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DENTAL LEARNING
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Knowledge for Clinical Practice
Early Diagnosis and Treatment of an
Anterior Crossbite
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Author Profiles
Dr. Sawsan Tabbaa, DDS., MS is an Assistant Professor, Department of Orthodontics,
School Dental Medicine, State University of
New York at Buffalo.
Dr. Michelle L. Burlingame, DMD, MS has an
orthodontics private practice in Ballston Spa,
NY. Dr. Burlingame attended dental school at
the University of Connecticut and completed
her residency program in orthodontics at the
University of Buffalo, NY.
Dr. C. Brian Preston, BDS, PhD is a Professor and Chairman
of the Department of Orthodontics, School of Dental Medicine, State University of New York at Buffalo.
Dr. Yogi Kothari, DMD is a Diplomate of the
American Board of Orthodontics. and an Assistant Professor in the Department of Orthodontics, School of Dental Medicine, State University
of New York at Buffalo.
Dr. Wael Y. Elias, DMD is a diplomate of
the American Board of Oral and Maxillofacial Pathology and the American Board of
Orthodontics. He is a faculty and Clinical
instructor in the Department of Orthodontics,
School of Dental Medicine State University of
New York at Buffalo, NY and the King Abdulaziz University,
Dental School, Jeddah, Saudi Arabia.
Rishi Kothari, DDS has a private practice in
orthodontics in Olean, NY.
Abdulfatah A. Hanoun, DDS, G.Dip, M.Sc is
a visiting research scholar and post-doctoral
fellow in the Department of Orthodontics,
School of Dental Medicine, State University
of New York at Buffalo in Buffalo, NY.
AUTHOR DISCLOSURE: The clinicians listed do not have a leadership position or a
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can be contacted by emailing [email protected]
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Early Diagnosis and Treatment of an
Anterior Crossbite
ABSTRACT
LEARNING OBJECTIVES
Early orthodontic intervention can have numerous benefits
for patients. Treating an anterior crossbite with early intervention can improve function, appearance and self-esteem. In
the case report included in this article, an 8-year-old girl was
treated successfully for an anterior crossbite. In this instance,
an acrylic bite jumper may have saved the patient from future
surgery while improving her occlusal function and social
interactions.
The overall objective of this article is to provide the participant with information on the treatment of anterior crossbites.
Upon completing this course, the participant will be able to:
Introduction
•Early management of maxillary anterior crossbites in
order to establish a correct relationship between the
maxilla and the mandible, achieve proper function,
improve the child’s facial profile, and in some cases,
eliminate the need for surgery at a later date.
E
arly orthodontic intervention is appropriate in patients exhibiting certain occlusal problems that could
continue to worsen, while also becoming more difficult
to treat, at a later stage of dental and skeletal development. If
such problems are not diagnosed and treated early enough,
they could hinder the normal craniofacial development of the
respective child. Interceptive orthodontic treatment reduces
the complexity of some malocclusions during the mixed
dentition phase of dental development; however, a follow-up
orthodontic treatment is usually required when the permanent dentition has been established.1
Examples of beneficial early interceptive orthodontic treatment include, but are not limited to:
•Early treatment of deep bites to prevent the lower
anterior teeth from impinging on the palatal tissue
and to redirect mandibular growth to achieve a normal facial height;
•Early treatment of open bites to eliminate parafunctional habits, such as thumb sucking and tongue
thrusting;2
•Early orthodontic treatment of severe crowding to
provide space for the permanent teeth during eruption;3
•Elimination of Class II division I malocclusions that
present with a protrusive maxilla and/or maxillary
teeth. The aim here is to provide facial harmony,
improve the child’s self-image, and perhaps reduce the
probability of incisor fractures.
January 2015
1.Determine the circumstances under which early
orthodontic intervention is appropriate.
2.Identify a case in which early orthodontic intervention
was used successfully to treat an anterior crossbite.
3.Identify the outcomes of orthodontic treatment, including
those that affect the patient’s quality of life.
Anterior Crossbite: An Overview and Case Study
Anterior crossbite is an orthodontic problem that presents with a reverse overjet of one or more of the anterior
teeth. As with many orthodontic problems, the underlying
etiology could be either skeletal or dental, or a combination of these two factors. The precise treatment of an anterior crossbite would thus be directed at the predominant
etiologic factor.
Etiology
Skeletal causes
The anterior posterior skeletal discrepancy is one of
the main causes of the anterior crossbite. For example,
any excessive mandibular growth may lead to a segment
crossbite on the anterior incisors. In addition, the retarded
development of the maxilla in the sagittal plane may also
result in an anterior crossbite. For instance, the small or
collapsed maxillary arch associated with cleft palate will
also cause an anterior crossbite in the majority of these
patients. The skeletal causes of the anterior crossbite are
generally inherited. They are manifested as size or position
discrepancies in the maxilla, the mandible, or both. A long
mandible or anteriorly positioned glenoid fossa, short or
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DENTAL LEARNING
posteriorly positioned maxilla, and even a short anterior
cranial base should be considered indicators of the skeletal
nature of the anterior crossbite.4 The skeletal etiological
factors can be elaborated under any of the following three
categories or any combination of these: genetic/syndromic
causes; maxillary deficiency; and mandibular excess.
Genetic factors
Many syndromes that affect facial development have
at least some basis in genetics. Syndromes such as cleft
lip and palate, Crouzon syndrome, and Apert syndrome
are associated with a degree of midface deficiency that,
in many instances, results in an anterior crossbite due to
the maxillary skeletal deficiency. The midface deficiency
observed in these syndromic patients can be aggravated by
the restriction of maxillary growth that may result from
scar tissue associated with the surgical correction of the
cleft lip and/or palate.5
Congenital maxillary deficiency
Prenatally, undue pressure against the developing fetal
face can lead to distortion of the rapidly growing facial
areas. On rare occasions, a limb is pressed across the face
in utero, resulting in a severe maxillary deficiency at birth6
and a Class III malocclusion. If the maxilla is small or
positioned posteriorly, the effect is direct. If it lacks vertical
growth, the effect is indirect and, due to the fact that the
mandible rotates upward and forward, produces a mandibular prognathism that is not due primarily to the size
of the mandible.7
Mandibular excess
Mandibular prognathism can be familial, in which case
there is the belief that the etiology in these instances can be
of a hereditary nature. In rare occasions, endocrinal disturbance such as an increase in circulating growth hormone
may result in acromegaly, which is characterized by an
abnormally large mandible.8
Dental causes
The most common etiologic factor for non-skeletal
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anterior crossbites is a lack of space for the permanent
incisors.9 The early loss of maxillary deciduous teeth,
impacted or lost permanent posterior teeth, or impacted
canines would allow the maxillary anterior teeth to
drift distally and palatally. In most children with anterior crossbites involving multiple teeth, a skeletal
discrepancy should be considered. A labially positioned
supernumerary tooth, over-retained deciduous tooth
with delayed exfoliation, trauma to the deciduous teeth
or permanent tooth bud, or even a lip biting habit may
lead to an abnormal axial inclination of upper incisors,
which is another cause of dental anterior crossbites. In
addition, the premature tooth contact during mandibular closure may lead to a pseudo-Class III, another cause
of dental anterior crossbites.10
Diagnosis
In order to determine the main cause of an anterior crossbite, it is important to differentiate between skeletal and dental problems. In this regard, midface deficiency or mandibular
overgrowth will result in a Class III tendency, which is usually
manifested in the sagittal plane. A prominent feature of the
Class III facial pattern is an anterior crossbite dental relationship. A single tooth in an anterior crossbite is usually associated with some degree of dental crowding.11 This generally
results from a dental etiological factor. On the other hand,
a segment crossbite (which involves several teeth rather
than a single tooth) is more likely to result from a skeletal
etiological factor, which can be confirmed by radiographs
such as lateral cephalograms. Moreover, if an anterior
crossbite is associated with a bilateral posterior crossbite,
the skeletal factor should be considered where the retropositioned or small maxilla relative to the mandible could
be the main etiological cause. However, a radiographic
confirmation is always required.
A lateral cephalometric X-ray offers an important
diagnostic tool, particularly if it is suspected that a skeletal
imbalance may be responsible for an anterior crossbite and
an incipient Class III malocclusion. The Steiner and the
McNamara analyses provide two different cephalometric
Early Diagnosis and Treatment of Anterior Crossbite
methods for measuring the severity of skeletal jaw imbalances in the sagittal plane.12,13 Whenever the cephalometric
analysis shows radiographic evidence of moderate to severe skeletal anterior-posterior discrepancy associated with
an anterior crossbite, the skeletal cause should be taken
into consideration.
The location of the tooth having crossbite can be used
as a diagnostic indicator of skeletal or dental etiology of
the anterior crossbite. In the skeletal crossbite, the teeth
are often normally positioned on the basic bone of the
jaw. On the other hand, a deflection of a tooth from the
normal position is most likely to be associated with the
dental crossbite.10 In addition, the closure pathway should
be examined for any premature contact, which could be
the cause of an anterior dental crossbite associated with a
pseudo Class III relationship. As an example, the premature incisor contact during closure may result in the development of anterior mandibular displacement manifested as
a dental anterior crossbite.
At the same time, dental study models provide an important tool when it comes to diagnosing dental problems,
such as crowding and lack of space due to tooth size arch
TABLE 1. Skeletal And Dental Anterior Crossbite Indicators
Etiology/cause
Skeletal Anterior Crossbite
Dental Anterior Crossbite
Genetic and hereditary in most cases
Lack of space, TSALD
(familial)
No maxilla and mandible size
Maxilla and mandible size discrepancy
discrepancy
(long mandible and/or short maxilla)
Anterior crossbite prevalence
Retrognathic maxilla: 25%
Dental cause only 33%
Prognathic mandible: 20%
Combination of both: 22%
Differential diagnosis
Skeletal Anterior Crossbite
Dental anterior crossbite
a- Molar and canine relationship
Class III
Class I
b- Maxillary incisor inclination
Proclined
Upright or retroclined
c- Transverse discrepancy
Coule be associated with posterior
None
crossbite in some cases.
d- Sagittal discrepancy
e- Mandibular growth pattern
Significant AP discrepancy between the
No significant discrepancy between the
maxilla and mandible
maxilla and mandible
Often vertical (except in cases of true
Normal
mandibular prognathism)
f- Position of teeth
Normally positioned
Deflected tooth position
g- Number of teeth in the crossbite
Segment crossbite
Mainly a single-tooth crossbite
January 2015
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DENTAL LEARNING
length discrepancy (TSALD) that may result in an anterior
dental crossbite. The study models allow clinicians to measure and compare the relationship that exists between the
combined sizes of the teeth and the amount of space that is
available to accommodate them. In the past, measurements
were made directly on plaster study models. Nowadays,
digital models, in combination with specific software,
make it possible to determine tooth and arch sizes with
greater ease.14,15
Table 1 provides a synopsis of the major characteristics
of skeletal and dental anterior crossbites.
Treatment options
Treatment options depend on the specific etiology of
the condition and, to a great degree, on the skeletal and
dental age of the patient.
Treatment of a skeletal anterior crossbite (Class III
malocclusion)
For growing children with an antero-posterior (sagittal) and/or vertical maxillary deficiency, the treatment of
choice is maxillary traction with a reverse-pull headgear
(face mask) to move the maxilla anteriorly and, in some
cases, slightly inferiorly. This traction allows new bone to
be added at the posterior and superior circum-maxillary
sutures, which effectively increases the size of the maxilla.
While it is easier and more effective to move the maxilla
forward at a young chronologic age (about eight years),
recent reports indicate that some positive sagittal changes
can be produced up to the beginning of
adolescence.16,17
Growing children who have a Class III malocclusion
because of a mandibular excess are more difficult (sometimes impossible) to treat without some surgical intervention. In these instances the treatment of choice may be
mandibular restraining devices such as a chin cup, designed to inhibit the growth of the mandible.18,19
Functional appliances may also be used in an effort to
promote maxillary development and to limit, if possible,
mandibular prognathism. A good example of such a
functional appliance is represented by the Frankel-III
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appliance, made with the mandible positioned posteriorly
and rotated open and with pads designed to stretch the
upper lip forward.20
For adult and adolescent patients who have finished
their growth, orthopedic treatment options such as growth
modification are difficult if not impossible. For these patients, the alternatives are either a camouflage treatment
or a surgical correction of the mandibular prognathism.
Camouflage treatment involves extracting lower first
premolars, followed by retracting the mandibular incisor
teeth. Although this method may correct an anterior crossbite in mild cases, it is not advised as a treatment modality
in more severe cases of mandibular protru­sion. In moderate to severe cases of mandibular prognathism, the treatment option of choice is surgical correction by mandibular
setback, on its own or in combination with a maxillary
advancement procedure.21,22
Treatment of a dental anterior crossbite
As noted earlier, the most common etiologic factor for
a non-skeletal (dental) anterior crossbite is a lack of space
for the permanent incisors. It is thus important in these
cases to manage the space problem while attempting to
correct the anterior crossbite.
If the developing crossbite is discovered prior to
completion of the incisor eruption and before an overbite
has been established, the adjacent primary teeth can be
extracted to provide the necessary space for the permanent
incisors. In instances where the overbite has been established, an appliance may be required to correct the
developing crossbite.
Tipping maxillary and mandibular anterior teeth out of
a crossbite can solve the crossbite problem in most instances. This can be done by using a removable appliance with
finger-springs for facial movement of the maxillary incisors
or, in some cases, an active labial bow for lingual movement of the mandibular incisors.
It is important to create enough space for the teeth
before moving them lingually in case of tipping lower
incisors.23,24
Early Diagnosis and Treatment of Anterior Crossbite
Case Study
This case study focuses on an 8-year-old girl who
presented with a relatively severe anterior crossbite. An
anterior crossbite is a good example of a malocclusion that
usually requires early intervention.
Although there is considerable debate as to whether
a Class III malocclusion will benefit from early treatment, it is generally well accepted that it is important
to treat this type of malocclusion as soon as it manifests. It is believed that the early diagnosis and timely
correction of an anterior crossbite may prevent the occurrence of functional shifts of the mandible, abnormal
wear of the permanent teeth, and temporomandibular
joint problems. More importantly, timely treatment
of the problem could reduce the need for orthognathic surgery in adulthood. It should be noted that
early treatment may not eliminate the need for further
orthodontic treatment at a later stage, but it is likely to
lessen the severity of the eventual malocclusion.25,26 The
bite jumper treatment described in this case study is
most useful for correcting an anterior crossbite that has
a dental etiology versus a skeletal one. It also would be
more appropriate if the patient presented with a lowto-normal mandibular plane angle.
History
Medical: The patient presented as a healthy 8-year-old
female (Figure 1).
Dental: The oral hygiene of the patient was considered
to be adequate and there was no history of craniofacial
trauma.
Etiology: The patient and her guardian did not provide
a family history of Class III malocclusion. This patient’s
malocclusion could be attributed to an altered eruption
pattern of the permanent incisor teeth, possibly resulting
from dental crowding.
Figure 1. Pre-treatment extraoral and intraoral photographs.
January 2015
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Diagnosis
Treatment Objectives
Skeletal:
•The Patient exhibited a Class III tendency because of
a relative underdevelopment of her maxilla. Her Sella,
Nasion to point “A” (SNA) value was 77.3° (normal
value, 82.0° + 3.5°).
•The patient’s vertical facial development was normal,
with a tendency toward a slightly skeletal deep bite
pattern; she had a low mandibular plane angle (SNGoGn) value of 24.9° compared with the normal
value of 32.9° + 5.2°. (Figure 2)
Dental:
•The bilateral molar relationships were Angle Class I.
•There was an anterior crossbite that included the central
and lateral teeth (Figure 1).
•The maxillary incisors were retroclined (94.9°) when
compared with the normal upper incisors to an SNA
value of 102.1° + 5.5°.
Soft Tissue:
•The patient’s soft-tissue profile was slightly concave
because of a retruded upper lip; her nasiolabial angle was
136.7° compared with the normal value of 102.0° + 8.0°.
•To maintain an Angle Class I molar relationship.
•To eliminate the anterior crossbite, properly align the
anterior teeth, and obtain a positive overbite and positive overjet.
•To retain all of the permanent teeth during the initial
phase of orthodontic treatment, anticipating that a more
definitive phase of treatment could be required at a later
stage of development.
Figure 2. Initial lateral cephalometric X-ray, traced and
measured.
8
Treatment
It was decided that the best course of treatment would be
to begin with a phase of dental leveling followed by having the patient wear an acrylic bite jumper appliance. Serial
extraction and protraction facemask treatment were alternative treatments that were considered but ruled out. When the
patient presented for treatment, the need for four premolar
extractions could not be determined with any certainty. At
that time, the negative consequences of extracting in a deficient maxillary arch was considered. Given the absence of a
family history of Class III malocclusion, the relatively minor
skeletal maxillary deficiency, the angulations of the maxillary and mandibular incisors, and the Class I molar occlusion, facemask therapy was not used during the first phase
of orthodontic treatment. However, the use of a facemask in
the future will depend on the age and the further facial and
skeletal development of the patient.
Figure 3. The bite-jumper appliance. This removable appliance
consists of an acrylic slope covering the anterior teeth, with a
wire framework following the lingual contours of the teeth for
retention.
Early Diagnosis and Treatment of Anterior Crossbite
Banding and Bite Jumper Appliance
The patient’s maxillary first permanent molars were
banded and the maxillary incisors were bonded with
0.018-inch Unitek’s Victory Series (3M ESPE) brackets.
A 0.016-inch nickel titanium arch wire was used to level
and align the maxillary anterior teeth. Following the phase
of dental leveling, the patient wore an acrylic bite jumper
appliance for four months (Figure 3). The appliance was
removable; however, the patient was instructed to wear
the appliance full time, except for cleaning purposes. The
patient was seen every four to six weeks while wearing the
bite jumper. Some adjustments were made to the bite plate
to reduce the bulk of the appliance; however, the slope of
the bite plane was maintained throughout treatment. No
retention was needed in the maxillary jaw once the proper
overjet was obtained.
Treatment Outcome
• The Class I molar relationship was preserved.
• A positive incisor overjet was obtained. (Figure 4)
•The soft-tissue profile was greatly improved (Figure 5).
The patient’s profile changed from concave with a retrusive
maxilla to normal and straight (Figure 6).
Discussion
Cephalometric evaluation of the patient before and
after appliance therapy revealed an improvement in the
maxilla from deficient to normal. After treatment, the SNA
value increased from 77.3° to 81.1°, which was close to
the accepted normal value of 82.0° +3.5°. After the early
phase of orthodontic treatment, the maxillary incisors
were somewhat proclined. The mandibular incisors were
uprighted and the mandibular plane angle was maintained.
There was great improvement in the soft-tissue profile
(Figure 6 & 7).
The patient’s mother reported an improvement in
her daughter’s social interactions and eating patterns.
After the elimination of the crossbite, the child became
Figure 4. Post-treatment extraoral and intraoral photographs.
January 2015
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DENTAL LEARNING
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Figure 5. A comparison of pre, progress and post treatment extra and intra oral photographs.
“proud of her smile.” Her eating habits improved because of the improved ability to bite and chew—and the
patient’s weight improved as a result of her better eating
habits.
Conclusion
Although the results for Phase I treatment were acceptable in terms of obtaining a positive overjet, it must be
noted that follow-up and facemask treatments may be necessary in the future if the patient’s skeletal growth exhibits
a prominent Class III tendency.
If this child had not been diagnosed and treated early,
her maxilla would have continued to be trapped behind
her mandible, resulting in permanent maxillary deficiency
and contributing to an unattractive concave profile.
Surgery is usually the ideal treatment for adults exhibiting a concave profile because of maxilla deficiency. Early
10
intervention to eliminate the anterior crossbite saved this
patient from having invasive surgery if she ever seeks
treatment in adulthood.
Acknowledgments
We would like to thank the patient and her family for
their compliance and cooperation. The patient’s mother
stated: “I would like to thank you for your concern and
for encouraging my daughter to receive early orthodontic
treatment. Early diagnosis may have saved my daughter
from future surgery. Her new smile is not just an esthetic
advantage; it has truly improved her chewing function.
My daughter enjoys her meals now and is able to drink
from a cup without a straw and do simple things like
biting into an apple. I hope dentists use this case study to
help other children and to understand the importance of
early diagnosis and prevention.”
Early Diagnosis and Treatment of Anterior Crossbite
Figure 6. Comparison of pre-treatment and post-treatment
profiles.
Figure 7. Final lateral cephalometric x-ray, traced and measured.
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20.Ulgen M, Firatli S. The effects of the Frankel’s function regulator on the
Class III malocclusion. AJO-DO. 1994;105(6):561-567.
21.Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical
procedures to correct mandibular prognathism and reshaping of the
chin. Oral Surgery, Oral Medicine, and Oral Pathology. 1957;10(7):677689.
22.Bell WH. Le Forte I osteotomy for correction of maxillary deformities. J
Oral Surgery. 1975;33(6):412-426.
23.Borrie F, Bearn D. Early correction of anterior crossbites: a systematic
review. J Orthodont. 2011;38(3):175-184.
24.Negi KS, Sharma K.R. Treatment of pseudo Class III malocclusion
by modified Hawleys appliance with inverted labial bow. Journal
of the Indian Society of Pedodontics and Preventive Dentistry,
2011;29(1):57-61.
25.Proffit WR, Fields Jr. HW, Sarver DM. Contemp Orthodontics, 4th ed.
St. Louis, MO: Mosby; 2007:431-443.
26.Graber TM, Vanarsdall Jr. RL, Vig KWL. Orthodontics: Current Principles and Techniques. St. Louis, MO: Mosby; 2005:543-545.
Webliography
1.King GJ, Brudvik P. Effectiveness of interceptive orthodontic treatment in reducing malocclusions. Am J Orthod Dentofacial Orthop.
2010;137:18-25.
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CEQuiz
Early Diagnosis and Treatment of Anterior Crossbite
1. Interceptive orthodontic treatment reduces the complexity of
some malocclusions during the __________ dentition phase of
dental development.
a. primary
b. mixed
c. secondary
d. all of the above
2. Early treatment of deep bites is performed to __________.
a. prevent the lower anterior teeth from impinging on the palatal
tissue
b. redirect mandibular growth to achieve a normal facial height
c. save money
d. a and b
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9. __________ should be considered indicators of the skeletal
nature of the anterior crossbite.
a. An anteriorly positioned glenoid fossa
b. A short anterior cranial base
c. A short or posteriorly positioned maxilla
d. all of the above
10. A long mandible is always an indication of a __________
malocclusion.
a. severe Class III
b. severe Class II div 1
c. severe Class II div 2
d. none of the above
3. Early treatment of open bites is performed to __________.
a. redirect maxillary growth to achieve a normal facial height
b. eliminate parafunctional habits
c. save time
d. a and b
11. __________ is associated with a degree of midface deficiency
that can result in an anterior crossbite.
a. Cleft lip and palate
b. Apert syndrome
c. Crouzon syndrome
d. all of the above
4. The elimination of a Class II division I malocclusion that presents
with a protrusive maxilla and/or maxillary teeth is aimed at
__________.
a. providing facial harmony
b. improving the child’s self-image
c. possibly reducing the probability of incisor fractures
d. all of the above
12. In a cleft lip and palate patient, midface deficiency can be
aggravated by the restriction of maxillary growth that may
result from __________.
a. thumb sucking
b. mouth breathing
c. scar tissue
d. all of the above
5. Early orthodontic treatment of severe crowding is performed
to __________.
a. create the correct overjet
b. create the correct overbite
c. provide space for the permanent teeth during eruption
d. all of the above
13. A severe maxillary deficiency at birth can result, on rare
occasions, from __________ pressing across the face
in utero.
a. a digit
b. a limb
c. the mother’s bladder
d. all of the above
6. An anterior crossbite exists if __________ present(s) with a
reverse overjet.
a. only one tooth
b. only if more than one tooth
c. if one or more teeth
d. if at least three teeth
14. Mandibular prognathism is __________ due primarily to the
size of the mandible.
a. always
b. never
c. not always
d. none of the above
7. The anterior posterior skeletal discrepancy is __________ cause
of the anterior crossbite.
a. an infrequent
b. a main
c. the only
d. none of the above
15. A chin cup is designed to __________.
a. push the mandible forward
b. inhibit growth of the mandible
c. push the maxilla forward
d. all of the above
8. The skeletal cause of the anterior crossbite is __________.
a. manifested as size discrepancies in the maxilla/mandible/
both
b. manifested as position discrepancies in the maxilla/mandible/
both
c. generally inherited
d. all of the above
16. __________ may lead to an abnormal axial inclination of
upper incisors.
a. A labially positioned supernumerary tooth
b. An over-retained deciduous tooth with delayed
exfoliation
c. Trauma to the deciduous teeth or permanent tooth bud
d. all of the above
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CE ANSWER FORM
Early Diagnosis and Treatment of
Anterior Crossbite
17. A pseudo-Class III can result from __________ tooth contact
during mandibular closure.
a. delayed
b. premature
c. lack of
d. any of the above
24. There is __________ debate as to whether a Class III
malocclusion will benefit from early treatment.
a. no
b. some
c. considerable
d. none of the above
18. A segment crossbite is likely to result from __________.
a. a dental etiological factor
b. a skeletal etiological factor
c. thumb sucking
d. none of the above
25. If a developing dental crossbite is discovered prior to
completion of the incisor eruption and before an overbite
has been established, the adjacent primary teeth can
be __________ to provide the necessary space for the
permanent incisors.
a. treated orthodontically
b. reduced interproximally using a standard IPR technique
c. extracted
d. none of the above
19. The Steiner and the McNamara analyses provide two
different cephalometric methods for measuring the severity
of __________ imbalances.
a. dental element
b. skeletal jaw
c. functional
d. all of the above
20. The early loss of maxillary deciduous teeth, impacted or lost
permanent posterior teeth, or impacted canines allows the
maxillary anterior teeth to __________.
a. erupt all at the same time
b. drift mesially and buccally
c. drift distally and palatally
d. all of the above
21. For growing children with an antero-posterior (sagittal) and/
or vertical maxillary deficiency, the treatment of choice is
__________ to move the maxilla anteriorly and, in some
cases, slightly inferiorly.
a. a Herbst appliance
b. maxillary traction with a reverse-pull headgear (face mask)
c. a rapid maxillary expander
d. all of the above
22. Early management of maxillary anterior crossbites is performed in order to establish a correct relationship between
the maxilla and the mandible, as well as to __________.
a. improve the child’s facial profile
b. achieve proper function
c. in some cases, eliminate the need for surgery at a
later date
d. all of the above
23. The Frankel-III appliance __________.
a. is made with the mandible positioned posteriorly and
rotated open
b. is made with the mandible positioned posteriorly and
rotated open
c. has pads designed to stretch the upper lip forward
d. all of the above
January 2015
26. Tipping maxillary and mandibular anterior teeth out of a
crossbite can be done by using __________ .
a. a removable appliance with finger-springs for facial movement
of the maxillary incisors
b. an active labial bow for lingual movement of the mandibular
incisors
c. a chin cup
d. a or b
27. In some patients whose crossbite has been treated,
follow-up and facemask treatments may be necessary
in the future if the patient’s __________.
a. skeletal growth exhibits a prominent Class III tendency
b. thumb sucking habit continues
c. maxilla develops only unilaterally
d. a or b
28. A deflection of a tooth from the normal position is most
likely to be associated with the __________ crossbite.
a. skeletal
b. dental
c. bilateral
d. all of the above
29. Surgery is usually the ideal treatment for adults exhibiting
a __________ profile because of maxilla deficiency.
a. concave
b. convex
c. flat
d. all of the above
30. It is easier and more effective to move the maxilla
forward __________.
a. in adolescence
b. at a young chronologic age
c. in adulthood
d. a and c
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Early Diagnosis and Treatment of Anterior Crossbite
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