European Journal of Orthodontics 35 (2013) 706712 The Author 2012.

2012. Published by Oxford University Press on behalf of the European Orthodontic Society.
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Advance Access publication 11 November 2012

Influence of sucking habits and breathing pattern on palatal

constriction in unilateral posterior crossbitea controlledstudy
JasminaPrimoi*, LorenzoFranchi**, GiuseppePerinetti***, StephenRichmond****
and MajaOvsenik*
*
Department of Dental and Jaw Orthopaedics, Medical faculty, University of Ljubljana, Slovenia, **Department
of Orthodontics, University of Florence, Italy, ***Department of Medical, Surgical and Health Sciences, School
of Dentistry, University of Trieste, Italy and ****Dental Health and Biological Sciences, Dental School, Cardiff
University, UK

Correspondence to: Maja Ovsenik, Department of Dental and Jaw Orthopaedics, University of Ljubljana, Ljubljana,
Slovenia. E-mail: maja.ovsenik@dom.si

SUMMARYThe aim of this study was to evaluate the influence of prolonged sucking habits and mouth
breathing on palatal vault morphology in a group of subjects with unilateral functional crossbite [cross-
bite (CB) group] compared with a group of subjects with normal occlusion [non-crossbite (NCB) group].
Asample of 80 Caucasian subjects (51 CB and 29 NCB; aged 5.30.8years) in the deciduous dentition
was selected. Aquestionnaire regarding the subjects sucking habits was answered by the parents. Any
sucking habit that lasted more than 24months was considered as a prolonged sucking habit. The breath-
ing pattern was assessed by an experienced otorinolarygologist and was classified either mainly nose or
mouth breathing. Intercanine and intermolar distances and palatal surface area and volume were recorded
three dimensionally on study casts. Univariate and multivariate analyses were employed. Posterior CB
was negatively correlated with all the dental and palatal parameters (P<0.01) with the exception of the
palatal surface area that did not reach the statistical significance. Only prolonged sucking habits (but not
mouth breathing) was a significant risk indicator for unilateral functional CB (P<0.001). However, the pro-
longed sucking habits were not significantly correlated with any of the investigated parameter, and mouth
breathing was negatively correlated with the intermolar distance only. Therefore, maxillary constriction in
unilateral functional CB might not be influenced by the presence or absence of prolonged sucking habits
or mouth breathing.

Introduction
Posterior crossbite (CB) often occurs in the deciduous and
early mixed dentition, with a reported prevalence from 6.4 to
23% (Kurol and Berglund, 1992; Keski-Nisula etal., 2003).
Most of the cases (more than 80%) are unilateral with a
functional mandibular shift towards the CB side (Malandris
and Mahoney, 2004).
Evidence shows that the most frequent cause of unilat-
eral functional CB is a mild bilateral maxillary constriction
(Allen etal., 2003). However, the aetiology of maxillary
constriction in unilateral functional CB is still a matter of
discussion. It is currently accepted that genes and gene
products regulate craniofacial morphogenesis, including
the maxilla. However, these gene products do not determine
growth and specific form, but they rather provide factors
that may affect the receptivity and responsiveness of cells
to intrinsic and extrinsic stimuli (Carlson, 2005). Therefore,
it appears that a range of physiological, pathological, and
mechanical factors can influence growth (Mew, 1986). It
has been previously reported that maxillary constriction
in unilateral functional CB can be induced by dummy or
finger sucking (Kurol and Thilander, 1984; Hannuksela and
Vaananen, 1987; Larsson etal., 1992; Ogaard etal., 1994;
Larsson, 2001; Warren etal., 2001; Warren and Bishara,
2002), certain swallowing habits (Melsen etal., 1979;
Melsen etal., 1987), or mouth breathing (Ovsenik, 2009)
due to obstruction of the upper airways caused by adenoid
tissues (Linder-Aronson, 1970; Hannuksela and Vaananen,
1987).
However, some of the reported studies (Melsen etal.,
1979; Melsen etal., 1987; Larsson etal., 1992; Ovsenik,
2009) examined the correlation between improper orofacial
function and the occurrence of CB but did not examine
the relationship between the maxillary form and orofacial
functions. Other studies (Warren etal., 2001; Warren
and Bishara, 2002) examined the correlation of improper
orofacial functions with the transverse dimension of
the maxillary arch, measured as intercanine/intermolar
distances. However, the intercuspal transverse distances do
not provide any adequate information about the maxillary
form as they can be biased due to tooth position (Oliveira
etal., 2004; Primoi etal., 2009).
INFLUENCE OF ORAL HABITS ON PALATAL CONSTRICTION 707
In order to assess any environmental effects on the devel-
opment of maxillary constriction, which often occurs in
unilateral functional CB, the knowledge of the influence of
given environmental factors, i.e. prolonged sucking habits
or mouth breathing, on palatal morphology would be useful.
Therefore, the aim of this study was to evaluate the influ-
ence of prolonged sucking habits and mouth breathing on
palatal vault morphology in a group of CB subjects com-
pared with a group of subjects with normal occlusion (NCB
group).
Subjects and methods
Subjects and studydesign
Approval for this study was gained from the local
Institutional Review Board and a signed informed consent
from the parents of all the subjects were obtained prior to
the beginning of thestudy.
A sample of 80 Caucasian subjects (42 females and 38
males, mean age 5years 4months 10months) in the
deciduous dentition were included in this study. The CB
group consisted of 51 subjects (29 females and 21 males,
mean age 5years 3months 1year) affected by unilateral
posterior CB, with a functional mandibular shift and a mid-
line deviation of at least 2mm. The functional mandibular
shift was assessed clinically by an experienced orthodon-
tist (MO) by observing the path of mouth closure (three
repeated observations). Twenty subjects had a functional
shift on the left side, 31 on the right side. The subjects were
recruited from a sequential group of patients and assigned
to the CB group. The non-crossbite (NCB) group consisted
of 29 subjects (12 females and 17 males, mean age 5years
5months 4months) who presented with normal occlusal
relationships on the transverse plane and were included in
a prospective longitudinal growth study (Primoi etal.,
2011b).
Before the clinical examinations, the parents (gen-
erally the subjects mother) answered a questionnaire
regarding the subjects type of sucking habits such as
finger, thumb, or dummy sucking and bottle feeding and
Figure1 Assessment of the difference in temperature of the airflow through the nose (left) or through the mouth (right) in a subject with incompetent lip
seal using the airflow registration device.
about the duration of the habit (i.e. less than 12months,
1224months, 2436months, 3648months and more
than 48months). As it has been previously shown (Warren
etal., 2001) that sucking habits beyond 24months of age
may result in increased risk of developing posterior CB, any
sucking habit that lasted more than 24months was consid-
ered as a prolonged suckinghabit.
The breathing pattern was assessed by an experienced
otorinolarygologist and was classified either mainly nose
or mouth breathing. The mode of breathing was determined
while the subject was in a relaxed position, and it was noted
whether he or she had competent lip closure. If this was not
the case, the subjects mode of breathing was determined
with a special airflow registration device (Farnik and
Rudel, 1995; Ovsenik, 2009) that registers the difference in
temperature of the airflow through the mouth or through the
nose in an incompetent lip seal (Figure1), thus distinguish-
ing mouth breathing from incompetent lipseal.
During the intraoral examination alginate impressions of
the maxillary arch were obtained for all subjects. Study casts
of the maxillary arch were then scanned using a Konica/
Minolta Vivid 910 laser scanner at a distance of 60cm using
a lens with a focal distance of 25mm and a reported accu-
racy of 0.22mm (Keating etal., 2008). The digital models
were used to measure the maxillary arch widths and palatal
surface area and volume.
Analysis of the maxillary archwidths
The maxillary widths were analysed as intercanine and
intermolar transverse linear arch distances. The intercanine
transverse distance was measured between the cusps tips of
the upper deciduous canines, while the intermolar distance
was measured between the central occlusal grooves of the
second upper deciduous molars.
Analysis of the palatal surface area andvolume
In order to measure the palatal surface area and calculate
the palatal volume the boundaries of the palate had to be
defined. The gingival plane and a distal plane were used as
boundaries for the palate. The gingival plane was created
708 J. PRIMOI ET AL.
Figure2 Assessment of the palatal surface area (left) and volume (right). The palatal surface and space were delimitated by the use of a gingival (black
dots) and distal plane.
by connecting the midpoints of the dentogingival junction
of all primary teeth. The distal plane was created through
two points at the distal of the second primary molar perpen-
dicular to the gingival plane (Figure2). The palatal surface
area delimitated by the gingival and distal planes and the
palatal volume delimitated by the same planes were then
calculated.
Method error and statisticalpower
Method error for each palatal parameter was calculated
using the Intraclasscorrelation coefficients on a random
sample of 10 replicate measurements. With the aim of
quantifying the full method error of the recordings for
either palatal parameter, the method of moments (MME)
variance estimator was used (Springate, 2012). Therefore,
the mean error and 95% confidence intervals (CIs) between
the repeated recordings were calculated by using the MME
variance estimator and were expressed as percentage
(Perinetti etal., 2012). The Intraclasscorrelation coefficient
for any parameter was above 0.90. Method errors as mean
(95% CI) were 1.5% (0.72.5) and 0.8% (0.41.4) for the
intercanine and intermolar distances, respectively, and 1.0%
(0.51.6) and 3.2% (1.55.4) for the palatal surface area
and volume, respectively.
The power of the study was calculated a posteriori and was
based on the probability of detecting an effect-size coeffi-
cient (Cohen, 1992) of 1.0 for any of the palatal parameters in
the comparisons between the presence/absence of prolonged
sucking habits or mouth breathing within each group, with
an alpha set at 0.05 (Perinetti etal., 2011). The effect-size
coefficient is the ratio of the difference between the record-
ings of the two groups, divided by the within-subject standard
deviation (SD). An effect size of at least 1.0 is regarded to as
clinically relevant with the corresponding parameter having
a potential diagnostic value in individual subjects (Perinetti
and Contardo, 2009). According to the sample sizes com-
pared in this study, the power ranged from 0.69 to 0.91.
Data analysis
Parametric methods were used for data analysis after hav-
ing tested the normality of the data with the ShapiroWilk
test and QQ normality plots, and the equality of variance
among the data sets with a Levene test. The balance of
experimental groups (CB and NCB) according to age and
gender was evaluated with an independent sample t-test and
a Fisher exact test, respectively.
A series of univariate and multivariate analyses was per-
formed as follows. The significance of the differences in
the percentages of children showing either (any) prolonged
sucking habits or mouth breathing in the CB and NCB
groups was assessed using chi-squared tests. Subsequently,
the significance of the differences in each palatal param-
eter between the groups, within the presence/absence of
prolonged sucking habits or mouth breathing, and between
the presence/absence of prolonged sucking habits or mouth
breathing within each group were assessed by the unpaired
sample t-test.
Finally, for the whole sample, multiple linear regressions
(models) were run to identify the explanatory variables
[age, gender, group (CB, NCB), prolonged sucking habits
(no, yes), mouth breathing (no, yes)] that affected each of
the four palatal parameters. All explanatory variables were
entered as dummy variables with the exception of age that
was run as continuous variable.
A P-value <0.05 was considered as being statistically
significant. The SPSS programme (SPSS Inc., Chicago,
IL, USA) was used to perform the data treatment.
Results
The groups were balanced by age and gender (P > 0.1, at
least).
The results of the univariate analyses are summarized
in Tables 1 and 2. Only prolonged sucking habits (but not
mouth breathing) was a significant risk indicator for unilat-
eral functional CB (P<0.001, Table1). In particular, sub-
jects reporting prolonged sucking habits showed a greater
prevalence of CB (77.8%) compared with those negative for
this risk indicator (45.7%). The palatal parameters recorded
between the groups, within the presence/absence of pro-
longed sucking habits or mouth breathing, were generally
significantly lower for the CB group compared with those
for the NCB groups (P<0.05, at least, Table2). Only the
INFLUENCE OF ORAL HABITS ON PALATAL CONSTRICTION 709

Table1 The distributions of the subjects between the groups Table2 The different dental and palatal parameters in the
according to the prolonged sucking habits and mouth breathing groups according to the prolonged sucking habits and mouth
(N=80). breathing (N=80).

Risk indicator Group Diff. Parameter Risk indicator Group Diff.

Crossbite Non-crossbite Crossbite Non-crossbite

Prolonged sucking habits Intercanine Prolonged sucking habits
distance
No 16 (45.7%) 19 (54.3%) (mm) No 26.92.8 28.51.4 *
Yes 35 (77.8%) 10 (22.2%) * Yes 26.62.0 28.92.0 **
Diff. NS NS
Mouth breathing
Mouth breathing
No 34 (69.4%) 15 (30.6%) No 27.22.2 28.51.3 *
Yes 17 (54.8%) 14 (45.2%) NS Yes 25.82.2 28.81.9 ***
Diff. * NS

Data are presented as N(%). Diff., significance of the difference between Intermolar Prolonged sucking habits
the groups. NS, not statistically significant. distance
*Level of significance (P<0.001). (mm) No 35.73.3 38.21.6 **
Yes 35.72.0 39.41.7 ***
Diff. NS NS
Mouth breathing
No 36.12.3 38.71.1 ***
palatal surface area was similar between the groups for the Yes 34.92.5 38.52.2 ***
Diff. NS NS
subjects negative for prolonged sucking habits and irrespec-
tive of the mouth-breathing pattern. Moreover, the palatal Palatal Prolonged sucking habits
surface area
volume was also similar between the groups for those sub- (mm2) No 773.496.2 758.174.6 NS
jects negative for both prolonged sucking habits and mouth Yes 750.461.2 831.767.2 **
breathing. On the contrary, the differences between the Diff. NS *
presence/absence of prolonged sucking habits or mouth Mouth breathing
No 753.175.8 762.878.6 NS
breathing within each group were generally not significant Yes 766.670.9 805.676.6 NS
with few exceptions. In particular, for the CB group, only Diff. NS NS
the intercanine distance was shorter in the subjects positive Palatal Prolonged sucking habits
for mouth breathing compared with those who were nega- volume
tive. For the NCB group, palatal surface area and palatal (mm3) No 2746.4539.8 2836.1433.3 NS
Yes 2616.1364.2 3262.0432.9 ***
volume were significantly greater in the subjects negative Diff. NS *
for prolonged sucking habits compared with those who Mouth breathing
were positive. No 2627.4428.5 2867.9476.0 NS
The results of the multivariate regression analyses are Yes 2716.1427.0 3106.3453.3 *
Diff. NS NS
summarized in Table3. All the models showed R2 ranging
from 0.109 (palatal surface area) to 0.424 (intermolar dis-
Data are presented as mean SD. Diff., significance of the difference
tance). Age and gender were significantly correlated to the between the groups or between the subjects positive/negative for the
intermolar distance only (P<0.05). Posterior CB was nega- prolonged sucking habits or mouth breathing. NS, not statistically
tively correlated with all the dental and palatal parameters significant.
Levels of significance (*P<0.05, **P<0.01, ***P<0.001).
(P<0.01, at least) with the exception of the palatal surface
area that did not reach the statistical significance. Finally,
the prolonged sucking habits were not significantly cor- of prolonged sucking habits and mouth breathing in two
related with any of the investigated parameter, and mouth groups of subjects with or without posterior CB. Very little
breathing was negatively correlated with the intermolar influence of these risk indicators on the dental and palatal
distanceonly. parameters has been seen irrespective of the presence of
posteriorCB.
Until recently, maxillary morphology was assessed only
Discussion by measuring transverse intercuspal distances on study
In this study, maxillary morphology was evaluated on 3D casts and palatal height giving incomplete information
laser scans of study casts in terms of maxillary arch widths, about the 3D morphology of the palatal vault (Gracco etal.,
palatal surface area, and volume in the presence or absence 2009; Primoi etal., 2012). To overcome these limitations,
710 J. PRIMOI ET AL.

Table3 Results of the multiple linear regressions for estimates sucking habits longer than 24months were defined as pro-
of association of the different dental and palatal parameters with longed sucking habits, regardless of the habit (thumb,
each explanatory variable (N=80).
dummy, and bottle feeding) as it has been shown (Ogaard
etal., 1994; Warren etal., 2001) that at least 2years of
Variable (SE) Sig. sucking habits were necessary to produce a significant
Model 1: outcome, intercanine distance; R2=0.225 effect on the transverse dimension of the maxilla.
Previous evidence showed that different sucking habits
Gender 0.43 (0.47) NS
Age 0.02 (0.02) NS could result in different types of malocclusion (Warren
Posterior crossbite 2.07 (0.53) * etal., 2001), as for instance, digit sucking was more fre-
Prolonged sucking habits 0.30 (0.52) NS quently associated with classII malocclusion, while paci-
Mouth breathing 0.90 (0.50) NS
fier use was associated with posterior CB. However, it has
Model 2: outcome, intermolar distance; R2=0.424 been previously shown that one of the classII malocclusion
Gender 1.07 (0.47) ** features is also a constricted maxillary arch, which does not
Age 0.05 (0.02) **
Posterior crossbite 3.13 (0.52) *
frequently result in posterior CB due to the sagittal interarch
Prolonged sucking habits 0.89 (0.52) NS relationship (Franchi and Baccetti, 2005). Therefore, as this
Mouth breathing 1.30 (0.50) ** study aimed to assess the influence of prolonged sucking
Model 3: outcome, palatal surface area; R2=0.109 habits on the maxillary morphology, the influence of each
Gender 12.57 (17.23) NS habit type was not considered.
Age 1.63 (0.86) NS Interestingly, herein, the subjects with prolonged sucking
Posterior crossbite 21.64 (19.20) NS habits showed a greater prevalence of posterior CB com-
Prolonged sucking habits 10.21 (18.96) NS
Mouth breathing 17.74 (18.32) NS
pared with those who were negative for this risk indicator
(Table1). This evidence is in accordance with previous
Model 4: outcome, palatal volume; R2=0.185
studies (Ogaard etal., 1994; Warren etal., 2001; Warren
Gender 48.62 (100.99) NS and Bishara, 2002) that reported a correlation of prolonged
Age 9.67 (5.06) NS
Posterior crossbite 305.88 (112.55) *** sucking habits with posterior CB and that pacifier habits
Prolonged sucking habits 62.70 (111.11) NS persisting beyond 2years of age significantly increased the
Mouth breathing 106.16 (107.35) NS prevalence of posterior CB (Warren etal., 2001; Warren
and Bishara, 2002). However, the presence of this habit did
, adjusted coefficient of the regression; SE, standard error; Sig, not necessarily yield to a significant reduction of the den-
statistical significance of the coefficient. NS, not statistically
significant. tal and palatal parameter when entered in the multivariate
Levels of significance (*P<0.001, **P<0.05, ***P<0.01). regression model (Table3). These results thus underline the
importance of considering confounding factors when ana-
palatal surface area and volume were measured to better lysing potential dental and skeletal effects of sucking hab-
assess the morphological characteristics of the palatalvault. its and may explain the apparent inconsistency between the
This study showed that subjects with unilateral functional present and previous results. In fact, in the previous studies
CB have a similar palatal surface area but significantly no precise definition of posterior CB, i.e. bilateral/unilat-
smaller intercanine and intermolar distances and palatal eral dental or skeletal with or without a functional shift,
volume compared with NCB subjects (Table2). Therefore, wasgiven.
CB subjects have a higher degree of maxillary constriction, Furthermore, the contrasting results could be also
mainly in the transverse direction, which is in accordance due to the subjects included in the present and previous
with previous studies (Oliveira etal., 2004; Primoi etal., studies. This study was a retrospective study that evaluated
2009; Gracco etal., 2009; Primoi etal., 2011a). a sequential group of patients who were recruited and
On the contrary, irrespective of the presence of a posterior assigned to the two study groups. Only children without
CB, generally no differences in either maxillary parameter malocclusion or children with unilateral functional CB were
were seen between subjects reporting prolonged sucking included, previous studies included children regardless the
habits and those negative for this risk indicator. This is in type of malocclusion and aimed to find the influence of
contrast with previous evidence (Larsson, 2001; Warren and sucking habits on the occurrence of malocclusion. However,
Bishara, 2002) that showed a greater maxillary constriction, the genetic influence of malocclusion occurrence was not
evaluated by intercanine/intermolar transverse distances, in considered in those studies.
subjects with prolonged sucking habits. Although data in this study about the sucking habits were
The different methods used in the present and reported gained retrospectively, when the children were approxi-
studies (Larsson, 2001; Warren and Bishara, 2002) may mately 5years of age, the selection criteria were very pre-
have influenced the results as it is possible that prolonged cise. Indeed, only subjects with a unilateral functional CB
sucking habits have a greater dental than skeletal effect, were included, exhibiting only a mild maxillary constric-
resulting mainly in tooth movement. Further, in this study, tion and were compared with NCB subjects. As it has been
INFLUENCE OF ORAL HABITS ON PALATAL CONSTRICTION 711
previously shown (Primoi etal., 2011a), that subjects
with unilateral functional CB have only a mild maxillary
constriction compared with control subjects, the inclusion
of subjects with a mild/no maxillary constriction may have
influenced the results. Indeed, it has been reported that 40%
of children with a history of sucking habit (thumb, finger,
or pacifier) did not exhibit malocclusion, while 16% of
those with no habits had malocclusion (Svedmyr, 1979).
Therefore, the mild maxillary constriction in subjects with
unilateral functional CB could not be influenced by the
presence or absence of prolonged sucking habits.
Previous studies (Melsen etal., 1987; Ovsenik, 2009)
also reported a correlation between posterior CB and
mouth-breathing pattern, showing that posterior CB is more
frequently seen in mouth-breathing subjects. Further, indi-
viduals with a mouth-breathing pattern have been classically
described as possessing a narrow, V-shaped maxillary arch
with a high palatal vault due to low tongue posture present
in mouth-breathing subjects (McNamara, 1980; McNamara,
1981). In this study, mouth breathing did not show a greater
prevalence of unilateral functional CB. Even more, no dif-
ferences in palatal surface area and volume were seen
between the mouth and nose breathers. Moreover, the nega-
tive correlation seen for mouth breathing with the intermo-
lar distance, although statistically significant, was little and
likely with very minimal clinical relevance. The contrast-
ing results in this study may be due to different age group
selection in different studies. Evidence shows that only a
prolonged lower tongue posture may have an influence on
the morphological characteristics of the jaws, however,
mainly on the mandible (Primoi etal., 2012). In fact, this
study included very young subjects in the primary dentition;
therefore, it is possible that the mouth breathing effect has
not yet resulted in a morphological change. Further, the con-
trasting results of the reported and present study could be
also due to the fact that maxillary morphology was assessed
three dimensionally in this study. Moreover, a clear defini-
tion of the malocclusion analysed, i.e. unilateral functional
CB, was made herein, while in the reported studies generally
posterior CB was examined.
Of note, even the interactions of the presence of CB, pro-
longed sucking habits, and mouth breathing with the inter-
canine and intermolar distance, palatal surface area, and
volume were not significant in a three-way analysis of vari-
ance (data notshown).
Therefore, according to the results of this study, it could
be concluded that the maxillary constriction present in uni-
lateral functional CB in the primary dentition is not influ-
enced by the presence or absence of prolonged sucking
habits and/or mouth breathing.
Conclusions
Subjects with unilateral functional CB have a maxillary
constriction compared with NCB subjects, in terms of
shorter maxillary arch widths and smaller palatal volume.
Further, this maxillary constriction in unilateral functional
CB subjects might not be influenced by the presence or
absence of prolonged sucking habits or by the breathing
pattern.
References
Allen D, Rebellato J, Sheats R, Ceron A M 2003 Skeletal and dental contri-
butions to posterior crossbites. Angle Orthodontist 73: 515524
Carlson D S 2005 Theories of craniofacial growth in the Postgenomic Era.
Seminars in Orthodontics 11: 172183
Cohen J 1992 A power primer. Psychological Bulletin 112: 155159
Farnik F, Rudel D 1995 Detektor dihanja -- nov pripomoek pri
funkcionalni diagnostiki malokluzij. Zobozdravstveni Vestnik 50:
244247
Franchi L, Baccetti T 2005 Transverse maxillary deficiency in classII and
classIII malocclusions: a cephalometric and morphometric study on
postero-anterior films. Orthodontics & Craniofacial Research 8: 2128
Gracco A, Malaguti A, Lombardo L, Mazzoli A, Raffaeli R 2009 Palatal
volume following rapid maxillary expansion in mixed dentition. Angle
Orthodontist 80: 153159
Hannuksela A, Vnnen A 1987 Predisposing factors for malocclusion in
7-year-old children with special reference to atopic diseases. American
journal of Orthodontics and Dentofacial Orthopedics 92: 299303
Keating A P, Knox J, Bibb R, Zhurov A I 2008 A comparison of plaster,
digital and reconstructed study model accuracy. Journal of Orthodontics
35: 191201
Keski-Nisula K, Lehto R, Lusa V, Keski-Nisula L, Varrela J 2003
Occurrence of malocclusion and need of orthodontic treatment in early
mixed dentition. American Journal of Orthodontics and Dentofacial
Orthopedics 124: 631638
Kurol J, Berglund L 1992 Longitudinal study and cost-benefit analysis of
the effect of early treatment of posterior cross-bites in the primary denti-
tion. European journal of Orthodontics 14: 173179
Kurol J, Thilander B 1984 Infraocclusion of primary molars and the effect
on occlusal development, a longitudinal study. European Journal of
Orthodontics 6: 277293
Larsson E 2001 Sucking, chewing, and feeding habits and the development
of crossbite: a longitudinal study of girls from birth to 3years of age.
Angle Orthodontist 71: 116119
Larsson E, Ogaard B, Lindsten R 1992 Dummy- and finger-sucking hab-
its in young Swedish and Norwegian children. Scandinavian Journal of
Dental Research 100: 292295
Linder-Aronson S 1970 Adenoids. Their effect on mode of breathing
and nasal airflow and their relationship to characteristics of the facial
skeleton and the denition. Abiometric, rhino-manometric and cepha-
lometro-radiographic study on children with and without adenoids. Acta
Oto-laryngologica 265: 1132
Malandris M, Mahoney E K 2004 Aetiology, diagnosis and treatment of
posterior cross-bites in the primary dentition. International Journal of
Paediatric Dentistry 14: 155166
McNamara J A 1981 Influence of respiratory pattern on craniofacial
growth. Angle Orthodontist 51: 269300
McNamara J A Jr 1980 Functional determinants of craniofacial size and
shape. European Journal of Orthodontics 2: 131159
Melsen B, Attina L, Santuari M, Attina A 1987 Relationships between
swallowing pattern, mode of respiration, and development of malocclu-
sion. Angle Orthodontist 57: 113120
Melsen B, Stensgaard K, Pedersen J 1979 Sucking habits and their influ-
ence on swallowing pattern and prevalence of malocclusion. European
Journal of Orthodontics 1: 271280
Mew J R 1986 Factors influencing mandibular growth. Angle Orthodontist
56: 3148
712 J. PRIMOI ET AL.
Ogaard B, Larsson E, Lindsten R 1994 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: 161166
Oliveira N L, Da Silveira A C, Kusnoto B, Viana G 2004 Three-dimensional
assessment of morphologic changes of the maxilla: a comparison of 2
kinds of palatal expanders. American Journal of Orthodontics and
Dentofacial Orthopedics 126: 354362
Ovsenik M 2009 Incorrect orofacial functions until 5years of age and their
association with posterior crossbite. American Journal of Orthodontics
and Dentofacial Orthopedics 136: 375381
Perinetti G, Baccetti T, Di Leonardo B, Di Lenarda R, Contardo L 2011
Dentition phase and chronological age in relation to gingival crevicu-
lar fluid alkaline phosphatase activity in growing subjects. Progress in
Orthodontics 12: 100106
Perinetti G, Contardo L 2009 Posturography as a diagnostic aid in den-
tistry: a systematic review. Journal of Oral Rehabilitation 36: 922936
Perinetti G, Di Leonardo B, Di Lenarda R, Contardo L 2012 Repeatability
of gingival crevicular fluid collection and quantification, as determined
through its alkaline phosphatase activity: implications for diagnostic use.
Journal of Periodontal Research doi: 10.1111/j.1600-0765.2012.01508.x
Primoi J, Baccetti T, Franchi L, Richmond S, Farcnik F,Ovsenik M 2011a
Three-dimensional assessment of palatal change in a controlled study
of unilateral posterior crossbite correction in the primary dentition.
European Journal of Orthodontics 35: 199204
Primoi J, Farcnik F, Richmond S, Perinetti G,Ovsenik M 2012 The asso-
ciation of tongue posture with the dentoalveolar maxillary and mandibu-
lar morphology in classIII malocclusion: a controlled study. European
Journal of Orthodontics 35: 388393
Primoi J, Ovsenik M, Richmond S, Kau C H, Zhurov A 2009 Early
crossbite correction: a three-dimensional evaluation. European Journal
of Orthodontics 31: 352356
Primoic J, Perinetti G, Richmond S, Ovsenik M 2012 Three-dimensional
longitudinal evaluation of palatal vault changes in growing subjects.
Angle Orthodontist 82: 632636
Primoi J, Richmond S, Kau C H, Zhurov A, Ovsenik M 2011b Three-
dimensional evaluation of early crossbite correction: a longitudinal
study. European Journal of Orthodontics 35: 713
Springate S D 2012 The effect of sample size and bias on the reliability of
estimates of error: a comparative study of Dahlbergs formula. European
Journal of Orthodontics 34: 158163
Svedmyr B 1979 Dummy sucking. Astudy of its prevalence, duration and
malocclusion consequences. Swedish Dental Journal 3: 205210
Warren J J, Bishara S E 2002 Duration of nutritive and nonnutritive suck-
ing behaviors and their effects on the dental arches in the primary den-
tition. American Journal of Orthodontics and Dentofacial Orthopedics
121: 347356
Warren J J, Bishara S E, Steinbock K L, Yonezu T, Nowak A J 2001 Effects
of oral habits duration on dental characteristics in the primary dentition.
Journal of the American Dental Association 132: 168593