Journal of Dental Herald

www.dherald.in Journal of Dental Herald

(April 2015) Issue:2, Vol.:2
E ISSN No. : 2348 – 1331
P ISSN No. : 2348 – 134X
Case Report
Early Correction Of Anterior Crossbite - A Report Of Two Cases
Neeraj Mahajan1, Siddharth Mahajan2
1
Prof. and H.O.D, Deptt. Of Pediatric and Preventive Dentistry, Guru Nanak Dev Dental College- Sunam (Punjab)
2
PG Student, Deptt. Of Pediatric and Preventive Dentistry, Guru Nanak Dev Dental College - Sunam (Punjab)
Abstract
Anterior crossbite is the term used to describe an abnormal labiolingual relationship between one or more maxillary and mandibular incisor teeth.
Single tooth anterior dental crossbite is the commonly encountered malocclusion during the development of occlusion in children. Different
techniques have been used to correct anterior crossbites. This paper describes the comparison between two methods for correction of single tooth
anterior crossbite namely the lower inclined plane and a Hawley’s appliance with double cantilever spring and posterior bite plane. Though
correction was achieved with both the methods but it was observed that the results were much faster with the lower inclined plane. This procedure is
a simple and effective method for treating anterior dental crossbite.
Key Words
Anterior cross bite, Catalan’s appliance, Double cantilever spring

Introduction
Anterior crossbite is a major esthetic and functional concern to
the parents during the developmental stage of a child. It is one
of the major responsibilities of pediatric dentist or orthodontist
to guide the developing dentition to a state of normalcy in line
with the stage of oral-facial growth and development. [1]
Anterior skeletal crossbites are most often associated with a
skeletal problem, such as mandibular prognathism and
midface deficiency. Differential diagnosis of dental versus
skeletal anterior crossbite is essential in determining clinical
treatment. This can be achieved by attempting to guide the
mandible into a centric relation and evaluating the molar and
incisor relationship: If the molars are in a Class I relationship
and the incisors in an edge to edge relationship, a dental
correction can be undertaken.[2]
Anterior dental crossbite has a reported incidence of 4 5% and
is usually the result of a palatal malposition of the maxillary
incisors resulting from a lingual eruption path. Other
etiological factors include:-
1) trauma to the primary maxillary incisors resulting in
lingual displacement of the permanent tooth buds
2) presence of supernumerary anterior teeth
3) crowding in the incisor region
4) a habit of biting the upper lip
5) an over retained, necrotic or pulpless deciduous tooth or
root
6) delayed exfoliation of the primary incisors; and
odontomas.[2],[3],[4]
An old orthodontic maxim states “the best time to treat a
crossbite is the first time it is seen.”[5]
In the following article, two cases of anterior crossbite were
treated with different treatment approaches i.e. one case was
treated with tongue blade therapy followed by Catalan’s
appliance and the second case was treated with Hawley’s
appliance with Z-spring and posterior bite plane and
comparison was made to see for faster results and better patient
compliance.
Case Report
Both the cases reported here were in the early mixed dentition
period and had Class-1 molar and canine relationship. In both
cases there was sufficient mesio-distal distance to achieve
labial movement of maxillary tooth.
Case-1
A 9 year old patient reported to the department of Pediatric and
Preventive Dentistry with the chief complaint of “crooked
teeth”. Examination revealed the normal profile of the patient,
the same whether the mandible was at rest or when the teeth
were occluded. The medical and dental histories were non-
contributory. Intraoral examination showed that the maxillary
permanent central incisors were erupted but the right central
incisor i.e. maxillary right central incisor had deflected
lingually. (Fig-1) The diagnosis in this case was a single tooth
dental type anterior crossbite.
Initially in this case tongue blade therapy was given. The
patient was instructed to insert the tongue blade at an angle
between the teeth and he was asked to bite firmly for five
seconds followed by rest. This is repeated for 25 times for three
times a day. But the patient reported after four days with no
change. So an inclined plane was constructed which was made
of acrylic, it produced a forward sliding motion of the
maxillary incisors on closure.(Fig-2) In this case, anterior

Quick Response Code Address For Correspondence:

Dr. Neeraj Mahajan
Prof. and H.O.D
Deptt. Of Pediatric and Preventive Dentistry
Guru Nanak Dev Dental College
Sunam (Punjab)

Fig - 1 : Pre-operative Picture Showing

Maxillary Right Central Incisor In Crossbite Fig - 2 : Catalan’s Appliance

©Journal of Dental Herald (April 2015 Issue:2, Vol.:2). 024

 Fig - 3 : Post-operative Picture After 7 Days
Fig - 4 : Pre-operative Picture Showing
Maxillary Right Lateral Incisor In Crossbite
crossbite correction was seen
within seven days itself.
(Fig-3) No post- operative
sensitivity or pain was
reported by the patient. But
the patient was advised soft
diet for one week to prevent
inflammation of the
surrounding periodontal
structures.
Case-2
Another 9 year old patient
reported to the Department of
Pediatric and Preventive
Dentistry with the chief
complaint of unaesthetic
appearance. The medical and
dental histories were non-
contributory. Extra oral
Fig - 7 : Catalan’s Appliance Mechanism examination revealed normal
profile of the patient.
Intraorally , it was observed that the maxillary right permanent
lateral incisor was lingually locked. (Fig- 4)
In this particular case, a Hawley’s appliance with a double
cantilever spring with the posterior bite plane. Since it was a
deep over bite the spring was given along with a posterior bite
plane to help in jumping the bite was given on maxillary left
permanent lateral incisor. In this case Z- spring was indicated
as there was adequate space for the labialization of the
maxillary lateral incisor. (Fig-5) The patient was recalled after
one week and the double cantilever spring was activated and
the desired results were seen within four weeks. (Fig-6) The
patient’s compliance was good and the patient did not
complain of any pain or inflammation.
Discussion
Anterior crossbite is a condition which seldom corrects by
itself because the maxillary incisor is locked behind the
mandibular incisors and continues to progress leading to
severe malocclusion, thus early treatment can reestablish
proper muscle balance and a well balanced occlusal
development. Early treatment is also directed towards
preventing dysplastic growth of both skeletal and the
dentoalveolar components.[1]
The ideal age for the correction of anterior dental crossbite is
between 8 to 11 years during which the root is being formed
and the tooth is in the active stage of eruption. The important
role plays not only the age of the child but also the motivation
for treatment, how he or she perceives the problem.[1],[7]
There are different treatment approaches for the correction of
anterior dental crossbite which can be used in early mixed
dentition period. These include tongue blade therapy, reverse
stainless steel crowns, removable Hawley retainer with
anterior Z-springs and bonded resin composite slopes.[4]
©Journal of Dental Herald (April 2015 Issue:2, Vol.:2).
Fig - 6 : Post-operative Picture After 4 Weeks
Fig - 5 : Hawley’s Appliance With A Double
Cantilever Spring With The Posterior Bite
Plane
The tongue blade therapy is successful only with patient
cooperation, and there is no precise control of the amount and
direction of force applied. The reverse stainless steel crowns
have been shown to be successful but the two main
disadvantages of using reverse stainless steel crowns are the
unaesthetic appearance of the crown form and the limitations
of working with an inclined slope that is already formed.[2],[4]
Because of the disadvantages of the methods mentioned
above, a cemented acrylic bite plane was given in Case 1. The
lower inclined plane caps the lower incisors and is inclined at
about 45° to the occlusal plane. On closing the upper incisors,
which formerly occlude behind the lower incisors , bite on the
inclined plane and the pressure of the bite (P) divides into two
force vectors P1 and P2 (Fig 7). The pressure (P1) proclines the
upper incisors. The Pressure (P2) intrudes the incisors. The
steeper the plane the greater the forward pressure on the
maxillary incisors. The advisable angle is 45°
So, desirable results in Case 1 were seen within seven days
itself with good patient compliance.
In Case 2, since there was sufficient space for the maxillary
central incisor to move labially, a Hawley’s appliance with a
double cantilever spring was given. A maxillary posterior bite
plate was inserted to allow clearance for the crossbite
correction. Though the patient’s compliance was good, the
desired results were seen within 4 weeks.
Conclusion
The main emphasis should be placed on the diagnosis and
evaluation of the malocclusion with consideration on the facial
profile and whether the child is benefited from the treatment at
this early stage of development.
In the following cases, since both the cases showed dental
anterior single tooth crossbite, a comparison was made
between two methods namely the inclined plane and the
Hawley’s type appliance and it was observed that the results
from anterior inclined plane were much faster provided the
patient’s compliances is good.
References
1. P. Prakasha, B. H. Durgesh. Anterior Crossbite Correction
in Early Mixed Dentition Period Using Catlan’s Appliance:
A Case Report. ISRN Dentistry 2011.
2. A. Ulusoy, E. BodruMlu. Management of anterior dental
crossbite with removable appliances. Contemporary
Clinical Dentistry 2013; 4(2): 223-226.
3. F. Borrie, D. Beam. Early correction of anterior crossbites:
a systematic review. Journal of Orthodontics 2011; 38
:175-184.
4. S. Chachra, P. Chaudhry. Comparison of two approaches
for the treatment of anterior crossbite. Indian Journal of
Dental Sciences
025
5. Moyers, R.E. Handbook of Orthodontics, 3rd Ed. Year 9. Jirgensone I, Liepa A, Abeltins A.Anterior Crossbite
Book Medical Publishers, Inc; Chicago, 1983, page 574- correction in primary and mixed dentition with removable
77. inclined plane. Stmatol, Bal Dent and Maxillofac J. 2008;
6. Pinkham J.R , Pediatric Dentistry- Infancy through 10: 140-144.
Adolescence , 4th Edition, Elseveir , a division of Reed 10. Sagarkar RM, Prashanth R. Orthodontic Correction of
Elsevier India Pvt. Ltd. anterior crossbite and mandibular deviation- a case report.
7. Susan A. , Mc Eroy . Rapid correction of a simple one tooth 2nd Dent Res and Rev. 2010: 48-49.
crossbite due to an over retained primary incisor . Pediatr 11. Mok C.W, Wong R.W. Self correction of anterior
Dent 1983; 5:280-82,200. Crossbite: a case report. Cases Journal
8. Bayrak S, Tune ES. Treatment of Anterior Dental Crossbite
using Bonded Resin – Composite slopes: Case reports. Eur
J Dent. 2008; 2: 303-306.

Source of Support : Nill, Conflict of Interest : None declared

©Journal of Dental Herald (April 2015 Issue:2, Vol.:2). 026