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Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: a Case Report

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Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: a Case Report International Journal of Environmental Research and Public Health Case Report Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report Marianna Pellegrino 1,*, Silvia Caruso 2, Tiziana Cantile 3 , Gioacchino Pellegrino 2 and Gianmaria Fabrizio Ferrazzano 3,4 1 Unit of Dentistry, Vita-Salute San Raffaele University, 20132 Milan, Italy 2 Department of Health, Life and Environmental Science, University of L’Aquila, 67100 L’Aquila, Italy; [email protected] (S.C.); [email protected] (G.P.) 3 Department of Neuroscience, Reproductive and Oral Sciences, School of Paediatric Dentistry, University of Naples, Federico II, 80138 Naples, Italy; [email protected] (T.C.); [email protected] (G.F.F.) 4 UNESCO Chair in Health Education and Sustainable Development: Oral Health in Paediatric Age, University of Naples Federico II, 80138 Naples, Italy * Correspondence: [email protected]; Tel.: +39-342-739-1187 Received: 26 April 2020; Accepted: 19 May 2020; Published: 20 May 2020 Abstract: The purpose of this investigation was to show how to manage an anterior crossbite in early mixed dentition with an eruption guidance appliance (EGA). The analyzed clinical case reported an anterior crossbite, a bimaxillary retrusion tendency, and a horizontal growth pattern. The anterior crossbite was an unfavorable occlusal condition that could lead to a class III malocclusion growth pattern. An early treatment approach was suggested to reach a correct sagittal jaw relationship. Hence, the selected approach acted on the dentoalveolar sector, aiming to have effects on the posterior vertical dimension and to improve the sagittal jaw’s relation. An EGA was selected to treat the patient in early mixed dentition. After 7 months of therapy with night-time use, the dental malocclusion was completely resolved. The patient continued to be treated with the same device, used as active retention. With the EGA treatment, the erupting forces, rather than the active forces, were used to resolve the dental malocclusion. This approach allowed a low compliance requirement and had a minimum psychosocial and psychological impact on the patient. The early treatment was essential to give a functional occlusion and a good balance of the soft perioral tissues and muscles. Keywords: eruption guidance appliance; class III malocclusion; early orthodontic treatment; EGA; anterior crossbite; interceptive orthodontics 1. Introduction Dental malocclusion is a condition characterized by abnormal relationships among the teeth or dentition. a malocclusion in primary dentition is a determinant factor of malocclusion in permanent dentition [1]. The anterior crossbite is a discrepancy on the sagittal plane, which causes the forward shift of the mandible. This unphysiological position of the lower jaw can favor a class III growth pattern. Class III malocclusion generally consists of hypoplasia or retrusion of the maxilla and/or prognathic mandible, and deficient maxilla accounts for 42–63% [2]. Regardless of the growth direction of both jaws and the functional or genetic involvements, the class III relationship should be treated early [3]. It is important to minimize the aesthetic impact that the malocclusion may have on the social life of the patient, especially during adolescence. Malocclusion may lead to low self-esteem in later years, as children with primary dentition undergo a period during which they establish self-identity and early personality [4]. Furthermore, early treatment in early development is essential to avoid or to Int. J. Environ. Res. Public Health 2020, 17, 3587; doi:10.3390/ijerph17103587 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, x 2 of 10 Int. J. Environ. Res. Public Health 2020, 17, 3587 2 of 10 identity and early personality [4]. Furthermore, early treatment in early development is essential to avoid or to reduce the malocclusion severity and to improve therapeutic outcomes. A sagittal reducediscrepancy the malocclusion of more than severity 7 mm, in and fact, to has improve a high therapeutic risk of relapse outcomes. [5]. Early a sagittal intervention discrepancy on the ofmaxilla more thanis recommended 7 mm, in fact, to has try ato high reach risk a correct of relapse sagittal [5]. Early relation intervention before the on maxillary the maxilla sutures is recommended close [3,6,7]. toA tryclass to III reach malocclusion, a correct sagittal if allowed relation to beforedevelop, the tends maxillary to worse suturesn with close age [3,6 ,because7]. a class the III growth malocclusion, of the ifmandible allowed exceeds to develop, the growth tends toof worsenthe maxilla with. The age anterior because cr theossbite growth favors of thesuch mandible a situation exceeds [6,8]. The the growthorthodontic of the treatment maxilla. Theaims anterior to correct crossbite the sagittal, favors the such transversal a situation and [6,8 the]. The vertical orthodontic relation treatment between aimsthe upper to correct and the the lower sagittal, jaws. the Several transversal approaches and the have vertical been relation used to between treat anterior the upper crossbite and theand lower class jaws.III malocclusions Several approaches. Some approaches have been adopt used functional to treat anterior appliances, crossbite which and use classmuscle III force malocclusions. to correct Somejaw relationship approaches [9] adopt. Other functional ones use appliances,orthopedic procedures, which use muscle such as force Fränkel to correct III [10] jaw, a facemask, relationship which [9]. Otherappears ones to be use the orthopedic most effective procedures, treatment such [11] as, the Fränkel association III [10 ],of a splints facemask, with which class III appears elastics to and be thechin most-cups e ff(SECective III) treatment [12,13], [ 11a ],Rapid the association Palatal Expander of splints with(RPE) class [14] III or elastics bone-ancho and chin-cupsred maxillary (SEC III)protraction [12,13], a [15,16] Rapid, Palatalwhich Expanderuses high (RPE)force to [14 stimulate] or bone-anchored the three-dimensional maxillary protraction maxillary [15 growth,16], which [17]. usesAfter high 10 years force of to follow stimulate-up, the the three-dimensional predictability of the maxillary orthopedic growth treatment [17]. After, with 10 a yearssagittal of follow-up,approach, thedecreases predictability and some of thechanges orthopedic might treatment, not be ma withintained a sagittal [2,18,19] approach,. Vertical decreases plane values andsome can influence changes mightthe diagnosis, not be maintained the prognosis [2,18 and,19]. the Vertical treatment plane planning values can of influencesagittal-plane the diagnosis,-related malocclusions the prognosis [20 and– the22]. treatment planning of sagittal-plane-related malocclusions [20–22]. EruptionEruption guidanceguidance appliances appliance (EGA)s (EGA) with with di ffdifferentialerential occlusal occlusal thickness thickness are generallyare generally used used to treat to classtreat Iclass and classI and II class malocclusions. II malocclusions. Only one Only study one in study the literature in the literature reports that reports the anteriorthat the crossbite anterior cancrossbite be treated can be with treated these with kinds th ofese oral kind devicess of oral [23]. devices The purpose [23]. The of this purpose investigation of this investigation was to show howwas toto manageshow how an to early, manage unfavorable an early, occlusal unfavorable condition, occlusal such condition, as the anterior such as crossbite,the anterior with crossbite, an eruption with guidancean eruption appliance guidance (EGA). appliance (EGA). 2.2. Materials and Methods 2.1.2.1. Case Presentation AA 5-year-and-10-month-old5-year-and-10-month-old male male reported reported with with forwardly forwardly placed placed lower frontlower teeth, front which teeth, worried which theworried patient’s the parents.patient’s He parents. was in He good was health; in good his medicalhealth; historyhis medical showed history no significant showed no abnormalities significant andabnormalit he hadies never and done he had orthodontic never done treatment orthodontic before. treatment The patient’s before. father The presentedpatient’s father a skeletal presented class III a malocclusion,skeletal class III implying malocclusion, a genetic implying predisposition. a genetic predisposition The boy remained. The atboy about remained the 75th at about percentile the 75th for heightpercentile and for weight height over and the weight entire over period the of entire observation. period of observation. 2.2.2.2. ClinicalClinical Findings OnOn clinicalclinical extraoralextraoral examination,examination, thethe patientpatient hadhad a straight profile,profile, goodgood face proportions, aa flatflat cheekbonecheekbone contour,contour, anan openopen nasolabialnasolabial angleangle andand aa regularregular labiomentallabiomental angleangle (Figure(Figure1 ).1). (a) (b) Figure 1. Extraoral pretreatment pictures: (a) frontal view; (b) laterallateral view.view. HeHe diddid notnot havehave clinicalclinical symptomssymptoms and the articular examination did not reveal any problem problems.s. OnOn clinicalclinical intraoralintraoral examination,examination, thethe patientpatient waswas foundfound toto bebe inin earlyearly mixedmixed dentition.dentition. OnOn the sagittal Int. J. Environ. Res. Public Health 2020, 17, 3587 3 of 10 Int. J. Environ. Res. Public Health 2020, 17, x
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