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Judicial Use Of Expansion Screws In Removable Appliances For Anterior

Crossbite Correction -Case Reports

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Case Report

Judicial Use Of Expansion Screws In Removable Appliances

For Anterior Crossbite Correction - Case Reports.
G.J. Anbuselvan1, M. Karthi2

1
Professor& Head of the Department,
ABSTRACT
Department of Orthodontics.
2
Senior Lecturer, Anterior cross bite is best managed once it is diagnosed early. Anterior
Department of Orthodontics. cross bite might be of dental, skeletal or functional origin. Dental cross
bite in mixed dentition is managed by Inclined plane, 2×4 appliance,
K.S.R. Institute of Dental Science and Research, Expansion screw with posterior bite plane. Functional cross bite is
K.S.R. Kalvi Nagar, Thokkavadi Post, managed by functional guidance and occlusal grinding. Skeletal cross
Tiruchengode, Nammakkal District, Tamilnadu bite is managed by Reversepull headgears.
PIN: - 637 215 Here we have shown four case reports showing management of dental
anterior cross bite using Removable Expansion Screw with posterior
Address for correspondence bite plane.
Dr. G.J. Anbuselvan, M.D.S, KEY WORDS
174, Brough Road, Opp. Telephone Bhavan, Inclined Plane, 2×4 appliance, Expansion Screw with Posterior Bite
Erode- 638 001 Plane, Functional Guidance, Occlusal Grinding, Reversepull
Mobile No: - 9788292602 Headgears.
E-mail:- gobijanbu@gmail.com

Introduction CASE 1
“The correct alignment of teeth is the key of the
PRE-TREATMENT MID-TREATMENT
development of a healthy occlusion” - Angle 1
Overjet is a horizontal measurement referring to
the distance between the lingual aspect of the maxillary
incisors and the labial surface of the Mandibular incisors
when the teeth are in habitual or centric occlusion. Normal
overjet is around 2 mm. Negative overjet is characteristic
feature of anterior cross bite. Anterior cross bite might be
2
dental, functional or skeletal .
“Anterior cross bite can be defined as upper POST-TREATMENT
frontal primary or individual permanent teeth lingual
position in relationship to lower incisor teeth. There is
relatively little literature data about the treatment
methods of anterior cross bite in primary and early
3
mixed dentition .”
Case Reports
We have shown four case reports in the age
group of 8, 7, 7 ½, and 11 years respectively of An eight year old boy reported with an
correction of anterior cross bite by use of Removable anterior cross bite of 1 1 and spacing. It was
Appliance incorporated with Expansion Screw and decided to treat him by an Anterior Expansion
Posterior Bite Plane. Screws are advantageous over appliance for the forward movement of 1 1 with a
springs because it is Easier to manage, Activated by Posterior Bite Plane. After active treatment the cross
patients with a key, Lesser tendency to dislodge, More bite was corrected in three months.
stability, Forces can be well controlled.

JIADS VOL -1Issue 1 Jan-March,2010 |38|

Judicial Use Of Expansion Screws In Removable Appliances
CASE 2
PRE-TREATMENT MID-TREATMENT
POST-TREATMENT (AFTER 21 DAYS)
A seven year old boy reported with an anterior cross
bite of 1 . It was decided to treat him by an
Expansion screw incorporated removable appliance
with a Posterior Bite Plane. Correction was achieved in
21 days time.
CASE 3
PRE-TREATMENT POST-TREATMENT
A seven and half year old male patient with an
anterior cross bite reported. It was decided to treat
him by a removable appliance incorporated with an
Expansion Screw and Posterior Bite Plane. Before
starting treatment retained right lower deciduous
central and lateral incisors were extracted. Correction
was achieved within two and a half months
Anbuselvan & Karthi
CASE 4
PRE-TREATMENT POST-TREATMENT
An eleven year old female patient with
anterior cross bite in left upper central incisor reported
to us. It was decided to treat with removable appliance
incorporated with Expansion Screw and Posterior Bite
Plane. Correction was achieved in two and half
months.
DISCUSSION
TYPES OF ANTERIOR CROSSBITE
There are three types of anterior cross bites found in
children:
(a) The simple dental cross-bite
(b) The functional or pseudo cross-bite
(c)The skeletal cross-bite
(a) Simple Dental Cross-bite
Simple anterior cross-bites are generally the
result of an abnormal eruption of the permanent
incisors. Various etiologic factors can be involved
including: trauma to the primary incisors with
displacement of the permanent tooth bud; delayed
exfoliation of a primary incisor with palatal deflection
of the erupting permanent incisor; supernumerary
anterior teeth; odontomas; congenitally abnormal
4
eruption patterns, and a arch perimeter deficiency .
Patients who have a simple anterior dental cross-bite
exhibit the following characteristics:
The cross-bite usually involves only one or two teeth.
JIADS VOL -1Issue 1 Jan-March,2010 |39|
Judicial Use Of Expansion Screws In Removable Appliances
(b) The Functional Anterior Cross-bite (Pseudo Class III)
Patients who have a functional anterior cross-
bite exhibit the following characteristics:
In centric relation or in a relaxed postural
position, the patient presents with a normal facial
5 A cross bite in the primary dentition is believed to
profile convexity .
In centric relation the opposing incisors
generally contact edge to edge with the molars
separated but in an Angle Class I relation.
During closing an early occlusal interference
causes an anterior shift of the mandible.
As the mandible shifts forward into centric
occlusion, the incisors are placed into cross-bite and
the molars into a Class III relationship.
(c) The Skeletal Anterior Cross-bite
Patients who have a true skeletal Class III or
mesiocclusion have a problem of skeletal dysplasia
involving mandibular hypertrophy, a marked
shortening of the cranial base or maxilla, or a
6
combination of both . Some of the characteristics they
will exhibit are:
In centric relation, their facial profile will be
straight or concave.
In centric relation, there will be a Class III
molar relationship and an anterior cross-bite.
In centric occlusion, there will he a Class III
molar relationship and an anterior cross-bite.
The arc of mandibular closure remains
smooth without any occlusal interference.
In an attempt to compensate for the skeletal
discrepancy during growth, the maxillary incisors
usually become proclined and the mandibular incisors
become retroclined.
ETIOLOGY
The possible causes of anterior cross bite include:
Inadequate upper arch length (crowding)
Lingual eruption path of maxillary incisors.
Delayed shedding of deciduous teeth.
Trauma to deciduous teeth resulting in displacement of
permanent tooth germs.
Supernumerary teeth, odontomes or other
pathological conditions leading to displacement of the
teeth in anterior region.
Early occlusal interference (dental). This results in a
forward mandible displacement to achieve maximum
intercuspation (functional anterior cross bite)
Anbuselvan & Karthi
Skeletal causes. There is discrepancy in the size or
position of the maxilla and mandible.
Rationale For Early Treatment
Little possibility for self-correction.
transfer to the permanent dentition.
Postponing treatment results in prolonged treatment
of greater complexity.
If left untreated, it can cause growth modifications and
dental compensations.
May eventually lead to a permanent deviation and
craniofacial asymmetry as well as potentially
deleterious masticatory patterns.
Associated with an increase in condylar deviation and
temporomandibular joint sounds.
Interference with growth of the middle third of the
face.
Abnormal speech patterns.
Loss of arch integrity.
Periodontal disease.
Undesirable esthetics.
Root resorption of central incisors.
Treatment
Treatment Modalities
Various options are available based on the
severity and types of the crossbites. The competency of
the operator has to be taken in to consideration. These
options are: -
Removable appliance with expansion screw.
Fixed appliance.
Combination of Removable & Fixed appliances.
Functional appliances.
Face Mask.
Chin- Cup/Cap.
Orthognathic Surgery is not an option for the mixed
dentition stage and is only considered when growth
has ceased.
Treatment With Removable Anterior Expansion
Screw Appliance
Screws are used to procline two or more teeth.
A screw applies a large intermittent force to the teeth.
It is placed parallel to the intended tooth movement.
Screw plates have an added advantage whereby the
teeth to be moved can also be clasped simultaneously.
This is particularly useful in cases where there is
inadequate number of teeth to be clasped for
JIADS VOL -1Issue 1 Jan-March,2010 |40|
Judicial Use Of Expansion Screws In Removable Appliances Anbuselvan & Karthi

7
example in partially erupted or badly carious teeth . ACTIVATION
However, screws are bulky and expensive. Screws are activated by the patient in the
8
Screws are advantageous over springs : - direction of the arrow shown in the baseplate. The
Easier to manage principle of the orthodontic screw is that its ends are
Activated by patients with a key threaded in opposite directions and when it is turned
the metal end plates move apart. The basic
Lesser tendency to dislodge
orthodontic screw is rigid, therefore it can only be
More stability adjusted by only a small amount at any one time, and
Forces can be well controlled otherwise the appliance cannot be inserted.
The activation is done one-quarter turn once
Indications 9 weekly which separates the acrylic by about 0.25 mm
When space necessary for the correction of producing forces ranging from 3 to 10 pounds. This
malocclusion is less than 3 mms. compresses the teeth in the socket by 0.12mm per
side, which is within the width of Periodontal Ligament
Fo r t h e c o r r e c t i o n o f d e n t a l c r o s s b i t e :
(0.25mm). Such a mild reduction of periodontal
-Anterior
ligament space wouldn't interrupt the blood
-Posterior circulation and creates ideal condition for the teeth
movement & bone transformation 11.
To correct single tooth malposition
More frequent adjustments, of up to one-
Basic Design of an Expansion Screw quarter turn twice a week is sometimes possible but
care must be taken not to overdo it as this can cause
the appliance to be ill-fitting.
GUIDE PIN

CENTRAL CYLINDER
FREQUENCY OF OPENING THE SCREW
SCREW Depends on,
THREAD Pitch of the screw.
KEY HOLE
Types and range of correction required.
Age of patient. (Children-twice a week Adults-
once)
Ideally frequency of opening the screw is done
every 3 – 7 days in slow expansion & about 54 – 84
days in the mixed dentition.

PITCH OF SCREW
When the expansion screw given one
complete turn, the two halves of the orthodontic
appliance advance a distance equal to the space
between the neighboring lines often called as
thread's height. This distance moved is called pitch
of the screw 10.
ANCHORAGE
Anchorage is the source of resistance to the
reaction from the active components. The active
components in removable appliance are “springs”
and “Expansion Screws”. Anchorage in the
removable appliance is provided by the (a) baseplate
and (b) the retentive component.
Baseplate
The acrylic baseplate hold together the other
components of the appliance. A posterior bite plane
should be incorporated to free the occlusion and
allow the tooth in cross bite to move effectively.
Baseplate design is very important for patient
comfort. A bulky baseplate is uncomfortable and
often interfere with speech. This will reduce patient co-
operation and tolerance to the appliance.
JIADS VOL -1Issue 1 Jan-March,2010 |41|
Judicial Use Of Expansion Screws In Removable Appliances
Conclusion
Appliances with expansion screws used at
right place & right time, “JUDICIALLY would
produce more stable results.”
Acknowledgements
We would like to thank Staff of the Department
of Orthodontics & P.V. Vishnudev Intern, KSR Institute
of Dental Science and Research for his support in the
preparation of the manuscript.
References
1) Angle EH. The latest and best in orthodontic
mechanisms. Dent Cosmos 1928; 70: 1143-58.
2) Graber T.M, Swain BF. Orthodontics current principles
and techniques. Am. J. Orthodont 1985; 25: 324-330.
3) Irena Jirgensone, Andra Liepa, Andris Abeltins.
Anterior crossbite correction in primary and
mixed dentition with removable inclined plane
(Bruckl appliance). Stomatologija, Baltic Dental
and Maxillofacial Journal. 2008; 10: 140-144.
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Anbuselvan & Karthi
4) Major, Glover. Treatment of anterior cross-bites in the
early mixed dentition, Journal. 1992; 58 : 574-579.
5) Croll, Fixed inclined plane correction of anterior
crossbite of the primary dentition, The Journal
of Pedodontics.1984; 9: 84-94.
6) Moyers: Handbook of Orthodontics, Third Ed, Y e a r
book Publishers Inc.Chicago.1973; 15: 564-577.
7) Vadiakas G, Viazis AD. Anterior crossbite
correction in the early deciduous dention. Am J
Orthod Dentofacial Orthop.1992; 102: 160-2.
8) Graber TM, Neuman B. Removable orthodontic
appliances.2nd ed. Saunders; 1984:57-9.
9) Ngan P. Biomechanics of maxillary expansion
and protraction in Class III patients. Am J
Orthod Dentofacial Orthop 2002;121:582 583.
10) Adams P. The design, construction and use of
removable orthodontic appliances. 5th ed. Bristol;
1984: 111-112.
11) Estreia F, Almerich J, Gascon F. Interceptive correction
of anterior crossbite. J Clin Pediatr Dent 1991; 15:
157-159.
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