Invisalign First Pediatric Orthodontics: Asymmetric Crossbite and Growth Orthodontics

Hello,

Let me introduce pediatric orthodontics in Apgujeong.

These days, our clinic has many children coming in for orthodontic treatment.

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If there are skeletal issues such as facial asymmetry or an underbite, not just simple crowding, it is best to address them during the growth period.

After growth is complete, the only way to correct them is double-jaw surgery.

If there is facial asymmetry, it may be helpful to check how pediatric orthodontic treatment is carried out.

23.12

This is an 8-year-old child who visited in December 2023 for orthodontic treatment.

They came in for orthodontic care after being told at another clinic that they had a crossbite, asymmetry, and insufficient space, so their front teeth could not erupt properly.

The midline is significantly deviated, and the blue arrow indicates a crossbite where the upper and lower teeth are biting in reverse.

The yellow line is the center of the lower jaw, and the white line is the centerline of the upper jaw.

This is asymmetry in which the lower jaw is twisted to the left by as much as the dental midline.

The primary canines are biting in reverse against each other, so there is occlusal interference in this area.

In some cases, occlusal interference causes the jaw to twist to one side when biting.

In such cases, if the reverse-biting area is resolved through arch expansion—in other words, if the occlusal interference is addressed—the asymmetry may improve naturally.

This is an incisal bite, where the upper teeth do not overlap the lower teeth.

There is also insufficient space for the lateral incisors and canine eruption, so arch expansion was needed.

Treatment began with Invisalign First, with the goals of restoring space for permanent tooth eruption through arch expansion, distributing space, resolving the crossbite, improving the lower jaw position by eliminating occlusal interference, and improving asymmetry.

24.04

As arch expansion resolved the blue-arrow crossbite, the occlusal interference disappeared.

The metal ring attached underneath is the attachment for elastics.

As the occlusal interference disappeared, the jaw found its correct position, and the shifted front-tooth midline naturally aligned.

24.04

Midline alignment can also be confirmed in the face.

24.04

Thanks to the widened arch from expansion, the lateral incisors that had been unable to erupt due to lack of space are now coming in well.

The Invisalign First clear aligner for children has a warranty period of 18 months.

Growth can be monitored during those 18 months, and remaking can be done at the appropriate time.

For this child, from April 2024 to November 2024, the last of the 16 appliances was worn only while sleeping as retention, while waiting for the permanent teeth to erupt.

Once the permanent teeth, including the newly erupted lateral incisors, had erupted to a certain extent, we proceeded with remaking.

24.11

This is after a 7-month break.

The lower jaw position has been well maintained, and now that the lateral incisors have erupted sufficiently, we are proceeding with remaking.

This is after wearing all 19 appliances in the second set from December 2024 to June 2025.

The front teeth, including the lateral incisors, are well aligned.

The anterior bite has improved so that the upper teeth properly overlap the lower teeth.

The gap between the primary canines was intentionally created so there would be enough space when the permanent canines erupt.

There is sufficient space for permanent tooth eruption, and the alignment, midline, and bite are all good.

Let’s look at the changes over 1 year and 6 months.

The appliances were worn for 9 months, and the break while waiting for permanent tooth eruption was 7 months.

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The front-tooth midline is precisely aligned, and the arrangement is good.

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It was an incisal bite in which the upper teeth could not properly cover the lower teeth, but appropriate anterior bite contact was formed using Class III elastics.

Now let’s compare the facial appearance.

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You can see improvement in the front-tooth midline.

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Let’s draw a reference line.

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In the facial photo taken with the teeth closed, you can see that the twisted lower jaw has improved to a centered position.

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Improved smile

Although it was not a skeletal underbite, the lower lip, which had appeared relatively protrusive due to the incisal bite, has improved, and the lip balance has also gotten better.

At this point, treatment could be finished.

However, after taking into account the parents’ opinion that it still looked a little protrusive, we decided to perform interproximal reduction on the front teeth to further reduce the slight protrusion, and we are preparing for another remake right before the warranty period ends.

We do not set limits and leave anything unfinished.

Our treatment philosophy and goal are to provide as much treatment as possible so that adult orthodontic treatment is not needed, and to maintain it thoroughly until adulthood.

I hope this was helpful for those who are considering pediatric orthodontic treatment.