Recurrence predictors of anterior crossbite in primary dentition treatment: a retrospective study

Background: Anterior crossbite is a frequently occurring clinical condition in children which can lead to Class III malocclusion. It is important to identify the recurrence predictors in children with anterior crossbite for achieving long-term stability in early orthopedic treatment. Methods: In this retrospective study, total of 36 patients with anterior crossbite in their primary dentition were enrolled. They were divided into two groups based on the subsequent relapse status in mixed dentition: the non-relapsed group and the relapsed group. The baseline characteristics for both groups were collected and compared before treatment. The cephalometric measurements were analysed at the pre-treatment and post-treatment phases. The cephalometric measurements of relapsed group were compared for the post-treatment phase and relapse phase after treatment. Results: A significant difference in participant characteristics was observed between the two groups wherein the relapsed group showed lower tongue position. The relapsed group before treatment exhibited more anteriorly and inferiorly mandible along with protrusion upper incisors. This condition did not change after the treatment. Early orthopedic treatment in both groups attained significant forward movement of maxilla and protrusive movement of upper incisors. The downward movement of hyoid bone was also noticed. In mixed dentition, patients in the relapsed group exhibited forward movement of the mandible and downward movement of hyoid bone. Conclusions: The findings indicate that the lower tongue position and specific cephalometric variables including forward growing mandible and lower positioned hyoid bone in patients with Class III growth patterns may serve as the potential predictors of relapse.

Anterior crossbite; Recurrence predictors; Cephalometric measurements; Clinical characteristics

[1] de Vasconcelos FMT, Vitali FC, Ximenes M, Dias LF, da Silva CP, Borgatto AF, et al. Impact of primary dentition malocclusion on the oral health-related quality of life in preschoolers. Progress in Orthodontics. 2021; 22: 38.

[2] Tsai HH. Components of anterior crossbite in the primary dentition. ASDC Journal of Dentistry for Children. 2001; 68: 27–32, 10.

[3] Yawaka Y, Hironaka S, Akiyama A, Matzuduka I, Takasaki C, Oguchi H. Changes in occlusal contact area and average bite pressure during treatment of anterior crossbite in primary dentition. Journal of Clinical Pediatric Dentistry. 2003; 28: 75–79.

[4] Staderini E, Patini R, Camodeca A, Guglielmi F, Gallenzi P. Three-dimensional assessment of morphological changes following nasoalveolar molding therapy in cleft lip and palate patients: a case report. Dentistry Journal. 2019; 7: 27.

[5] Chawla M, Saraf BG, Sheoran N, Paul S, Elizabeth S, Singh S. Dental cross-bite: the paradigm of interception in orthodontics. The Journal of Dental Panacea. 2021; 3: 29–32.

[6] Bishara SE, Khadivi P, Jakobsen JR. Changes in tooth size—arch length relationships from the deciduous to the permanent dentition: a longitudinal study. American Journal of Orthodontics and Dentofacial Orthopedics. 1995; 108: 607–613.

[7] Zhou C, Duan P, He H, Song J, Hu M, Liu Y. Expert consensus on pediatric orthodontic therapies of malocclusions in children. International Journal of Oral Science. 2024; 16: 32.

[8] Zohud O, Lone IM, Midlej K, Obaida A, Masarwa S, Schröder A. Towards genetic dissection of skeletal Class III malocclusion: a review of genetic variations underlying the phenotype in humans and future directions. Journal of Clinical Medicine. 2023; 12: 3212.

[9] Milosevic O, Nikolic N, Carkic J, Juloski J, Vucic L, Glisic B, et al. Single nucleotide polymorphisms MYO1H 1001 C>T SNP (rs3825393) is a strong risk factor for mandibular prognathism. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 162: e246–e251.

[10] Rodríguez-Olivos LHG, Chacón-Uscamaita PR, Quinto-Argote AG, Pumahualcca G, Pérez-Vargas LF. Deleterious oral habits related to vertical, transverse and sagittal dental malocclusion in pediatric patients. BMC Oral Health. 2022; 22: 88.

[11] Florez BM, Tagawa DT, Inoue DP, Yamashita HK, Aidar LAA, Dominguez GC. Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions. International Journal of Pediatric Otorhinolaryngology. 2023; 166: 111471.

[12] Woon SC, Thiruvenkatachari B. Early orthodontic treatment for Class III malocclusion: a systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2017; 151: 28–52.

[13] Baccetti T, Franchi L, McNamara JA III. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 118: 404–413.

[14] Lee MS, Le VNT, Kim JG, Yang YM, Lee DW. Prediction model for future success of early orthopedic treatment of Class III malocclusion. Children. 2023; 10: 355.

[15] Paoloni V, De Razza FC, Franchi L, Cozza P. Stability prediction of early orthopedic treatment in Class III malocclusion: morphologic discriminant analysis. Progress in Orthodontics. 2021; 22: 34.

[16] Ghiz MA, Ngan P, Gunel E. Cephalometric variables to predict future success of early orthopedic Class III treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2005; 127: 301–306.

[17] Baccetti T, Reyes BC, McNamara JA III. Craniofacial changes in Class III malocclusion as related to skeletal and dental maturation. American Journal of Orthodontics and Dentofacial Orthopedics. 2007; 132: 171.e1–171.e12.

[18] Baccetti T, Franchi L, McNamara JA III. Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy. American Journal of Orthodontics and Dentofacial Orthopedics. 2004; 126: 16–22.

[19] Ardani I, Wicaksono A, Hamid T. The occlusal plane inclination analysis for determining skeletal Class III malocclusion diagnosis. Clinical Cosmetic and Investigational Dentistry. 2020; 12: 163–171.

[20] Tahmina K, Tanaka E, Tanne K. Craniofacial morphology in orthodontically treated patients of Class III malocclusion with stable and unstable treatment outcomes. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 117: 681–690.

[21] Kim YH. Overbite depth indicator with particular reference to anterior open-bite. American Journal of Orthodontics. 1974; 65: 586–611.

[22] Wells AP, Sarver DM, Proffit WR. Long-term efficacy of reverse pull headgear therapy. Angle Orthodontist. 2006; 76: 915–922.

[23] Chow SC, Shao J, Wang HS, Lokhnygina Y. Sample size calculations in clinical research. 3rd edn. Chapman and Hall/CRC: New York. 2017.

[24] Kim YH, Vietas JJ. Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis. American Journal of Orthodontics. 1978; 73: 619–633.

[25] Ngoc VTN, Phuong NTT, Anh NV. Skeletal Class III malocclusion with lateral open bite and facial asymmetry treated with asymmetric lower molar extraction and lingual appliance: a case report. International Journal of Environmental Research and Public Health. 2021; 18: 5381.

[26] Chen L, Chen R, Yang Y, Ji G, Shen G. The effects of maxillary protraction and its long-term stability—a clinical trial in Chinese adolescents. European Journal of Orthodontics. 2012; 34: 88–95.

[27] Zou Y, Fu QM, Xu XY. Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class Ⅰ, Class Ⅱ and Class Ⅲ malocclusions. Shanghai Journal of Stomatology. 2020; 29: 632–637. (In Chinese)

[28] Kang Y, Lee S, Gong Y, Kim SH, Moon CH. Three-dimensional morphologic evaluation of the changes in the pharyngeal airway and hyoid bone after bimaxillary surgery in patients with skeletal Class III malocclusion with facial asymmetry: a preliminary study. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 162: 42–50.

[29] Gobeille DM, Bowman DC. Hyoid and muscle changes following distal repositioning of the tongue. American Journal of Orthodontics. 1976; 70: 282–289.

[30] Haralabakis NB, Toutountzakis NM, Yiagtzis SC. The hyoid bone position in adult individuals with open bite and normal occlusion. European Journal of Orthodontics. 1993; 15: 265–271.

[31] Ravanmehr H, Abdollahi D. The position of hyoid bone in skeletal Class I, II and III patients. Journal of Dental Medicine. 2001; 13: 27–37.

[32] Deshkar M, Thosar NR, Kabra SP, Yeluri R, Rathi NV. The influence of the tongue on the development of dental malocclusion. Cureus. 2024; 16: e61281.

[33] Hotokezaka H, Matsuo T, Nakagawa M, Mizuno A, Kobayashi K. Severe dental open bite malocclusion with tongue reduction after orthodontic treatment. Angle Orthodontist. 2001; 71: 228–236.

[34] Choi YK, Park JJ, Jeon HH, Kim YI. Comparison of the skeletodental effects of miniscrew‐anchored and tooth‐anchored facemask treatment in growing patients with skeletal class III malocclusions. Orthodontics & Craniofacial Research. 2023; 26: 695–703.

[35] Singh H, Kapoor P, Sharma P, Maurya RK, Mittal T. Management of skeletal Cl III malocclusion using simultaneous alternate rapid maxillary expansion and constriction (Alt-RAMEC) and facemask protraction in adolescence. Journal of Dental Research, Dental Clinics, Dental Prospects. 2022; 16: 62–69.

[36] P J M, Chinnapan V, Pothuri A, S K, Frank CS. Facemask and rapid maxillary expansion with alternative rapid maxillary expansion and constriction protocol in the management of skeletal Class III malocclusion. Cureus. 2023; 15: e50764.

[37] Bozkaya E, Yüksel AS, Bozkaya S. Zygomatic miniplates for skeletal anchorage in orthopedic correction of Class III malocclusion: a controlled clinical trial. Korean Journal of Orthodontics. 2017; 47: 118–129.

[38] Mandall N, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R. Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. Journal of Orthodontics. 2016; 43: 164–175.

[39] Raghupathy Y, Ananthanarayanan V, Kailasam V, Padmanabhan S. Posttreatment stability following facemask therapy in patients with skeletal Class III malocclusion: a systematic review. International Journal of Clinical Pediatric Dentistry. 2023; 16: 897–907.

[40] Maino GB, Cremonini F, Maino G, Paoletto E, De Maio M, Spedicato GA. Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: a retrospective follow-up study. Progress in Orthodontics. 2022; 23: 44.