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References

Borrie F, Bearn D. Early correction of anterior crossbites: a systematic review. J Orthod. 2011; 38:175-184 https://doi.org/10.1179/14653121141443
Bayrak S, Tunc ES. Treatment of anterior dental crossbite using bonded resin-composite slopes: case reports. Eur J Dent. 2008; 2:303-306
Kravitz ND, Jorgensen G, Frey S, Cope J. Resin bite turbos. J Clin Orthod. 2018; 52:456-461
Sari S, Gokalp H, Aras S. Correction of anterior dental crossbite with composite as an inclined plane. Int J Paediatr Dent. 2001; 11:201-208 https://doi.org/10.1046/j.1365-263x.2001.00256.x
Croll TP, Lieberman WH. Bonded compomer slope for anterior tooth crossbite correction. Pediatr Dent. 1999; 21:293-294
Tobias M, Album MM. Anterior crossbite correction on a cerebral palsy child: report of case. ASDC J Dent Child. 1977; 44:460-462

Tricks of the Trade: Anterior Crossbite Correction: Bevelled Resin Turbos

From Volume 15, Issue 3, July 2022 | Pages 153-154

Authors

Gursharan Minhas

MSc, BDS, BSc, MFDS RCS Eng, MOrth RCS Eng, FDS (Orth) RCS Eng

Orthodontic Consultant, Royal Surrey County Hospital

Articles by Gursharan Minhas

Article

Anterior crossbites are often treated interceptively to reduce the risk of enamel wear, periodontal loss of attachment or mandibular displacement. Although various techniques have been described, treatment usually entails the use of a removable or fixed appliance.1 This Trick of the Trade describes an alternative to standard methods for treatment, which involves the chairside placement of lingually bevelled composite resin turbos on the mandibular teeth, thereby nudging the maxillary incisor labially and the mandibular incisor lingually (Figures 1–3).2,3,4,5,6

Figure 1. Illustration of the bevelled resin turbo. This will nudge the maxillary incisor labially, and the mandibular incisor lingually. Adapted from Kravitz et al.3
Figure 2. (a) An 11-year-old male patient with a mild Class III malocclusion. Although all the maxillary incisors are in anterior crossbite, he is able to achieve edge-to-edge incisor contact. (b) Disclusion with resin turbos placed on the LR1 and LL1. (c) A positive overjet and overbite have been achieved 4 weeks later.
Figure 3. (a) A 10-year-old female patient with an anterior crossbite affecting both the maxillary central incisors. (b) Resin turbos placed on the LR1 and LL1. (c) A positive overjet and overbite have been achieved. Note how the gingival architecture of both the mandibular central incisors has also improved.

Method

The mandibular incisor opposing the maxillary incisor in anterior crossbite is prepared with self-etch primer.

  • Composite resin, dissimilar in shade to the tooth surface, is incrementally placed to produce a lingually inclined slope, 3–4 mm in thickness, at an angle of 45° to the long axis of the tooth. The treated incisors now represent the only points of contact between the two arches.
  • Patient recall at 4 weeks to monitor treatment progress. Crossbite correction is typically achieved between 4 weeks and 3 months.
  • Removal of resin slope with a slow speed handpiece and tungsten carbide debonding bur.

    • These ‘functional turbos’ are well tolerated, do not rely on patient compliance and provide cost savings compared with removable and fixed appliances (Table 1). However, this technique must only be employed when the patient can achieve edge-to-edge incisor contact in centric relationship, with a positive overbite to provide stability of correction.


    Fixed appliances Removable appliances
    Less aesthetic Compliance dependent
    Greater potential for decalcification Socially inhibiting (speech, saliva etc)
    Greater cost Lab fee required
    Greater orthodontic treatment fatigue Increased number of appointments

    Although conventional composite is easier to place compared to flowable composite, owing to its increased filler content and resultant wear resistance, if left for a prolonged period of time, it may lead to iatrogenic enamel wear of the opposing tooth. The authors have modified their technique to reduce the adhesive filler content and improve handling properties by incorporating a small volume of flowable composite resin to conventional composite when constructing the turbo.

    To conclude, bevelled resin turbos can be used to successfully treat a mild anterior crossbite. This technique is well tolerated by patients, simple to perform and can be completed chairside in one appointment. In addition, it has the added benefits of avoiding a laboratory fee or the inherent risks and costs of fixed appliances.