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Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 ORTHODONTIC TREATMENT NEEDS IN MIXED DENTITION FOR CHILDREN OF 6 AND 9 YEARS OLD Anne-Marie Rauten1, Catrinel Georgescu1, M.R. Popescu2, Camelia Fiera Maglaviceanu3, Dora Popescu4, Dorin Gheorghe4, A. Camen5, Cristina Munteanu5, Madalina Olteanu3 1 Department of Orthodontics, Faculty of Dental Medicine, UMF Craiova 2 Department of Prosthetics, Faculty of Dental Medicine, UMF Craiova 3 Department of Pedodontics, Faculty of Dental Medicine, UMF Craiova 4 Department of Periodontology, Faculty of Dental Medicine, UMF Craiova 5 Department of Oral and Maxillofacial Surgery, UMF Craiova Correspondent author: ABSTRACT: Early identification of a developing malocclusion and initiation of simple orthodontic therapy procedure represent ways to prevent or reduce the number of late orthodontic treatments, which can be complex, lengthy and costly. We aimed to assess the need for interceptive therapy of dentomaxillary anomalies on a group of 147 children, 69 of age 6 years old and 78 of age 9 years old, which called for an orthodontic or pedodontic treatment during 2014- 2015 in 4 private offices in Craiova. We observed a high prevalence of caries in temporary and young permanent dentition (52.98% for age 6 years old and 37.17% for age 9 years old) and of early loss of temporary teeth (17.39% for age 6 years old and 23.07% for age 9 years old). The need for orthodontic treatment was high or very high for 10.13% of the children age 6 years old and 24.35% of the children age 9 years old, and small or moderate for 13.03% of children age 6 years old and 33.33% of the children age 9 years old. IOTN can be a valuable tool in identifying, planning and interception of potential dentomaxillary malocclusions. Keywords: early loss of temporary teeth; malocclusions; prevention and interception in orthodontics. INTRODUCTION: Need to establish an orthodontic treatment in children is increased, varying according to the literature between a quarter and a third of this population group members [1,2,3,4]. In many cases the development of dentomaxillary anomalies can be early detected, since temporary or mixed dentition [5,6], but many doctors assess subjects in orthodontic terms only after completion of dental permutation. Thus they refuse an interceptive treatment to such patients, which performed correctly can reduce on the one hand the risk of developing major dental mismatch, severe malocclusions or some facial asymmetries (the potential of skeletal growth modification is higher at younger ages); on the other hand it reduces the need for complex or lengthy orthodontic treatments, providing a more stable therapeutic results [7,8,9]. The interception of malocclusions promotes a better oral health care and decreases the risk of dental caries [10,11]. There were described several indices able to identify people who need orthodontic treatment and to minimize the subjectivity related to the diagnosis [12]. Shaw and co-workers (1995) [13] divided occlusal indices into five different categories: indices for diagnosis, epidemiological, orthodontic treatment need, treatment outcome, and orthodontic treatment complexity indices. Most of them relate to permanent dentition. The best known and used is Index of Orthodontic Treatment Need 28 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 (IOTN), because it is easily reproducible and the recording of all the relevant features of malocclusion can be done in a minute amount of time [14]. This index has been recommended and widely used for patients in the full permanent dentition but not in the mixed dentition stage [3]. So the IOTN has two separate components, a clinical component called the Dental Health Component (DHC) and an Aesthetic Component (AC). The Dental Health Component of IOTN is divided into five grades, with Grade 1 indicating no treatment is required and Grade 5 showing great need for treatment (Brook and Shaw, 1989) [15]. The occlusal trait with the highest score indicates the grade in which the malocclusion belongs to determining the degree of treatment needs. Regarding the aesthetic component it relies on a series of 10 photographs of different malocclusion arranged according to their attractiveness (from the least to the most attractive). In the original study the scale for AE assessment was determined by Evans & Shaw (1987) [16] for a lot of children of age 12 years old. In 2014 Mohamed et al. [1] tried to assess whether IOTN may find utility in interception, by assessing occlusal changes in the frontal maxillary and mandible in a group of children aged 8-10 years old, concluding that IOTN is effective in identifying dentomaxillary anomalies linked to increased overjet and overbite or to the presence of crossbite. Specific index for mixed dentition that allows early detection of developing malocclusion is the index for preventive and interceptive orthodontic need, IPION, described by Coetzee (1997) [17]. IPION consists in recording of various occlusal traits that have scores depending on their severity. The trait scores are then added, yielding a total score that indicates the need for preventive or interceptive orthodontic treatment [3]. The index does not show the real prevalence of malocclusion, however, because there are severe malocclusions that can not benefit from preventive or interceptive treatment, which according to this index, have a low score [3]. It may be possible because of the small number of studies that have dealt preventive and interceptive orthodontics over the years and of the growing interest in this subject in recent years (Karaiskos et al., 2005 [3]; Silkestrand, 2007 [2] Sandoval and colab.2010 [18]; Borre 2013 [19]; Mohamed et al. 2014 [1]). The purpose of the present study was to investigate by means of some occlusal parameters analysis how necessary is a preventive or interceptive orthodontic treatment in several dental officies with private practice in Craiova, for children aged 6 and 9 years old. The two age groups were chosen because at 6 years of age starts the mixed dentition phase, and within this phase the age of 9 years old marks the beginning of canin-premolar group eruption, when it completes the arch and harmonious implanting of permanent teeth into the alveolar arch and anterior and lateral guidance in eccentric motion of the mandible [20]. MATERIAL AND METHOD The study was conducted during 2014-2015 in four private dental offices in Craiova with orthodontics and pedodontic activity. Were targeted children aged 6 and close to 9 years old, resulting in a sample of 147 children for which informed consent was obtained from caregivers in order to use clinical data records and analysis of study models and dental radiographs. In order to determine the necessity of establishing a preventive or interceptive orthodontic treatment depending on the age 29 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 they were valued for each child from the study group more clinical parameters which are 6 year olds shown in Table 1.by two different examiners. 9 year olds Caries Caries Early loss Early loss Molar relationship Molar relationship Overjet Overjet Overbite Overbite Anterior crossbite Anterior crossbite Posterior crossbite Posterior crossbite Open bite Open bite Submerged teeth Active frenum Table 1. Analyzed clinical parameters Molar relationship appreciation was based on Angle occlusal classification of malocclusions [21]. The overjet was assessed in millimetres as the distance between the edge of the upper central incisor and the labial surface of the lower central incisor measured in millimeters. Overjet between 0.1 and 3 mm was considered as normal, greater than 3 mm was considered as increased, and 0 mm was taken as edge to edge. The open bite was measured in millimeters as the perpendicular distance from the edge of the central lower to the upper central incisor edge. The calculated IOTN scores of the 6 and 9 year old children were mainly based on labial segment of the upper and lower arches. The occlusal traits that were scored upon were the overjet, anterior crossbite, posterior crossbite, overbite and open bite. For conformity assessment between clinical examinations results, the intra-examiner agreement was set at 10%. The collected data were statistically analyzed with the dedicated software (SPSS 16.0, Chicago, IL, USA). Differences between groups were calculated using the Mann Whitney UU test and for correlations among the groups the Pearson test was used. All results were tested for statistically significant differences between age groups and genders using the χ2 test [22]. Inter- and intra-examiner agreement was evaluated using the weighted kappa statistic. RESULTS 69 patients of the subjects included in the study were aged around 6 years old (6 years ± 3 months) and about 78 around 9 years old (9 30 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 years ± 6 months). Within the 6 years old group, 39 (56.52%) were girls and 30 boys (43.48%) and from those of age 9 years old, 41 (52.56%) were girls and 37 boys (47.44 %). Caries: In the 6-year-old group, 24% of children had caries affecting 1 tooth and 28.98% had caries affecting more than 1 tooth; in the 9 years old group, 16.66% had caries affecting 1 tooth and 20.51% had caries affecting more than 1 tooth (table 2). Early loss of temporary teeth: 12 of the 6 years old subjects (17.39%) and 18 of the 9 years old (23.07%) had early loss for ≥ 1 tooth. The most commonly missing teeth were the primary first molars (43,75%), followed by the primary canines (31.25%) for the 6 years old; in the 9 years old, the primary canines (46.15%) were most commonly missing, followed by the primary first molars (19.23%) (table 4). The most affected tooth by carries was primary second molar: for 6 years old in 39.47%, and for 9 years old 37.70% (table 3). No. of teeth No. (and %) No. (and %) of 6 years old of 9 years old 0 32 (47.02%) 49 (62.82%) 1 17 (24%) 13 (16.66%) ≥1 20 (28.98%) 16 (20.51%) Table 2. Number of teeth affected by caries No. (and %) No. (and %) Tooth affected of 6 years old of 9 years old Primary incisors 6 (7.89%) 0 (0%) Primary canines 5 (6.57%) 7 (11.47%) Primary first molars 23 (30.26%) 18 (29.50%) Primary second molars 30 (39.47%) 23 (37.70%) 12 (15.78%) 13 (21.31%) Permanent first 31 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 molars Table 3. Teeth most commonly affected by caries No. (and %) No. (and %) of 6 years old of 9 years old Primary canine 5 (31.25%) 12 (46.15%) Primary first molar 7 (43.75%) 9 (34.61%) Primary second molar 4 (15.00%) 5 (19.23%) Tooth affected Table 4. Teeth most commonly affected by early loss Molar relationship: For 6 years old group 22 subjects (31.88%) could not be included in a class of malocclusion by Angle because that they had no erupted first permanent molars, and for 9 years old group 2 patients (2.56%) to which early extraction of first permanent molars did not allow the assessment of this relationship. Of the 47 children of 6 years old group with molar relations, 62.3% had a class I malocclusion, 32.1% class II and 5.7% class III by Angle, and of the 76 subjects of 9 years old group 53.84% showed class I malocclusion, 35.89% class II and 7.69% class III after Angle (table 5). No. (and %) No. (and %) Classification of 6 years of 9 years old old Not measurable 22 (31.88%) 2 (2.56%) 31 (44.92%) 42 (53.84%) 12 (17.39%) 28 (35.89%) 4 (5.79%) 6 (7.69%) Class I Class II Class III Table 5. Molar relationships by Angle classification 32 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 Overjet: 7 of 6 years old subjects (10.14%) showed an increased overjet, while for the group of 9 years old the number was much higher, 43 subjects (55.12%) (Figure 1). Figure 1. Number of children with overjet Overbite: 5 subjects of 6 years old and 37 subjects of 9 years old (47.43%) presented an increased overbite (7.24%) (Figure 2) . Figure 2. Number of children with overbite Openbite: 12 of subjects of 6 years old (17.39%) and 9 of the subjects of 9 years old (11.53%) were diagnosed with open bite (Figure 3). Figure 3. Number of children with open bite 33 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 Crossbites: There were found to be more common in the anterior segment than the posterior segment for both groups. In the 6 years old group 5.79% (4 subjects) exhibited anterior crossbite. In the 9 years old group 14.10% (11 subjects) exhibited more than 1 tooth in crossbite. Submerged teeth and active fraenum: For the 9 years old group the percentage of subjects with submerged teeth and active fraenum was very small 2.56% (by 2 subjects for each anomaly). The IOTN score were mainly based on occlusal alterations in the labial segment of the upper and lower arches. 10.13% of the children from the 6 years old group and 24.35% of the children from the 9 years old group have a high or very high need of orthodontic treatment (table 6). Posterior crossbites occurred in 4.34% (3 subjects) of the 6 years old children, while in the 9 years old children the percentage was 8.97% (7 subjects). No. (and %) No. (and %) of 6 years old of 9 years old 53 (76.81%) 33 (42.30%) 3 (4.34%) 5 (6.41%) IOTN scores 1 2 No need for treatment Little need for treatment 3 Moderate need for treatment 6 (8.69%) 21 (26.92%) 4 Great need for treatment 5 (7.24%) 14 (17.94%) 2 (2.89%) 5 (6.41%) 69 (100%) 78 (100%) 5 Very great need for treatment Total Table 6. Distribution of IOTN in relation to labial segment malocclusion conflicting views over the need for early orthodontic intervention. Those who are against treatment in mixed dentition argue the existence of clinical situations where the interceptive treatment does not eliminate the need for curative treatment [23] and the shortening of the treatment duration for 2-3 DISCUSSIONS: Interceptive orthodontic treatment is generally defined as treatment aimed to eliminate or reduce unfavourable ongoing signs of malocclusion, thus providing favourable conditions for normal growth [2]. There are 34 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 years if its onset is delayed after the eruption of premolars and permanent second molars [5,24]. They sustain that by delaying is can be lost the moment when the skeletal growth can be influenced, the dental alveolar can be guided and bad habits deconditioning is the least difficult [10,11,24,25]. The need for a complex fixed orthodontic treatment is significantly reduced [23,26] and may have an adverse effect on dental health and surrounding tissues [24]. According to the American Academy of Paediatric Dentistry (AAPD) [27], factors we should keep in mind when choosing the initiating of and orthodontic treatment in mixed dentition period are: chronological/ mental/emotional age of the patient and the patient’s ability to understand and cooperate in the treatment; intensity, frequency, and duration of an oral habit, parental support for the treatment, compliance with clinician’s instructions, craniofacial configuration, craniofacial growth, concomitant systemic disease or condition, accuracy of diagnosis appropriateness of treatment, timing of treatment. Among the clinical parameters that we considered necessary to investigate for determining which would be the need for preventive or interceptive methods of dentomaxillary anomalies, caries were a common symptom. 52.98% of patients in 6 years old group and 37.17% in 9 years old group had at least one tooth affected by decay. This percentage is below the World Health Organization report, according to which 6090% of the school population is affected by caries [28], but the result should rather be considered with caution given the low addressability to private dental offices for treatment of dental injuries on deciduous teeth. It must not be forgotten that caries are among the etiological factors of early loss of deciduous teeth [29]. In our study population-based sample 17.39% of subjects in 6 years old group and 23.07% in 9 years old group showed early loss of more than 1 tooth, these percentages being consistent with data reported in the Romanian literature [30]. In turn early loss of temporary teeth can have varying effects such as shortness of dental arch [10] up to 4 mm [31]; early loss of temporary canines can lead to the collapse of the mandibular anterior region with subsequent collapse of the maxillary anterior region [31] and the emergence of incongruency of permanent front teeth [10,32], to ectopic eruption [33], staying in impaction of permanent canine or interincisive line diversion [32]; early loss of second temporary molar can result into migration in the sagittal plane of the first permanent molar and a molar relationship of class II or III [34]. In this study the majority of the children were found to be Class I after Angle, 62.3% of children in 6 years old group and 53.84% in 9 years old group, like other previous Romanian studies that found class I malocclusions as the most common [35-36]. Although the proportion of subjects with malocclusion class II and III, ranked second and third as the frequency, is much lower, this subjects are candidates for interceptive orthodontic treatment if only to prevent dental class III to become skeletal [37], or to reduce the risk of injuries to the upper incisors in patients with malocclusion class II [38]. The other analyzed occlusal parameters (previously presented), the overjet, overbite, open bite, depending on the severity and the simple presence of the cross bite, may represent themselves the reason for initiating orthodontic treatment in mixed dentition. Thus at this stage of development of teeth the overbite and overjet may increase with the eruption of 35 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 permanent incisors [39], but if overcoat degree is bigger than 5 mm, we might suspect an evolution towards covered deep bite [5]. Detrimental effects of a deep bite include TMJ problems [40], attrition of the anterior teeth, direct trauma of the palatal gingiva and periodontal problems [41]. A deep bite could also restrict the development of the mandibular anterior dentoalveolar process, which is difficult to subsequently treat [24]. Open bite may be accompanied by multiple functional disorders: atypical swallowing of protrusion type [42], oral breathing, chewing [43] and phonetic [44] disorders. Anterior cross bite untreated cause attrition to the labial surface of the upper incisor, fractures or mobility of incisor teeth, gingival recession or temporomandibular joint dysfunction [4546]. Untreated lateral cross bite is one of the etiological factors of a narrow jaw [47], a facial asymmetry [48], or TMJ dysfunction through asymmetric condylar growth or as a result of the side slide of the mandible [49-50]. IOTN scores mainly based on occlusal changes in labial segment of the upper and lower arches that we analyzed was 10.13% for children in 6year old group and 24.35%for children in 9year old group. The IOTN value for 9-year old group is very similar to that found by Karaiskos et al. (2005) [3] of 28% for the same age group based on calculation of IPION and smaller than the percentage of 33% identified by Kerosuo et al. (2008) [51] or Al Nimri and Richardson (2000) [52] based on IOTN determination. CONCLUSIONS 1. It is possible to identify early development of progressive malocclusion symptoms since the onset of mixed dentition. 2. They can be highlighted by IOTN and are in agreement with the acronym 'MOCDO' missing, overjet, cross bite, displacement and overbite. 3. Early treatment of these changes can create a normal occlusal relationship and a balanced neuromuscular environment at an early age which helps the normal growth of the facial skeleton. 4. IOTN can be a valuable tool in identifying, planning and interception of potential malocclusions. 36 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 Acknowledgment This paper was published under the frame of the research contract no 835 from 17.07.2014. REFERENCES: 1) Mohamed M Alizae, Ariffin WFM, Rosli TI, Mahyuddin Alida. The feasibility of Index of Orthodontic Treatment Need (IOTN) in labial segment malocclusion among 8-10 years old. Arch Orofac Sci 2014; 9(2):76-84. 2) Silkestrand S. Interceptive orthodontic care in Uppsala County. A retrospective study on frequency of interceptive treatment, treatment approaches and treatment providers. Stockholm, 2007 [Thesis]. 3) Karaiskos N, Wiltshire WA, Odlum O, Brothwell D, Hassard TH. Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children. J Can Dent Assoc 2005;71:649. 4) Tausche E, Luck O, Harzer W. Prevalence of malocclusions in the early mixed dentition and orthodontic treatment need. Eur J Orthod 2004;26:237-44. 5) Proffit, W., Fields, H.W., Sarver, D.M. Contemporary Orthodontics 5th Edition. Elsevier 2013 215, 46-50, 73-90, 133-145, 403-442. 6) Vig KWL, Fields HW. Facial growth and management of orthodontic problems. Pediatr Clin North Am 2000, 47(5): 1085-1123. 7) Seehra J, Newton JT, Dibiase AT. Interceptive orthodontic treatment in bullied adolescents and its impact on self-esteem and oral-health-related quality of life. Eur J Orthod 2013, 35(5): 615-621. 8) Keski-Nisula K, Hernesniemi R, Heiskanen M, Keski-Nisula L, Varrela J. Orthodontic intervention in the early mixed dentition: a prospective, controlled study on the effects of the eruption guidance appliance. Am J Orthod Dentofacial Orthop 2008, 133(2): 254-260. 9) Tulloch JF, Phillips C, Koch G, Proffit WR. The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Orthod Dentofacial Orthop 1997, 111(4): 391-400. 10) Kerosuo H. The role of prevention and simple interceptive measures in reducing the need for orthodontic treatment. Med Princ Pract 2002;11 Suppl. 1:16-21. 11) King G.J. and Brudvik P. Effectiveness of interceptive orthodontic treatment in reducing malocclusions. Am J Orthod Dentofacial Orthop 2010, 137(1): 18- 25. 12) Borzabadi-Farahani A. An insight into four orthodontic treatment need indices. Progress in Orthodontics 2011, 12(2):132-142. 13) Shaw WC, Richmond S,O’Brien KD. The use of occlusal indices: a European perspective. American Journal of Orthodontics and Dentofacial Orthopedics 1995, Vol.107, pp.1-10. 14) Cardoso CF, Drummond AF, Lages EM, Pretti H, Ferreira EF, Abreu MH. The Dental Aesthetic Index and dental health component of the Index of Orthodontic Treatment Need as tools in epidemiological studies. Int J Environ Res Public Health 2011, 8(8): 3277-3286. 15) Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. European Journal of Orthodontics 1989, Vol.20, pp. 309-320. 16) Evans R, Shaw WC. Preliminary evaluation of an illustrated scale for rating dental attractiveness. European Journal of Orthodontics 1987, Vol.9, pp. 314-318. 17) Coetzee CE, de Muelenaere KR. Development of an index for preventive and interceptive orthodontic needs (IPION). International Association for Dental Research; XXXI Scientific Session of the South African Division; XI Scientific Session of the East and Southern African Section,1997. Abstract 83. 18) Sandoval VP, Ceballos CM, Acevedo AC, Jans MA. Caracteristicas orofaciales en relacion a la necesidad de tratamiento ortodoncico en ninos. Int. J. Odontostomat. 2010, 4(1):59-64. 19) Borrie P, Felicity R. Interceptive Orthodontics; the evidence, current general dental practice, and way forwards in the UK. University of Dundee, 2013 [Thesis]. 37 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 20) Firu P. Stomatologie infantilă. Ed Didactică și Pedagogică, București 1983:238. 21) Angle EH. Classification of malocclusion. Dental Cosmos 1899;4:248-264. 22) Labăr AV. SPSS pentru ştiinţele educaţiei. Metodologia analizei datelor în cercetarea pedagogică. Ed.Polirom, Iaşi 2008: 84-157. 23) Jolley CJ, Huang GJ, Greenlee GM, Spiekerman C, Kiyak HA, King GJ. Dental effects of interceptive orthodontic treatment in a Medicaid population: Interim results from a randomized clinical trial. Am J Orthod Dentofacial Orthop 2010; 137(3): 324-333. 24) Patti A, D’Arc GP. Clinical success in Early Orthodontic Treatment. Paris: Quintessence International 2005, 7-8, 24-32. 25) Proffit WR. The timing of early treatment: An overview. Am J Orthod Dentofacial Orthop 2006, 129:S47-9. 26) Bresnahan Bw, Asuman Kiyak H, Masters Sh, Mcgorray Sp, Lincoln A, King G. Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid. Journal of the American Dental Association 2010, 141, 1202-1212. 27) American Academy of Pediatric Dentistry. Guideline on Management of the Developing Dentition and Occlusion in Pediatric Dentistry, Reference Manual 2014, 6:14-15. 28) Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme - Community Dent Oral Epidemiol. 2003, 1, 31: 3–23. 29) Popovich F, Thompson GW. Space Maintenance. In: Preventive dental services. 2nd ed., D.W. Lewis, Ed. Ottawa Canada:Minister of Supply Services 1988; 192-196. 30) Petcu A, Bălan A, Maxim A. Current tendencies of the prevalence of the premature loss of the primary molars. J Rom Med Den 2009, 13(4):128-130. 31) Hudson APG, Harris AMP, Mohamed N. Early identification and management of mandibular canine ectopia. SADJ 2011, 64(10): 462-467. 32) Laing E, Ashley P, Naini FB, Gill DS. Space maintenance. International Journal of Paediatric Dentistry 2009, 19: 155-162. 33) Fleming PS, Johal A DiBiase AT. Managing Malocclusion in the Mixed Dentition: Six Keys to success Part 2. Dent Update 2008, 35: 673-676. 34) Rao A. Principles and practice of pedodontics. 2nd ed. India: Jaypee 2008, 61, 70-76, 122-160. 35) Temelcea A, Bartok RI, Stanciu R, Stanciu D. Epidemiology of malocclusion with transverse maxillary deficiency. Rev Română Stom 2012, 2, 58, 96-98. 36) Zegan G, Anistoroaiei D. The statistical study of malocclusion. Roman Oral Rehabil 2009, 1, 3, 43-49. 37) Yelampalli MR, Rachala MR. Timely management of developing class III malocclusion. J Indian Soc Pedod Prev Dent 2012, 30(1):78-84. 38) Baccetti T, Giuntini V, Vangelisti A, Darendeliler MA, Franchi L. Diagnostic performance of increased overjet in class II 199 division 1 malocclusion and incisor trauma. Progress in Orthodontics 2010, 11, 145-150. 39) Keski-Nisula K, Letho R, Lusa Keski-Nisula L, Varrela J. Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics 2003, 631- 638. 40) Darendeliler N, Dinçer M, Soylu R. The biomechanical relationship between incisor and condylar guidances in deep bite and normal cases. Journal of Oral Rehabilitation 2004, 31(5):430-437. 41) Singla R, Singla N, Madhumitha N. Management of deep overbite. GUIDENT, August 2013, 4044. 42) Urzal V, Braga AC, Ferreira AP. The prevalence of anterior open bite in Portuguese children during deciduous and mixed dentition - correlations for a prevention strategy. Int Orthod 2013, 11(1):93-103. 43) Leme MS, Barbosa T, Gavião, MBD. Relationship among oral habits, orofacial function and oral healthrelated quality of life in children. Braz Oral Res., (São Paulo) 2013, 27(3): 272-278. 44) Dixit UB, Shetty RM. Comparison of softtissue, dental, and skeletal characteristics in children with and without tongue thrusting habit. Contemporary Clinical Dentistry 2013, 4(1):2-6. 38 Romanian Journal of Oral Rehabilitation Vol. 8, No. 1, January - March 2016 45) Huang CH, Brunsvold MA. Reactive correction of a maxillary incisor in single-tooth crossbite following periodontal therapy. Journal of Periodontology 2005, 76, 832-836. 46) Seehra J, Fleming PS, Dibiase AT. Orthodontic treatment of localised gingival recession associated with traumatic anterior crossbite. Australian Orthodontic Journal 2009, 25, 76-81. 47) Wong CA, Sinclair PM, Keim RG, Kennedy DB. Arch dimension changes from successful slow maxillary expansion of unilateral posterior crossbite. Angle Orthodontist 2011, 81(4): 616-623. 48) Kecik D, Kocadereli I, Saatci I. Evaluation of the treatment changes of functional posterior crossbite in the mixed dentition. Am J Orthod Dentofacial Orthop 2007, 131:202-215. 49) Tecco S, Crincoli V, Di Bisceglie B, Saccucci M, Macri M, Polimeni A., Festa F. Signs and symptoms of temporomandibular joint disorders in caucasian children and adolescents. Cranio Journal of Craniomandibular Practice 2011, 29, 71-79. 50) Thilander B, Bjerklin K. Posterior crossbite and temporomandibular disorders (TMDs): Need for orthodontic treatment? European Journal of Orthodontics 2012, 34, 667-673. 51) Kerosuo H, Väkiparta M, Nyström M, Heikinheimo K. The seven-year outcome of an early orthodontic treatment strategy. Journal of Dental Research 2008, 87, 584-588. 39