MANAGEMENT OF CROSSBITE
Dr MOHAMED JASIM O
SENIOR LECTURER
DEPT OF ORTHODONTICS
American association of orthodontist defines crossbite as : An abnormal relationship of tooth or teeth to the opposing tooth or teeth in which normal buccolingual or labiolingual relationships are reversed.
· BASED ON LOCATION
ANT. CROSSBITE POST.CROSSBITE
NO. OF TEETH NO. OF TEETH SIDE INVOLVED
UNILATERAL BILATERAL
SINGLE SEGMENTAL
SINGLE SEGMENTAL
· BASED ON ETIOLOGICAL FACTOR
CROSSBITE
SKELETAL FUNCTIONAL
CROSSBITE DENTAL CROSSBITE
CROSSBITE
Etiology
Dental factors: trauma to primary teeth or to the permanent tooth bud, over retained primary tooth, supernumerary teeth, inadequate arch length, lip biting, repaired cleft lip or palate,
SKELETAL : Excessive mandibular growth, Genetic or inherited cleft palates where there is retrognathic maxilla.
FUNCTIONAL CROSSBITE: Due to functional interference of mandible during closure.
This is because of premature contact and leads to pseudo class 3 malocclusion.
· Number of teeth involved: single tooth
indicates local origin and dental crossbite .
· Location of tooth in crossbite : any deflection
from original position or inclination indicates
dental cross bite.
· Functional path of closure of mandible and
occlusal prematurities : simple occlusal
grinding may eliminate development of cross
bite.
· Molar and canine relationships: will be class
1 for dental crossbite in centric occlusion. In
true skeletal cross bites the molar and
canine relationship will be class 3.
· Radiographic findings: lateral cephalogram
is useful to find out skeletal discrepancy and
axial inclination of incisors.
· IN 4 STAGES
⮚ IN PRIMARY DENTITION
⮚ IN MIXED DENTITION
⮚ IN PERMANENT DENTITION
⮚ IN POST PERMANENT DENTITION
· (PREVENTIVE ORTHODONTIC)
ELIMINATION OF FACTORS
▪ OCCLUSAL PREMATURITIES
▪ SUPERNUMERARY TOOTH
▪ HABITS
· (INTERCEPTIVE ORTHODONTIC )
TREATMENT BASED ON :
⮚ INSIOR POSITIONING AND SPACE AVAILABLE
⮚ STAGE OF ERUPTION
⮚ DEGREE OF OVERBITE
· Correction of pseudo class 3 anterior cross bite may
require only the removal of premature contact by incisal
grinding of maxillary or mandibualr incisors.
· TONGUE BLADE
Ideally suited for a case of one tooth anterior cross bite. Lower incisor acts a s fulcrum. Tongue blade placed 45 degree behind the locked tooth. used for 1 to 2 hors for 10 to 14 days daily.
⮚ INDICATIONS:
1.INCISORS STILL ERUPTING
2.ADEQUATE SPACE
3.NO MAJOR OVERBITE
⮚ DISADVANTAGES:
1.EFFECTIVE TILL CLINICAL
CROWN NOT COMPLETELY
ERUPTED
2.PATIENT CO-OPERATION
Introduced by catlan . A lower acrylic inclined plane
is cemented and the plane should be at 45 degree
angle to the long axis of lower incisor teeth.
INDICATION:
Treatment of dental anterior cross bite involving one
or more teeth can be accomplished.
DISADVANTAGES :
⮚ Difficulty in speech and chewing.
⮚ Patient cooperation is needed.
⮚ Possibilty of opening the bite if used for more than 2
or 3 weeks.
⮚ CANNOT BE GIVEN IF
MANDIBULAR TEETH MALALLlGNED
PERIODONTICALLY COMPROMISED
· Maxillary hawley’s appliance with z spring incorporated into the
acrylic resin.
· Retention can be obtained by use of ball clasps, adams or c type clasps.
· Movement of the in locked incisors is accomplished by activating the
spring 1.5 to 2mm per weeks.
· If the bite is deeper than normal then a slight opening of the bite may
be desirable by means of a bite plane.
❑ DOUBLE CANTILEVER
SPRING/Z- SPRING
INDICATION:
WHEN INVOLVE 1 - 2 MAXILLARY
ANT. TEETH
DISADVANTAGES
EFFECTIVE ONLY WHEN SPACE
AVAILABLE
FACE MASK
INDICATION:
SKELETAL ANTERIOR CROSBITE
⮚ FRANKEL III APPLIANCE
- SKELETAL CLASS III
MALOCCLUSION
⮚ CHIN CAP APPLIANCE
- PREVENT OR CORRECT ANT.
CROSSBITE
DUE TO PROMINENT MANDIBLE
[III] IN PERMANENT DENTITION
⮚ SCREW APPLIANCE:
MINI SCREW
MEDIUM TO CORRECT SINGLE OR
SCREW SEGMENTAL CROSSBITE
⮚ FIXED APPLIANCE:
TO CORRECT SINGLE OR MULTIPLE TEETH
[IV] IN POST PERMANENT DENTITION :
SURGICAL ORTHODONTIST
DEFINITION: a transverse discrepancy in arch relationship in which the palatal cusps of one or more upper posterior teeth do not occlude in the central fossae of opposing lower teeth.
Dental factors :
Insufficent arch length leads to lingual or buccal deflection of teeth during eruption,
Over retained primary teeth leads to lateral shift of mandible,
Ectopic eruption and prolonged thumb sucking.
Skeletal factors:
Asymmetric growth of maxilla or mandible: inherited growth pattern, trauma, long standing functional problem.
Difference in basal width of maxilla and mandible: constricted maxilla cleft palate
· Posterior crossbite present as any one of the
combination
lingual crossbite
buccal crossbite
complete lingual crossbite
· Usually in posterior single tooth crossbite, both the
antagonist teeth are tipped out of position.
· Bite elastics are effective in such cases.
· First any fuctional interfernce present is
eliminated by occlusal equlibration.
· Treatment of bilateral contraction -quad helix,
w -arch, RME.
· Treatment of unilateral cross bite- removable
plates, quad helix , w -arch and coffin spring.
· This may be due to narrow maxilla or mandible.
· Narrow maxilla:
mild cases -quad helix or w -arch
severe cases - RME
· Narrow mandible - usually associated with
retrognathic mandible- functional appliance.
· Severe cases treated by surgery.
· One of the oldest appliance still used in orthodontics.
· Broadly classified as:
Slow expansion appliance
rapid expansion appliance
Niti PALATAL EXPANDER
SARPE
JACKSCREW
RME
QUAD HELIX
COFFIN SPRING
· Designed primarily to produce dentoalveolar
changes.
· In young children might produce skeletal
changes with opening of midpalatal suture.
· Relieve crowding in minimal space discrepancy
(<4mm)
· Posterior dental crossbite in one or two teeth.
· Cleft palate cases with collapsed maxilla.
· Constricted maxillary arch.
response, less damage to teeth, produces skeletal
effect in young children.
than bodily expansion.
· Removable slow expansion :
Expansion plates with jack screws
Coffin springs
Removable quad helix
· Fixed slow expansion :
W – arch
Quad helix
Expansion screw
· Application of force to widen the maxilla causes
opening of midpalatal suture and then new bone
formation is induced.
· The space created in the midline is filled with tissue
fluids and blood.
· After 3 months new bone fills in the space.
Before 15yrs
Activate twice in a day
90 degree activation each time
0.5mm a day
Review after 1 week
15 -20 yrs
Activate 4 times a day
45 degree activation
0.5mm per day
Detection of these condition in primary dentition
can allow either intervention or monitoring on an
effective basis.
Deciding when or even whether to treat an
orthodontic problem in primary dentition is a
controversial issue.
· Better long term stability.
· Reduction in overall treatment complexity
and time.
· Better functional and aesthetic end results.
Transverse discrepancy between maxilla and mandible,
Anteroposterior skeletal discrepancy
Cleft palate
· Correct any habit that has contributed to the
aetiology of crossbite or monitor for
spontaneous correction.
· Remove tooth interferences or generate
cuspal guidance that prevents the patient
from biting into functional crossbite.
· Actively expand a constricted maxillary arch
using one of several removable or fixed
appliance.
· With upto 45% of posterior crossbites in the
primary dentition self correcting with
continued development of the dentition there
is no evidence at present time to support the
routine correction of crossbites in primary
dentition.
· CROSSBITE SHOULD BE CONSIDERED IN
THE CONTEXT OF PATIENT’S TOTAL
TREATMENT NEEDS:
· CROSSBITE CORRECTION
1.REDUCE DENTAL ATTRITION
2.IMPROVE DENTAL ESTHETICS
3.REDIRECT SKELETAL GROWTH
4.IMPROVE TOOTH TO ALVEOLUS
RELATIONSHIP
5.INCREASE ARCH PERIMETER
THANK YOU