engleski

Treatment modality for a dysfunctional lateral crossbite associated with an anterior crossbite and skeletal class III in growing subject

Aim: To present treatment modality for a dysfunctional lateral crossbite associated with anterior crossbite in growing subject. Materials and Methods: A girl at the age of 7.5 years with the mixed dentition had a dysfunctional anterior and left lateral crossbite with lower midline shift for 2mm to the left ; also, a traumatic occlusion on lower right central incisor. Angle dental class I. Oral hygiene was poor, gingival phenotype thick on the upper and thin on the lower frontal teeth. Face was slightly asymmetric with chin towards left, her profile was concave. More of the lower than upper teeth were visible during smiling. Lateral cephalogram revealed: bimaxillary protrusion (much more pronounced mandible) in skeletal class III (Wits appraisal -6.3mm), neutral growth pattern, retroinclined lower incisors and both lips retruded in relation to the Rickets E-line. The Condylar axis : mandibular plane angle was 131.5°, which was in favour of the early treatment for class III. The cervical vertebral maturation method was used for assessing the skeletal maturity, it was assessed as the cervical stage (CS) 2, indicating prepubertal stage. Results and Conclusions: Treatment plan had goals to resolve dysfunctional anterior and lateral crossbite, discontinue traumatic occlusion on the tooth 41 and improve skeletal class III by stimulating the forward and downward growth of the maxilla. To resolve transversal discrepancy, the rapid maxillary expansion was applied. The acrylic bite blocks covering all upper lateral teeth were connected by the hyrax screw arms, vestibular hooks for protraction face mask were added at the level of the first deciduous molars. The hyrax screw was activated two times per day for two weeks, elastic traction was applied for 10 hours every day, for one year in total, after that time the acrylic hyrax was removed and elastics discontinued. Final occlusion resolved dysfunctional crossbite and traumatic occlusion on the 42. Angle dental class changed to class II. Lateral cephalogram revealed reduced Wits appraisal (-4.1mm), unchanged neutral growth pattern, retruded and retroinclined lower incisors, and both lips retruded in relation to the Rickets E-line, CS 3 circumpubertal stage. The superimposition on the sella-nasion line showed that the growth was predominantly vertical. Smile was improved with the upper teeth visibility, there was no visible deviation of the chin, profile became straight.

dysfunction ; unilateral cross-bite ; orthodontics ; anterior cross-bite

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