Clinical case report: anterior crossbite of four upper permanent incisors treated with increases in photocured resin based on the principles of dr. Pedro Planas in primary health care in the Maule region of Chile

The previous cross bite in mixed dentition represents a functional impairment that can affect craniofacial growth and neuromuscular organization. Early intervention is important to avoid the establishment of structural compensation, especially in primary health care [PHC]. When accessible, conservative and cost-effective approaches are desired. To describe the clinical management of a 10-year-old female patient in the second phase of mixed dentition, who presented an earlier cross bite compromising the four superior permanent incisors, associated with facial asymmetry, an inclined occlusal plane and a unilateral masticatory pattern, based on the principles of neuro occlusal rehabilitation. The clinical case corresponds to a patient of the telemedicine platform, asynchronous teleorthodontic model with specialized remote support in the region of Maule in Chile. The clinical records, including panoramic radiography and extraoral and intraoral photographs, were presented through a digital platform for evaluation by specialists in orthodontics and functional orthopedics of the maxillary. The therapeutic plan consisted of modifying the vertical dimension with photocuring resin increments applied to remaining primary teeth, selective occlusal adjustments and functional orientation towards a physiological masticatory pattern. All subsequent clinical modifications were provided digitally and implemented in the primary care dental team under specialized supervision every 30 days. Due to the eruption of the superior permanent incisors in this clinical case, an individualized adaptation of the conventional approach was made using resin increments on the remaining primary teeth. For 18 months, a progressive improvement of the previous cross bite was observed, accompanied by normalization of the occlusal plane, evolving from an abnormal configuration to an orthognathic relationship, as well as modifications in the previous guide. The masticatory pattern shifted progressively from one-sided chewing to bilateral alternation. In this clinical case, the resin increments were adjusted gradually to avoid interference during the permanent tooth eruption. On the one hand, the use of photocured resin increments in the remaining primary teeth, associated with selective occlusal adjustments and functional rehabilitation, was associated with favorable clinical changes in anterior occlusion and masticatory function. On the other hand, the case presented illustrates the feasibility of providing specialized support through asynchronous teleorthodontic in primary health care. As this is a unique clinical case, findings should be interpreted with caution, and additional studies are required to assess the stability and reproducibility of this therapeutic approach.