Class I Anterior Localized Cross Bite

CCO Case File: Class I with Anterior Localized Cross Bite/ Female 12.6 yrs.

Author: Dr. Antonino Secchi

Initial extraoral photos
Initial extraoral photos.

 

Intraoral photos before treatment.
Intraoral photos before treatment.

 

Secchi Case 3 Pre Tx
Case summary:
12:6 yo Female, Class I late mixed dentition with a localized cross bite (upper right canine), which causes the mandible to shift. Midlines off. Based on the lat ceph and PA ceph, she presents with a normal sagittal, vertical and transverse dimensions.

Tx Strategy by Stages:
Stage I: leveling and aligning moving upper right canine buccally correcting cross bite. Her bite will be opened adding occlusal stops on lower 6’. The bite should be opened just enough to allow the canine in cross bite to move buccally as the arch aligns.
Stage II: Coordinate upper and lower arches, level mandibular occlusal plane, consolidate all spaces and achieve a good OJ/OB.
Stage III: Achieve optimal intercuspation of the buccal segment using vertical triangular elastics.

Appliance:
In-Ovation ‘C’ CCO System

Wire Sequence:
Stage I: 0.014” Sentalloy AccuForm Medium.
0.018” Sentalloy AccuForm Medium.
0.020” x 0.020” Bioforce AccuForm Medium.
Stage II: 0.019” x 0.019” SS AccuForm Medium.
Stage III: 0.019” x 0.019” Braided AccuForm Medium.

Auxiliaries:
Occlusal stops “blue” on lower 6’.
Elastics 3/16” 6oz (Thailand).

Secchi Case 3 Stage IAStage I. In-Ovation ‘C’ CCO System with upper and lower 0.014” Sentalloy AccuForm Medium wires. Bite was opened adding occlusal stops on lower 6’. In these photos, patient is intentionally opening her mouth to better appreciate the blue occlusal stops. They are flat and even like a flat splint, so the patient can close without any mandibular shift.

Secchi Case 3 Stage IBStage I. Upper and lower 0.018” Sentalloy AccuForm Medium wires. The blue occlusal stops were reduced.

Secchi Case 3 Stage ICStage I. Upper and lower 0.020” x 0.020” Bioforce AccuForm Medium wires. Upper left canine was engaged and upper right 5 was repositioned more gingivally.

Secchi Case 3 Stage IIAStage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Vertical triangular elastics 3/16” 6oz.

Secchi Case 3 Stage IIBStage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Upper and lower occlusal planes leveled and paralleled. Power Chain is used to consolidate any remaining space. Vertical triangular elastics 3/16” 6oz.

Secchi Case 3 Stage IIIStage III. Upper and lower 0.019” x 0.025” ss. Braided AccuForm Medium wires. Spaces are consolidated. Good OJ/OB. Lower right 5 was repositioned. Continues with vertical triangular elastics 3/16” 6oz.

Secchi Case 3 FinalIntraoral final photos. 22 months of active Tx.

Extraoral final photos.
Extraoral final photos.

 

Intraoral photos 1year post Tx.
Intraoral photos 1year post Tx.

Final comments:
I started this case with full comprehensive orthodontic treatment earlier than I usually do. I had to balance length of treatment versus correcting the canine’s cross bite (patient chief complaint) and functional shift as soon as possible. Should I wait to have all her permanent teeth at the time of initial bonding or should I start right away, solve the cross bite, but make the treatment longer than otherwise? We (patient, parents and myself) decided to start treatment right away. Stage I lasted 12 months, Stage II lasted 8 months and Stage III, 2 months. Stage I was the longest one, what is not very common. Generally the longest stage is Stage II. I had her on a 0.014″ and then 0.018”Sentalloy wires for several months waiting for her premolars and canines to completely erupt. We worked hard on her oral hygiene and motivation. Fortunately, patient responded exceptionally!

If you found this article interesting you may also enjoy  Class I, Anterior Open Bite, Extraction/ Male 14.9 yrs. Author: Dr. Antonino Secchi

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