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Early Orthodontic Treatment
Treat early or wait
- which is better?
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Early Orthodontic Treatment: treat early or wait?
Anterior crossbite
Posterior crossbite
Class II correction
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Anterior crossbite:
treat early
Functional shift
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Anterior crossbite:
treat early
Functional shift
Attrition
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Anterior crossbite:
treat early
Functional shift
Attrition
Periodontal problem
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Anterior crossbite:
treat early
Functional shift
Attrition
Periodontal problem
Difculty eating
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Anterior crossbite:
treat early
Functional shift
Attrition
Periodontal problem
Difculty eating
Mild/moderate Mx deciency
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Anterior crossbite:
wait
Severe Mx
2
deciency
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Anterior crossbite:
wait
Mandibular
excess
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Anterior crossbite:
wait
Severe Mx deciency
Mandibular excess
Crowding
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Anterior crossbite:
treatment methods
Inclined plane
Removable appliance
Elastics
Fixed appliances
Facemask
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Anterior crossbite treatment:
inclined plane
Minor tooth movement
Deciduous or erupting permanent
Skeletal Class I or mild Class III
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Anterior crossbite treatment:
inclined plane
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Anterior crossbite treatment:
removable appliance
Moving 1 or 2 teeth
Space available
Mixed dentition with posterior retention
Careful handling
Frequent short visits
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Anterior crossbite treatment:
elastics
Skeletal Class I or mild Class III
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Anterior crossbite treatment:
elastics
Skeletal Class I or mild Class III
Minimal overbite
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Anterior crossbite treatment:
elastics
Skeletal Class I or mild Class III
Minimal overbite
Upper and lower teeth need moving
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Anterior crossbite treatment:
elastics
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Anterior crossbite treatment:
elastics
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Anterior crossbite treatment:
elastics
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Anterior crossbite treatment:
elastics
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Anterior crossbite treatment:
fixed appliances
Several teeth to be moved in one arch
Space may be insufcient
Rotation needed
No need for posterior retention
Hygiene, diet control
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Anterior crossbite treatment:
fixed appliances
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Anterior crossbite treatment:
indications for face mask
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Anterior crossbite treatment:
indications for face mask
Skeletal Class III decient maxilla, mild to moderate
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Anterior crossbite treatment:
indications for face mask
Skeletal Class III decient maxilla, mild to moderate
Usually forward shift
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Anterior crossbite treatment:
indications for face mask
Skeletal Class III maxillary decient, mild to moderate
Usually forward shift
Upper 6s erupted
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Anterior crossbite treatment:
indications for face mask
Skeletal Class III decient maxilla, mild to moderate
Usually forward shift
Upper 6s erupted
Permanent incisors erupted at end of active phase
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Anterior crossbite treatment:
face mask technique
Framework with hooks, expander - bonded or banded
Incisor control if erupted
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Anterior crossbite treatment:
face mask technique
Up to 4-500 gm force total
! 14 hours per day
Slowly increase hrs at start
Slowly decrease hrs at end
Cotton pads prevent rash
Over-treat, allow for relapse
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Face mask treatment:
guarded prognosis
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Face mask treatment:
guarded prognosis
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Posterior crossbite
- classification
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Posterior crossbite
- classification
5
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Posterior crossbite
- classification
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Posterior crossbite
- classification
Dental
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Posterior crossbite
- classification
Dental
Skeletal
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Posterior crossbite
- classification
Dental
Skeletal
Functional
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Posterior crossbite
- classification
Dental
Skeletal
Functional
Combination
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Posterior crossbite
prevalence
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Effect of posterior crossbite: Font
90% of chewing is done on crossbite side
TMJs are at different levels
Condyles are shaped differently on each side
Ramus lengths are different on each side
Occlusal plane is tilted
46 Morphological and positional asymmetries of young children with functional
unilateral posterior crossbite. Pinto et al. AJODO Nov 2001
Prospective study 7-10 year olds
Mandibles shifted to crossbite side, had increased joint space on non-crossbite side
Mandibular skeletal asymmetry: changed ramus shape and mandibular position
Little change in glenoid fossa position
Early expansion Tx improved growth, eliminated positional & skeletal
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asymmetries
47 Changes in the masticatory cycle following treatment of posterior unilateral
crossbite in children. Throckmorton et al. AJODO Nov 2001
Chewing cycle duration longer in crossbite patients
A-P and vertical excursions greater in crossbite patients
Lateral excursions less in crossbite patients
After 6 mo crossbite treatment, cycle duration became normal, but no change in
excursions or pattern
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Effect of posterior crossbite
Class II tendency on crossbite side
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Effect of posterior crossbite
Class II tendency on crossbite side
Mandibular growth can be asymmetrical until functional shift is eliminated
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Effect of posterior crossbite
Class II tendency on crossbite side
Mandibular growth can be asymmetrical until functional shift is eliminated
Crowding and protrusion of upper incisors due to narrow upper arch
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Treating posterior crossbite:
functional
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Treating posterior crossbite:
functional
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Treating posterior crossbite:
narrow maxilla / upper arch
Porter: deciduous dentition
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Treating posterior crossbite:
narrow maxilla / upper arch
Porter: deciduous dentition
Quad helix: mixed dentition
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Treating posterior crossbite:
narrow maxilla / upper arch
Porter: deciduous dentition
Quad helix: mixed dentition
Hyrax screw: we use for permanent dentition, can be bonded, banded, or combination
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Treating posterior crossbite:
narrow maxilla / upper arch
Porter: deciduous dentition
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Quad helix: mixed dentition
Hyrax screw: we use for permanent dentition, can be bonded, banded, or combination
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Treating posterior crossbite:
narrow maxilla / upper arch
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Fixed vs removable

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Fixed is faster (3-5 mo. vs ~12 mo)
Fixed has more skeletal effect than removable
Fixed is more reliably worn
Fixed is more compact
Fixed has fewer problems
Fixed requires banding materials and skill unless bonded
Bonded requires meticulous hygiene and diet
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
narrow maxilla / upper arch
Separate, t bands, take impression, make appliance
Try in appliance
Expand
Heat treat if Elgiloy
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Treating posterior crossbite:
narrow maxilla / upper arch
Cement with glass ionomer
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
narrow maxilla / upper arch
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Treating posterior crossbite:
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narrow maxilla / upper arch
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