Orthodontic treatment for posterior crossbites

Alessandro Ugolini, Paola Agostino, Armando Silvestrini-Biavati, Jayne E. Harrison, Klaus B.S.L. Batista 

Key messages

Orthodontic treatment with quad‐helix (fixed) or expansion plates (removable) is effective for correcting posterior crossbite in children. Quad‐helix is probably even more effective than expansion plates. For adolescents, there is probably no difference between Hyrax and Haas for posterior crossbite correction.

What is the problem?

Posterior crossbite occurs when the top teeth or jaw are narrower than the bottom teeth. It can happen on one side or both sides of the dental arches. This condition may increase the likelihood of dental problems (e.g. tooth wear), abnormal development of the jaws, joint problems, and unbalanced facial appearance. Posterior crossbites affect around 4% and 17% of children and adolescents in Europe and America. 

Different treatment approaches have been proposed, resulting in many different braces being produced. The basic treatment to correct crossbite correction treatment involves using an orthodontic device on the palate (roof of the mouth) to expand the upper jaw by exerting pressure on both sides of the jaw. The devices can be fixed (e.g. quad‐helix, Haas, Hyrax expander) or removable (e.g. expansion plate). Fixed appliances are bonded to the teeth, while removable devices can be taken out of the mouth by patients.

What did we want to know?

We wanted to know the effects of different braces for posterior crossbite correction. 

What did we do?

We searched for studies that assessed the effectiveness of braces used to correct posterior crossbites.

What did we find?

We found 31 studies with 1410 children and adolescents who were randomly assigned to a treatment or no treatment group. Thirteen studies included children (7 to 11 years old), 12 included adolescents (12 to 16 years old), and six included both. Eight studies were conducted in Turkey, four in Brazil, four in Sweden, three in the USA, three in  Italy, two in Canada, and one each in Germany, UK, Switzerland, Iran, Spain, India, and Australia. Twenty‐seven studies were carried out in universities and clinical centres, one study in private practice, and three did not state the location.

What were the main results?

For children, expansion of the upper arch with fixed or removable braces can correct posterior crossbites. 

When testing fixed and removable braces against each other, the studies found that quad‐helix (fixed appliance) was more successful than expansion plate (removable appliance) and that treatment with quad‐helix took less time. 

For other comparisons between different types of treatments, there was no evidence to show that one worked better than another, but we had moderate to low certainty in the results, so future research may change them.

How reliable are these results?

Our confidence in the results is high to moderate for the main results. For the other comparisons, our confidence in the results is low.

How up‐to‐date is this review?

This review is an update. The evidence is current to April 2021.

Read the full review.

Ugolini A, Agostino P, Silvestrini-Biavati A, Harrison JE, Batista KBSL. Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews 2021, Issue 12. Art. No.: CD000979. DOI: 10.1002/14651858.CD000979.pub3.