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AJOH
Correction of an anterior crossbite in mixed dentition: a case report
Bationo R1., Ouedraogo Y2., Jordana F3.
1 Medical Center, General Aboubacar Sangoulé Lamizana Camp, Burkina Faso.
2 Health Department, University of Ouaga I Professor Joseph Ki-Zerbo, Yalgado Ouédraogo Teaching Hospital,
Burkina Faso.
3 Department of Odontology, University of Nantes, Nantes Teaching Hospital, France.

ABSTRACT
Anterior crossbite is a situation in which one or more maxillary incisors occlude lingually to their
antagonists. It constitutes major esthetic and functional concern during the stages of dental
development. Single tooth anterior crossbite is a commonly encountered malocclusion during the
development of occlusion in children.
The correction of anterior crossbite requires the creation of enough space, to bring the displaced tooth
or teeth across the occlusion into proper position.
Early treatment in very young children prevents the establishment of maloclusion that can potentialy
worsen with age.
Different techniques have been used to correct anterior crossbite in mixed dentition. In this 8-year-old
patient, a rapid maxillary expander with welded arm was used. This therapy combined with
tonsillectomy followed by breathing exercises improved respiratory function.
It is therefore essential to intervene as early as possible to achieve the anatomical and physiological
conditions for optimal of growth.
Keywords: anterior crossbite, rapid maxillary expansion, early treatment.

INTRODUCTION long-term effects on the growth and development of

In the mixed dentition, dental and alveolar the teeth and jaws. 6
abnormalies include premature loss of primary or Anterior crossbite constitute a major esthetic and
permanent teeth, anterior dental crowding, agenesis, functional concern during the stages of dental
retained primary teeth, supernumerary teeth, alveolar development; when the purpose of an interceptive
insufficiency, open bite, over bite and crossbite. treatment is to normalize occlusion and create
Graber 1 defined crossbite as a condition where one or conditions for normal occlusal development.
more teeth may be abnormally malposed either Correction of anterior crossbite consists of labial
lingually or labially with reference to opposing teeth. 1 tipping of upper incisors and lingual tipping of lower
Anterior crossbite is a situation in which one or more incisors.
maxillary incisors occlude lingually to their Interception is a simple therapeutic procedure to
antagonists. 2 achieve a partial or total correction before onset of full
Factors such as palatal eruption of the maxillary blown malocclusion. Its aim is to optimise anatomical
incisors, trauma to the primary incisors, and physiological conditions thus allowing normal
supernumerary anterior teeth, retained primary teeth, growth to take place.
odontomas, crowding in the incisor region, and According to Salvadori7, interception makes it possible
inadequate arch length have been implicated in the to prevent worsening of alveolar and skeletal
aehology of anterior crossbite. 3-5 disorders, thereby disrupting growth, function,
In the early mixed dentition, anterior and posterior aesthetics and sometimes the psyche of the child. This
crossbites are believed to be transferred from the is achieved by correcting the malocclusion in the three
primary to the permanent dentition and can have dimensions of space, in order to restart the
momentarily disturbed growth in its intensity or
Correspondence: Dr Raoul Bationo direction. 7
Medical Center, General Aboubacar Sangoulé However, elimination of the abnormalities is an
Lamizana Camp, Burkina Faso essential pre-requisite for treatment in mixed
E-mail: [email protected] dentition. 8
Received: 10/27/2017 Bassigny9 identified very early treatment in primary
Accepted: 03/04/2018
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Correction of an anterior crossbite in mixed dentition: a case report
02

dentition, early treatment in mixed dentition and late (Figures 1 and 2).
treatment in adult dentition. A voluminous tonsil appended to the palate was
Early therapy will be short-lived and will involve present on lateral cephalometric radiograph (Figure 4).
simple methods. The devices used may have
orthopedic or orthodontic action. The orthodontic
treatment will most often be done after a period of
suspension and supervision of varying duration.
This article documents a case in which an incisor cross
bite was corrected using a rapid maxillary expander.

Case report
An 8-year-old female patient presented with
anterior crossbite to the Department of Orthodontics
of Pellegrin Teaching Hospital (Bordeaux). Clinical
examination revealed the presence of mouth
breathing with poorly developed nasal orifices and
labial malocclusion at resting position with a lowered
lip. There were also a slight palatal tipping of teeth 65 Figure 3: Lateral cephalometric radiograph
and 26 and single anterior incisor crossbite 11/41 The nasopharyngeal obstruction required a
tonsillectomy after ENT consultation followed by
Figure 1: Pre-treatment extraoral views
breathing exercises.
The early treatment was aimed at correcting dental
and alveolar abnormalies and preventing future tooth
size-arch length discrepancy. A rapid maxillary
expander with welded arm (Figure 4) was cemented to
the maxillary teeth and activated by a quarter turn
twice a day for 7 days. The activation of the welded
arm made it possible to tip labially the maxillary
incisor. The correction of the incisor crossbite was
achieved after 14 days. The rapid maxillary expander
was then kept passive for one month.
Figure 2: Pre-treatment intraoral views
Figure 4: Clinical views of the rapid maxillary
expander and lingual arch

Panoramic radiograph showed normally developing permanent

successor tooth germs (Figure 3).

Figure 3: Panoramic radiograph

After a 3-month clinical monitoring, extractions of
primary teeth (52, 62, 73, 83) were planned and a
lingual arch with loops was set up to limit mandibular
discrepancy.
Two years after treatment with maxillary expander,
clinical observation indicated nasal breathing. The lips
were competent at rest and a correction of initial
abnormalies have been obtained. However, the over
bite was exaggerated (Figures 5 and 6).
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Figure 5: Extraoral views after two years composite inclined plane is a simple and non-invasive
effective technique but it cannot be used in cases
where the anterior crossbite exceeds one third of the
crown length. 14 Removable orthodontic appliances
are safe, easy and esthetically acceptable. 15
Anterior crossbite involving one tooth, could have
been corrected with a double helix apparatus. 16
In our patient, because of mouth breathing, we have
preferred the use of a rapid maxillary expander in
order to obtain a slight enlargement of the floor of the
nasal cavities, which will increase the nasal passage
and facilitate nasal breathing. 17
Figures 6: Intraoral views after two years This transverse action induces, a reduction of the
upper incisors malpositions and favors the
spontaneous improvement of the respiratory
functions. 18 Anterior crossbite is one of the major
responsibilities of pediatric dentist or orthodontist to
guide the developing dentition to a state of normalcy
in line with the stage of oro-facial growth and
development. 19
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