Management of Cross Bite

crossbitesteeth may be abnormally malposed buccal or
lingually or labially with reference to opposing
teeth.
DEFINITION:
the upper and lower teeth. By convention the
transverse relationship of the arches is described in
terms of the position of the lower teeth relative to
the upper teeth.
POSTERIOR CROSS BITE
Single tooth
Cross bite
Unilateral Bilateral
Skeletal
Crossbite
Dental
Crossbite
Functional
Crossbite
Anterior Posterior
Skeletal Dental Functional
crossbite crossbite crossbite
relationship (reverse overjet)
and mandibular anterior teeth.
maxilla and mandible when the 2
dental arches are brought into
Centric Occlusion.
Clinical Features
single tooth crossbite Segmental tooth crossbite
(2) According to existence on one/both sides of arch
unilateral bilateral
skeletal dental functional
Lingual
Buccal cusp of one/more The maxillary posteriors occlude Maxillary posteriors
teeth occlude lingual to entirely on buccal aspect of occlude entirely on
the buccal cusp of mandibular posteriors.Also known as lingual aspect of
mandibular teeth
buccal to the buccal cusps of the upper teeth
This crossbite is typically associated with an underlying skeletal discrepancy. often a Class II malocclusion with the upper arch further
forward relative to the lower so that the lower buccal teeth occlude with a wider segment of the upper arch
Buccal cross bite
lingual to the lingual cusps of the upper teeth
Single tooth crossbite
Unilateral cross bite
Simple posterior crossbite
practice
posterior teeth occlude lingual to the
buccal cusps of the mandibular teeth.
Buccal Non-occlusion (Scissors bite)
mandibular posteriors.
[I] Dental Causes
1. Traumatic injury to primary dentition that causes a lingual displacement of permanent tooth bud.
Persistance of a deciduous tooth
Palatal deflection of its erupting successor
Single tooth anterior cross bite 2. Super numerary tooth. 3. A habit of biting the upper lip 4. Cleft lip repair cases
5. Arch length inadequacy
Etiology of posterior cross bite
1. Prolonged retention of primary tooth.
2. Ectopic eruption of the permanent first molar. 3. Prolonged thumb or finger sucking.
4. Cleft palate cases.
[II] Skeletal Causes
3. Excessive abnormal mandibular growth in anteriorly.
4. Combination of both 2. & 3.
1. Genetic.
2. Due to deficient lateral growth of maxilla. Eg. In cleft palate cases
se Stimulation in mid palatal suture
se Lateral maxillary growth
Etiology of Posterior cross biteEtiology of Anterior cross bite
[III] Functional Cross bite
1. Pseudo class III
cross bite.
closure
The most common local cause is crowding where one or two teeth are displaced from the arch
early loss of a second deciduous molar causing a second premolar to erupt palatally/lingually
retention of a primary tooth can deflect the eruption of the permanent successor leading to a cross bite.
Mismatch in the relative width of the arches e.g in thumb sucking, can cause skeletal crossbite if not treated early for habits.
Crossbite in ceft lip & palate cases
an anteroposterior discrepancy, which results in a wider part of one arch occluding with a narrower part of the opposing jaw e.g sk.cl II, sk cl III
Skeletal cross bite Discrepancy in the size of maxilla & mandible. Causes :-
1. Inherited
2. Defective embryological development. Cross bites can also be associated with true skeletal asymmetry e.g trauma to TMJ, Hemifacial microsomia, Hemimandibular hypertrophy
Anterior crossbite due to
2. PA view of cephalogram (for posterior cross bite)
Patient with anterior skeletal
cross bite (Lateral cephalogram)
MANAGEMENT OF ANTERIOR CROSSBITE
1. Primary dentition stage
2. Mixed Dentition stage
3. Permanent dentition stage
IN PRIMARY DENTITION: (Preventive orthodontic)
Elimination of the factors that may lead to the anterior cross bite—
Eg –
Habit breaking
pre-adolescent age group)
Anterior cross bite should be treated at an early stage.
Because
(i) If a cross bite present in the deciduous dentition, it may manifest in
the mixed & permanent dentition as well.
(ii) If a simple anterior cross bite is not treated in early stage
It may progress into skeleton malocclusion that later need
complicated orthodontic treatment or surgical treatment.
A developing cross bite can be managed by:
1) Tongue blade therapy
3) Posterior bite block
(1)Use of tongue blade Indications
Used when a cross bite is seen at the time the
permanent teeth are making an appearance in the
oral cavity.
aspect of the maxillary teeth at 45 degree
Upon slight closure of jaw the opposing side of the
stick come in contact with the labial aspect of the
opposing mandibular tooth acts as a fulcrum.
This is continued for 1-2 hours for
about 2 weeks.
cross bite is due to a palataly place
Single or two max incisors during
eruption of these teeth.
lower anterior teeth by acrylic or cast
metal d
Drawbacks of using tongue blade
-Only effective till the clinical crown not completely erupted in the oral
cavity.
=Used only if sufficient space is available for the correction.
=Patients cooperation is required.
Disadvantages of Catlan’s Appliance
1) Difficulty in speech & chewing
2) Patient cooperation required
3) Require frequent recementation
4) Catlance appliance also as a anterior bite plane
Prevent the posterior teeth from coming into contact If prolonged use
Supra eruption of posterior teeth & can cause Anterior open bite
5) Can not be given if
Mandibular incisors are malaligned
Indication
involving 1 or 2 max. anterior
teeth.
Disadvantage
teeth.
Pre-treatment
(i) Microscrew
individual tooth in segmental cross bite
(ii) Mini screw
(iii) Medium screw
(iv) 3-D screw (3-dimensional screw)
Capable of correcting posterior as well as anterior cross bite
Correction of crossbite with fixd appliances
[5] Face mask (or face mask along with
RME) Indications - Used to correct skeletal anterior cross bite (Anterior cross bite due to actual
skeletal deficiency of the maxilla (SNA angle is less than normal)
Protraction face mask or Reverse head gear
If maxilla is narrow
[7] Chin cap appliance
due to a prominent mandible.(Skeletal Class III-
ANB angle is Less than 2 degree & more SNB
angle.)
backward and downward.
[6] Frankel III appliance Used to correct skeletal class III Malocclusion.
[III] IN PERMANENT DENTITION (In Adolescent & Adult)
(1) Screw appliance
tooth or segmental cross bite.
Adequate space is required to correct the anterior cross bite
Otherwise results will be compromised
(2) Fixed Appliance
[B] MANAGEMENT OF POSTERIOR CROSS BITE
1 CROSS BITE ELASTICS
Indication
s i n g l e tooth cross bite involvingmolars can be
treated by elastics
and mandibular buccal surface.
elastics can extrude the teeth].
2 COFFIN SPRING
O m e g a shaped wire appliance is capable 0of
correcting cross bite in the young developing
dentition.
symmetrical.
& soldered to the molar bands that is
cemmented generally on the first permanent
max. molars.
C a p a b l e of dentoalveolar expansionof the
molar as well as premolar region (slow
expansion
having to be removed from oral cavity
Done in adolescents and adults where strong interdigitation of suture is present
This creates 10 to 20 pounds of pressure across the suture-enough to create microfractures of interdigitating bone spicules
rate of 0.5 to I mm/day
2 to 3 week
The expansion device is left in place for 3 to 4 months new bone forms in the space at the suture, and the skeletal expansion is stable
NiTi expanders
maxillary permanent molars
Fixed orthodontic Appliance
NiTi
expander