Early Treatment of Anterior Crossbite With Eschler Appliance: Two Case Reports
Early Treatment of Anterior Crossbite With Eschler Appliance: Two Case Reports
Early Treatment of Anterior Crossbite With Eschler Appliance: Two Case Reports
crossbite with eschler Dental School, Federal University of Bahia, Av. Araújo
Pinho, 62 - 7 ° Andar – Canela, Salvador, Bahia, Brazil,
Tel: +55 71 3336 6973; E-mail:
Horizonte, Brazil
2
DDS, MS, PhD, Associate Professor and Program Director of Orthodontics, Pontifical Catholic
3
DDS, MS, PhD, Associate Professor, Section of Orthodontics, Dental School, Federal University of
Abstract
Anterior Crossbite (AC) originates from skeletal alterations, functional, dental or their association, and may have genetic and/or environmental influences. Its
prevalence varies between 2.2% and 12% depending on age, ethnicity and the type of AC. During the primary dentition, it varies between 4% and 7%. The aim of this paper
is to present two clinical cases of anterior crossbite correction in the primary dentition, in which the Eschler appliance was chosen for both treatments.
063
Citation: Novais Machado KDO, Oliveira DD, Machado AW (2020) Early treatment of anterior crossbite with eschler appliance: Two case reports. J Dent Probl Solut
7(2): 063-067. DOI: https://dx.doi.org/10.17352/2394-8418.000087
https://www.peertechz.com/journals/journal-of-dental-problems-and-solutions
and absence of any pathology. Cephalometric analysis showed ANB 2° ± 2 - 2.8° 0.2°
a developing Class III skeletal pattern (Figure 2: Pretreatment Wits Appraisal 0 mm - Women - 3.9mm - 1.8mm
cephalometric radiograph and tracing; Table 1). 1.NA 22 15.8 18.9
Citation: Novais Machado KDO, Oliveira DD, Machado AW (2020) Early treatment of anterior crossbite with eschler appliance: Two case reports. J Dent Probl Solut
7(2): 063-067. DOI: https://dx.doi.org/10.17352/2394-8418.000087
https://www.peertechz.com/journals/journal-of-dental-problems-and-solutions
Like the previous case, the treatment aimed early SNA SNA 82° ±82°
2 ±2 81.7° 81.7° 82.9° 82.9°
interception of the anterior crossbite. The treatment was SNB SNB 80° ±80°
2 ±2 81.9° 81.9° 82.1° 82.1°
performed with the same appliance previously described and ANB ANB 2° ± 22° ± 2 - 0.2° - 0.2° + 0.8° + 0.8°
under the same recommendations (Figure 7: Intra-oral frontal
WitsWits
Appraisal
Appraisal 1 mm
1 mm
- Men
- Men - 0.9mm
- 0.9mm - 1.1mm- 1.1mm
view of the appliance).
1.NA 1.NA 22 22 17.2 17.2 20.7 20.7
Activation was initiated at the time of device’s adjustment 1.NB 1.NB 25 25 24.1 24.1 24.8 24.8
and activations of 1mm per month were performed for 5 1.1 1.1 131 131 144.2 144.2 136.6 136.6
months, totaling a period of 6 months. After this period, the
IMPA IMPA 90 ± 590 ± 5 92.5 92.5 92.9 92.9
patient had a normal anterior relationship and after achieving
an appropriate overjet, activations were discontinued. In the
retention phase, the same device was used for 7 months.
Citation: Novais Machado KDO, Oliveira DD, Machado AW (2020) Early treatment of anterior crossbite with eschler appliance: Two case reports. J Dent Probl Solut
7(2): 063-067. DOI: https://dx.doi.org/10.17352/2394-8418.000087
https://www.peertechz.com/journals/journal-of-dental-problems-and-solutions
upper incisors were moved buccally providing dentoalveolar 2. Terada HH, Suguino R (1997) Utilização do Aparelho Progênico para Correção
das Mordidas Cruzadas Anteriores. Rev Dent Press Ortod e Ortop Facial 2: 87-
remodeling [2]. However, because the corrections are only
105. Link: https://bit.ly/32f7sPz
dentoalveolar, it makes the follow-up of patients who manifest
AC in primary dentition indispensable in order to facilitate the 3. Wiedel AP, Bondemark L (2005) Stability of anterior crossbite correction: A
second phase of treatment if necessary [2,10,11,16,22]. randomized controlled trial with a 2-year follow up. Angle Orthod 85: 189-195.
Link: https://bit.ly/3fuJZO7
Another problem encountered in AC associated with Class III
4. Khalaf K, Mando M (2020) Removable appliances to correct anterior crossbites
skeletal patients is the long-term stability. Although literature in the mixed dentition: a systematic review. Actaɸodontol. Acta Odontol Scand
shows encouraging results with facemask therapy1,10, great 78: 118-125. Link: https://bit.ly/2OkcMJi
relapse tendencies are also found which points out that a
5. Bittencourt MAV, Machado AW (2010) Prevalência de má oclusão em crianças
consistent retention phase is needed as well as longer periods
entre 6 e 10 anos – um panorama brasileiro. Dent Press J Orthod 15: 113-22.
of follow-up [14]. In the case presented the same appliance was
Link: https://bit.ly/3gYlB80
used as retention for 6 – 7 months. According to the literature
a positive overjet and overbite at the end of treatment appears 6. Abraham KK, James AR, Thenumkal E, Emmatty T (2016) Correction of
to maintain the anterior occlusion [23]. On the other hand, anterior crossbite using modified transparente aligners: An esthetic approach.
Contemp Clin Dent 7: 394-397. Link: https://bit.ly/2ZrHZR8
since Class III patients grow similar to untreated Class III
patients after treatment, the patients needs to be kept under 7. Devasya A, Ramagoni NK, Taranath M, Prasad KEV, Sarpangala M (2017)
observation till the time they pass the third growth spurt at 18 Acrylic Planas Direct Tracks for Anterior Crossbite Correction in Primary
years of age [14]. Dentition. Int J Clin Pediatr Dent 10: 399-403. Link: https://bit.ly/3fqjcm0
Lastly, to obtain favorable outcomes in early treatment 13. Kanno Z, Kim Y, Soma K (2007) Early correction of a developing skeletal Class
of AC, it’s essential to provide family guidance regarding III malocclusion. Angle Orthod 77: 549-556. Link: https://bit.ly/3j15OXJ
the need and importance of patient and family adherence 14. Kapur A, Chawla HS, Utreja A, Goyal A (2008) Early class III occlusal tendency
to the treatment. Also, the family should be warned about in children and its selective management. J Indian Soc Pedod Prev Dent 26:
the uncertainty of long-term stability and the possibility of 107-113. Link: https://bit.ly/32iOvvk
retreatments if unfavorable growth pattern occurs [1,16]. In
15. Almeida MR, Almeida RR, Oltramari-Navarro PVP, Conti ACCF, Navarro RL, et
such cases, when AC relapse occurs due to the unfavorable
al. (2011) Early treatment of Class III malocclusion: 10-year follow-up. J Appl
growth manifested by Class III malocclusion, the therapeutic Oral Sci 19: 431-439. Link: https://bit.ly/2B03u28
approach of choice is to use the facial mask1,10 or skeletal
anchorage [23]. 16. Araújo EA, Araújo CV (2008) Abordagem clínica não-cirúrgica no tratamento
da má oclusão de Classe III. Rev Dent Press Ortod e Ortop Facial 13: 128-157.
Conclusion Link: https://bit.ly/2B1LZ1u
17. Machado AW, Caldas SGR, Maia LGM (2016) Early correction of a developing
The proper diagnosis associated with early treatment of
Class III Malocclusion with a removable appliance. Dent Oral Craniofacial Res
anterior crossbite is decisive to achieve good occlusal and facial 2: 359-361. Link: https://bit.ly/30mB9vJ
results, as well as reestablishing an appropriate psychological
component for children. The use of the Eschler appliance 18. Miamoto CB, Marques LS, Abreu LG, Paiva SM (2018) Comparison of two
early treatment protocols for anterior dental crossbite in the mixed dentition:
represents a simple and effective option for the treatment of
A randomized trial. Angle Orthod 88: 144-150. Link: https://bit.ly/3fESxCl
this condition while still in primary dentition.
19. Jacobson A (1975) The “Wits” Appraisal of Jaw Disarmony. Am J Orthod 67:
References 125-137. Link: https://bit.ly/3fvbreO
1. Oltramari PVP, Garib DG, Henriques JFC, Conti ACCF, Freitas MR (2006) 20. Alhaija ESJA (2006) Skeletal, Dental and Soft Tissue Changes in Postural
Tratamento ortopédico da Classe III em padrões faciais distintos. Rev Dent Class III Malocclusion Treated with a Maxillary Removable Appliance. J Clin
Press Ortod e Ortop Facial 10: 72-82. Link: https://bit.ly/305jbh3 Pediatr Dent 31: 149-152. Link: https://bit.ly/2C0ERD7
066
Citation: Novais Machado KDO, Oliveira DD, Machado AW (2020) Early treatment of anterior crossbite with eschler appliance: Two case reports. J Dent Probl Solut
7(2): 063-067. DOI: https://dx.doi.org/10.17352/2394-8418.000087
https://www.peertechz.com/journals/journal-of-dental-problems-and-solutions
21. Baccetti T, Tollaro I (1998) A retrospective comparison of functional appliance A longitudinal retrospective study. Am J Orthod Dentofac Orthop 117: 669-
treatment of class III malocclusions in the deciduous and mixed dentition. Eur 680. Link: https://bit.ly/2DFtOQ6
J Orthod 20: 309-317. Link: https://bit.ly/38WGYn6
23. Woon SC, Thiruvenkatachari B (2017) Early orthodontic treatment for Class III
22. Saadia M, Torres E (2000) Sagittal changes after maxillary protraction with malocclusion: A systematic review and meta-analysis. Am J Orthod Dentofac
expansion in class III patients in the primary, mixed and late mixed dentitions: Orthop 151: 28-52. Link: https://bit.ly/3eqYalW
Copyright: © 2020 Novais Machado KDO, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
067
Citation: Novais Machado KDO, Oliveira DD, Machado AW (2020) Early treatment of anterior crossbite with eschler appliance: Two case reports. J Dent Probl Solut
7(2): 063-067. DOI: https://dx.doi.org/10.17352/2394-8418.000087