is to investigate the upper airway analysis at two-time points after the rapid maxillary expansion was performed, using cone-beam computed tomography. Subjects from the Orthodontic Department at the Aristotle University of Thessaloniki with unilateral or bilateral posterior crossbite were screened according to the selection criteria. A sample size calculation was performed, and a total of 14 subjects were recruited. All subjects received a rapid maxillary expansion with a Hyrax-type device as part of their comprehensive treatment. A CBCT was taken before the treatment (T1), immediately after the expansion was completed (T2), and 6 months after (T3). Their upper airway was measured using the CBCT images. Airway volume (V) and minimal cross-sectional area (MCS) were extracted and compared using SPSS to analyze the means. A statistically significant difference was found between all time points regarding both V and MCS (p < 0.001, p = 0.001). There was a statistically significant increase in both V and MCS measurements immediately after RPE expansion (T1-T2) and six months after expansion (T1-T3). Between the end of expansion and 6 months after (T2-T3), there was a decrease in V and no statistical difference in MCS. RPE can significantly increase the volume and minimal cross-sectional area of the nasal passage airway.

Non Surgical Treatment of Bilateral Posterior Crossbite Using MARPE

Non Surgical Treatment of Bilateral Posterior Crossbite Using MARPE

Dento-skeletal effects of different rapid maxillary expanders for growing patients-which is better?

Single-blind, two-arm parallel-group randomised controlled trial. Patients aged 11-14 years old attending for comprehensive orthodontic treatment between January and July 2018. All subjects needed to have the following: present upper first premolars and first permanent molars; transverse maxillary deficiency; unilateral or bilateral posterior crossbite. The exclusion criteria was: cleft lip or palate, previous orthodontic treatment; congenital deformity; absent permanent teeth. Rapid maxillary expansion via two techniques were used and placed by the same orthodontist. Group A were treated via the tooth-bone-borne Hybrid Hyrax expander, Group B had the tooth-borne (hyrax) expander. CBCT scans of the maxilla were taken before treatment and 3 months after the activation phase when the appliances had been removed. Analysis of the dental and skeletal changes was completed via measuring pre and post treatment CBCT scans using Dolphin software for Group A and Group B. Measurements included: specific naso-maxillary widths in the first premolar region (i.e. nasal cavity, nasal floor, maxilla, palate), naso-maxillary widths in the first molar region, premolar/molar inclination, buccal cusp distance, and apices distance, as well as suture maturation. Baseline characteristic data was compared using one-way ANOVA. Intergroup comparison of changes was analysed using ANCOVA. P < 0.05 (5%) was considered statistically significant. Inter-rater reliability was assessed using correlation coefficient. Skeletal effects: The Hybrid Hyrax patients (HHG) showed a significantly higher increase in dimensions in the nasal cavity, nasal floor and maxilla in the premolar region only, of 1.5 mm, 1.4 mm and 1.1 mm, respectively, compared to the Hyrax expander patients (HG), to a 5% significance level. The HHG showed a significantly higher increase in dimensions in the nasal cavity of 0.9 mm, in the molar region, compared to the HG. Dental effects: Premolar inclination was significantly higher in the HG, with the difference being -3.2 degrees on the right 1st premolar and -2.5 degrees on the left 1st premolar. The higher the amount of activation, the higher the nasal skeletal changes in the Hybrid Hyrax group. The Hybrid Hyrax (tooth-bone-borne expander) resulted in increased skeletal dimension changes (i.e. in the nasomaxillary structures in the first premolar region, and nasal cavity in the first molar and first premolar region) and only minimal premolar inclination/tipping compared to the Hyrax (tooth-borne expander). There were however no differences between the expanders for position of premolar or molar apices, or molar crowns.

Novel concept for posterior crossbite correction : Preliminary results.

The efficiency of dentoalveolar compensation involving both jaws for posterior crossbite correction using computer-aided design/computer-aided manufacturing (CAD/CAM) expansion and compression archwires was evaluated. Treatment outcome was tested against the null hypothesis that the transverse correction achieved would be significantly smaller than planned. This retrospective study included 64patients (mean age 23.5years, median17.0, minimum/maximum:9.0/63.0, standard deviation13.7) with uni- or bilateral posterior crossbite. In all consecutively debonded patients, expansion and/or compression archwires were used for dentoalveolar correction involving both jaws. Plaster casts prior to(T1) and following treatment(T2) with completely customized lingual appliances (CCLA) were compared with the treatment plan represented by an individual target set-up. The statistical analysis was carried out using the Schuirmann TOST (two one-sided t‑tests) equivalence test on the basis of aone-sample t‑test with α = 0.025 to one side. The non-inferiority margin was set at δ = 0.5 mm. All posterior crossbites could be corrected by dentoalveolar compensation involving both jaws. The mean total correction achieved was 6.9 mm (mean maxillary expansion: 4.3 mm/mean mandibular compression: 2.6 mm) with amaximum of 12.8 mm. The transverse corrections achieved in both arches atT2 were equivalent to the planned corrections in the set-up (p < 0.001). The results of this study indicate that CAD/CAM expansion and compression archwires can be an efficient tool to achieve the desired correction in patients with aposterior crossbite even in more severe cases.

Evaluation of swallowing in transverse maxillary deficiency patients before and after rapid maxillary expansion.

To evaluate swallowing function in relation to oropharyngeal dysphagia (OD) in adolescents who had transverse maxillary deficiency with posterior crossbite and high-arched palate, before, and after rapid maxillary expansion (RME). Twenty patients (mean age: 13.0 ± 3.1) with bilateral posterior crossbite and high-arched palate (RME group: RMEG) and 20 volunteers (mean age: 13.4 ± 2.6) with Class I crowding without posterior crossbite or high-arched palate (control group: CG) were recruited. OD signs and symptoms were evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaire, patient complaints, and physical examination of swallowing function before (T1) and 7 months after (T2) RME. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and cracker was performed. In CG, evaluation of swallowing was performed only once, corresponding to T1 of RMEG. Prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (5%-15%), and nonsignificant differences were observed between CG and RMEG at T1 for these parameters as well as for EAT-10 scores. Total post-swallow pharyngeal residue with yogurt was significantly different between CG and RMEG at T1, with a prevalence of 60% in RMEG (P < .05). There was no significant difference regarding residue with yogurt between T1 and T2 in RMEG (P > .05). Patients with a maxillary transverse deficiency were affected by pharyngeal residue as indicated by FEES, but it did not appear to improve in short-term follow-up in patients treated with RME.

Oral manifestations in child patient with Ellis-van Creveld syndrome: case report

Ellis–van Creveld syndrome is an autosomal recessive disorder characterized by a tetrad of disproportionate dwarfism, ectodermal dysplasia, postaxial polydactyly, and congenital heart malformations. In this article, we hereby present a case of a 6-year-old Brazilian boy with Ellis–van Creveld syndrome who presented with a remarkable number of classical oral and dental features and uncommon findings such as taurodontism. Clinical examination revealed multiple enamel hypoplasia, absent vestibular sulcus, alveolar serrations in the maxilla anterior region, missing teeth, conical teeth, lower canine rotation, bilateral posterior crossbite, dental caries, and a nodule. Radiographically were observed teeth agenesis, taurodontism of deciduous and permanent molars, and delayed tooth eruption. Clinical and radiographic findings may be present from birth and the pediatric dentist has a fundamental role in the early diagnosis of Ellis–van Creveld syndrome, as well as oral problems prevention, rehabilitation, and aesthetic interventions.

ORTHODONTIC-SURGICAL TREATMENT OF CLASS III MALOCCLUSION WITH MANDIBULAR ASYMMETRY: A CASE REPORT

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone shift may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 19 years with Class III skeletal malocclusion, having narrow maxilla, bilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the mandibulary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patients final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.

Evaluation of the Changes of the Intercanine and Intermolar Widths Following Palatal Expansion in the Mixed Dentition Patients with Bilateral Posterior Crossbite: A Systematic Review.

This systematic review aimed to identify the intercanine and intermolar width changes following palatal expansion in bilateral posterior crossbite (PXB) in mixed dentition. This review was registered in the PROSPERO database (CRD42021275833). All randomized controlled trials (RCT) and non-RCT articles between 1980 and August 2022 on the palatal expansion of bilateral PXB in mixed dentition were searched in seven online databases (Google Scholar, Ovid, Web of Science, Scopus, EBSCOHost, Cochrane Library and PubMed). The risk of bias (RoB) of the articles included was analyzed using the Joanna Briggs Institute (JBI) critical appraisal tool. Three non-RCT studies were included and showed a low risk of bias. Meta-analysis on the changes in intercanine and intermolar widths was not performed due to study design heterogeneity. One study reported an over-correction of the bilateral PXB. There is a need for more RCT studies with standardized landmark measurements, outcome assessment methods and retention periods to investigate the interdental changes following palatal expansion.

Veau’s group IV Cleft: A case report

The case report demonstrates treatment of Group 4 cleft under Veau’s Classification of cleft lip and palate. The patient had complete cleft palate, displaced premaxilla, bilateral cleft alveolus, repaired bilateral cleft lip, bilateral posterior crossbite and severe crowding in maxillary arch.A 18 year old male reported with forwardly placed premaxilla , severe crowding in maxillary arch. Therefore treatment was planned to make a 3D printed model of the maxillary arch for proper treatment plan. To relive severe crowding with modified Transpalatal Arch, followed by expansion of maxillary arch and to achieve proper occlusion with fixed orthodontic treatment. After achievement of proper leveling and alignment fixed prosthesis was planned to achieve desired aesthetics.

Invisalign Treatment of a Three-Year-Old Child with Bilateral Posterior Scissor Bite and Multisite Upper Airway Obstruction: A Case Report

Scissor bites have been reported in relatively few epidemiological studies because of their extremely low prevalence rate (below 1%). The etiology of scissor bites remains obscure, but its impact on growth and function should not be ignored. In this case report, a novel treatment that utilizes Invisalign aligners was performed on a 3-year-old child who presented with a bilateral posterior scissor bite and anterior crossbite, accompanied by multisite obstruction in the upper airway. The aligners functioned as occlusion pads to unlock the scissor bite relationship and combined with cross-traction to narrow the maxillary arch and enlarge the mandibular arch simultaneously. The duration of orthodontic therapy was 28 weeks. A multidisciplinary consultation (orthodontics department, ENT department, and spinal surgery) was conducted and a stable result was achieved. A healthy occlusal relationship, improved dental esthetics and a better lateral profile were eventually obtained. Positive treatment outcomes rely on patients' good compliance in this case. In addition, we hope that clinicians will consider our situation in terms of alternative treatments and interprofessional experience.

Effectiveness of low-level laser therapy in facilitating maxillary expansion using bone-borne hyrax expander: A randomized clinical trial.

The objective of this randomized clinical trial was to study the skeletal and dental effects of low-level laser therapy (LLLT) along with a miniscrew-assisted expander (Hyrax) after six months of retention. After sequence generation, concealed allocation, and implementation, 24 female patients were randomly divided (1:1) into two-groups: bone-borne rapid palatal expansion (BBE) without LLLT (n = 12) and BBE with LLLT (n = 12). Eligibility criteria included female patients aged 10-13 years old with bilateral posterior crossbites. Intraoral and extraoral photographs, cone-beam computed tomography images, and digital study models were obtained before expansion and six months after retention. The 7 mm Hyrax appliance was anchored to four palatal mini-screws, which were activated twice daily for 15 days, then locked and kept in place as a retainer. LLLT was performed in the laser group during expansion and retention, according to the guidelines provided. The records of 24 patients were analyzed. According to the post-retention measurements, both groups showed a significant increase in nasal and maxillary widths and total facial height. In the laser group, the Sella-Nasion-Point A and Point A-Nasion-Point B angles and the interpremolar apical distance were significantly increased. Within the limitations of this study, the results suggest that the parameters and protocol of LLLT do not clinically affect the efficiency of BBE in prepubertal and pubertal patients.

Evaluation of dentoskeletal effects of surgically assisted rapid maxillary expansion using computed tomography

Introduction: Patients with transverse maxillary deficiency may have unilateral or bilateral posterior crossbite, crowded and rotated teeth and narrow palate. The treatment for adults is surgically assisted rapid maxillary expansion, a procedure that results in changes not only to bones, but also to teeth, nasal cavity, air space, lips and surrounding soft tissues. Objective: This study evaluated dentoskeletal changes in patients that underwent surgically assisted rapid maxillary expansion (SARME). Methods: Cone beam computed tomography (CBCT) scans were obtained before and after SARME. The thickness of buccal and lingual cortical bone and the angle of the long axis of posterior maxillary teeth were measured. Data were analyzed statistically. Results showed changes in thickness of buccal and lingual cortical bone and tooth movement and tipping. Conclusion: Tooth tipping increased and buccal bone thickness decreased, although osteotomies were used.