Early Treatment of Anterior Crossbite in Skeletal Class III Using Fix Orthodontic Appliance

Sunaryo, Iwa R., drg., Sp.Ort., M.Kes.**Lecturer, Department of Orthodontics,

Falculty of Dentistry University of Padjadjaran, Bandung

HŌPǾŎŇÞŃPÒŎŌ Noticeable characteristics of Class III malocclusion result in unpleasant aesthetics for a child, and consequently lead parents to seek for orthodontic treatment at an early age. The negative dentoskeletal discrepancy between the apical bases, at the sagittal dimension, is mainly verified by a concave profile caused by deficiency of the facial middle third, absence of a zygomatic prominence and excess of the facial lower third(1). Angle Class III malocclusion has raised controversies among researchers concerning diagnosis, prognosis, and treatment(2). A greater incidence in people of Asian origin(3). Among the approaches for treating Class III malocclusion is the use of orthopedic appliances, such as chincups, facial masks, functional orthopedic appliances of the jaws, preventive orthodontic appliances (e.g.: Eschler arch and Porter appliance or “W” arch), multibracket fixed appliances(4,5), and a combined orthodontic and orthognatic surgery protocol(6).

GÒMŊŌŎŒÒŒ Dentoalveolar Class III malocclusions (half unit) right subdivision, skeletal Class III, with a flat facial profile, crowding anterior maxilla and mandible, and dental crossbites 42x11.

Ī MŇÒŎŊǾMŐOÒŃ ĜŔMÖ ÒŌMPÒŎŌ ŎǾ I MNŎǾMPŎǾŘ ĜŔMÖ ÒŌMPÒŎŌ

SKELETAL

SNA (81o-83o) 77.65o Retrognatic

SNB (79o-81o) 80.43o Normal

ANB (1o-3o) -2.78o Skeletal class III

Mandibular Plane to SN (31o-33o) 36.30o Increased

Wits -10mm Skeletal class III

DENTAL

Occlusal Plane to SN (13o-15o) 30.85o Increased

Upper Incisor to NA (21o-23o) 33.76o Proclined Upper Incisors

Lower Incisor to NB (24o-26o) 14.45o Retroclined Lower Incisors

Inter-Incisal Angle (130o-132o) 134.57o Retroclined Incisors

Upper Incisor to NA Distance

(3.0mm-5.0mm)

6.43mm Protrusive Upper Incisors

SOFT TISSUE

Upper Lip to S Line (0mm) -1.73mm Retrusive Upper Lip

Lower Lip to S Line (0mm) 0.46mm Normal

ĖÑPÒŎÕŎŊŘ The etiology of the crossbites needs to be determined prior to treatment planning. Anterior crossbites are one of the most common orthodontic problems that we see in growing children. They usually occur in the primary and mixed dentition as a result of disharmony in either the skeletal, functional, or dental components of the child’s orthognathic system(15). In this case crossbites will happen because the direction of tooth eruption 42 tends more to the labialy.

ĖÒÖ Œ ŎŅ İ ǾÑMPÖ ÑŌP The anterior crossbites must be treated in the primary and mixed dentition. Allowing this malocclusion to continue into the permanent dentition without correction will result in a reduction of treatment options and provide a less than ideal environment for growth to proceed(15). Advance care planning to move to the lingual tooth 42 using a bracket on the teeth 41, 42, and 84. Teeth 41, 42, and 84 mounted roth brackets with .022 inch slot and to push the teeth 42 to lingual used .12 inch NiTi wire.

İ ǾÑMPÖ ÑŌP Ĩ ǾŎŊǾÑŒŒ Treatment is starting on 6 November 2015 and done on 4 December 2015 by using fixed orthodontic appliance (brackets and archwire Niti 0.12) on the teeth 84, 42, and 41. Progress occurs after 4 weeks of treatment, with the position 42 has been corrected from crossbites.

GÒŒŃÞŒŒÒŎŌ The etiology of Class III malocclusion is multifactorial because of an interaction of both hereditary and environmental factors. The contributions of the cranial base, maxilla, mandible, and temporomandibular articulation have been described in detail in the literature(7-10). Class III malocclusions associated with craniofacial disharmonies are much more difficult to treat and tend to relapse(11-13). Early treatment of Class III malocclusion has been advocated to reduce the need of treatment in the permanent dentition, when camouflage orthodontic treatment or surgery become the only options. A series of treatment approaches can be found in the literature regarding orthopedic treatment in Class III malocclusion(14). Treatment in deciduous dentition produces greater skeletal changes than those produced in the mixed dentition stage(15); moreover, when therapy begins in the early mixed dentition, it seems to induce more favorable changes in the craniofacial skeleton, compared with the same treatment started in the late mixed dentition(16, 17).

FŎŌŃÕÞŒÒŎŌ Interseptif orthodontic treatment in cases crossbites anterior mandible may be performed using several brackets. In dental treatment intended to reduce malocclusion that will occur in the future. The movement of the teeth 42 move toward lingual corrects crossbites happened. Interseptif expected orthodontic treatment can make the development of the upper jaw is not impeded.

Pre-treatment Treatment Post-treatment

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