Crossbite Relationship Research Articles

Treatment Plan and Discussions of Class I with Smilestream: A Case Report

The aim of the study was to present a Class I case and the treatment plan related to orthodontic diagnosis. The chief complaint of a patient and his parents are crowded teeth upper and lower and anterior crossbite. “@I’m looking like a crocodile” were the first words of the boy sitting on the dental chair. The main task was functional but also esthetics because it was from the first important to him. The treated malocclusion is characterized with a narrow maxillary width and prominence of the mandible. The maxilla was deficient in anteroposterior and transverse dimensions, causing a slightly concave and unpleasant profile, a crossbite relationship of lateral incisors and upper and lower anterior crowding. The use of mechanics was preferred and accepted as a better solution for the patient according to the idea to generate well directed growth. The patient was 12 year-old boy with Class I malocclusion and anterior crossbite. A molar and canine class 1 and correction of the malocclusion were obtained. The improvement of facial aesthetics and smile enlarging were also ensured.

Anterior crossbite treatment in the transitional period of mixed dentition: a case report

Anterior crossbite refers to the abnormal vestibulolingual relationship in the sagittal dimension between one or more anterior superior and inferior anterior teeth. It can be classified as dental, functional or skeletal. Each has its own diagnostic criteria and specific treatment, and it is up to the dentist to know how to distinguish between these different natures of malocclusion. In this sense, the aim of this study is to show a case report about an ACM. Patient HCA, female, 7 years old, attending the Preventive Orthodontics Clinic of the Faculty of Dentistry of Araçatuba - UNESP, having as main complaint “untidy front tooth”. The patient has no history of systemic diseases or medication use. The patient was in the first transitional period of mixed dentition with her right maxillary central incisor in crossbite relationship with its antagonists mandibular central incisor. On both sides, the patient had the first permanent molars in Class I relationship, the deciduous second molars with mesial step and the deciduous canines in a Class I. Initially, an acrylic appliance with an expander was installed. Due to lack of cooperation, the treatment plan was changed and the patient received a fixed appliance with a 2x2 configuration, with brackets on maxillary central incisors and edgewise tubes on maxillary deciduous molars. In the lower arch, a bite lift was performed on the occlusal surface of mandibular deciduous molars to unblock the occlusion and facilitate the movement of right maxillary central incisor. The total treatment time was 60 days.

Reducing dietary loading decreases mouse temporomandibular joint degradation induced by anterior crossbite prosthesis

Purpose: Loading on temporomandibular joint (TMJ) originates from the contraction of jaw-closing muscles. Variations in food properties, such as volume or hardness, will initiate different levels of masticatory muscle contraction via periodontal-muscular reflex, leading to differences in levels of occlusal force and TMJ loading. Soft diet will cause growing rats a thinning cartilage, enhanced cartilage catabolic activity and decreased subchondral bone volume fraction in condyles. Aberrant biomechanical stimulation from abnormal dental occlusion plays an important role in TMJ osteoarthritis (OA) development. Incisors of rodent animals function more than other teeth because when a rodent catches or cuts foods they used to move the mandible in the sagittal direction following the incisal guidance. Unilateral anterior crossbite prosthesis will heavily interfere with this function because the totally opposite guidances will be provided by the normal incisor pair and the crossbite incisor pair while the TMJ can support only one pattern of them at the same time. A small-size diet may diminish the requirement of the cutting function of incisors, and thus may reduce the harmful biomechanical stimulation from the anterior crossbite prosthesis. Hence, in the present study, we exposed the mice that received the unilateral anterior crossbite prosthesis to a small-size versus a large-size diet. The aim was to test whether mice receiving soft diet have a decreased TMJ degradation induced by the unilateral anterior crossbite prosthesis using our reported methods. Methods: Forty 6-week-old female C57BL/6J mice were randomly divided into two experimental and two control groups (n = 10), one experimental and one control group received small-size diet, less than 3mm thick and the other two groups received large-size diet, about 12.5mm in diameter and 15-20mm in length. For experimental groups, metal tubes made of pinheads were bonded onto the mouse left maxillary and mandibular incisors to create unilateral anterior crossbite relationship. For the control groups, the mice underwent the similar procedures but no metal tubes were bonded. No differences in degrading changes were found between the left side and right side TMJs in the experimental mice as we reported. Left side TMJ tissue blocks from six mice of each group were fixed, decalcified and embedded in paraffin. Sagittal sections were prepared for Hematoxylin & Eosin (H-E) staining, toluidine blue staining, Safranin O staining, tartrate-resistant acid phosphatase (TRAP) staining and immunohistochemical staining of Collagen II, OPG and RANKL. For each group, the condylar cartilages and subchondral bones of the other 14 TMJs were respectively separated and preserved at -80°C. Four to five condyles from 3 or 4 different mice were pooled to create a single sample of the cartilage or subchondral bone respectively for RNA extraction to compare the mRNA expression levels of Col2a1, Aggrecan, ADAMTS-5, RANK, OPG, RANKL. Differences were set at 0.05 level (α=0.05). Results: Thinner and degraded cartilage, reduced cartilage cellular density, decrease in toluidine blue staining (reflecting reduced proteoglycan levels) in cartilage, decreased expression levels of Collagen II and Aggrecan, loss of subchondral bone assessed by histomorphometry, and enhanced osteoclast activity were observed in both experimental groups. However, the cartilage degradation phenotype was less severe and cartilage ADAMTS-5 mRNA was lower while OPG/RANKL ratio in both cartilage and subchondral bone was higher in the small-size diet than the large-size experimental group. In contrast, no differences of histomorphology and OPG/RNAKL expression were found in the two control groups. Conclusions: The current findings suggest that a lower level of functional loading by providing small-size diet could reduce TMJ degradation induced by the biomechanical stimulation from abnormal occlusion.

Reactive Correction of a Maxillary Incisor in Single‐Tooth Crossbite Following Periodontal Therapy

The reactive correction of a single tooth anterior crossbite following periodontal therapy is described. This case report provides new information regarding correction of a crossbite relationship and con- firms existing reports of tooth movement following periodontal therapy. A 39-year-old woman in good general health presented with a history of recurrent periodontal abscesses of a maxillary incisor. Probing depths of the abscessed tooth ranged from 5 to 12 mm, and class 1 mobility was noted. Radiographs revealed that the tooth had previously been treated endodontically. The patient's periodontal diagnosis was generalized chronic moderate to severe periodontitis. Treatment considerations were complicated by a single-tooth crossbite relationship of the involved incisor and clinical evidence that the periodontal abscess communicated with an apical infection. Treatment of the abscess consisted of cause-related therapy, bone grafting, and occlusal adjustment. Five months after surgical treatment, an edge-to-edge incisal relationship was observed, the first indicator of tooth movement. Further correction to a normal incisal relationship resulted 1 year after modification of the proximal contact. At this time, there was normal probing depth with only slight recession and mobility. Bone fill was radiographically noted. It appears that some cases of maxillary incisor crossbite that are complicated by periodontal disease may be corrected, without orthodontic appliances, following periodontal treatment.

Oro-dental manifestations in Hallopeau-Siemens-type recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa of Hallopeau-Siemens (RDEB-HS) is a rare genetic disorder characterized by trauma-induced blisters, milia, acral pseudosyndactyly, and scarring. RDEB-HS patients present with a distinct pattern of oral involvement consisting of microstomia, ankyloglossia, vestibule obliteration and dental caries. In this review, we describe the orodental manifestations of RDEB-HS and present our experience in a cohort of six new cases of RDEB-HS in children aged 6-10 years, documenting the presence of microstomia, ankyloglossia and vestibule obliteration in childhood. We also show that compared with unaffected control children, RDEB-HS subjects have a greater risk of developing high caries indices with early onset, both for permanent or deciduous teeth, and a worse oral hygiene index (scored as OHI). Tooth malpositions and the cross-bite relationship between maxilla and mandible could play a major role in promoting these events. We propose that dental management of RDEB-HS subjects should commence as soon as tooth eruption begins.

Facemask therapy with rigid anchorage in a patient with maxillary hypoplasia and severe oligodontia

In this report, we describe the treatment of a 10-year-old girl with a Class III skeletal relationship with maxillary hypoplasia and severe oligodontia. The maxillary arch was in a complete crossbite relationship with the mandibular arch. The treatment plan called for displacing the maxillary complex anteriorly with a facemask. Because of the lack of available teeth, a rigid anchorage implant was used in combination with the remaining teeth to provide anchorage. A titanium lag screw was placed in the maxillary alveolus. Three weeks later, 800 g of orthodontic force was applied. A significant anterior displacement of the nasomaxillary complex was acheived with the facemask. At the end of treatment, a temporary removable partial denture was placed.

The dentofacial manifestations of XXXXY syndrome: a case report

This paper presents a six-year-old patient with XXXXY syndrome, whose oral findings included a cleft soft palate, hyper- or meso-taurodontism in eight primary molars and in the mandibular permanent first molars, five congenitally missing premolars, and delayed development of the permanent tooth germs. The maxillary and mandibular primary central incisors were in a cross-bite relationship. Cephalometric findings showed a short ramus of the mandible and a short maxilla in the anterioposterior plane. The anteroposterior jaw relationship was in harmony. The cross-bite was considered to be due to the retroinclination of the maxillary primary incisors. This case emphasises the importance of regular dental care, and monitoring of facial growth and dental development in children with XXXXY syndrome.

Changes in jaw movement and jaw closing muscle activity after orthodontic correction of incisor crossbite

The possible influences of the direction of occlusal loading delivered to the incisors in the sagittal direction during chewing on jaw movement and jaw closing muscle activity were investigated. Ten healthy children with crossbite of one or two incisors on the right side were selected. Each subject chewed a piece of chewing gum on the right side, and jaw displacements and electromyographic signals from the posterior temporalis and superficial masseter muscles on the ipsilateral side were sampled simultaneously. After orthodontic correction of the incisor crossbite relationship, identical records were taken. The inclinations of the gliding contacts for each posterior tooth in the lateral jaw excursion position were consistent before and after the treatment. The posttreatment records showed broader jaw movement patterns in the frontal view and faster jaw movement velocity in the lateral direction at a level close to the habitual maximum intercuspation position, when compared with the pretreatment records ( P < 0.05). The duration of the muscle activity and the incidence of the silent periods of the masseter muscle during chewing significantly decreased after the treatment ( P < 0.05). The current results give a neurophysiologic rationale for explaining the significance of orthodontic treatment in improving lowered masticatory efficiency in the way that the change in direction of the occlusal load achieved by tooth movement influences on the periodontal sensory input, which, in turn, modifies the trigeminal motor output and thus, eventually, jaw muscle activities. (Am J Orthod Dentofac Orthop 1997;112:403-9.)

Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis

There is an agreement among orthodontists that a posterior crossbite relationship should be treated early. The Haas expansion appliance is frequently chosen whenever a maxillary skeletal constriction exists in the deciduous, mixed, or permanent dentition. In this study we evaluated the efficacy of rapid maxillary expansion for 32 children between 5 and 11 years of age, by inspection of anteroposterior radiographs. Our results confirm previous data in the literature that the triangular opening in the frontal alveolar area is greater than in other parts of the midpalatal suture. It is evident that with expansion there is a real orthodontic effect, even at an early age. (A M J O RTHOD D ENTOFAC O RTHOP 1995;107:268-75.)

Dentofacial Relations in Young Adults with Unilateral Complete Cleft Lip and Palate: A Follow-up Study

A retrospective study was made on 30 patients born between 1958 and 1969 with unilateral complete cleft lip and palate (C-UCLP) and operated on at the Department of Plastic Surgery, University Hospital, Umeå, Sweden. All patients were operated on by the same surgeon. The results are based on data from records at 5, 10, 16 and 20 years of age. The facial morphology of the cleft children at 5 years of age was rather close to that of the normal children. During growth the faces became retrognathic, more visibly so in the maxilla resulting in straight or concave profiles. This was more evident among the boys. There were no differences regarding maxillary growth between children bone grafted at 10 to 16 years of age and those bone grafted after 16 years of age or not at all. Although surgical procedures and orthodontic treatment varied, 70% had less than 3 teeth in crossbite relationships at 20 years of age. An important factor to take into consideration is the fact that in addition to the influence that the cleft morphology and treatment have on the dentofacial growth, other dentofacial growth patterns also exist among the cleft patients. Generally the groups of patients reported are rather small and therefore conditions like these can have a strong influence on the results.

Orthopedic/orthodontic treatment of a class I malocclusion with a class III skeletal pattern and maxillary deficiency An American board of Orthodontics case report

A case report of a Class I dental malocclusion superimposed on a Class III skeletal pattern with normal mandible and underdeveloped maxilla is presented. The patient was a 15-year-old girl whose statural growth was complete. The maxilla was deficient in anteroposterior and transverse dimensions, causing a slightly concave profile, a crossbite relationship of most of the anterior and posterior teeth, and upper anterior crowding. Sutural expansion and orthopedic advancement of the maxilla was used to reduce the maxillary deficiency. A complete 0.018-inch slot straight-wire appliance was used to align the teeth, close lower spaces, and detail the occlusion.

Functional regulator therapy for cleft palate patients

Nine cleft lip and palate children exhibitng collapse of maxillary segments and cross-bite were treated orthodontically with the functional regulator (FR) for periods ranging from 6 to 18 months. The purpose of this investigation was to evaluate quantitatively treatment of cleft palate patients with the functional regulator and to evaluate the effect of the appliance on their speech. Cleft palate patients typically have speech, nose, and lip defects which make patient cooperation and appliance acceptance more difficult. However, patient cooperation was considered good with an average mean of 12.7 hours per day of appliance wear and a range of 5.6 to 18.2 hours. Change in interimplant dimension was measured on frontal radiographs, and dental changes were measured of serial dental casts. The resulting data indicated no significant change in maxillary width or cross-bite relationship. The functional regulator was not clinically useful in this sample when the treatment objective was primary expansion of collapsed maxillary segments in the cleft palate patient. Good speech-production skills prior to treatment will minimize the adverse effect that the FR has on speech intelligibility. A significant amount of accommodation to the appliance occurs within 1 week after insertion, but maximum improvement in speech intelligibility occurs with full-time wear of the appliance for as many hours per day as possible.

The effects of early Le Fort I osteotomies on craniofacial growth of juvenile Macaca nemestrina monkeys.

Le Fort I osteotomies were performed on three juvenile Macaca nemestrina monkeys with midface deficiencies from prior extraoral traction. The maxillas of these monkeys were moved anteriorly an amount necessary to achieve about 8 mm. of horizontal overjet. Interosseous wires were used to stabilize the segments; the animals were not placed in intermaxillary fixation. Craniofacial growth in the three experimental monkeys and in three control monkeys was monitored for 2 years with serial cephalometric radiographs. Compared to the controls, the maxillas of the experimental animals demonstrated less anterior growth, and this was manifested clinically in anterior dental cross-bite relationships. Histologic examination of the circummaxillary sutural complex revealed normal morphology. It is concluded, therefore, that early Le Fort I osteotomies significantly affect subsequent maxillary growth in monkeys and that this effect probably is due to formation of scar tissue.