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Archives of Oral Sciences & Research
RAPID CORRECTION OF ANTERIOR DENTAL CROSSBITE USING A SECTIONAL
FIXED APPLIANCE: A CASE REPORT.
Hiremath M. C.*, Suresh K. S.*
ABSTRACT
Anterior cross-bite is a commonly encountered problem that is traditionally managed with removable appliances.
Most incisors in cross-bite are managed with removable appliances. However, in view of the advantages outlined in
this paper, following appropriate case assessment, clinicians can use sectional fixed appliances to manage some of
the cases. This paper demonstrates some of the advantages of using fixed appliances to correct these malocclusions.
In this case, treatment was completed more rapidly using a sectional fixed appliance.
AOSR 2011; 1(1):11-13.
Key Words: Anterior Cross-bite, Sectional Fixed Appliance, Posterior Biteplate.
*Department of Pedodontics, Govt. Dental College & Research Institute, Bangalore 560002, INDIA.
INTRODUCTION:
Cross-bite is a discrepancy in the bucco-lingual
relationship of the upper and lower teeth.1
Kharbanda et al in 1991 have reported that in Delhi
about 36.6% of malocclusions were seen in the age
group of 5-13 years school children. 9.5% of these
malocclusions were crowding in the maxillary anterior
region and anterior cross-bite.2 The anterior dental
cross-bite may be the result of one or a combination of
several etiologic factors:
1. Traumatic injuries to the primary dentition that cause
a lingual displacement of the permanent tooth bud
2. An over-retained primary tooth
3. A labially situated supernumerary tooth
4. A sclerosed bony or fibrous tissue barrier caused by
losing a primary tooth prematurely
5. An inadequacy of arch length causing the lingual
deflection of the permanent tooth during eruption.3
6. Detrimental habit patterns
7. A repaired cleft lip.4
Anterior cross-bite should be corrected as soon as it is
detected.1 Most of the anterior cross-bites can be
corrected using removable appliances. It is important for
clinicians to understand the limitations of removable
appliances and to be aware of alternative treatment
options.1 In this case, rapid correction of the single tooth
anterior cross-bite was achieved using a sectional fixed
appliance.
CASE REPORT:
A 11 year old boy reported to the pediatric dental
section of Government Dental College and Research
Institute Bangalore, with a parental complaint that one
of his upper teeth was malaligned. The general health
history and examination of the head and neck were
normal. There was no history of a retained primary tooth
or a supernumerary tooth. Clinical examination revealed
a mixed dentition stage. The patient had a class-I
occlusion. Eight permanent incisors were erupted. The
right permanent maxillary lateral incisor was in cross-
bite (figure-1). The right primary maxillary canine was
in normal position. After discussing the problem with
the child’s parent, the decision was made to use a
sectional fixed appliance that would perform the
necessary correction. A fixed appliance allows more
precise control over movement of lateral incisor, thus
preventing possible damage to the root.1 The routinely
used "2x4 appliance" was not considered because it
requires lengthy chair-side time to fix the molar bands,
molar tubes and the arch wire. 5
Figure 1:Permanent
maxillary right lateral
incisor(11) in cross-bite
relationship.
Figure 2: A sectional fixed
appliance in maxillary arch
and a mandibular bilateral
posterior bite plate in place.
Figure 3: Satisfactory correction of anterior cross-bite
and 21 restored with composite resin.
Brackets were bonded on 11,12,14,21 and 22 and a
round 0.16 Nickel-Titanium arch wire was used to
engage all the bonded brackets (figure-2).1,3 The
amount of force applied to achieve the desired tooth
movement was 35-60gms/tooth.6 Right primary
maxillary canine (53) was extracted in the same
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Hiremath M. C.et al
appointment. Mandibular posterior bilateral bite plate
was placed to open the bite. The patient was called for
check up after a week and the appliance was left in place
for 2-weeks. This sectional fixed appliance utilizes light
continuous force for correction of malaligned tooth.
Satisfactory alignment of the right mixillary lateral
incisor was noticed at the end of 2-weeks. The brackets
were debonded and the teeth were polished. There was
no need for any retainer as the overbite was sufficiently
deep to retain the result achieved (figure-3). Ellis Class-I
fracture involving 21 was restored with composite resin.
The patient was recalled after a week for checkup and at
the same visit the contra-lateral canine (63) was
extracted to balance the previous extraction. The
patient’s developing occlusion was assessed periodically
for any future orthodontic treatment. After three months
when the patient reported for follow-up, we noticed the
permanent maxillary canine bulges labial to arch
because of inadequate space in the arch. We referred the
patient to an orthodontist as there was severe space
deficiency requiring extraction of maxillary first
premolars and further fixed appliance therapy.
DISCUSSION:
One of the major responsibilities of a Pedodontist is to
intercept adverse patterns of developing occlusion.4,7
Anterior dental cross-bites are frequently seen in mixed
dentition and are an indication for early intervention.
Delayed treatment of anterior crossbite can lead to
serious complications such as:8
1) Loss of arch length.
2) Traumatic occlusion.
3) Gingival stripping of the lower incisors.
4) Periodontal pocket formation.
5) Wear facets on labial surface of maxillary
incisors.
Apart from the above mentioned complications,
untreated cross-bite can also restrict the growth of
maxilla and may lead to craniofacial asymmetry.8,9
There are many possible approaches to the treatment of
anterior dental cross-bites. It is important for practioners
to understand the limitations of removable appliances
and to be aware of alternative treatment options.1
Limitations of Removable Appliances:1,4
The active component of a removable appliance
provides only a point contact and the tooth movement is
principally by tipping. For this reason, removable
appliances are not effective for:a) Bodily moving teeth if space needs to be created for
an instanding incisor.
b) Torquing the incisor roots: If the incisor root is
positioned palatally, simply tipping the tooth will
procline the tooth excessively. This can result in
poor esthetics and poor gingival contour and may
increase the chance of relapse.
c)
Extruding the incisors: The overbite is important
in retaining the corrected incisors. If there is little or
no adequate overbite, it may be advantageous to
extrude the incisors to achieve sufficient overbite to
improve long term stability.
d) Rotation of teeth: Single-point contact and the
resultant tipping movements are much less effective
at providing derotation of incisors than fixed
applilances.9
This case demonstrates some of the advantages of
using a sectional fixed appliance to correct an
anterior crossbite. The applicance was fitted in one
appointment and required very minimal laboratory
work for the preparation of mandibular posterior
bilateral bite plate. A rectangular archwire was
unnecessary as there was no need to apply torque to
the teeth.
In cases where there is a major discrepancy in the
inclination of the upper incisors, it may be
necessary to use a rectangular nickel titanium wire,
or even something more rigid such as a TMA-wire
to correct the inclinations of the incisor teeth.1 The
amount of patient’s cooperation necessary during
treatment is less than that required for removable
appliance. It is essential that the patient is able to
maintain an adequate standard of oral hygiene, in
view of the increased risks of decalcification and
caries associated with fixed appliances.1,4 In this
case, correction was completed more rapidly than
could have been achieved with a removable
appliance.
CONCLUSION:
Most incisors in crossbite are managed with
removable appliances. However, in view of the
advantages outlined in this paper, following
appropriate case assessment, clinicians can use
sectional fixed appliances to manage some of the
cases. Patients must be selected carefully when
using this sectional fixed appliance.The crossbite
must be a simple dental cross-bite, with no skeletal
component. The facial profile and occlusion should
be class-I. There should be adequate space in the
arch for correction of the cross-bite. As a part of
interceptive orthodontic procedure the anterior
cross-bite was corrected more rapidly than could
have been achieved with other appliances.
REFERENCES:
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Rapid Correction of Anterior Dental Cross-bite
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Randall SA, Curtis GK, Leslie E. Anterior dental
cross-bite correction using a simple fixed appliance.
Case Report. Pediatric Dent 1986; 8(1):53-55.
McKeown HF, Sandler J. The "2x4 appliance": A
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HW.
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Correspondence: Dr Mallayya C. Hiremath, Department
of Pedodontics,
Govt. Dental College & Research Institute, Fort,
Bangalore-560002, Karnataka, India.
E-Mail: [email protected]
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