A crossbite: a simultaneous over and underbite

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Crossbites are a mixed misalignment. They can have an interesting profile position and are unlikely to be based on either a right or left location. But this malformation of teeth is not simple to treat either, requiring force to be placed in opposite directions. In the case of a very severe crossbite, splaying of the teeth both into and out of the mouth can be seen and is debilitating, significantly reducing the patient’s food choices.

But for patients in this situation, what’s the most appropriate treatment going forwards? Historically the answer would have been easy; this was a situation for the metal brackets and the archwire of a traditional orthodontic brace, but is that still true?

Clinical vs cosmetic

Cosmetic reasons for treating a crossbite are entirely valid, to put up with a condition that you could get treatment for has a sort of glorifying self-denial in it. But beyond that, there are medical issues that come with dental misalignments, like the increased complexity of thorough brushing and greater likelihood of cavities and gum disease.

The uneven pressure applied to the teeth focusses stress and can make the risk of chipped and cracked teeth more likely.

Using braces

woman with braces

Alignment bars of functional appliances can be useful in the early stages of treating crossbites, as the teeth both in front and behind the arch can be levied against one another to bring them both back in line. Often there is limited room and overcrowding that also has to be resolved by extraction and re-spacing out the teeth. Alternatively, the palate itself can be extended with a functional appliance which pushes outwards from the inside of the mouth.

Without braces

Crossbites can be very severe and when treatment has been delayed into adulthood, it may be necessary to carry out jaw surgery in order to realign the arch. This is obviously invasive and fairly disruptive, so it is only used when other treatment options have been exhausted.

Out of the box solution – clear aligners

Clear aligners like Invisalign London  provide an interesting solution for crossbite sufferers; they may not be practical in the most extreme cases, but for the vast majority of crossbite patients, they offer a more convenient (and in the case of adult dentistry) cheaper alternative to traditional orthodontic braces.

On top of their relative convenience to clean and maintain, they are considered significantly less uncomfortable than traditional braces. Not to mention that they are entirely translucent, so they are particularly compatible with working adults and those wanting to combine their dental care with more pressing obligations like work meetings and official presentations.


It seems that between the application of functional appliances and palate extensions for the severe cases and clear aligner treatment in more cosmetic situations, that the traditional metal brace is being squeezed in the middle. It is likely to find itself used less and less often to treat crossbites in clinics, particularly in situations where clear aligners in effect seem to be able to rectify the case in question.

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