New methods of treating crossbite in children and adolescents

For a long time, the treatment of crossbites in children and adolescents involved uncomfortable, fixed appliances. Now there is a modern and comfortable alternative: removable palatal expansion splints can be used to gently widen the upper jaw without leaving a fixed appliance in the mouth. This modern solution offers significant relief, especially for young patients. In this article, Dr. Carina Wick, a specialist orthodontist in Vienna and Linz, explains what a crossbite is, how crossbite treatment has developed, and the advantages of the new method.

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What exactly is a crossbite?

A crossbite occurs when the upper teeth come together behind the lower teeth. This can cause numerous problems and should therefore be treated as early as possible in children:

• Asymmetric jaw growth: One-sided loading can lead to misalignments.


• Temporomandibular joint problems: Incorrect loading can cause tension in the muscles of the head and neck, problems in the temporomandibular joint area and even pain.


• Impaired function: Chewing and speaking can be affected.


• Increased wear on the teeth: incorrect contact can lead to premature tooth abrasion (find out more about teeth grinding in children here).

What causes crossbites?

There are a number of possible causes:

Genetics: crossbites are genetically predisposed, i.e. the shape of the jaw and the position of the teeth are inherited.

Tongue position: An incorrect position of the tongue, i.e. a faulty tongue position, can negatively influence the growth of the upper jaw. A speech therapy evaluation is strongly recommended if the tongue tends to be “down”, i.e. in the lower jaw. This should then be changed by means of targeted exercises.

Breathing: Those who breathe through the mouth often have a low-lying tongue in the lower jaw. When breathing normally through the nose, however, the tongue rests against the palate and supports its development. A check-up by an ear, nose and throat specialist can be informative here.

A healthy tongue position, on the other hand, means that the tongue rests against the upper palate and shapes it, allowing the upper jaw to develop well.

Important: early treatment for crossbite is crucial

The main goal of crossbite treatment is to expand and stretch the upper jaw and to move the teeth into the correct position. The earlier a misalignment is detected and treated, the better the natural growth can be used for the correction.

Until the largest growth spurt in the teenage years, the palate can still be stretched relatively easily because the palatal suture has not yet fused. Such treatment can also have a positive effect on nasal breathing.

Why is it useful to correct a crossbite in childhood or adolescence?

If the correction is not carried out until adulthood, often only the lateral teeth tip outwards without the jaw actually being widened. In such cases, jaw surgery, known as SARPE, is then necessary.

SARPE (Surgically Assisted Rapid Palatal Expansion) is a surgically assisted palatal expansion used to widen the upper jaw in adults with ossified palatal sutures.

Crossbite treatment process

Depending on the appliance chosen, the upper jaw will expand slowly or quickly.

When appliances are worn full-time or at all times, the rapid widening results in an expansion of the palatal suture in the upper jaw (a growth plate that has not yet fused in children and adolescents ).

Diastema during crossbite treatment

Due to the stretching of the upper jaw, a gap often forms between the upper incisors, which can be quite large depending on the stretching. This is a good sign, as it shows that not only the teeth have been tilted, but the entire upper jaw, including the nasal area, has been widened. The gap usually closes by itself during the course of treatment.

Retention after crossbite treatment: stabilizing the results

Stabilization is necessary to ensure that the expanded palate remains stable and does not narrow again (relapse). We use retention devices to maintain the new jaw shape.

Further orthodontic treatment

Depending on the severity of the crossbite, further orthodontic treatment may be necessary after the palatal expansion. This is done either with removable or fixed braces or with transparent aligners.

This allows us to adjust the bite, i.e. the tooth contacts of the upper and lower jaw, correctly.

Previous crossbite treatment methods

For a long time, crossbites were treated with fixed appliances that were attached directly to the teeth. While these methods are effective, children and adolescents often find them uncomfortable.

1. fixed palatal expansion appliance (GNE device)

This metal appliance is attached to the lateral permanent teeth and contains a screw that gradually stretches the upper jaw.

This treatment is suitable for teenagers who no longer have any milk teeth and have not yet experienced their greatest growth spurt (i.e. up to about 16 years of age). The older and more fused the palatal suture is, the more likely it is that surgical support in the form of surgical separation of the palatal suture will be necessary.

Advantage:

• Very effective: Rapid expansion is possible, especially in the case of a pronounced crossbite.


• Supports nasal breathing: by widening the nasal floor, breathing is facilitated.


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Disadvantages:

• Impaired oral hygiene → Brushing teeth is more difficult, increasing the risk of caries.


• Inconvenient to wear: Pressure sensation, speech problems and food particles under the appliance.

2. Bonded cap splint

This treatment is suitable for children with primary or early mixed dentition, i.e. when many primary teeth are still present.

The treatment is carried out with a plastic splint that is glued over the milk teeth and allows controlled expansion.

Advantage:

• Softer pressure distribution: More comfortable to use than metal appliances because it is simply cemented over the entire side teeth.


• Rapid expansion of the upper jaw with improved nasal breathing


• Can be started as early as the late milk or beginning mixed dentition (from about 5 to 6 years of age)

Disadvantages:

• Fixed appliances can still cause a feeling of pressure and affect speech, and they are bulkier than the metal version. This makes eating very difficult, especially when chewing tough or hard food.

3. Removable expansion plates (for milk and mixed dentition)

These classic plastic plates are only made for the upper jaw and are worn only at night, otherwise they would be a hindrance when speaking.

Advantage:

• Better oral hygiene: Can be removed for brushing.


• Pleasant because it is only worn at night

Disadvantage:

• Due to the short period of wear, it can only be used for less pronounced crossbites.


• Requires discipline: Must be worn regularly, otherwise it will not be successful.

New method: Removable expanders

The newly developed method with removable expanders (not to be confused with invisible braces!) enables a new type of palatal expansion – without fixed metal parts or screws in the mouth.

The treatment is suitable for milk and mixed dentition as well as for teenagers with permanent teeth before the next growth spurt.

The palatal expanders can be attached to the teeth and also cover the palate. There are several expansion devices, with each expander having to be worn for a certain number of hours. The palatal expanders are made of a strong nylon material.

Until the desired, predefined palate width is achieved, the expander must be changed daily.

Advantage:

• Better oral hygiene: Can be removed for brushing.

Disadvantage:

• Requires discipline: Must be worn regularly, otherwise it will not be successful. Must be worn throughout the day (with only a few exceptions).

Palatal Expander: How does this new method work?

These specially adapted expanders exert gentle pressure on the upper jaw using an integrated mechanism, in order to gradually widen it along the palate. The expanders have to be changed daily and should only be removed for eating and cleaning the teeth. The continuous pressure causes the upper jaw to widen, which can be recognized by the formation of the diastema explained above.

As soon as the widening is complete, the result must be stabilized with additional special holding expanders until the bone and structures have adapted to the new jaw width.

Why is this method more comfortable for children and adolescents?

• Removable: No foreign body in the mouth during meals or when brushing teeth.


• Less pressure sensation: The correction is gentle.


• No metal or screws in the mouth: No uncomfortable tension or sores.


• Aesthetically less noticeable.


• No influence on speech: Children and adolescents can speak relatively normally because the palate is not distorted by a screw or thick plastic plate. The expanders are narrow and fit well on the palate.

This method is a huge relief, especially for young patients. While fixed appliances are often perceived as annoying, the new splints can be conveniently integrated into everyday life.

Conclusion: Treat crossbites in children early!

Early treatment of crossbites is important to avoid later dental and jaw problems. Dr. Carina Wick, a specialist in orthodontics, will be happy to discuss which therapy is best for your child during an initial examination at our orthodontic practices in Vienna and Linz.

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