Search

Clear aligners are esthetical mechanics that provide good pushing (compressive) loads when they are well-fitted to the surfaces of teeth. They were considered excellent for a pushing (compression)–type movement but poor for pulling (tension) to close large molar spaces and were inappropriate for short clinical crowns with few if any undercuts. However, temporary skeletal anchorage devices such as miniscrews can provide strong anchorage for pull (tensile) loads. In this article, the extraalveolar miniscrews were placed in the mandibular buccal shelf or mandibular ramus in the mandible and infrazygomatic crest in the maxilla to integrate with clear aligners for retraction, uprighting, and erupting impactions or correcting the severe posterior lingual crossbite. By demonstrating these challenging patients, the authors wish to raise clinicians’ awareness of the importance of extending treatment possibilities.

BACKGROUND & OBJECTIVE: Crossbite is a commonly occurring malocclusion. It may be anterior or posterior, and it may occur either unilaterally or bilaterally. This study determined the prevalence of crossbite in children of different schools of Sundar industrial state and Raiwind. METHODOLOGY: Nine hundred (428 male and 472 female) children of various schools of Raiwind and Sundar Industrial State, Lahore, were examined. Information regarding age, sex, and crossbite were noted. The recorded data were analyzed by using SPSS version 20. Frequency distribution was used for the descriptive analysis. Statistical level of significance using student’s t-test was p< 0.05. RESULTS: Out of 900 children, 117(13%) were noted to have at least one tooth in crossbite, which was more frequent in permanent (13.2%) than in mixed dentition (12.3%). The prevalence of crossbite was slightly greater in female subjects (16.1%) than in male subjects (9.1%). Crossbite was seen more frequently in the posterior (6.3%) than the anterior region (5.9%). Combined anterior and posterior crossbite was found in 7(0.8%) children. Unilateral crossbite on the left side was found to be more frequent (6.6%) than on the right side (4.6%), and the bilateral crossbite was found to be in 1.9% of children. Buccal crossbite was more prevalent (6.8%) than lingual crossbite (5.8%). Combined lingual and buccal crossbite was found to be in 0.4% of children. CONCLUSION: Crossbite is a frequently occurring malocclusion in school children of Sundar industrial state and Raiwind, Lahore. Posterior crossbite is more prevalent than anterior crossbite.

An asymmetry caused by a complete lingual crossbite can compromise aesthetics and impair occlusal function. The following case report describes the correction of a complete lingual crossbite using orthodontic mini implants and mini-plates to achieve absolute anchorage. A comprehensive correction of the crossbite and re-establishment of the buccal occlusion was achieved.

A 33-year-old woman with severe facial asymmetry and unilateral lingual crossbite was treated with orthodontics combined with differential maxillary impaction and intraoral vertical ramus osteotomy. After 12 months of preoperative orthodontic treatment, 2-jaw surgery was performed. The total active treatment time was 18 months. Both her occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. The occlusion was stable after 5 years of retention. Posttreatment records after 5 years showed excellent results with good occlusion and long-term stability.