The Saudi Dental Journal (2012) 24, 105–113

King Saud University

The Saudi Dental Journal

www.ksu.edu.sawww.sciencedirect.com

CASE REPORT

Simple removable appliances to correct anterior

and posterior crossbite in mixed dentition: Case report

Naif A. Bindayel *

Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 60169,Riyadh 11545, Saudi Arabia

Received 20 October 2011; revised 5 December 2011; accepted 20 December 2011Available online 30 January 2012

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KEYWORDS

Anterior;

Posterior;

Crossbite;

Functional shift;

Treatment

Tel.: +966 1 4673591; fax:

-mail address: nbindayel@k

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sevier B.V. All rights reserve

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Abstract Different techniques have been used to correct anterior and posterior crossbites in mixed

dentition. This case report illustrates the treatment of anterior and unilateral posterior crossbites

during the mixed dentition. The patient was a 9-year-old boy with a crossbite of the maxillary right

permanent central incisor and a unilateral right posterior crossbite, both expressed by a functional

shift in the sagittal and transverse dimensions. Two upper acrylic removable appliances, each with

an expansion jackscrew, were used to correct the crossbites. The total active treatment time was

4 months; the treatment outcomes were successfully maintained for the subsequent 4 months. Gen-

eral and pediatric dentists, as well as orthodontists, may find this technique useful in managing

crossbite cases of the mixed dentition and utilizing the discussion and illustrations for further clin-

ical guidance.ª 2012 King Saud University. Production and hosting by Elsevier B.V. All rights reserved.

1. Introduction

Anterior crossbite can be a major esthetic and functional con-cern during the early stages of dental development. Anterior

crossbite is defined as a situation in which one or more primaryor permanent mandibular incisors occlude labially to their

4679017.

y. Production and hosting by

Saud University.

lsevier

antagonists (or when one or more maxillary incisors are lin-

gual to their antagonists) (Daskalogiannakis, 2000). Crossbitehas a reported incidence of 4–5% and usually becomes evidentduring the early mixed dentition period (Hannuksela andVaananen, 1987; Heikinheimo et al., 1987; Major and Glover,

1992). It results from a variety of factors such as palatal erup-tion of the maxillary incisors, trauma to the primary incisors,supernumerary anterior teeth, overretained primary teeth,

odontomas, crowding in the incisor region, and inadequatearch length (Valentine and Howitt, 1970; McEvoy, 1983;Bayrak and Tunc, 2008).

Posterior (lateral) crossbite is another concern of the earlymixed dentition; several studies have reported its incidence torange between 8% and 22% (Kutin andHawes, 1969; Thilander

and Myrberg, 1973; Egermark-Eriksson et al., 1990). Patientswith normal occlusion in the primary dentition were shown todevelop a lateral crossbite in 3.1% by the time the permanentdentition was reached (Legovic andMady, 1999). In most cases,

106 N.A. Bindayel

the crossbite is accompanied by a mandibular shift that causes

midline deviation (Thilander and Myrberg, 1973; Kurol andBerglund, 1992). The etiology of posterior crossbite can includeany combination of dental, skeletal, and neuromuscular func-tional components. However, it is usually associated with

reduction in maxillary arch width. This reduction can be in-duced by digit sucking, certain swallowing habits (Melsenet al., 1979), or mouth breathing––usually the result of upper

airway obstruction due to hypertrophied adenoid tissue (Breso-lin et al., 1983; Oulis et al., 1994).

Anterior and posterior crossbites in the early mixed denti-

tion are believed to be transferred from the primary to the per-manent dentition and can have long-term effects on the growthand development of the teeth and jaws (McNamara, 2002).

Anterior crossbite may lead to abnormal enamel abrasion orproclination of the mandibular incisors, which, in turn, leadsto thinning of the labial alveolar plate and/or gingival reces-sion (Valentine and Howitt, 1970). Mandibular shift caused

by abnormal mandibular movements may place strain on theorofacial structures, causing adverse effects on the temporo-mandibular joints and masticatory system (Troelstrup and

Moller, 1970; Ingervall and Thilander, 1975). Spontaneouscorrection of such malocclusion has been reported to be toolow to justify nonintervention (Kutin and Hawes, 1969;

Schroder and Schroder, 1984; Lindner et al., 1986), and therate of self-correction was shown to range from 0% to 9%(Kutin and Hawes, 1969; Thilander et al., 1984). Therefore,interceptive treatment is often advised to normalize the occlu-

sion and create conditions for normal occlusal development.Bonding brackets to the four maxillary incisors in combina-

tion with banding the two maxillary permanent first molars

(2 · 4 fixed appliance) is one of the methods used for the cor-rection of anterior crossbite with fixed appliances. It has beenreported to effectively manage anterior crossbite in the mixed

dentition (Dowsing and Sandler, 2004) as well as in the adultdentition (Brooks and Polk, 1999). This method has the advan-tages of requiring little or no patient compliance or alteration

of speech. Other reported treatment modalities for correctionof anterior crossbite include rare earth magnetic appliances(Xie, 1991), fixed acrylic inclined planes (Croll, 1984), bondedresin-composite slopes (Bayrak and Tunc, 2008), and multiple

sets of Essix-based appliances (Giancotti et al., 2011). Variousmodes of treatment have been suggested for posterior crossbitecorrection such as rapid maxillary expansion (Sandikcioglu

and Hazar, 1997; Erdinc et al., 1999) and slow expansion witha quad-helix or a removable expansion plate (Bjerklin, 2000).

Removable appliances have the advantages of easier mainte-

nance and oral hygiene care for young patients, utilization ofpalatal anchorage, and the ability to move a selected block ofteeth (Littlewood et al., 2001). The literature includes manage-

ment techniques for unilateral crossbite using removable appli-ances with midsagittal expansion screws. However, thesearticles consist of only brief illustrations with general discussion(Littlewood et al., 2001) and lack a display of extraoral images

and additional removable appliance components such as biteplanes (Ngan andWei, 1990; Cunha et al., 1999). Other case re-ports reported appliances require special supplies (Piancino

et al., 2007) or attempted to correct combined sagittal and pos-terior vertical problems (Al-Sehaibany and White, 1998).

This case report aims to provide general and pediatric

dentists with a simple technique to manage anterior andposterior crossbites in the mixed dentition. Illustrations of

treatment progress and appliance design are included for fur-

ther clinical guidance.

2. Case report

A 9-year-old boy was referred by his pediatric dentist for anorthodontic consultation regarding his anterior bite. Extrao-rally, he had a balanced face with a pleasant profile, with the

maxillary dental midline coincident with the facial midlineThe chin was deviated to the right side by 3 mm from the facialmidline, and the entire maxillary right posterior segment was

tipped palatally (especially the right primary canine) (Figs.1–9). He presented in the mixed dentition stage with Class I leftand half-cusp Class II right molar relationships (Figs. 10–14).

The overbite was deep (100% on the left maxillary central inci-sor), and an anterior crossbite of the maxillary right perma-nent central incisor and unilateral (right) posterior crossbite

were evident. Both crossbites were being expressed as a resultof functional shifts in the sagittal (i.e., forward) and transversedimensions (to the right side). The mandibular dental midlinedeviated from the maxillary dental midline (designated as the

mesial of the maxillary right central incisor) by 4 mm to theright in centric occlusion. The panoramic radiograph showedsymmetric condylar shapes and positions bilaterally and

normally developing permanent successor tooth germs.

2.1. Treatment plan

Based on the above findings, the patient was scheduled forlimited early interceptive treatment to restore normal occlu-sion and alleviate the underlying functional shift. To reach

these objectives, two treatment approaches were considered.Quad-helix expansion combined with bite opening and brack-et-bonding only the four maxillary incisors would permit

simultaneous correction of both anterior and posterior cross-bites. However, expansion with the quad-helix would notcontrol the palatal tipping of the right posterior segment me-

sial to the first molar (especially the primary maxillary rightcanine). Therefore, a removable appliance was chosen to bet-ter control the canine and the adjacent palatal tipping.

The removable appliance option included the use of twoupper removable appliances. The first incorporated a jack-screw set to act in an anteroposterior direction to tip the max-illary right permanent central incisor labially and bilateral

posterior bite planes (about 4 mm thick) to disengage the biteand facilitate tooth movement (Fig. 15). That was followed byanother removable appliance with a midpalatal jackscrew and

bilateral posterior bite planes (of minimal thickness) to furtherexpand the right maxilla (differential expansion). Two Adamsclasps and two ball clasps were incorporated in both appli-

ances to aid retention.A set of two appliances, rather than one, was utilized

because of the proximity of the posterior aspect of the anterior

jackscrew site to the splitting line emerging anteriorly andlaterally from the midpalatal jackscrew. A Z-spring could havebeen used anteriorly instead to overcome that lack of thespace; however, the jackscrew was more advantageous in terms

of appliance stability. The patient’s parents were asked to acti-vate the jackscrew a quarter turn every second day. The patientwas instructed to wear the appliance full-time (day and night)

except for eating and teeth cleaning. After each meal and

Figure 1–9 Pre-treatment extraoral, intraoral photographs and panoramic radiograph.

Simple removable appliances to correct anterior and posterior crossbite in mixed dentition: Case report 107

before sleeping, the patient was asked to brush his teeth andthe appliance before reinserting it. The roll technique was dem-onstrated for teeth brushing, and the parents were asked to

monitor the brushing frequency and duration (minimum of 2minutes). The patient was also instructed to handle the appli-ance gently and avoid holding its wire extensions or edges

while cleaning.

Upon treatment completion, an upper Hawley retainer wasplanned to replace the second appliance to ensure stability ofthe corrected malocclusion. Retention using a new appliance

was preferred over grinding the bite planes of the second oneto improve adaptation and patient comfort. The parentsconsented to the treatment plan and were informed that a

second stage of comprehensive treatment for final leveling

Figure 10–14 Pre-treatment orthodontic study models.

Figure 15 Insertion of first removable appliance to correct the anterior crossbite; maxillary occlusal (A), frontal (B), right lateral (C),

and left lateral intraoral views (D).

108 N.A. Bindayel

might be indicated upon clinical reevaluation during the earlypermanent dentition stage.

2.2. Treatment progress

The first appliance was used for 7 weeks to achieve a positiveoverjet of the maxillary right central incisor. After anteriorcrossbite correction, a bilateral, posterior open bite resultedfrom use of the posterior bite planes that caused intrusion of

mostly the mandibular posterior segments. At this point, adecrease in severity of the mandibular midline deviation

became evident (Figs. 16–18). Use of the second appliancewas followed for 8½ weeks (Fig. 19). Expansion was contin-ued until the desired transverse correction of the maxillary

right posterior segment was achieved. The total activetreatment period was about 4 months. For both appliances,the patient was seen during the first week after appliance inser-tion to ensure comfort and monitor cooperation. Thereafter,

Figure 16–18 Intraoral photographs after anterior crossbite correction.

Figure 19 Activated second removable appliance to correct the unilateral right posterior crossbite; frontal view (A), right lateral view

(B), maxillary occlusal view (C) and laboratory drawing of the appliance design (D).

Simple removable appliances to correct anterior and posterior crossbite in mixed dentition: Case report 109

follow-up appointments were scheduled every 3–4 weeks.Upon completion of treatment, the anterior and posterior

crossbites had been corrected, the right molar relationshipwas restored to Class I, the left molar relationship had a ten-dency to Class III, and chin asymmetry was reduced (Figs.

20–27). Some occlusal adjustments were made to the maxillaryand mandibular right primary canines (inclined planes) to en-sure a stable and functional relationship. The upper Hawley

was then used full-time (day and night) for 6 months. Use ofthe Hawley retainer promotes retention and resolution ofany residual lateral posterior open bite. The patient was thenasked to wear the retainer only at night for another 4 months.

The case was followed up out of retention for an additional4 months (Figs. 28–32). Stable anterior and posterior relation-ships were evident, and continued spontaneous alignment of

the mandibular incisors was noticed. Furthermore, there wasa spontaneous decrease in the maxillary diastema.

3. Discussion

The pretreatment photographs demonstrated fair oral hygiene.

However, by the end of treatment, maxillary and mandibulargeneralized marginal gingivitis were evident (Figs. 20–27).The inflammation was followed by an improvement in oral

hygiene during the retention period. Despite the demonstra-tion of proper oral hygiene measures to the patient, the

patient’s hygiene worsened during the treatment period, possi-bly because of such factors as lack of patient cooperation, lackof motivation and follow-up by the dentist, lack of parental

support, and the hygienic demand of an intraoral appliance.A study has shown that only 26.1% of a group of Saudi chil-dren aged 6–9 were caries free (Alamoudi et al., 1996). A more

recent investigation indicated that the prevalence of cariesamong a sample of Saudi primary school children was94.4% (Wyne et al., 2002). Therefore, more emphasis shouldbe focused on maintaining good oral hygiene before, during,

and after any dental treatment.The case presented with a functional shift, a discrepancy

that is indicated for early management. The mixed dentition

period offers a great opportunity for occlusal guidance andinterception of malocclusion (Kocadereli, 1998). If treatmentis deferred to a later developmental stage, treatment may

become more complicated (Tse, 1997).On extraoral evaluation, the patient displayed chin devia-

tion to the right side in centric occlusion. Facial asymmetry

with chin deviation to the crossbite side is a known concurrentfinding in cases affected by mandibular functional shift (Pirt-tiniemi et al., 1990). Therefore, the treatment was provided

Figure 20–27 Post-treatment extraoral and intraoral photographs.

Figure 28–32 Four months post-retention intraoral photographs.

110 N.A. Bindayel

to help avoid growth imbalance of both skeletal and dentoal-veolar structures (Vadiakas and Viazis, 1992).

In cases of unilateral crossbite, determining the correcttreatment approach for each individual case is the key to

Simple removable appliances to correct anterior and posterior crossbite in mixed dentition: Case report 111

treatment success and stability. The clinician must first distin-

guish crossbites of dental origin from those of skeletal origin.Dental crossbite involves localized tipping of a tooth or teethand does not involve the basal bone (Bayrak and Tunc,2008). Pseudo Class III malocclusion is another example of

dental anterior crossbite that needs to be differentiated fromsagittal skeletal discrepancies. It involves retroclination ofmaxillary incisors that cause the mandible to shift forward

(Rabie and Gu, 2000). That is why treatment of these casesshould aim to correct maxillary incisor inclination (Hagget al., 2004). Moyers has distinguished pseudo Class III maloc-

clusion from cases with simple linguoversion. The latter in-volves palatal positioning of one or more maxillary anteriorteeth and does not produce a positional relationship brought

about by early interference (Moyers, 1988).The maxillary arch displayed an asymmetric shape due to

palatal tipping of the right posterior segment. The asymmetrymight have developed as a consequence of the premature ante-

rior bite forcing the mandible to shift to the right side. The me-sial and distal line angles of the respective maxillary andmandibular left central incisors acted as a guide plane during

development of the shift, resulting in an axial tipping of theseteeth. Therefore, treatment was geared to alleviate the anteriorcrossbite first and then control the remaining transverse

discrepancy. It should be noted that cases with symmetricalarches could benefit from symmetric expansion even in thepresence of unilateral crossbite and mandibular shift. In suchcases, the amount of intermaxillary transverse discrepancy is

usually reduced to less than a full bilateral crossbite. Althoughthe second appliance was designed to express more expansionon the right side, minor expansion of the opposite side

unavoidably occurred. Thus, the expansion of both sides mustbe carefully monitored in such cases. Overcorrection is usuallyrecommended for posterior crossbite cases; however, we

limited correction of the right side to avoid any undesiredoverexpansion of the left (unaffected) side.

Before treatment, the molar relationship was Class I on the

left side and a half-cusp Class II on the right. In crossbite caseswith a mandibular shift, studies have indicated that molars onthe crossbite side showed a partial Class II relationship (Hesseet al., 1997). Furthermore, tomogram studies have supported

that finding by showing asymmetric condylar positioning inthose cases. The condyle on the noncrossbite side was foundto be positioned downward and forward, while on the cross-

bite side it was centered in the articular fossa (Hesse et al.,1997). In the present case, the right molar relationship hadbeen corrected to a Class I relation by the end of treatment.

Another study showed that, out of 65 Class II subdivision pa-tients having a unilateral crossbite with a shift, 50% of the sub-division relationships that accompanied the crossbite were

resolved after its correction (Ben-Bassat et al., 1993).In regard to the bite plane, clear instructions should be in-

cluded to specify the thickness of the acrylic and the amount oftooth separation. For the first appliance, an acrylic thickness

of 4 mm was specified (i.e., barely enough to disengage theanterior crossbite tooth). For the second appliance, a minimalacrylic thickness was requested. The clinician must always

communicate effectively with the laboratory technician to pro-duce the required amount of bite opening. Increased andunnecessary amounts of bite opening may lead alteration of

the vertical relationship and the patient’s decreased compli-ance. From clinical observation, the author has noticed that

managing similar cases without use of the posterior bite plane

did not produce the desired outcome, wherein expansion mightbe only expressed on the noncrossbite side (i.e., the freed side).

Generally, the recommended activation frequency of simi-lar appliances is every second or third day (Kennedy and

Osepchook, 2005). In this case, we followed an every-other-day activation protocol, which was found to be efficient andeffective in the management of this case. Activation every third

day is recommended during the first week of therapy forimproved patient comfort and acceptance. Other authorsadvocate activation twice a week (Al-Sehaibany and White,

1998) and once a week (Cunha et al., 1999).By the end of the treatment, and because of increased

palatal tipping of the maxillary right primary canine, the in-

clined planes had been adjusted on both the maxillary andmandibular right primary canines. Selective grinding has beenshown to aid in correcting and retaining cases having unilat-eral posterior crossbite with a shift (Lindner, 1989; Tsarapat-

sani et al., 1999).The duration of treatment with removable appliances is re-

ported to range from 6 to 12 weeks (Kennedy and Osepchook,

2005). With a slower expansion rate, treatment can take up to6 (Al-Sehaibany and White, 1998) and 12 months (Cunhaet al., 1999). The first and second appliance therapies lasted

for 7 and 8½ weeks, respectively, which is in agreement withthe above-mentioned range.

Treatment objectives were met by the end of the presentedtherapy. It has been shown that correction of crossbite with

functional shift in the mixed dentition can be successful in84% to 100% of cases (Bell and LeCompte, 1981; Hermansonet al., 1985; Ranta, 1988; Egermark-Eriksson et al., 1990;

Bjerklin, 2000; Thilander and Lennartsson, 2002). The typeof appliance, follow-up period, and criteria used for the defini-tion of success also affect the reported success rate (Kennedy

and Osepchook, 2005).The Hawley retainer was used for 6 months. The recom-

mended retention period for similarly treated cases is 4–

6 months (or for a period at least equal to that required forcrossbite correction) (Kennedy and Osepchook, 2005). Afterbeing out of retention for 4 months, the case demonstratedgood stability. An extended retention period would add to

the stability of the posterior crossbite correction; therefore,other cases must be evaluated and judged individually. It hasbeen shown that early treatment with slow expansion for a uni-

lateral crossbite with a shift was found to be stable (Bartzelaand Jonas, 2007).

The mandibular incisors underwent continued spontaneous

alignment throughout the treatment period. This can be attrib-uted to the overjet correction that allowed the maxillary inci-sors to fully overlap the mandibular ones and enabled the

latter to tip back to their original places. Such spontaneousalignment is an example of how early treatment can produceadditional favorable effects on the developing dentition.

Increased treatment time and cost have been associated

with the use of removable appliances versus fixed (eg, quad-helix) for crossbite correction (Hermanson et al., 1985; Ranta,1988). Nevertheless, treatment of the present case was confined

to the expected treatment time and matched the reported treat-ment duration using similar removable appliances. This high-lights the importance of case selection and the necessity of

enlisting patient and parental compliance before the start oftreatment.

112 N.A. Bindayel

4. Conclusions

A simple removable appliance for the correction of anterior

and posterior unilateral crossbite with functional shift waspresented. Thorough clinical assessment and accurate diagno-sis must be performed in order to plan proper treatment strat-egies and appliance design. General practitioners and pediatric

dentists can utilize this technique to manage cases with similarmalocclusions.

Ethical Statement

The consent of the parents of the patient were sought prior to

and approved the inclusion of his case and his photograph inthis study.

Conflict of interest

No conflict of interest declared.

Acknowledgment

The author would like to address Dr. Moataz B. Alruwaithi’svalued contributions during the process of the development ofthis manuscript.

References

Al-Sehaibany, F., White, G., 1998. A three dimensional clinical

approach for anterior crossbite treatment in early mixed dentition

using an ultrablock appliance: case report. J. Clin. Pediatr. Dent.

23 (1), 1–7.

Alamoudi, N., Salako, N.O., Massoud, I., 1996. Caries experience of

children aged 6–9 years in Jeddah, Saudi Arabia. Int. J. Paediatr.

Dent. 6 (2), 101–105.

Bartzela, T., Jonas, I., 2007. Long-term stability of unilateral posterior

crossbite correction. Angle Orthod. 77 (2), 237–243.

Bayrak, S., Tunc, E.S., 2008. Treatment of anterior dental crossbite

using bonded resin-composite slopes: case reports. Eur. J. Dent. 2

(4), 303–306.

Bell, R.A., LeCompte, E.J., 1981. The effects of maxillary expansion

using a quad-helix appliance during the deciduous and mixed

dentitions. Am. J. Orthod. 79 (2), 152–161.

Ben-Bassat, Y., Yaffe, A., Brin, I., Freeman, J., Ehrlich, Y., 1993.

Functional and morphological-occlusal aspects in children treated

for unilateral posterior cross-bite. Eur. J. Orthod. 15 (1), 57–63.

Bjerklin, K., 2000. Follow-up control of patients with unilateral

posterior cross-bite treated with expansion plates or the quad-helix

appliance. J. Orofac. Orthop. 61 (2), 112–124.

Bresolin, D., Shapiro, P.A., Shapiro, G.G., Chapko, M.K., Dassel, S.,

1983. Mouth breathing in allergic children: its relationship to

dentofacial development. Am. J. Orthod. 83 (4), 334–340.

Brooks, S.A., Polk, M., 1999. Anterior crossbite correction with fixed

appliances in the adult dentition. Gen. Dent. 47 (3), 298–300.

Croll, T.P., 1984. Fixed inclined plane correction of anterior cross bite

of the primary dentition. J. Pedod. 9 (1), 84–94.

Cunha, R.F., Delbem, A.C., Costa, L., de Abreu, M.G., 1999.

Treatment of posterior crossbite in mixed dentition with a

removable appliance: reports of cases. ASDC J. Dent. Child. 66

(5), 357–360, 295.

Da skalogiannakis, J., 2000. Glossary of orthodontic terms, First ed.

Quintessence, Berlin.

Dowsing, P., Sandler, P.J., 2004. How to effectively use a 2 · 4

appliance. J. Orthod. 31 (3), 248–258.

Egermark-Eriksson, I., Carlsson, G.E., Magnusson, T., Thilander, B.,

1990. A longitudinal study on malocclusion in relation to signs and

symptoms of cranio-mandibular disorders in children and adoles-

cents. Eur. J. Orthod. 12 (4), 399–407.

Erdinc, A.E., Ugur, T., Erbay, E., 1999. A comparison of different

treatment techniques for posterior crossbite in the mixed dentition.

Am. J. Orthod. Dentofacial Orthop. 116 (3), 287–300.

Giancotti, A., Mozzicato, P., Mampieri, G., 2011. An alternative

technique in the treatment of anterior cross bite in a case of Nickel

allergy: a case report. Eur. J. Paediatr. Dent. 12 (1), 60–62.

Hagg, U., Tse, A., Bendeus, M., Rabie, A.B., 2004. A follow-up study

of early treatment of pseudo Class III malocclusion. Angle Orthod.

74 (4), 465–472.

Hannuksela, A., Vaananen, A., 1987. Predisposing factors for maloc-

clusion in 7-year-old children with special reference to atopic

diseases. Am. J. Orthod. Dentofacial Orthop. 92 (4), 299–303.

Heikinheimo, K., Salmi, K., Myllarniemi, S., 1987. Long term

evaluation of orthodontic diagnoses made at the ages of 7 and

10 years. Eur. J. Orthod. 9 (2), 151–159.

Hermanson, H., Kurol, J., Ronnerman, A., 1985. Treatment of

unilateral posterior crossbite with quad-helix and removable plates.

A retrospective study. Eur. J. Orthod. 7 (2), 97–102.

Hesse, K.L., Artun, J., Joondeph, D.R., Kennedy, D.B., 1997.

Changes in condylar postition and occlusion associated with

maxillary expansion for correction of functional unilateral

posterior crossbite. Am. J. Orthod. Dentofacial Orthop. 111 (4),

410–418.

Ingervall, B., Thilander, B., 1975. Activity of temporal and masseter

muscles in children with a lateral forced bite. Angle Orthod. 45 (4),

249–258.

Kennedy, D.B., Osepchook, M., 2005. Unilateral posterior crossbite

with mandibular shift: a review. J. Can. Dent. Assoc. 71 (8), 569–

573.

Kocadereli, I., 1998. Early treatment of posterior and anterior

crossbite in a child with bilaterally constricted maxilla: report of

case. ASDC J. Dent. Child. 65 (1), 41–46.

Kurol, J., Berglund, L., 1992. Longitudinal study and cost-benefit

analysis of the effect of early treatment of posterior cross-bites in

the primary dentition. Eur. J. Orthod. 14 (3), 173–179.

Kutin, G., Hawes, R.R., 1969. Posterior cross-bites in the deciduous

and mixed dentitions. Am. J. Orthod. 56 (5), 491–504.

Legovic, M., Mady, L., 1999. Longitudinal occlusal changes from

primary to permanent dentition in children with normal primary

occlusion. Angle Orthod. 69 (3), 264–266.

Lindner, A., 1989. Longitudinal study on the effect of early intercep-

tive treatment in 4-year-old children with unilateral cross-bite.

Scand. J. Dent. Res. 97 (5), 432–438.

Lindner, A., Henrikson, C.O., Odenrick, L., Modeer, T., 1986.

Maxillary expansion of unilateral cross-bite in preschool children.

Scand. J. Dent. Res. 94 (5), 411–418.

Littlewood, S.J., Tait, A.G., Mandall, N.A., Lewis, D.H., 2001. The

role of removable appliances in contemporary orthodontics. Br.

Dent. J. 191 (6), 304–306, 309–310.

Major, P.W., Glover, K., 1992. Treatment of anterior cross-bites

in the early mixed dentition. J. Can. Dent. Assoc. 58 (7), 574–575,

578–9.

McEvoy, S.A., 1983. Rapid correction of a simple one-tooth anterior

cross bite due to an over-retained primary incisor: clinical report.

Pediatr. Dent. 5 (4), 280–282.

McNamara Jr., J.A., 2002. Early intervention in the transverse

dimension: is it worth the effort? Am. J. Orthod. Dentofacial

Orthop. 121 (6), 572–574.

Melsen, B., Stensgaard, K., Pedersen, J., 1979. Sucking habits and

their influence on swallowing pattern and prevalence of malocclu-

sion. Eur. J. Orthod. 1 (4), 271–280.

Simple removable appliances to correct anterior and posterior crossbite in mixed dentition: Case report 113

Moyers, R.E., 1988. Handbook of orthodontics, First ed. Year Book

Medical Publisher Incorporated, Chicago.

Ngan, P.W., Wei, S.H., 1990. Treatment of posterior crossbite in the

primary and early mixed dentitions. Quintessence Int. 21 (6), 451–

459.

Oulis, C.J., Vadiakas, G.P., Ekonomides, J., Dratsa, J., 1994. The

effect of hypertrophic adenoids and tonsils on the development of

posterior crossbite and oral habits. J. Clin. Pediatr. Dent. 18 (3),

197–201.

Piancino, M.G., Farina, D., Merlo, A., Greco, M., Aprato, M.,

Bracco, P., 2007. Early treatment with ‘‘function generating bite’’

of a left unillateral posterior cross-bite: chewing pattern before

and after therapy with FGB. Int. J. Orthod. Milwaukee. 18 (2),

33–38.

Pirttiniemi, P., Kantomaa, T., Lahtela, P., 1990. Relationship between

craniofacial and condyle path asymmetry in unilateral cross-bite

patients. Eur. J. Orthod. 12 (4), 408–413.

Rabie, A.B., Gu, Y., 2000. Diagnostic criteria for pseudo-Class

III malocclusion. Am. J. Orthod. Dentofacial Orthop. 117

(1), 1–9.

Ranta, R., 1988. Treatment of unilateral posterior crossbite: compar-

ison of the quad-helix and removable plate. ASDC J. Dent. Child.

55 (2), 102–104.

Sandikcioglu, M., Hazar, S., 1997. Skeletal and dental changes after

maxillary expansion in the mixed dentition. Am. J. Orthod.

Dentofacial Orthop. 111 (3), 321–327.

Schroder, U., Schroder, I., 1984. Early treatment of unilateral

posterior crossbite in children with bilaterally contracted maxillae.

Eur. J. Orthod. 6 (1), 65–69.

Thilander, B., Lennartsson, B., 2002. A study of children with unilateral

posterior crossbite, treated and untreated, in the deciduous denti-

tion–occlusal and skeletal characteristics of significance in predict-

ing the long-term outcome. J. Orofac. Orthop. 63 (5), 371–383.

Thilander, B., Myrberg, N., 1973. The prevalence of malocclusion in

Swedish schoolchildren. Scand. J. Dent. Res. 81 (1), 12–21.

Thilander, B., Wahlund, S., Lennartsson, B., 1984. The effect of early

interceptive treatment in children with posterior cross-bite. Eur. J.

Orthod. 6 (1), 25–34.

Troelstrup, B., Moller, E., 1970. Electromyography of the temporalis

and masseter muscles in children with unilateral cross-bite. Scand.

J. Dent. Res. 78 (5), 425–430.

Tsarapatsani, P., Tullberg, M., Lindner, A., Huggare, J., 1999. Long-

term follow-up of early treatment of unilateral forced posterior

cross-bite. Orofacial status. Acta Odontol. Scand. 57 (2), 97–104.

Tse, C.S., 1997. Correction of single-tooth anterior crossbite. J. Clin.

Orthod. 31 (3), 188.

Vadiakas, G., Viazis, A.D., 1992. Anterior crossbite correction in the

early deciduous dentition. Am. J. Orthod. Dentofacial Orthop. 102

(2), 160–162.

Valentine, F., Howitt, J.W., 1970. Implications of early anterior

crossbite correction. ASDC J. Dent. Child. 37 (5), 420–427.

Wyne, A.H., Al-Ghorabi, B.M., Al-Asiri, Y.A., Khan, N.B., 2002.

Caries prevalence in Saudi primary schoolchildren of Riyadh and

their teachers’ oral health knowledge, attitude and practices. Saudi

Med. J. 23 (1), 77–81.

Xie, Y.Y., 1991. [Treatment of cross-bite of anterior teeth with rare

earth magnetic appliance with double rails]. Zhonghua Kou Qiang

Yi Xue Za Zhi. 26 (3), 140–2, 190.