In the debate over early dental treatment, the literature is in agreement over treating crossbites with a shift. Whether the crossbite is anterior or posterior, it needs to be treated as soon as possible. When the crossbite is causing a shift of the mandible, the malocclusion correction becomes more urgent in growing children.
The following is a case report on my middle granddaughter who, at the time, was 4-years-old. Katy presented with a crossbite of the right side of her primary teeth. The problem mainly was an interference of tooth C with tooth R. The interference caused the mandible to shift to the right approximately 3mm. This is confirmed by the midline (Figs.1 & 2).
The first choice of treatment was to equilibrate the primary canines, but the amount of enamel removal would have been too extensive. A removable appliance was considered but quickly rejected due to age and cooperation concerns. I prefer a fixed non-compliant approach when possible.
The treatment consisted of banding A and J along with brackets on C through H. I then placed a .016 stainless arch wire with stops mesial to the molar tubes. A bead purchased at the local hobby store was then place between the molar band and the stop. This placed the arch wire 1mm out of the anterior incisor brackets (Fig. 3).
All brackets were ligature tied tightly to the arch wire with the exception of tooth C, which was secured with an elastic tie only.
My hope was the light force placed on the upper anterior teeth would have more of an effect on tooth C and less of an effect on D through H.
I saw Katy every three weeks and simply placed an additional bead to keep a light advancement force. The total treatment time was nine weeks.
Once the interference was corrected, the crossbite and shift was also corrected (Fig. 4).
The correction was self-retentive (Fig. 5). I was pleasantly surprised how easy the correction of this crossbite was and how well Katy tolerated the treatment. The crossbite left untreated could have lead to a much more difficult malocclusion in the future.
The final extra oral photo shows that a better facial symmetry has been produced.
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