Anterior and posterior crossbites in mixed dentition. Pediatric Dentistry and Orthodontics.

1. CROSS BITE MANAGEMENT IN MIXED DENTITION
Riwa Kobrosli – 201202978 – PEDIATRIC DENTISTRY INTERCEPTIVE ORTHODONTICS – PROF. ALI OTHMAN

2. OUTLINE
 Introduction
 Definition
 Types of cross bite
 Etiology
 Rationale for early treatment
 Contra-indications
 Diagnosis
 Treatment
 Appliances
 Case reports
 Conclusion
 References

3. INTRODUCTION
Early treatment of crossbite during
the mixed dentition stage is
extremely important as it provides
the correct positioning of osseous
bases, teeth, and the TMJ when the
stomatognathic system is in growth
and development
Early interceptive
orthodontic treatment
can potentially eliminate
the need for future
complicated and costly
orthodontic treatment.

4. CLINICAL QUESTIONS
 How to recognize and diagnose the different types of crossbite?
 What are the types that can be treated by early intervention?
 What is the importance of timely intervention of crossbite in children?
 How can early treatment of crossbite in children be managed
successfully?

5. DEFINITION
Under normal circumstances, maxillary arch overlaps
mandibular arch both labially and buccally.
But when mandibular teeth overlap maxillary teeth
labially or buccally, crossbite exists.
 Cross bite is the deviation of the normal faciolingual relationship of
teeth when arches set in Centric Occlusion.
 Normal buccolingual or labiolingual relationships are reversed.

6. CLASSIFICATION OF CROSSBITES
According to the location in the arch
Anterior Posterior
According to the nature of crossbite
Skeletal Dental Functional
crossbite crossbite crossbite

7. I.ANTERIOR CROSSBITE
 Anterior crossbite occurs when the upper anterior teeth (one or more) occlude lingual to the lower
anterior teeth (anteroposterior plane).
 There are 3 types of anterior crossbite:
Skeletal
Due to the discrepancy
of the underlying skeletal
relationship.
Early treatment may not
be successful due to the
unpredictability of the
growth pattern.
Dental
Patients presented
with Class I skeletal
relationship with
one or more teeth
in crossbite
Functional
(Pseudo Class III)
A positional
malrelationship dt
acquired muscular
reflex caused by an
occlusal interference.

8. Diagnostic characteristics:
• Mandible can be pushed back to edge to
edge (retrusion of mandible is possible)
• Path of closure is deviated anteriorly
(protrusive shift of mandible in centric
occlusion; condyles displaced downward and
forward).
• Normal or edge to edge molar and canine
relationship at centric relation.
• Patient’s profile: straight at rest and concave
in maximum occlusion.
• Retroclined upper incisors (in true skeletal
class 3, they are inclined labially)
Habitual
occlusion
Centric
relation

9. ETIOLOGY
• Anterior posterior skeletal discrepancy
• maxillary deficiency, mandibular excess, or a combination of both
• Usually associated with family history of Class III skeletal origin
Skeletal
• Crowding, arch length deficiency i.e. Tooth size arch length discrepancy.
• Supernumerary teeth.
• Palatal eruption path of maxillary incisors (abnormal inclination).
• Trauma to permanent teeth resulting in the incisors being displaced by luxation
• Trauma to deciduous teeth resulting in displacement of permanent tooth germs
• Delayed shedding or retained deciduous teeth.
Dental
(Local
Factors)
• Occlusal interferences which result in mandibular displacement to achieve Maximum
intercuspation.
Functional
The possible causes of anterior crossbite include

10. ETIOLOGY
• Cleft lip and palate
• Scar tissue of the cleft repair can restrain the growth of the maxilla,
resulting in a narrow maxilla.
• Trauma or pathology of the temporomandibular joint can lead to restriction
of the growth of mandible on one side leading to asymmetry.
• Arthritis, acromegaly, condylar hyperplasia and Osteochondroma.
Pathological
conditions
The possible causes of anterior crossbite include
Ant. Crossbite in
relation to Cleft Lip &
Palate
Condylar
hyperplasia

11. Little possibility for self-
correction
Crossbite in the primary
dentition is believed to
transfer to the
permanent dentition
Postponing treatment
results in prolonged
treatment of greater
complexity
Functional crossbite can
develop from cuspal
interference, resulting in a
mandibular shift
Improve maxillary lip
posture and facial
appearance if corrected
in the mixed dentition
Provide space for
eruption of canines. Lack
of space in the arch could
be caused by retroclined
upper incisors
RATIONALE FOR EARLY TREATMENT

12. CONSEQUENCES OF UNTREATED ANTERIOR CROSSBITE
Ifleftuntreated,itmayleadto:
Damage to the teeth in crossbite through attrition traumatic occlusion causing:
gingival recession and loss of alveolar bone support to the lower incisors
mobility of the lower incisors affected by the crossbite
Influencing potential adverse growth of the mandible and maxilla
TMJ dysfunction, which has been associated with childhood anterior crossbite

13. CONTRAINDICATIONS OF CROSSBITE TTT
Patients who
present skeletal
discrepancy, which
may require joint
orthodontic
surgical
management
Teeth where
dento-alveolar
compensation has
taken place
(proclined upper
incisors,
retroclined lower
incisors
Minimal
or no
overbite
Non-
compliant
patient

14. MANAGEMENT OF CROSSBITE

15. DIAGNOSIS
For successful treatment we should know
The type of anterior cross bite
Differentiate between skeletal or dental
The cause of anterior cross bite

16. EXAMINATION
1. Patient assessment
• chief complaint
• crowding
• no exposure of upper front teeth on smiling
• gingival recession
2. History
• medical/dental history
• family history of a Class III skeletal pattern
• social history

17. EXAMINATION
3. Extra-oral examination
• Skeletal pattern: A-P, Vertical and Transverse relationship
• TMJ: tenderness, clicking, crepitus, mobility.
• Soft tissue profile: straight, convex, concave
4. Intra-oral examination
• oral hygiene, gingival health and DMF
• Number of teeth involved in the anterior crossbite, overjet, overbite
• Signs of attrition and periodontal breakdown due to traumatic occlusion if present

18. EXAMINATION
5. Radiographic examination
• Panoramic x-ray: presence/absence of teeth, condition of teeth and the periodontal
status
• Occlusal x-ray: To detect any supernumerary teeth and if pathology is suspected in
the anterior region
6. Study models
• Study model and wax bite registration in maximum intercuspation must be taken for
diagnosis and treatment planning.
• Used for space analysis.

19. EXAMINATION
7. Clinical photographs
• Both extraorally and intraorally with standardized settings for pre- and post-
treatment records.

20. TREATMENT OF ANTERIOR CROSSBITES
• Dento-alveolar compensation:
• proclination of upper teeth alone or combination of
proclination of upper teeth and retroclination of lower
teeth.
• Maxillary protrusion
• Backward rotation of mandible
• Combination of 1,2 &3
TREATMENT
PRINCIPLES
Anterior crossbite
is corrected by:

21. TREATMENT OF ANTERIOR CROSSBITES
FACTORS TO CONSIDER PRIOR TO SELECTION OF TREAMENT MODALITIES
1. Adequate space in the arch to reposition the tooth.
2. Sufficient overbite to hold the tooth in position following correction.
3. Incisors inclination and favorable position of root apex.
4. A Class I occlusion
5. Patient compliance
6. Timing of treatment
7. Periodontal breakdown
8. Growth potential

22. APPLIANCES FOR ANTERIOR CROSSBITE
TONGUE BLADE REMOVABLE APPLIANCE FIXED APPLIANCE INCLINED BITE PLANE
FACE MASK CHIN CUP FUNCTIONAL APPLIANCES

23. TINGUE BLADE
• Used for treatment of a developing (incipient) crossbite  NO INTERLOCK.
• The child is instructed to place it behind the tooth expected to become in
locked.
• Slight pressure is exerted on the tooth in a labial direction.
• Repeated 10 minutes every hour for 10 to 14 days.

24. UPPER REMOVABLE APPLIANCE
Removable appliances act by applying tipping forces to
the crowns of the teeth.
The advantages are:
• simple
• can be removed for oral hygiene purposes
• reduced chairside time
• cost-effective
The disadvantages are:
• highly dependent on patient’s compliance
• Needs laboratory support
• Only allows tipping movement.
Components:
1. Active components
2. Retentive components
3. Anchorage
4. Baseplate

25. Expansion Screws
• Used to procline two or more teeth.
• Applies large intermittent force to the teeth.
• Advantages:
• clasp can be placed on the teeth to be moved.
• useful if inadequate number of teeth for retention.
• The activation is done one-quarter turn once weekly which
separates the acrylic by about 0.25mm.
• twice a week is possible
1.Active Components: Provide force to move teeth. Z- spring and expansion screw.
Z-spring
• Corrects a simple crossbite involving one tooth.
• The spring has an arm and two activation coils.
• The arm is placed on the palatal surface of the
tooth.
• Activation of spring is either by opening of the
coils or pulling the outer arm of the spring
forward and away from acrylic base plate.
care must be
taken not to
overdo
activation as
this can cause
the appliance to
be ill-fitting

26. 2. Retentive Components (Adams
and Southend clasps)
If the appliance is loose, the patient
may have difficulty wearing it and
the active components will not work
effectively in a loose appliance.
4. Baseplate
hold together the other components.
The posterior bite plane should be appropriate in thickness and free the occlusion
to allow the tooth in crossbite to move effectively
3. Anchorage
provided by the
baseplate and
the retentive
components.
• Successful
correction should
be achieved within
6-9 months.
• No retention is
required if there is
positive overbite
(stable result)

28. 2020

29. - 6 years old, early mixed dentition
- anterior crossbite with 1 mm negative overjet
- He has 3-mm deviation of the mandibular midline
- During the opening of the mouth, midlines became
coincident and the chin deviation disappeared. This was
the sign of a functional problem and not a skeletal one
EGA Used for night-time use only; it had to be fitted soon
after dinner until the next morning.
Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report Marianna Pellegrino et al

30. edge-to-edge occlusion obtained after 4 months of treatment
After 7 months, the anterior crossbite was resolved.
The initial negative overjet and deep bite were treated.
The mandible’s functional deviation disappeared
Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report Marianna Pellegrino et al

31. EGA is a solution to
treat patients with
anterior crossbite in
early age, during the
eruption of incisors
Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report Marianna Pellegrino et al

32. FIXED APPLIANCE
Simple fixed appliance such as the 2×4 appliance is preferred when complex
movement is needed. Fixed appliance is capable of tooth movement in all
three dimensions including bodily movement, root torquing, derotation and
movement of multiple teeth.

33. 2018
Interceptive Correction of Anterior Crossbite Using Short-SpanWire-Fixed Orthodontic Appliance:A Report of Three Cases 2018 S. Nagarajan M. P. Sockalingam et al

34. Interceptive Correction of Anterior Crossbite Using Short-SpanWire-Fixed Orthodontic Appliance:A Report of Three Cases 2018 S. Nagarajan M. P. Sockalingam et al

35. INCLINED BITE PLANE
Can be fixed or removable.
Composite resin has been used as fixed inclined bite plane and suitable when:
• the anterior crossbite is not more than 1/3 crown length
• no tooth rotation
• sufficient space present for labial movement.
• The crossbite should be solely of dental origin.
Disadvantages: causes food accumulation and gingivitis (bad oral hygiene)

36. The Catlan’s appliance is also known as Lower Inclined Bite Plane which is cemented onto
lower incisors.
- It is a lower jaw inclined plane which is based on Newton’s 3rd law of motion (natural forces)
- creates a slight lingual movement in the mandibular teeth, while generating labial movement
in the maxillary teeth

37. Pseudo class 3
8 years
Palatally placed 21
8 years
Single crossbite
with Midline shift
9 years
Treatmentafter1week
Nishidha Tiwari., et al. “Management of Anterior Cross Bite in Mixed Dentition Using Catlan’s Appliance”. Acta Scientific Dental Sciences 4.2 (2020): 106-109

38. Anterior crossbite involving multiple
teeth with gingival recession on
mandibular left central incisor
The lower inclined bite plane
was cemented to the
mandibular teeth
Positive bite was noticed
after 3 weeks of treatment
The corrected bite was maintained during one-month review
(October. 2019)
Fadzlinda Baharin. “Management of Anterior Crossbite in Mixed Dentition Using Lower Inclined Bite Plane: A
Case Report.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 18, no. 10, 2019, pp 54-57.

39. FUNCTIONAL APPLIANCE
• Functional appliance utilizes the forces of the orofacial musculature to move teeth and
modify growth to correct a malocclusion.
• stimulate forward maxillary growth and restrain mandibular growth.
• major effect is mostly dento-alveolar.
• Function Regulator (1), Reverse Twin Block (2) and Reverse Bionator (3) used in the
treatment of anterior crossbite with Class III skeletal base.
(1) (2) (3)

40. Face Mask
• The preferred treatment for skeletal
maxillary retrusion is anterior movement
of the maxilla.
• results in the advancement of maxilla
along with a backward and downward
rotation of mandible and correction of
anterior crossbite
• For maximum skeletal effect, treatment
should commence before the age of 8
years (in early mixed dentition stage).
• worn at least 12 hours per day.

41. Chin cup
• This treatment produces a backward rotation of mandible giving
the appearance that the mandible has been restrained.
• Can be used to treat mandibular prognathism in early mixed
dentition.
• The best age is before canine and premolar erupt (first growth
spurt of mandible)
• Indications:
• 1. Mild to moderate Skeletal III, ability to achieve edge to edge
incisors
• 2. Short vertical facial height (Chin cup causes clockwise rotation
of the mandible).
• 3. Proclined or upright LI (Chin cup causes lingual tipping of the
lower incisors)

42. Patient with
anterior
crossbite
Dental and
functional
crossbite
Removable
appliance
Fixed appliance
Skeletal
crossbite
Mild
discrepancy
Deficient
maxilla
Facemask /
functional
appliance
Mild to moderate
mandibular
prognathism
Chin cup
Severe
discrepancy
Wait for growth
to stop
Orthogenetic
surgery

43. II. POSTERIOR CROSSBITE
In normal circumstances, mandibular buccal cusps occlude
in the central fossae of maxillary posterior teeth
In posterior crossbite case, mandibular buccal cusps
occlude buccal to maxillary buccal cusps
This refers to an abnormal transverse relationship between
upper and lower posterior teeth. . (transverse plane)

44. CLASSIFICATION OF POSTERIOR CROSSBITES
According to the number of teeth involved
single tooth segmental
According to the number of arch sides
unilateral bilateral

45. CLASSIFICATION OF POSTERIOR CROSSBITES
According to the extent of crossbite
Simple Buccal non-occlusion Lingual non-occlusion
Maxillary posteriors
occlude entirely on
lingual of mandibular
posteriors
Maxillary posteriors
occlude entirely on
Buccal of mandibular
posteriors
Buccal cusp of max.
teeth occlude lingual
to buccal cusp of
madibular
Scissor bite

46. Dental
• 1) Anomalies in tooth number (supernumerary, missing teeth)
• 2) Anomalies in tooth size (microdontia, macrodontia)
• 3) Anomalies in tooth shape
• 4) Premature loss of teeth
• 5) Prolonged retention of deciduous teeth
• 6) Delayed eruption of permanent teeth
• 7) Abnormal eruption path
• 8) Ankyloses
Functional
• Lateral Deviation of mandible during jaw closure (with midline shift) because of:
• 1) Presence of occlusal interferences.
• 2) Early loss of decidous teeth
• 3) Decayed teeth
• 4) Ectopically erupted teeth.
ETIOLOGY OF POSTERIOR CROSSBITES

47. Skeletal
• 1) Retarded maxilla.
• 2) Prognethic mandible.
• 3) Unilateral hypo/hyperplastic growth of any jaw.
• 4) Hereditary (Class III skeletal malocclussion).
• 5) Congenital ( Cleft lip and palate).
• 6) Trauma at birth (forcep injury leading to ankylosis of TMJ.)
• 7) Trauma to TMJ (ankylosis)
• 8) Habits such as prolonged thumb sucking and mouth
breathing.
• Because they cause lowered tongue position ,thus tongue no
longer balances the forces exerted by the buccal muscles, which
leads to narrowing of upper arch leading to posterior crossbite.
ETIOLOGY OF POSTERIOR CROSSBITES
Note: causes of anterior
and posterior crossbite
are the same except for
habits, they cause only
posterior crossbite.

48.  Posterior crossbite correction in mixed
dentition can be difficult and confusing.
 determine whether a skeletal/dental
correction is necessary.
 in areas where mandibular shift is present it
should be managed as soon as possible to
prevent soft tissue and dental compensation.
TREATMENT OF POSTERIOR CROSSBITES
Occlusal equilibrium is done in a dental crossbite by removing the occlusal interferences
usually in the cuspid area.

49. APPLIANCES USED IN POSTERIOR CROSSBITES
Coffin spring Cross elastics / fixed
Soldered W –arch
(Porter appliance).
Quad Helix
Removable appliance
Rapid maxillary
expansion (hyrax)
Ni-Ti expanders Oral screening

50. • It is a removable, omega shaped wire appliance
• It produces slow and bilaterally symmetrical
expansion.
• Free ends of omega are embedded in an acrylic
plate that covers the slopes of the palate.
• It brings about dento alveolar expansion.
• However, it is capable of skeletal changes when
used in mixed dentition with a good retention.
COFFIN SPRING

51. It is used to treat localized crossbites.
Put hooks or button on palatal surface of the maxillary teeth and on buccal surface of the
mandibular teeth. Rubber elastics are attached on the hooks (usually crossbite corrected within 3-
4 months with continuous wearing of elastics)
CROSS ELASTICS / fixed orthodontic appliance
Advantage: no need of retentive appliance Disadvantages: Needs patient’s cooperation
Fixed orthodontic appliance are ideal for accurate placement of teeth in a dental arch as they
provide a three dimensional control over the tooth

52. - It is an efficient appliance for the correction of posterior
crossbite assosciated with thumb sucking.
- Preformed stainless steel bands are adapted to the most
distal tooth involved.
- W-arch steel wire- contoured to the arch.
- Wire is made free of tissue by 1-2 mm.
- Anterior extension of the wire should touch only the teeth
that must be moved buccally.
- W-arch is expanded about 4mm wide than its passive
width or so that one arm of
“W” is resting over central grooves of teeth when the
other arm is in proper position.
SOLDERED W – ARCH (PORTER APPLIANCE)
Retainer
used for
additional 3
months
Appliance
expands the
arch approx
1mm/side/m
onth

53. QUAD HELIX
The quad helix is a spring that consists of 4 helices-
2 helices in the anterior palate and
2 helices near solder joint in the posterior palate.
It is capable of dento alveolar mainly and maybe skeletal
expansion.
PROCEDURE :
• Fit bands to either primary second molars or the permanent
first molars.
• stainless steel wire contacts all posterior teeth,
• anterior aspect of wire is just distal to primary canines,
• the contact is close to, but not touching the soft tissue at
cervical margin,
• loops or helixes and palatal portion should be 2-3 mm distal to
banded teeth
Loop may
be added to
quad helix
in cases of
habits.
Retainer used
for additional
3 months

54. • Used in case of true unilateral crossbites.
• It has long and short arms.
• Short arm- touches only the teeth to be moved.
• Long arm – touches as many contralateral teeth as
possible.
• The idea behind the unequal W-arch is to pit the
movement of a large number of teeth against
movement of small number of teeth.
• The side with smaller number of teeth – more
movement
• side with larger number of teeth - less movement.
Modification : UNEQUAL W-ARCH & UNEQUAL QUAD HELIX

55. REMOVABLE APPLIANCES
• bilateral maxillary expansion is achieved with a parallel
expansion screw housed in upper acrylic plate.
• The appliance should have excellent tissue contact and
anchorage with clasps on teeth.
• Provide acrylic relief – palatal to anterior teeth.
• The labial bow should be passive; when expansion occurs-
bow becomes activated.
• The conventional expansion schedule– ¼ turn every 3-4
days.
• Correction is dental only.
• Relapse potential is high.

56. Note: if the patient is young age, the appliance may do skeletal
expansion by opening the sutures.
REMOVABLE APPLIANCES
Clinical tip: if we have anterior crowding, place the screw more
anteriorly to increase the intercanine width. A wire can be
soldered posteriorly joining the mesial and distal parts for
stabilization of posterior teeth.

57. ORAL SCREEN/VESTIBULAR SCREEN
- It is a myofunctional appliance – that takes form of a
curved acrylic shield placed in labial vestibule. PRINCIPLE
It works on principle of “PASSIVE EXPANSION”
force application + force limitation.
i.e. to apply the forces of circumoral musculature to certain
teeth OR
to relieve those forces from teeth
therefore allowing them to move due to forces exerted by
tongue

58. ORAL SCREEN/VESTIBULAR SCREEN
INDICATIONS:
To intercept habits (mouth breathing, thumb sucking,
tongue thrusting, lip/cheek biting)
To treat mild disto-occlusions.
To perform muscle exercise to help correction of hypotonic
lip and cheek muscles.
CONTRAINDICATIONS :
In children with nasal obstruction or respiratory distress
The patient is made to wear the appliance at night and 2-3
hours during the day time and maintain lip seal

59. MODIFICATIONS :
• Hotz modification – made up of additional metal ring.
• Patient with tongue thrust – additional screen placement on lingual aspect
• In Mouth breathers – vestibular screen with a number of holes which are
gradually decreased

60. NICKEL TITANIUM EXPANDERS
They bring about slow expansion (dental changes).
They require less adjustments than conventional stainless
steel quad helix appliances.
Molar bands are cemented to maxillary first permanent
molars
Cooling the expander  it gets constricted and inserted
into lingual tubes on the maxillary molars.
As it warms to body temperature it becomes springy and
exerts continuous force on teeth

61. RAPID MAXILLARY EXPANSION
• Rapid maxillary expansion is indicated for severe cases
of bilateral crossbites where correction requires skeletal
expansion.
• It involves the splitting of the mid palatal suture
• orthopaedic increase in maxillary width.
• It can easily occur in a growing child (< 9 years).
• The appliance uses a mid–palatal screw (Hyrax)
soldered to bands on the first permanent molars and
primary molars.
The appliance produces a rapid
expansion over 3-4 weeks
Crossbite should be over corrected
and then retained for atleast 3
months with the same applaince

62. 9-year-old patient who presented with functional unilateral posterior crossbite and
was treated with a modified Hyrax expander. The case report highlights a simple,
low-cost, effective treatment protocol. The malocclusion was corrected with 15 days
of active use of the appliance, 5 months of use for retention purposes, and 5 years of
post-treatment follow-up.
de Mendonça Rogério, M., et al. "Case Report of Posterior Crossbite: Description of an Effective Treatment Protocol." Compendium of continuing education in dentistry 37.8 (2016): e13-6.

63. Posterior crossbite Class 1 molar 3 mm open bite moderate crowding
occlusal radiography Modifoed Hyrax appliance transversal overcorrection After 15 days
Retention 5 months After 1 year After 5 years Final result
de Mendonça Rogério, M., et al. "Case Report of Posterior Crossbite: Description of an Effective Treatment Protocol." Compendium of continuing education in dentistry 37.8 (2016): e13-6.
Grinding cusp

64. CONCLUSION
 The early and correct diagnosis of crossbite is essential to prevent the
forthcoming occlusal discrepancies in the permanent dentition.
 It is the prime role of pediatric dentists as well as orthodontists to
diagnose the case as soon as possible and treat it the correct way.
 Adequate curative measures and treatment modalities can be advocated
to correct the crossbite

65. REFERENCES
1. S.I. Bhalajhi – Orthodontics-The Art and Science
2. Gurkeerat singh – A Textbook of orthodontics.
3. Mc Donald RE, Avery DR, Dean JA --Dentistry for the child and adolescence.
4. Angus C Cameron – Handbook of Pediatric Dentistry.
5. Pinkham, Casammassimo, McTigue, Nowak - Pediatric Dentistry Infancy Through Adolescence.
6. Interceptive Correction of Anterior Crossbite Using Short-Span Wire-Fixed Orthodontic Appliance: A Report of Three
Cases 2018 S. Nagarajan M. P. Sockalingam et al
7. Nishidha Tiwari., et al. “Management of Anterior Cross Bite in Mixed Dentition Using Catlan’s Appliance”. Acta
Scientific Dental Sciences 4.2 (2020): 106-109
8. Fadzlinda Baharin. “Management of Anterior Crossbite in Mixed Dentition Using Lower Inclined Bite Plane: A Case
Report.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 18, no. 10, 2019, pp 54-57.
9. Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report Marianna Pellegrino et al,
2020.
10. de Mendonça Rogério, M., et al. "Case Report of Posterior Crossbite: Description of an Effective Treatment
Protocol." Compendium of continuing education in dentistry 37.8 (2016): e13-6.