Case Report ISSN 2639-9490

Oral Health & Dental Science

Correction of Anterior Crossbite, Using Removable Appliances in Mixed

Dentition: 5-Year Follow-Up
Laura Mendoza Oropeza1*, Antonio Fernandez López and Ricardo Ortiz Sanchez1

Professor of Orthodontics in faculty of Odontology, University

1
*
Correspondence:
National Autonomy of Mexico.
Laura Mendoza Oropeza, Professor of Orthodontics in faculty of
2
Professor of Orthodontics in division of studies of postgraduate Odontology, University National Autonomy of Mexico.
and investigation, Faculty of Odontology, University National
Autonomy of Mexico. Received: 07 Jul 2023; Accepted: 11 Aug 2023; Published: 17 Aug 2023

Citation: Oropeza LM, López AF, Sanchez RO. Correction of Anterior Crossbite, Using Removable Appliances in Mixed Dentition:
5-Year Follow-Up. Oral Health Dental Sci. 2023; 7(4); 1-6.

ABSTRACT
The anterior crossbite (ACB) is a malocclusion where the upper anterior teeth are occluding lingually with respect
to the lower anterior teeth. Moyers describes anterior crossbites as dental malocclusions resulting from abnormal
axial inclinations of the anterior teeth.

This type of malocclusion can be dental, functional or skeletal and can occur in the primary, mixed and second
dentition. Diagnosis is made using diagnostic aids. While the treatment was carried out through interceptive
orthodontics, with the use of different removable appliances.

The objective of the study is to present the diagnosis and treatment for 5 years with the use of removable appliances.

The results were favorable, being able to uncross the bite in 4 months, it was maintained throughout the dental
replacement. One of the conclusions reached is that the treatment time is slightly longer since the use of preventive
and interceptive orthodontics takes more time because these treatments are performed during the growth of the
patients.

Keywords ACB when there is an anterior displacement of the mandible, due

Anterior Crossbite, Diagnosis, Treatment, Removable Appliances. to local causes, this habit can create an anterior crossbite or pseudo
class III, which over time can develop a true class III [2].
Introduction
Anterior crossbite (ACB) is the term used to describe an occlusion It is important to mention that normal occlusion at the transverse
abnormality in the anteroposterior plane where the lower teeth lie level is when the palatal cusps of the upper molars and premolars
in front of the upper teeth, when the patient occludes in centric occlude in the main fossa of the lower molars and premolars. At
relation. This alteration can be formed during dental replacement the antero-posterior level, the upper incisors occlude vestibularly
from the first dentition to the mixed dentition or develop due to from the lower incisors, presenting an anterior projection that
deficiencies in maxillary growth or due to an increase in the size should generally cover the lower ones. Broadly, classified the
of the mandible [1]. anterior crossbite as: type 1.- Functional, there is a discrepancy
between the centric relation and centric occlusion due to premature
Moyers, describes anterior crossbites as dental malocclusions occlusal points. Type 2.-Tendency to a true class III. Type 1 can be
resulting from abnormal axial inclinations of the anterior teeth, classified as type 1a simple, with no abnormal dentition or without
which must be clearly differentiated from skeletal class III dentoalveolar changes, and type 1b, complex, with an abnormal
mesioclusions or malocclusions. Occasionally they can present an dentoalveolar relationship that mimics true class III [3].

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Anterior crossbite (ACB) is a malocclusion that can occur in the ANB negative; or a normal SNA, increased SNB and negative
primary, mixed, and second dentition as a result of these disharmony ANB; and usually a horizontal growth direction. For diagnosis,
in the child's skeletal, functional, or dental components. This can cephalometric evaluation is important, which determines the
be characterized because one or more upper anterior teeth are positions of the maxilla and mandible, as well as the position of
occluding on the lingual side of the lower anterior teeth, being the upper and lower incisors, in order to determine the skeletal
of great importance since it clinically affects the aesthetics and and dental relationships of a class III. Therefore, a class III
masticatory function of the individuals who present it [4]. malocclusion can be classified as a dentoalveolar malocclusion, a
skeletal malocclusion or a malocclusion pseudo class III [9].
The etiology is of multifactorial origin and heredity has an
important factor, as well as ectopic eruption, tooth germ in a The prevalence of anterior crossbite in primary dentition is 6.7%
bad position (dental trauma) which sometimes causes a palatal reported by Carvalho, while in mixed dentition 12.8% reported by
displacement of the developing permanent tooth, forcing it to erupt Mendoza et al., and 2.4% by Montes et al. and 8% in Shanghai
in a palatal position [5,6]. in children at the aged 3 to 5 years and Taiwanese 13.83% which
varies according to the population and age group. The etiology of
Prolonged retention of deciduous teeth or inadequate length of the ACB can be skeletal, dental, and functional. The skeletal class III
dental arch are some of the causes that can cause lingual deviation has a prevalence of 50% in Asians and 5% in Caucasians with a
of the teeth of the second dentition during eruption, as well as predisposition for the female gender [10-14].
supernumerary teeth when they are located buccally and crowding
of the upper anterior teeth [5]. For the diagnosis, cephalometry, intraoral and extraoral clinical
photographs, analysis of models and tomography are necessary.
The non-nutritive habit of biting with the jaw forward forces the Regarding treatment, it can be preventive, interceptive, orthopedic
upper incisors to recline. This habit can cause either a retrusion of or surgical orthodontic [15].
the maxilla or a protrusion of the mandible, or a combination of
both (skeletal type crossbite); but when it affects one or several The objective of this study is to present a clinical case with a 5-year
teeth in isolation, the cause is usually dental, finding the upper follow-up of interceptive treatment of anterior crossbite performed
teeth lingually, behind the lower incisors. The bone support is well with removable orthodontic appliances during mixed dentition.
related to each other, and dentition is the origin of the anomaly. This
type of occlusion may be a predisposing factor in the development Material and Methods
of a skeletal class III malocclusion [7]. Case Report
A 9-year-old female patient who demands care at the Venustiano
When it is dental, one or two teeth are involved, the facial profile Carranza Peripheral Clinic of the Faculty of Dentistry of the
is straight in occlusion and centric relation. It presents class I National Autonomous University of Mexico, the reason for the
molar and canine relationship, in the cephalometric analysis the consultation was that the mother reported that she had cavities, the
SNA, SNB and ANB angles are in the norm, and it is generally the lower teeth bit in front of the upper ones whilst those above were
product of a dental axial inclination. crooked. In the facial analysis, the 3 thirds are of the same size,
with a straight profile (Figure 1).
Developing class III malocclusions usually express themselves
clinically as an anterior crossbite in the mixed dentition. The
functional anterior crossbite or pseudo class III, occurs when
it affects the four upper incisors. This is caused by mandibular
hyperpropulsion, causing, in turn, a low position of the tongue and
premature contact of the canines, which trap the maxilla. It is the
product of a mandibular advancement that is sometimes necessary
to achieve maximum intercuspation [8].

Several authors recommend that functional dental crossbites in the

primary dentition should be corrected at the time they are identified, Figure 1: Relationship of front thirds, slightly convex profile.
in order to promote normal dental and skeletal development.
The front intraoral picture shows mixed anterior crossbite in the
While the skeletal or class III anterior crossbite presents a class first temporary molars and first-degree cavities in the second
III molar and canine relationship, both in centric occlusion and in dentition. The intraoral front picture shows mixed anterior crossbite
centric relation, edge-to-edge in centric relation is not achieved. involving the 4 superior anterior teeth, presence of diastema, loss
It presents a concave profile accompanied by upper retrochelia, a of space for the lateral found without erupting on the left side and
prominent chin and a diminished lower third. In the cephalometric in the other side the teeth is rotation (Figure 2) [6].
analysis, the SNA angles are decreased, SNB increased and

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 and a relationship of the anterior cranial base with a 59.8 with
respect to the mandibular body of 57.1, la, IS to the palatal plane
103.8°, anterior facial height at 95.0, the posterior facial height
between anterior facial height at 70.7, with a SNA 88°, SNB 86°,
ANB 2°. , IMPA 100°, while the angles of the saddle, articular,
ramus height, are in the norm (Figure 4).

The analysis of the models in the table shows a discrepancy in

the jaw’s anterior length of -3 millimeters, and in the anterior and
posterior width of the arch of -5 millimeters with respect to the
mandible, resulting in maxillary deficiency in the anterior sector
and maxillary compression (Table 1).

Table 1: Model analisys.

Maxillary Mandible
4:4: 34mm. 4:4: 39mm
6:6: 45mm. 6:6: 50mm.
Figure 2: Intraoral Pictures. Anterior Length: 14mm Anterior Lenght: 15mm

In the posteroanterior and anteroposterior radiographs of the The diagnosis according to the realized analysis was A 9-year-
tomography, open apices are observed in the upper centrals, slightly old female patient presents a biprotrusive skeletal class I, with
dilacerated and with short roots, laterals, unerupted canines, ugly horizontal growth, protrusion and proclination of the lower incisor
duck phase. In addition, the teeth of the second dentition with with a straight profile with prochelia of the lower lip, presents a
formation of 2/3 of the root and without eruption (Figure 3). vert, severe brachi, in the Jarabak analysis shows a biprotrusive
skeletal class I, with growth counterclockwise, dentally presents
the lower incisors proclined with a straight profile.

The treatment consisted in first phase, the elaboration of an active

plate with a screw in the sagittal form and a posterior bite plane
to uncross the anterior crossbite, in addition, a spring was placed
at the upper lateral level in order to bring it towards the vestibular
area [16].
a b The patient was asked to activate the screw twice a week indicating
Figure 3: Radiography’s, a) anterior and b) posterior. the use of the device throughout the day, night and even for eating.
Also, the temporary molars were restored by placing steel crowns
to avoid deeper caries; preventive measures were applied as
brushing technique and plaque control (Figure 5) [17].

Figure 5: Used Appliances.

Figure 4: Roth Jaraback análisis.

Results
During the first two months bring the bite edge to edge was
In the Roth Jaraback cephalometric analysis, it presents a class
achieved, first of one of the central ones and later the other,
I biprotrusive skeleton, with horizontal growth with mandibular
managing to completely uncross at 4 months. In addition, the
hyperflexion, slightly lower incisal proclination and straight
diastema was gradually closed by activating the screw twice a
profile. Dentally it presents an anterior crossbite and class I molar
week (Figure 6).

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 After achieving the necessary space, a button was placed in the
upper left canine to bring it towards the vestibular area (Figure 10).

Figure 6: Fourth month of progress.

Subsequently, once the anterior bite was uncrossed, the upper

teeth continued to erupt, improving their occlusion. At that time,
selective carving with a 45° inclination on the cusp of the lower
Figure 10: Available space for the canine.
primary canine was considered, using a diamond fissure bur to
allow vestibularization of the upper lateral while waiting for the
The superimposed radiograph shows the correction of the anterior
eruption of the lower canine of the second dentition (Figure 7).
crossbite with the following cephalometric data that can be seen
in figure 11.

Figure 7: Selective tore down in the lower canine.

Then an upper lingual reminder was placed to prevent the patient

from placing the tongue between the teeth and causing an open
bite, since the tongue was in a low position. Also, a screw was
placed transversely to help in the transverse development of the
maxillary (since it presented a transversal discrepancy) with an
activation of a weekly quarter turn. Exercises were directed to
bring the tongue into the normal position, and the left temporal
canine was maintained to conserve space naturally (Figure 8) [18].

Figure 11: Superimposed radiography.

At the end of the treatment with removable appliances, the patient

is recommended to undergo corrective orthodontics to correct the
tipping and torque of the upper and lower sides and thus be able to
have an adequate occlusion (Figure 12).
Figure 8: Lingual reminder with spring.

Closure of the diastema, presence of mixed dentition, the upper

central have yet to be erupted, the upper canines are still unerupted,
while the upper canine and the upper and lower primary molars
were exfoliated (Figure 9).
Figure 12: Final oclusión.

Finals Results of the front and profile of the patient show that
the straight profile was preserved after interceptive orthodontic
treatment after treatment with the use of removable orthodontic
appliances (Figures 13 and 14).
Figure 9: Progress.

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 is very useful since it allows malocclusion to be modified with
greater control and thus prevents the formation of caries and
periodontal disease such as demineralization of molars with the
use of bands. Because it is a removable appliance, it is easy to use
and to clean, allowing the patient to have greater hygiene.

Conclusions
The results that were achieved were very favorable, although the
Figure 13: Final extra-oral photographs of the patient. treatment time is slightly longer, since the use of preventive and
interceptive orthodontics takes more time because these treatments
The finals results of the treatment during the 5 years. are carried out during the growth of the patients.

Therefore, it is essential that the patient is cooperative to obtain

satisfactory results, in addition, anterior crossbites are easier
to treat in patients who are growing (early mixed dentition),
improving masticatory function.
Figure 14: Pictures from beginning, between and at the end of treatment.
Interceptive treatments of anterior crossbites allow reducing
malocclusion even when it is a dental ACB in order to avoid future
Discussion
surgeries, reducing corrective orthodontic treatment time.
Many authors mention that the objectives of preventive and
interceptive treatments are not only to restore masticatory function
and facial aesthetics, but also to help eliminate the severity of the Acknowledgments
existing problem, achieving favorable growth development that This work was supported by UNAM-PAPIME PE200822.
contributes to improving psychological development of the child.
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© 2023 Oropeza LM, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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