Co esponding au ho : P awa i Nu aini
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Timely in e en ion, las ing esul s: Managing den al an e io c ossbi e wi h a
emo able appliance
Aloci a Anindyana i, Be adion Rizki Sina edi and P awa i Nu aini *
Depa men o Pedia ic Den is y, Facul y o Den al Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1964-1968
Publica ion his o y: Recei ed on 01 Ap il 2025; e ised on 09 May 2025; accep ed on 11 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1799
Abs ac
In oduc ion: An e io c ossbi e, a common malocclusion in ea ly mixed den i ion, is cha ac e ized by one o mo e
lowe inciso s posi ioned an e io o he uppe inciso s. Ea ly iden i ica ion and managemen a e essen ial o p e en
p og ession o mo e se e e malocclusion and associa ed complica ions.
Desc ip ion o Case: A 7-yea -old emale pa ien p esen ed wi h a den al an e io c ossbi e in ol ing he uppe igh
pe manen inciso . Clinical examina ion e ealed a 1 mm e e sed o e je and su icien space o co ec ion. A
emo able o hodon ic appliance o Hawley's e aine wi h Z sp ing was u ilized o ea c ossbi e a e ob aining
pa en al consen . The appliance was ac i a ed weekly, and he pa ien was ins uc ed on p ope use and o al hygiene.
Posi i e o e je was achie ed wi hin ou weeks, wi h comple e alignmen obse ed a e an addi ional six weeks,
despi e a b ie pe iod o non-compliance.
Discussion: Ea ly in e cep i e ea men o an e io den al c ossbi e is c ucial o es o e no mal occlusion and p e en
mo e complex p oblems. Remo able o hodon ic appliances, such as he Hawley’s e aine wi h Z sp ing, a e e ec i e
in cases wi h adequa e space and ac i e oo h e up ion. These appliances o e ad an ages including ease o ab ica ion,
main enance o o al hygiene, and cos -e ec i eness. Howe e , pa ien compliance emains a key ac o in luencing
ea men du a ion and success.
Conclusion: Timely in e en ion using emo able appliances wi h Z sp ing is an e ec i e and p ac ical app oach o
co ec ing den al an e io c ossbi e in young pa ien s. Appliance selec ion should be ailo ed o indi idual pa ien
ac o s, emphasizing he impo ance o ea ly diagnosis and pa ien coope a ion o op imal ou comes
Keywo ds: An e io c ossbi e; Remo able o hodon ic appliance; In e cep i e o hodon ic; Human and heal h
1. In oduc ion
The de eloping den i ion and occlusion play a c ucial ole in he well-being o in an s, child en, and adolescen s. The
Ame ican Academy o Pedia ic Den is y emphasizes he impo ance o managing he de eloping den i ion and
occlusion, which in ol es iden i ying, diagnosing, and app op ia ely ea ing den o acial abno mali ies [1,2].
Malocclusion e e s o he misalignmen be ween he den al a ches o wi hin he a ches in any plane and any anomalies
in he oo h's posi ion. Malocclusion is a common o al condi ion, especially among child en [2,3].
An e io c ossbi e is a malocclusion de ined by one o mo e lowe inciso s posi ioned mo e an e io ly han uppe
inciso . An e io c ossbi e can be di ided in o skele al and den al. When an e io c ossbi e a ises due o a skele al
disc epancy (maxilla y e ogna hia and mandibula p ogna hism), i is classi ied as a skele al c ossbi e. On he o he
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1964-1968
1965
hand, i he c ossbi e esul s om he uppe inciso being displaced pala ally and is o en associa ed wi h he
labio e sion o he lowe inciso , i is conside ed a den al c ossbi e [4,5]. An e io den al c ossbi e accoun s o 4%-5%
o he popula ion, and o he epo s s a ed ha an e io den al c ossbi e p e alence anging om 1.6% o 8%, mainly
in he ea ly mixed den i ion phase [5–7].
Possible causes o den al an e io c ossbi e in ol e auma o he p eceding p ima y oo h leading o he pe manen
ee h being pushed inwa d, ec opic posi ion o he pe manen oo h ge m, supe nume a y ee h, a habi o bi ing he
uppe lip, o e - e ained o deciduous ee h o hei oo s, odon oma, anomalies in oo h shape and size, and a ch leng h
inadequacy [8–10]. Ea ly managemen o an e io c ossbi e is ecommended o p e en mo e complica ed o mo e
se e e malocclusion and ea men a a la e s age [6].
Va ious ea men op ions, anging om simple o complex me hods, a e a ailable o ea an e io c ossbi e;
emo able appliances and o he ixed appliances can be used o ea ing an e io c ossbi e. The mos sui able
ea men op ion o an e io c ossbi e depends on he e iology o he c ossbi e, he pa ien ’s age and compliance,
e up ion s a us o he oo h, space a ailabili y, and ea men cos s [10]. Se e al appliances, including Hawley's Z sp ing,
ongue blade, and Inclined bi e plane (Ca lan’s) appliance, a e o en used o ea ing den al an e io c ossbi e [6,8,11].
In he p esen case, a emo able o hodon ic appliance wi h a Z sp ing was used o co ec he c ossbi e.
2. Desc ip ion o Case
A 7-yea -old heal hy emale pa ien , accompanied by he mo he , was e e ed o he Depa men o Pedia ic Den is y
a Ai langga Den al Hospi al wi h he chie complain o he uppe igh pe manen inciso posi ioned behind he lowe
inciso s, which some imes caused discom o when bi ing ood. The pa ien had no amily his o y o class III
malocclusion. The e was a his o y o a pe sis en uppe igh cen al p ima y inciso , which had been ex ac ed be o e.
Ex ao al examina ion e ealed a s aigh acial p o ile and no TMJ p oblems.
In ao al examina ion showed a den al an e io c ossbi e o oo h #11 and a class I mola ela ionship (Figu e 1). I was
measu ed ha he pa ien had a 1 mm e e sed o e je and 2 mm o e bi e on oo h #11, and he eeway space was 3
mm. Fu he mo e, he maxilla y and mandibula la e al inciso s had no e up ed ye . F om clinical examina ion and
his o y- aking, no pa a unc ional habi was obse ed in he pa ien . Su icien mesiodis al space wid h was a ailable o
oo h #11 o mo e labially.
Figu e 1 In ao al examina ion showed den al an e io c ossbi e o oo h #11
The ea men objec i e o he pa ien was o co ec he an e io c ossbi e, o amelio a e he o e je o no mal, and o
align he pa ien 's an e io ee h, which may enhance he pa ien 's acial and den al aes he ics and p e en mo e se e e
malocclusion. 0
A emo able o hodon ic appliance consis ing o Z Sp ing, Adam’s clasp, and Hawley e aine was cons uc ed o co ec
he c ossbi e a e he pa en s consen ed ( igu e 2). The Z sp ing was ac i a ed by slowly pulling he ac i e pa labially,
and i should be ensu ed ha he Z sp ing a m was al eady in con ac and pa allel o he pala al su ace o he desi ed
oo h upon inse ion. The pa ien and he pa en s we e ained o inse and emo e he appliance independen ly unde
pa en al guidance. Fu he mo e, ins uc ions on main aining p ope o al hygiene and he cleanliness o he appliance
we e also gi en o bo h he pa ien and he pa en s. The pa ien and he pa en s we e also ins uc ed o wea he
appliance con inuously, excep when ea ing and p ac icing o al hygiene. The pa ien was ecalled e e y 7 days o
ac i a e he Z sp ing.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1964-1968
1966
Figu e 2 Inse ed emo able o hodon ic appliance
A e ou weeks o using he appliance, a posi i e o e je had been achie ed on oo h #11. Howe e , pa ien compliance
declined a e wa d; he pa ien did no show up o he nex ou weeks, and when he pa ien came back, ac i a ion o
Z sp ing was pe o med, and alignmen o he inciso was seen co ec ed a e he nex wo weeks (Figu e 3). The pa ien
was s ill ins uc ed on he appliance's u iliza ion o he e en ion phase, al hough he desi ed posi ion o he oo h was
al eady achie ed. I was in ended o main ain he s able o e je and o e bi e o he inciso .
Figu e 3 In ao al condi ion Pos - ea men
3. Discussion
An e io c ossbi e is a common condi ion in child en du ing he ea ly mixed den i ion pe iod, mos o which comes om
den al o igin. In e cep i e ea men o co ec an an e io c ossbi e may help elimina e he se e i y o he exis ing
p oblem and p e en u he malocclusion [10–12]. I is ecommended o ea an e io den al c ossbi e when hey a e
iden i ied o p omo e no mal den al and skele al de elopmen . Delayed ea men can lead o se ious complica ions,
such as loss o a ch dimensions, asymme ic midlines, auma ic occlusion wi h s ipping o gingi al issue on he labial
aspec o a lowe oo h, and e en un owa d g ow h pa e ns i unc ional shi is in ol ed [12,13].
T ea men me hods o co ec ing den al an e io c ossbi e should be conside ed based on hese se e al ac o s, such as
he inciso posi ioning and a ailable space o di ec he mo emen o he oo h o wa d, s age o e up ion o he
displaced oo h; i he oo h is in ac i e e up ion, he ea men may use simple le e aging echniques, and he deg ee
o o e bi e [13,14].
An e io c ossbi e co ec ion can be achie ed using se e al emo able o ixed appliances such as inclined bi e plane,
ongue blade, Hawley e aine wi h Z sp ing and sc ews, and e e se c own [15,16]. Each o hese appliances comes
wi h i s ad an ages and disad an ages.
In he p esen case, a emo able o hodon ic appliance (Hawley e aine wi h Z sp ing) was u ilized o ea he an e io
c ossbi e. The easons o choosing his appliance we e based on he pa ien -speci ic ac o s, including age, occlusal
analysis, and skele al de elopmen . The pa ien 's age was in ea ly mixed den i ion, and he oo h was in ac i e e up ion.
Based on hose ac o s, a emo able appliance was a sui able ea men op ion o c ossbi e in he ea ly mixed den i ion
phase [14]. Z-sp ings o pala al sp ings we e chosen as hey p o ided he bes choice o his case since he igh la e al
inciso o bo h he uppe and lowe jaw had no e up ed ye . Z sp ing a m was placed on he pala al o ee h #11, making
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1964-1968
1967
he p essu e om he pala al di ec he oo h o mo e o wa d labially. Enough eeway space was a ailable in his
pa ien , so he need o bi e opening by inco po a ing occlusal bi e planes can be elimina ed [13].
The emo able appliance was ab ica ed in a labo a o y, so chai side ime was signi ican ly educed. Mo eo e , he
design o his appliance allowed he pa ien o clean i easily, hence good o al hygiene could be achie ed. Mo e
impo an ly, he emo able appliance is cos -e ec i e and easy o manage [14,17]. Howe e , pa ien s' and pa en s' lack
o compliance can be a hu dle p ac i ione s migh ace. As in his case, he pa ien was no complian ega ding he ecall
isi . Lack o pa ien ’s compliance may lead o longe ea men du a ion [18].
In his case, he ea men pe iod o co ec ing he e e se o e je was ou weeks, and ano he six weeks we e needed
o align he oo h. Once he desi ed adjus men was achie ed, he use o Hawley appliance was con inued o es ablish
adequa e o e je and o e bi e [16]. Success ul an e io c ossbi e co ec ion is achie ed by es ablishing no mal o e je
and o e bi e, and ensu ing he inciso s a e aligned in hei no mal ela ionship [19].
4. Conclusion
Ea ly ea men o an an e io c ossbi e highligh s he impo ance o imely in e en ion o p e en mo e complex
malocclusions. The p ac i ione can e ec i ely ea den al an e io c ossbi e wi h he igh appliance based on he
pa ien 's speci ic ac o s, such as age, skele al, and occlusion analysis. A emo able appliance wi h a Z sp ing is one o
he app op ia e ea men op ions o ea ing den al an e io c ossbi e.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s hank he e iewe s o hei insigh ul sugges ions
Disclosu e o con lic o in e es
The au ho s decla e ha he e is no con lic o in e es ega ding he publica ion o his documen .
S a emen o in o med consen
In o med consen was ob ained om pa ien included in he s udy.
Re e ences
[1] Ame ican Academy o Pedia ic Den is y. Managemen o he De eloping Den i ion and Occlusion in Pedia ic
Den is y. In: The Re e ence Manual o Pedia ic den is y. Chicago: Ame ican Academy o Pedia ic Den is y;
2024. p. 475–93.
[2] Sake P, A umugam S, A chana SP, Chona A, Vasan hakuma i A, Dhi ya S. Awa eness and A i ude o Pa en s
ega ding Malocclusion and Ea ly In e cep ion o O al Habi s-associa ed Den o acial De o mi y in Child en.
Wo ld Jou nal o Den is y. 2022 Ap 11;13(3):266–70.
[3] Pelleg ino M, Ca uso S, Can ile T, Pelleg ino G, Fe azzano GF. Ea ly ea men o an e io c ossbi e wi h e up ion
guidance appliance: A case epo . In J En i on Res Public Heal h. 2020 May 2;17(10).
[4] Woon SC, Thi u enka acha i B. Ea ly o hodon ic ea men o Class III malocclusion: A sys ema ic e iew and
me a-analysis. Vol. 151, Ame ican Jou nal o O hodon ics and Den o acial O hopedics. Mosby Inc.; 2017. p. 28–
52.
[5] Lo Giudice A, Polizzi A. Pedia ic T ea men o An e io -Uppe -Single Den al C ossbi e Using a Ve sa ile Sagi al
Sc ew Sys em: A Case Se ies. Pedia Rep. 2025 Feb 1;17(1).
[6] Tiwa i N, Tiwa i S, Sha ma D. Managemen o An e io C oss Bi e in Mixed Den i ion Using Ca lan’s Appliance.
Ac a Scien i ic Den al Sciences. 2020;4(2):106–9.
[7] Vishnu G, R R. Compa a i e Clinical Ou comes in he T ea men o An e io C ossbi e Using Th ee Di e en
Appliances: A Case Se ies. Cu eus. 2024 Sep 5;
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1964-1968
1968
[8] Amudala N, Sandeep K, Ma ha S, A hyala A, Sadik MA, Anudeep M, e al. Explo ing Managemen Techniques o
C ossbi e Co ec ion: A Case Se ies Demons a ing Success ul T ea men S a egies. Jou nal o Medical and
Den al Science Resea ch. 2023;10(4):68–74.
[9] Mai W, Xiao L, Chen S, Chen S, Li A, Zhang T, e al. P e alence and con ibu ing ac o s o malocclusion in Zhuang
child en aged 7–8 yea s in sou he n China. F on Pedia . 2024;12(Janua y):1–8.
[10] Sockalingam SNMP, Khan KAM, Kuppusamy E. In e cep i e Co ec ion o An e io C ossbi e Using Sho -Span
Wi e-Fixed O hodon ic Appliance: A Repo o Th ee Cases. Case Rep Den . 2018;2018.
[11] Ami ah Sa aswa i P ono aha djo, P awa i Nu aini, Pu i Qoma ia Anda ini, Meidy Damayan i, Si i Nu les a i,
Fi li Cahaya Khai ani. Inclined bi e plane o managing an e io c ossbi e: A case epo . Wo ld Jou nal o
Ad anced Resea ch and Re iews. 2024 May 30;22(2):1655–7.
[12] O opeza LM, López AF, Sanchez RO. Co ec ion o An e io C ossbi e, Using Remo able Appliances in Mixed
Den i ion: 5-Yea Follow-Up. O al Heal h and Den al science. 2023 Dec 30;7(5).
[13] Dean JA. McDonald and A e y’s DENTISTRY o he CHILD and ADOLESCENT. 11 h ed. Jones J, Sande s B, Vinson
L, Yepes JF, edi o s. Missou i: Else ie ; 2022.
[14] Alma houmi A, Alwa i MM. Ea ly In e cep i e Co ec ion o An e io C ossbi e Using a Remo able Appliance: A
Pedia ic Case S udy. Cu eus. 2024 Ma 13;
[15] Ko adya J, Fe nandes S, Ba na Y, Soni S, Pa el J. An e io C oss Bi e Co ec ion wi h Th ee Di e en App oaches :
A Se ies o Th ee Cases. Jou nal o Medical Science And Clinical Resea ch. 2019;7(1):176–81.
[16] Sinha A, Mohan y S, Acha ya S. Single An e io C ossbi e Co ec ion in Mixed Den i ion Using Z’sp ing Along wi h
Pos e io Bi e Plane: A Case Repo . Indian Jou nal o Fo ensic Medicine & Toxicology [In e ne ].
2020;14(4):8637. A ailable om: www.Docs oc.
[17] Kaul S, Kansal V, Rawal S. Di e en Techniques o Co ec ing an An e io C ossbi e: A Case Se ies. Ac a Scien i ic
Den al Scienecs. 2023 Feb 1;7(2):134–8.
[18] Khala K, Mando M. Remo able appliances o co ec an e io c ossbi es in he mixed den i ion: a sys ema ic
e iew. Vol. 78, Ac a Odon ologica Scandina ica. Taylo and F ancis L d; 2020. p. 118–25.
[19] Mus apha NMN, Asha i A. Simpli ied Fixed Technique o Co ec ion o An e io C ossbi e: A Case Se ies. A chi es
o O o acial Sciences. 2021;16(1):77–85.
