Orthodontic treatment for posterior crossbites

Harrison JE, Ashby D

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Summary

Early treatment of posterior crossbites appears to prevent them from being passed on to the adult dentition. However, this is only based on data from two small studies.
'Posterior crossbite' occurs when the top back teeth bite inside the bottom back teeth. It is unclear what causes posterior crossbites and they may develop or improve at any time from when the baby teeth come into the mouth to when the adult teeth come through. If they affect one side of the mouth the lower jaw may need to move to one side to allow the back teeth to meet together. This movement may have long term effects on the growth of the teeth and jaws. Several treatments have been used to correct posterior crossbites and stop this abnormal movement.
A substantive amendment to this systematic review was last made on 15 November 2000. Cochrane reviews are regularly checked and updated if necessary

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Harrison JE, Ashby D. Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD000979. DOI: 10.1002/14651858.CD000979

This version first published online: January 24. 2000
Date of last substantive update: November 16. 2000

Abstract

Background

'Posterior crossbite' occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth the lower jaw may have to move to one side to allow the back teeth to meet together. It is unclear what causes posterior crossbites and they may develop or improve at any time from when the baby teeth come into the mouth to when the adult teeth come through. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth whilst others are directed at treating the cause of the posterior crossbite e.g. breathing problems or sucking habits. Most treatments have been used at each stage of dental development.

Objectives

The aim of this review was to evaluate orthodontic treatments used to expand the maxillary dentition and correct posterior crossbites.

Search strategy

All randomised and controlled clinical trials identified from the Cochrane Controlled Trials Register according to the Oral Health Group Search Strategy and stored in the Cochrane Collaboration Oral Health Group Database of Clinical Trials, a MEDLINE search using the Mesh term Palatal Expansion Technique and relevant free text words, hand searching the British, European and American journals of orthodontics and Angle Orthodontist, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment to expand the maxillary dentition and/or correct a posterior crossbite that were published as abstracts or papers between 1970 and 1999.

Selection criteria

All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes crossbite correction, molar and/or canine expansion, signs and symptoms of temporomandibular joint dysfunction or respiratory disease.

Data collection and analysis

Data were extracted without blinding to the authors, treatments used or results obtained.
The first named authors of randomised and controlled clinical trials were written to in an attempt to establish the method of randomisation / allocation and identify unpublished studies.
Odds ratio, relative risk, relative risk reduction, absolute risk reduction, the number need to treat and corresponding 95% confidence intervals, were calculated for event data. The weighted mean difference and 95% confidence intervals were calculated for continuous data.

Main results

Using the search strategy seven randomised and five controlled clinical trials were identified but following correspondence with the authors, three of the randomised and one of the controlled clinical trials were reclassified giving five randomised and seven controlled clinical trials for inclusion in the review. For the update an additional CCT was found giving five RCTs and eight CCTs for inclusion in this update.
Trials comparing occlusal grinding in the primary dentition with/without an upper removable expansion appliance in the mixed dentition versus no treatment, banded versus bonded and two point versus four point rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque, an upper removable expansion appliance versus quad-helix were identified.
Occlusal grinding in the primary dentition with/without the addition of an upper removable expansion plate, in the mixed dentition for those children who did not respond to grinding, was shown to be effective in preventing a posterior crossbite in the primary dentition from being perpetuated to the mixed and permanent dentitions.
No evidence of a difference in treatment effect (molar and canine expansion) between the test and control intervention was found in the trials which compared banded versus bonded and two point versus four point rapid maxillary expansion, banded versus bonded slow maxillary expansion, transpalatal arch with/without buccal root torque, or upper removable expansion appliance versus quad-helix. Insufficient data were provided in the paper comparing two point versus four point rapid maxillary expansion to allow a formal analysis.

Authors' conclusions

The evidence from the trials reported by Lindner (1989); Thilander (1984) suggests that removal of premature contacts of the baby teeth is effective in preventing a posterior crossbite from being perpetuated to the mixed dentition and adult teeth. When grinding alone is not effective, using an upper removable expansion plate to expand the top teeth will decrease the risk of a posterior crossbite from being perpetuated to the permanent dentition.
The comparisons of treatments made in the trials reported by Asanza (1997); Sandikçioglu (1997); Mossaz-Joëlson (1989); Ingervall (1995); Schneidman (1990) were inconclusive so recommendations for clinical practice can not be made based on the results of these trials. However, these trials were small and inadequately powered so further studies, with appropriate sample sizes, would be required to assess the relative effectiveness of these interventions.

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