Management of anterior dental crossbite with removable appliances
An 8-year-old Turkish girl was referred to the pediatric dentistry clinic with the chief complaint of an unaesthetic appearance of the maxillary central incisors, which were located behind the lower anterior teeth. Her medical and dental history was non-contributory, and the patient did not have a family history of Class-III malocclusion. The permanent maxillary right and left central incisors were both in crossbite [], and maxillary lateral incisors had not yet fully erupted. The patient was in early-mixed dentition and had a Class-I molar relationship on both sides, with a 2 mm overjet and 100% overbite. The maxillary dental midline was coincident with the facial midline; however, the mandibular dental midline deviated approximately 2 mm to the left. Mild spacing was present in the maxillary arch, and there was sufficient mesiodistal distance to achieve labial movement of the maxillary central incisors. A panoramic radiograph showed no evidence of bone or dental pathology [] and lateral cephalometric radiographic view showed no evidence of basal problem between mandibular and maxillary arches [].\nThe treatment objectives for the patient were to correct the anterior crossbite, to establish normal overbite and overjet, to align the anterior teeth for ideal inclination and to improve the patient's facial and dental esthetics. The child was motivated to maintain good oral hygiene. To align the maxillary anterior teeth and correct the crossbite, a removable acrylic appliance with a posterior bite-opening platform was used [Figure and ]. A screw incorporated in the appliance platform was activated 0.25 mm every 4 days for 16 weeks. After 2 months, the maxillary and mandibular incisors displayed an edge-to-edge bite relationship, and the crossbite was corrected in an additional 2 months []. The posterior bite-opening platform was then removed, and screw activation continued every 7 days for another 2 months in order to establish a normal overjet. During the course of treatment (at 6 months), the permanent maxillary lateral incisors erupted, with the left lateral tooth in crossbite []. Accordingly, a new acrylic plate with a labiolingual spring was prepared, and the spring was activated every month for 2 months until this crossbite was resolved. At the end of 8 months of active treatment, the crossbite of all maxillary incisors was successfully corrected, and no problems were observed during 6 months of follow-up clinically and radiographically [Figure -].