15: Bilateral crossbite

15 Bilateral crossbite

Case 1

History

Medical history

Jean is asthmatic and uses a salbutamol (Ventolin) inhaler. She is prone to upper respiratory tract infections and is unable to breathe through her nose. Her mother reports that she snores and is prone to day-time drowsiness, which her teachers have noticed. Otherwise she is well. Her mother wonders if the narrow appearance of Jean’s upper teeth is related in any way to her mouth breathing and snoring. She is keen to know if Jean’s mouth breathing and snoring could be improved by any brace treatment.

Examination

Treatment

image What options are there for management of the bilateral buccal crossbite? Which would you choose?

The options are given in Table 15.2. In view of the severity of the crossbite and the desire to simultaneously, if possible, improve nasal breathing, rapid maxillary expansion (RME) would be the preferred choice of treatment.

Table 15.2 Management options for bilateral buccal crossbite

Management option Indications Comments
Accept and monitor Patient not keen for correction. Not an option here as Jean is keen for correction
Part of underlying skeletal III problem which is likely to worsen with mandibular growth, especially in males
Removable appliance with midline screw or heavy midline spring Primary/early mixed dentition Rate of expansion must be quite slow and force employed low: otherwise retention of appliance compromised by higher expansion forces
Compliance with wear and activation may be problematic
Not cost-effective as often lengthy time required to produce desired expansion
Quadhelix Preferred approach in early mixed dentition Made of 1 mm stainless steel wire attached to bands cemented to molar tooth on each side
3–5 mm maxillary expansion required (mainly dental but some skeletal expansion) Delivers few hundred grams of force
Teeth preferably tipped palatally but molar inclination may be adjusted with fixed appliances later Produces efficient slow expansion
May derotate />

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 15: Bilateral crossbite
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