Types of Wires Used in Orthodontic Adjustments

Types of Wires Used in Orthodontic Adjustments

Brief overview of orthodontic treatment for kids and the importance of imaging methods in diagnosis and treatment planning

Orthodontics, a specialized field within dentistry, focuses on correcting misaligned teeth and jaws. A crucial component of orthodontic treatment is the use of wires, which play a pivotal role in guiding teeth into their proper positions. Orthodontists specialize in correcting dental irregularities in kids Children's braces treatment tooth. Understanding the different types of wires used in orthodontics is essential for both practitioners and patients. This overview will explore the various wires utilized in orthodontic adjustments, highlighting their unique properties and applications.


The most commonly used orthodontic wires are made from stainless steel, nickel-titanium (NiTi), and beta-titanium (TMA). Each type offers distinct advantages and is chosen based on the specific needs of the patient and the stage of treatment.


Stainless steel wires are the workhorse of orthodontics. Known for their strength and formability, these wires are ideal for the later stages of treatment when precise tooth positioning is required. They provide the necessary rigidity to make fine adjustments and are less likely to bend out of shape, ensuring stability in the final alignment of teeth.


Nickel-titanium wires, on the other hand, are renowned for their flexibility and shape memory. These properties make them particularly useful in the initial stages of treatment. NiTi wires can apply a gentle, continuous force to move teeth gradually into alignment without causing discomfort. Their shape memory allows them to return to their original form after being bent, which is beneficial for patients who may accidentally bend their braces.


Beta-titanium wires, also known as TMA wires, offer a balance between the properties of stainless steel and nickel-titanium. They are more flexible than stainless steel but stronger than NiTi, making them suitable for various stages of treatment. TMA wires are often used when a combination of flexibility and strength is needed, such as in cases requiring more complex tooth movements.


In conclusion, the selection of orthodontic wires is a critical decision in the treatment process. Each type of wire-stainless steel, nickel-titanium, and beta-titanium-has its unique characteristics that cater to different stages and needs of orthodontic treatment. By understanding these differences, orthodontists can tailor their approach to ensure the most effective and comfortable treatment for their patients.

Explanation of the various orthodontic imaging methods commonly used, such as panoramic radiographs, cephalometric radiographs, and cone-beam computed tomography (CBCT) —

Certainly! Let's delve into the fascinating world of stainless steel wires, which play a pivotal role in orthodontics, especially in children's orthodontic adjustments.


Stainless steel wires are a cornerstone in orthodontic treatment, celebrated for their robustness and versatility. These wires are primarily composed of iron, chromium, and nickel, a blend that endows them with exceptional strength and resistance to corrosion. This is particularly crucial in the oral environment, where the wires are constantly exposed to saliva and various food substances.


One of the most significant characteristics of stainless steel wires is their high tensile strength. This means they can withstand considerable force without deforming, making them ideal for moving teeth into their correct positions. Their stiffness is another notable feature. While this might sound like a drawback, it's actually a boon in orthodontics. The rigidity of stainless steel wires allows orthodontists to apply consistent and precise forces to teeth, ensuring effective and predictable tooth movement.


The advantages of using stainless steel wires in children's orthodontics are manifold. Firstly, their durability means they can withstand the rigors of daily use, which is particularly important for children who may not always be gentle with their orthodontic appliances. Secondly, their biocompatibility ensures they are safe for use in the mouth, reducing the risk of allergic reactions or other adverse effects. Lastly, the predictability of tooth movement with stainless steel wires allows orthodontists to plan treatments more effectively, leading to better outcomes.


In terms of applications, stainless steel wires are incredibly versatile. They are used in a variety of orthodontic appliances, including braces, expanders, and retainers. In children's orthodontics, they are often used in the initial stages of treatment to correct significant misalignments. As treatment progresses, orthodontists may switch to more flexible wires to fine-tune the positioning of teeth.


In conclusion, stainless steel wires are a vital component in the realm of orthodontics, particularly in children's orthodontic adjustments. Their strength, stiffness, and biocompatibility make them an excellent choice for orthodontists looking to achieve precise and effective tooth movements. As we continue to advance in orthodontic technology, the role of stainless steel wires remains as crucial as ever, ensuring that children around the world can achieve healthy, beautiful smiles.

Citations and other links

Description of the benefits and limitations of each imaging method, including factors such as radiation exposure, image quality, and cost

Nickel-titanium wires are a game-changer in the world of orthodontics, especially when it comes to treating young patients. These wires are composed of a superelastic alloy, which makes them incredibly flexible and resilient. This unique property allows them to apply a gentle, constant force over time, which is ideal for moving teeth into their proper positions without causing discomfort or damage.


One of the key benefits of nickel-titanium wires is their superelasticity. This means they can be stretched or bent significantly without losing their original shape. When used in braces, this property ensures that the wires can exert a consistent force on teeth, even as they move. This is particularly beneficial for young patients, whose teeth and jaws are still developing. The gentle, continuous pressure helps to guide teeth into alignment more comfortably and efficiently.


Another advantage of nickel-titanium wires is their corrosion resistance. This is crucial in the mouth, where saliva and food can cause other types of wires to degrade over time. The durability of nickel-titanium wires means they can remain effective throughout the treatment period, reducing the need for frequent adjustments and replacements.


In terms of specific uses, nickel-titanium wires are often the first choice for the initial stages of orthodontic treatment. They are particularly effective in leveling the teeth, meaning they help to bring all the teeth to the same height. This is a critical step before more precise adjustments can be made. Additionally, their flexibility makes them suitable for young patients who may be more sensitive to the discomfort often associated with traditional metal wires.


In summary, nickel-titanium wires offer a combination of flexibility, durability, and gentle force application that makes them an excellent choice for young patients undergoing orthodontic treatment. Their superelastic properties ensure a more comfortable experience, while their corrosion resistance guarantees long-lasting effectiveness. Whether it's for leveling teeth or providing a stable foundation for further adjustments, these wires play a vital role in achieving successful orthodontic outcomes.

Description of the benefits and limitations of each imaging method, including factors such as radiation exposure, image quality, and cost

Discussion of the role of digital imaging technologies in modern orthodontics, including the use of 3D imaging and computer-aided design and manufacturing (CAD/CAM) systems

When it comes to orthodontic adjustments, especially for children, the type of wire used can make a significant difference in the effectiveness and comfort of the treatment. Beta-titanium wires are one of the popular choices in this field. These wires, also known as beta-Ti or simply titanium-molybdenum alloy (TMA) wires, have distinct features and advantages that make them particularly suitable for young patients.


One of the primary features of beta-titanium wires is their excellent flexibility. This flexibility is crucial when working with the developing dental structures of children. Unlike stainless steel wires, which are stiffer, beta-titanium wires can bend more easily without causing undue stress on the teeth and gums. This is particularly important in growing mouths where the bones and tissues are still developing.


Another notable feature is the moderate spring-back property of beta-titanium wires. This means they can return to their original shape after being bent, providing continuous gentle pressure on the teeth. This is advantageous in guiding teeth into the correct positions without causing discomfort or excessive force, which is especially important for young patients who may have more sensitive teeth and gums.


In terms of advantages, beta-titanium wires offer a balance between strength and flexibility. They are strong enough to withstand the forces required to move teeth but flexible enough to adapt to the unique shapes and sizes of a child's mouth. This makes them ideal for complex orthodontic cases where precise tooth movement is necessary.


Moreover, beta-titanium wires are biocompatible, meaning they are well-tolerated by the body. This is a significant advantage when considering the long-term wear that orthodontic treatments often require. The biocompatibility reduces the risk of allergic reactions or irritation, which can be a concern with some metal alloys.


Beta-titanium wires are preferred in scenarios where precise control over tooth movement is needed. For instance, in cases where rotation or tipping of teeth is required, these wires provide the necessary flexibility and control. They are also beneficial in the early stages of treatment when initial alignment and leveling of the teeth are critical.


In summary, beta-titanium wires offer a combination of flexibility, moderate spring-back, strength, and biocompatibility that makes them an excellent choice for orthodontic adjustments in children. Their ability to provide gentle, continuous pressure and adapt to the unique needs of a growing mouth makes them a preferred option in many orthodontic scenarios.

Overview of the importance of proper image interpretation and analysis in orthodontic treatment planning, including the use of landmarks, measurements, and tracings

When it comes to orthodontic treatments for children, choosing the right type of wire is crucial. Not only does it affect the efficiency of the treatment, but it also impacts the child's comfort and overall experience. Let's delve into the comparison of wire flexibility, strength, and patient comfort for children in orthodontic adjustments.


Firstly, wire flexibility is a key factor to consider. Flexible wires are often preferred in the initial stages of orthodontic treatment. They apply gentle forces to the teeth, which is particularly important for children whose teeth and jawbones are still developing. Stainless steel wires, for instance, are commonly used due to their moderate flexibility. However, newer materials like nickel-titanium (Ni-Ti) wires offer even greater flexibility. These wires can bend more without permanent deformation, providing a more comfortable experience for young patients.


Strength is another critical aspect. As treatment progresses, stronger wires may be needed to apply more force and make significant adjustments. Stainless steel wires are renowned for their strength and are often used in the later stages of treatment. They can withstand greater forces without bending, ensuring that the teeth move into the desired positions. On the other hand, beta-titanium wires offer a balance between flexibility and strength, making them a versatile choice throughout different phases of treatment.


Patient comfort cannot be overstated, especially for children who may already be anxious about orthodontic procedures. Flexible wires not only reduce discomfort but also minimize the risk of pain and soreness. Additionally, the use of coated wires can further enhance comfort by reducing friction between the wire and the brackets. This is particularly beneficial during the initial stages when adjustments are frequent.


In conclusion, the choice of wire in orthodontic treatments for children should be carefully considered. Balancing flexibility, strength, and patient comfort ensures a more effective and pleasant experience. Stainless steel and nickel-titanium wires are commonly used, each offering unique advantages. Ultimately, the goal is to provide the best possible outcome with minimal discomfort, making the journey to a healthier smile a positive one for young patients.

Explanation of the role of orthodontic imaging in monitoring treatment progress and evaluating treatment outcomes

When it comes to pediatric orthodontic treatment, choosing the right type of wire is crucial for achieving successful and efficient results. Several factors influence this decision, each playing a significant role in the overall outcome of the treatment. Understanding these factors can help orthodontists make informed choices that best suit the needs of their young patients.


Firstly, the age and developmental stage of the child are paramount. Younger patients, particularly those still undergoing significant growth spurts, may require wires that offer flexibility and adaptability. This is because their jaws and teeth are still developing, and a more adaptable wire can accommodate these changes without causing undue stress or discomfort.


Another critical factor is the specific orthodontic issue being addressed. Different malocclusions or alignment problems may necessitate different types of wires. For instance, some wires are better suited for initial alignment, providing gentle and consistent force to move teeth into their proper positions. Others might be more appropriate for the later stages of treatment, where more precise adjustments are needed.


The mechanical properties of the wire also play a vital role. Orthodontists must consider the wire's stiffness, resilience, and ability to deliver the desired force. A wire that is too stiff may cause discomfort and slow progress, while one that is too flexible may not provide enough force to effect change. Striking the right balance is key.


Patient compliance and comfort are additional considerations. Younger patients, in particular, may have difficulty tolerating certain types of wires. Orthodontists must choose wires that minimize discomfort and are less likely to cause irritation or ulcers in the mouth. This not only improves the patient's experience but also encourages better compliance with the treatment plan.


Lastly, the duration of treatment and the expected outcomes should guide the choice of wire. Some wires are designed for short-term use, providing rapid initial corrections, while others are meant for longer-term adjustments. Orthodontists must align their wire choices with the projected timeline and goals of the treatment.


In summary, selecting the appropriate type of wire in pediatric orthodontic treatment involves a careful consideration of the child's age, the specific orthodontic issues, the mechanical properties of the wire, patient comfort, and the treatment's duration and goals. By weighing these factors, orthodontists can ensure they are using the most effective tools to achieve optimal results for their young patients.

Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

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Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

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An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

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An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

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Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

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An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

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Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

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Unilateral posterior crossbite

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Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

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A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

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Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

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  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

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  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
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