Early Treatment

Palatal Expander

The palatal crossbite is corrected with a fixed (cemented) appliance, and usually requires about six months to get the correction. There are variations in the devices which are used to make the correction. We use two types of fixed rapid palatal expander which actively moves the upper jaw apart (without any discomfort and in as little as two weeks) These devices are used for more severe bone constrictions.

Positive results which occur from correcting the constricted palate are: widening of the cheek bones, opening up of the airway and nasal passages to improve breathing, better muscle control during chewing, more space to align the teeth and avoid crowding, and allows normal growth of the lower jaw, normal development of the jaw joints.

A longer acting removable appliance is used when long term expansion of just teeth is needed. The doctor will decide which appliance is best suited for your particular problem.

Protraction Mask

A variation of the Class III malocclusion is the lack of upper jaw growth. Typically this patient will appear to lack cheek bones, the nose is depressed, and the face appears dished-in due to lack of mid-facial growth. Generally there is a cross-bite associated with the problem.

Treatment is more difficult with this type of patient, but is correctable given enough time and growth. The need for growth indicates the need for early treatment with these mid-face deficient patients. Non-growers or adult patients are generally a surgical candidate with mid-facial problems. Typically Class III elastics in association with a protraction mask may be used with these maxillary deficient patients.

Below is the type of maxillary advancing headgear we use in our practice. It rests on the forehead and chin and then elastics are attached to a crossbow in the front of the mouth and then to the upper archwire. This applies a light force to advance the maxilla forward.

The problem is to diagnose correctly because a true Class III will commonly become progressively worse as the child grows. There are many clues to the degree of growth. Each patient has to be evaluated over a long period of time with progressive x-rays and models of the teeth and jaws.

Removable Appliance to Correct an Anterior Crossbite

When there is a crossbite of a single tooth or in some cases a couple of teeth, this is called a dental crossbite as opposed to a skeletal crossbite. Most often it involves one or more of the front teeth. Skeletal crossbites usually involve the palate bone.

We correct single tooth crossbites because they can and usually do cause tissue problems as well as abnormal wear of the tooth structure. The correction of this dental problem is usually performed with a removable orthodontic appliance.

Space Maintainers

A space maintainer is required when there is premature loss of a primary tooth. If the primary tooth is loss through tooth decay or trauma, the lower permanent tooth may not be ready to erupt. We must therefore place a space maintainer while we wait for the permanent tooth to erupt. Otherwise, teeth will move into the space and when the permanent tooth is ready to erupt, there will be a lack of space.

Space Maintainer (upper arch)

A Nance appliance is used as a space maintainer for the upper arch.

Space Maintainer (upper and lower arches)

Here is an example of a space maintainer used when there is premature loss of a tooth. It can be used on both dental arches.