Early class III occlusal tendency in children and its selective management

Treatment Modalities for Early Management of Class III Skeletal Malocclusion: A Case Series

The characteristic features of Class III malocclusion are present at an early age, usually between 3 and 5 years of age. If left untreated, the Class III malocclusion or severe anterior crossbite may worsen, with the majority of these patients ultimately requiring orthognathic surgery as adults. The treatment in all developing Class III cases should be undertaken as soon as the abnormality is diagnosed to prevent it from becoming permanent and resulting in a full-blown Class III malocclusion. It provides more pleasing facial esthetics (the lip posture and facial appearance), thus improving the psychosocial development of a child. Various treatment options available for the management of developing Class III malocclusion are as follows: (1) functional appliances such as reverse twin block, Frankel appliance, and the removable mandibular retractor; (2) orthopedic appliances such as chin cap and face mask; and (3) orthodontic appliances, namely removable maxillary expansion plate or fixed orthodontic appliance with expanded upper arch wire. A treatment plan may be chosen depending on the amount of maxillary growth restriction, mandibular plane angle, the soft-tissue profile, and the age of the patient. This article discusses the various treatment options and the decision-making for different clinical cases based on the clinical features with a description of four different treatment approaches.

Guiding the Child's Teeth with Class III Dental Malocclusion into Correct Occlusion: A Clinician's Parenting

Pediatric dentists are often the first ones to be consulted for the presence of an anterior cross bite in the primary dentition. The condition requires an early interception to avoid progressive dentoalveolar and skeletal changes. The management, however, poses unique challenges in terms of young age of the child, correct choice of appliance and unpredictability of the response to treatment due to inability to ascertain the inherent growth potential. It is very important therefore for the specialist, to be able to recognize the early signs of a developing class III malocclusion tendency and also know the basic details of successful management of such cases. The following article describes the appropriateness of appliance choice for a case of incisor cross bite in primary dentition using different appliances based on their varied clinical presentations.

Early correction of anterior crossbites: a systematic review

OBJECTIVES

To identify the appropriate treatment for the correction of anterior crossbite.

DESIGN

Systematic review.

DATA SOURCE

A search strategy was developed along with inclusion criteria and run in Scopus, Medline, Cochrane Library, EMBASE and psychINFO databases.

SELECTION CRITERIA

Children in the primary or mixed dentition with an anterior crossbite affecting one or more incisors, and no underlying skeletal class III discrepancy.

DATA SELECTION AND EXTRACTION

All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. Reference lists were checked for relevance and possible inclusion. Manual data extraction was carried out using a standardized format and agreed by the two investigators.

OUTCOMES

Time taken to correct the crossbite and treatment duration.

DATA SYNTHESIS

The data were arranged by type of study and further subdivided by treatment type.

RESULTS

A total of 499 articles were identified following electronic and hand searching and checking reference lists. Following examination of titles, abstracts and, where applicable full articles, 46 articles were included. Owing to the low levels of evidence, no statistical methods were employed.

CONCLUSION

This review has highlighted the lack of high quality evidence for the management of anterior crossbites in children. Although the level of evidence is low, there is similarity in the length of time it took to successfully treat anterior crossbites using similar treatment modalities. High level studies are required before definitive conclusions can be made.

Self correction of anterior crossbite: a case report

A 9-year-old Chinese boy presented with an anterior crossbite, no treatment was performed at that time because the incisors have open root apices. The crossbite self-corrected after one year. This case demonstrated that an anterior crossbite may self-correct without treatment.