Correcting anterior crossbites in young patients is a common goal for phase 1 treatment. Here you can see that both upper central teeth are in crossbite with the lower front teeth. The upper laterals can be seen just below the surface of the gums and would also erupt into crossbite without treatment.
1: Accounting for shifts
There are different reasons for crossbites. In this case the patient's bite shifts forward due to an interference between the front teeth. Our first step in planning for success is to make sure we understand the extent of the shift and estimate our movements accordingly. Our offices uses cephalometric tracing to accomplish this planning process.
2: Factoring in growth
Growth can be a challenge in achieving our goals. We use a growth prediction to plan for changes that happen during treatment. Without this type of planning we may not be able to estimate the amount of movement we need.
3: Executing our plan
Good clinical techniques helped us to jump this bite quickly and finish treatment in 10 months. You can see the crossbite is gone and the upper laterals have erupted favorably.
4: Planning beyond phase 1
Growth won't stop just because we took of braces. We need to plan for additional changes before permanent teeth erupt. For this patent we used a lower holding arch to keep the molars (teeth that have bands around them) from moving forward. This allows us to preserve E-space and retract the anterior teeth later in treatment if needed. The lower holding arch also allows for premolars to erupt by preserving a band of tissue lingual to the primary teeth (baby molars).
5: Comparing Results
No treatment is complete without a comparison of planned movements vs. actual movements. We do this with a cephalometric superimposition. Below you can see the planned tracing (in red) superimposed on the actual tracing (in lavender). We were very successful in jumping our bite despite the lower jaw growing forward far more than expected. This is a good example of why step 4: planning beyond phase 1 is so important.
