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CROSS BITE.
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What is cross-bite?. Crossbite is a condition that describes malposed labiolingual relationship between one or more maxillary and mandibular teeth.
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C LASSI FICATION Based on Location OF CROSSBITE Based on Etiology 6.
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CLASSIFICATION OF CROSSBITE? COO [Elsevier-2008]. Etiological Factor Dental Functional Pseudo Class Ill Skeletal Habitual Acts.
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ETIOLOGICAL FACTORS COO 1. 2. Skeletal: Genetic predisposition (Inheritance). Embryological defective development. Dental: Lingual eruption path of maxillary anterior teeth. Trauma to deciduous dentition in which there is displacement of tooth buds. Retained deciduous causing lingual eruption of permanent teeth. Supernumerary teeth..
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ETIOLOGICAL 3. Functional: FACTORS COO a. b Habits: Digital or pacifier sucking habits. Oral Respiration. Low Tongue Position. Stomach Sleeping Posture. Tongue Thrusting. Pesudo Class Ill: Class I skeletal relationship. o Insuffecient maxillary overjet and incisor interference. Multi-tooth anterior crossbite may result from a functional shift of the mandible in an effort to avoid anterior interference in centric relation and to achieve maximum intercuspation..
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. III Based on Location Cross bite ANTERIOR CROSS BITE a. According to no. of teeth involved POSTERIOR CROSS BITE a. According to no. of teeth involved Single tooth Cross bite Segmental Cross bite Single tooth Cross bite Segmental Cross bite b. According to side involved Unilateral c. According to extent Single posture Cross bite Buccal Non-occlusion Bilateral Lingual Non-occlusion.
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DEFINITION OF ANTERIOR COO CROSSBITE? Anterior crossbite is defined as a malocclusion resulting from the lingual positioning of the maxillary anterior teeth in relationship to the mandibular anterior teeth. [7Sai HH-2001]. • This condition is also referred to as "Under-bite" or "Reversed Overjet'..
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EXAMPLE OF ANT. CROSS BITE th sitting bdtind.
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Posterior Crossbite. One or more posterior teeth locked in an abnormal relation with the opposing teeth of the opposite arch; can be either buccal or a lingual cross-bite and may be accompanied by a shift of the mandible..
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abstract. Unilateral crossbite. Bilateral crossbite.
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00. Palatal Width AB CD. . .
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Diagnosis. Clinical examination Study models Radiographs Figure out any habits.
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Rationale for Early Interceptive Treatment ? Little possibility for self-correction ? A crossbite in the primary dentition is believed to transfer to the permanent dentition. ? Postponing treatment results in prolonged treatment of greater complexity.
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Management.
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Management of anterior crossbite. MANAGEMENT: COO 1 -SKELETAL Choice of treatment depends upon the cause: Can be controlled during growth by growth 1. Skeletal: modification appliances, such as: Protraction facemasks . Protraction facemask therapy has been advocated in the treatment of Class Ill patients with maxillary deficiency. [Ngan P-1992], [McNamara JA-19871, [Turley P-1988]. If skeletal factors were not managed during the growth period, an orthognathic surgery will need to be the alternative treatment modality..
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TREATMENT : 17 SKELETAL 14 COO.
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MANAGEMENT: COO 2-DENTAL & FUNCTIONAL 2. Dental and Habitual Acts: • Bonded resin-composite slopes [Bayrak s-2008].
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MANAGEMENT: COO 2-DENTAL & FUNCTIONAL Reversed stainless steel crowns. The chief disadvantage of this method is the difficulty in adapting a preformed crown to fit the tooth in crossbite. Furthermore, the reversed stainless steel crown is an unaesthetic treatment that is often rejected by children and their relatives. [Crol/ TP-1996], [Crow-1999]..
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MANAGEMENT: COO 2-DENTAL & FUNCTIONAL Removable acrylic appliances with posterior bite opening platforms and anterior finger springs for labial tipping of maxillary teeth (Jacobs SG-1989]..
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MANAGEMENT: COO 2-DENTAL & FUNCTIONAL • Tongue Blade/Depressor. The tongue blade can also be an effective method of treatment during the early phase of eruption; however, it requires total cooperation from the patient, which in most cases is difficult to obtain.
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MANAGEMENT: COO 2-DENTAL & FUNCTIONAL • Lower acrylic inclined-bite-plane is another effective treatment method; however, it requires a laboratory phase, which increases the price of treatment, and the cement used with this type of appliance may cause gingivitis. [Croll TP-1988], [Crow-1988]..
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. Fixed appliance.
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Treatment of cross bite. Occlusal equilibrium Coffin spring Cross elastics Soldered w arch Quad helix Rapid maxillary expansion Ni ti expanders.
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Selective grinding of teeth ? For slight maxillary constriction due to primary canine interferences ? Functional shift of the mandible eliminated and the mandible allowed to assume its natural position ? Usually contraindicated for permanent teeth.
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Elastics ? When only few posterior teeth in crossbite and crossbite is caused by a mere tipping ? Use cross elastics if both arches contribute to the crossbite problem ? Overcorrect and leave the bands in place right after active treatment ? In case of relapse, reinstate the elastics ? The major problem - patient cooperation.
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Palatal expansion ? Opening of the midpalatal suture is possible until about age 16 or 17 before the maxillary sutures fuse ? After fusion, the suture may be opened with a surgical assist and a fixed rapid palatal expander (RPE).
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Fixed rapid palatal expansion (RPE). . Haas Expander: A fixed maxillary expander that uses acrylic pads and heavy lingual wires to apply pressure to both the teeth and the palatal tissue during expansion..