crossbite
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This document discusses the definition, etiology, classification, clinical features, diagnosis, and management of cross bites. Cross bites can be anterior or posterior and can have dental, skeletal, or functional causes. Management involves correcting the cross bite through various appliances depending on the stage of dentition, from simple elastics in primary dentition to more complex appliances like face masks or orthognathic surgery in permanent dentition. The goal is to intercept and correct cross bites early to prevent progression to more severe malocclusions requiring prolonged treatment.
![Etiology of cross bite
Etiology of Anterior cross bite Etiology of posterior cross bite
[I] Dental Causes
1. Traumatic injury to primary dentition that1. Prolonged retention of primary tooth.
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 2. Ectopic eruption of the permanent first molar.
4. Cleft lip repair cases 3. Prolonged thumb or finger sucking.
5. Arch length inadequacy 4. Cleft palate cases.
Causing lingual deflection of permanent
tooth during eruption.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-4-320.jpg)
![Etiology of Anterior cross bite Etiology of posterior cross bite
[II] Skeletal Causes
1. Genetic. 1. Genetic.
2. Due to deficient anterior growth of maxilla 2. Due to deficient lateral growth of
maxilla.
Eg. In cleft palate cases
se Stimulation in mid palatal suture
se Lateral maxillary growth
3. Excessive abnormal mandibular growth in3. Excessive abnormal mandibular growth
anteriorly. laterally.
4. Combination of both 2. & 3. 4. Combination of both 2. & 3.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-5-320.jpg)
![Etiology of Anterior cross bite Etiology of Posterior cross bite
[III] Functional Cross bite
1. Pseudo class III 1.Unilateral posterior cross bite
2. Habitual forward positioning of the mandible Due to occlusal interferences
to obtain maximum intercuspation may lead
to an anterior cross bite.
Deviation of mandible during jaw closure](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-6-320.jpg)
![CLASSIFICATION
[I] Based on Location
Cross bite
ANTERIOR CROSS BITE POSTERIOR CROSS BITE
a. According to no. of teeth involved a. According to no. of teeth involved
Single tooth Segmental Single tooth Segmental
Cross bite Cross bite Cross bite Cross bite
b. According to side involved
Unilateral Bilateral
c. According to extent
Single posture Buccal Lingual
Cross bite Non-occlusion Non-occlusion](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-7-320.jpg)
![[II] Based on the Etiologic Factor
Cross bite
Skeletal Dental Functional
Crossbite Crossbite Crossbite](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-8-320.jpg)
![[A] MANAGEMENT OF
ANTERIOR CROSSBITE
In 4 stages
[I] In primary [II] In mixed [III] In permanent [IV] In post
dentition dentition dentition permanent dentition](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-18-320.jpg)
![[I] IN PRIMARY DENTITION:
(Preventive orthodontic)
Elimination of the factors that may lead to the anterior cross bite
Eg –
Removal of occlusal prematurities
Extraction of supernumerary tooth before they cause displacement
of other tooth.
Habit breaking appliance.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-19-320.jpg)
![[II] IN MIXED DENTITION:
Interceptive orthodontics
(In 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.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-20-320.jpg)
![[3] Double cantilever spring / z-spring
Indication
Used when anterior cross bite
involving 1 or 2 max. anterior
teeth. Pre-treatment
Disadvantage
Effective only when there is
During treatment
enough space for aligning the
teeth.
Post-treatment](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-24-320.jpg)
![[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
Protraction face mask or Reverse head gear
If maxilla is narrow
RME screw also used for transverse expansion.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-26-320.jpg)
![[6] Frankel III appliance
Used to correct skeletal class III Malocclusion.
[7] Chin cap appliance
Used to correct or prevent the anterior
cross bite due to a prominent mandible.
Chin cap appliance rotate mandible
backward and downward.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-27-320.jpg)
![[III] IN PERMANENT DENTITION (In Adolescent & Adult)
(1) Screw appliance
Mini screw May be used to correct single
Medium screw tooth or segmental cross bite.
Adequate space is required to correct the anterior cross bite
Otherwise results will be compromised
(2) Fixed Appliance
Used to correct single tooth or multiple tooth
[IV] IN POST PERMANENT DENTITION
Surgical orthodontist
(After the active growth is complete)](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-28-320.jpg)
![[B] MANAGEMENT OF POSTERIOR CROSS BITE
[1] CROSS BITE ELASTICS
Indication
Single tooth cross bite involving molars
can be treated by elastics
Elastics are stretched b/w the max palatal
surfaces and mandibular buccal surface.
[Worn day & night & treatment should
not be continued for more than a weeks
because elastics can extrude the teeth].
[2] COFFIN SPRING
Omega shaped wire appliance is capable
of correcting cross bite in the young
developing dentition.
Expansion produced is slow & bilaterally
symmetrical.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-29-320.jpg)
![[3] QUAD HELIX APPLIANCE
A spring that consists of 4 helices
Being soldered to the molar bands that are
commented generally on the first
permanent max. molars.
Capable of dentoalveolar expansion of the
molar as well as premolar region (slow
expansion).
It can be reactivated by 3 prong wires
without having to be removed.](https://image.slidesharecdn.com/32074443-crossbite-ortho-120103101756-phpapp02/85/crossbite-30-320.jpg)
crossbite
- 1. Cross Bite
- 2. CONTENTS 1. Definition 2. Etiology 3. Classification 4. Clinical Features 5. Diagnosis 6. Management
- 3. DEFINITION: According to Graber: Cross bite is a condition where one or more teeth may be abnormally malposed buccal or lingually or labially with reference to opposing teeth.
- 4. Etiology of cross bite Etiology of Anterior cross bite Etiology of posterior cross bite [I] Dental Causes 1. Traumatic injury to primary dentition that1. Prolonged retention of primary tooth. 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 2. Ectopic eruption of the permanent first molar. 4. Cleft lip repair cases 3. Prolonged thumb or finger sucking. 5. Arch length inadequacy 4. Cleft palate cases. Causing lingual deflection of permanent tooth during eruption.
- 5. Etiology of Anterior cross bite Etiology of posterior cross bite [II] Skeletal Causes 1. Genetic. 1. Genetic. 2. Due to deficient anterior growth of maxilla 2. Due to deficient lateral growth of maxilla. Eg. In cleft palate cases se Stimulation in mid palatal suture se Lateral maxillary growth 3. Excessive abnormal mandibular growth in3. Excessive abnormal mandibular growth anteriorly. laterally. 4. Combination of both 2. & 3. 4. Combination of both 2. & 3.
- 6. Etiology of Anterior cross bite Etiology of Posterior cross bite [III] Functional Cross bite 1. Pseudo class III 1.Unilateral posterior cross bite 2. Habitual forward positioning of the mandible Due to occlusal interferences to obtain maximum intercuspation may lead to an anterior cross bite. Deviation of mandible during jaw closure
- 7. CLASSIFICATION [I] Based on Location Cross bite ANTERIOR CROSS BITE POSTERIOR CROSS BITE a. According to no. of teeth involved a. According to no. of teeth involved Single tooth Segmental Single tooth Segmental Cross bite Cross bite Cross bite Cross bite b. According to side involved Unilateral Bilateral c. According to extent Single posture Buccal Lingual Cross bite Non-occlusion Non-occlusion
- 8. [II] Based on the Etiologic Factor Cross bite Skeletal Dental Functional Crossbite Crossbite Crossbite
- 9. Clinical Features Anterior cross bite Posterior cross An abnormal labiolingual bite abnormal An buccolingnal relationship (reverse overjet) relationship of teeth in the between one or more maxilary maxilla and mandible when the 2 and mandibular anterior teeth. dental arches are brought into Centric Occlusion.
- 10. Single tooth Segmental crossbitesingle tooth crossbite Involve only Involve a segment of arch
- 11. Unilateral cross Bilateral cross bite bite Involving and side of arch Involving both side of arch
- 12. Simple posterior crossbite -Seen most frequently in clinical practice - buccal cusp of one or more maxillary posterior teeth occlude lingual to the buccal cusps of the mandibular teeth.
- 13. Buccal Non- Palatal/Lingual Non- occlusion (Scissors occlusion bite) - Maxillary posterior - Maxillary posterior occlude entirely on the teeth occlude entirely on lingual aspect of the the buccal aspect of the mandibular posterior. mandibular posteriors.
- 14. Skeletal cross bite Discrepancy in the size of maxilla & mandible. Causes :- 1. Inherited 2. Defective embryological development.
- 15. Anterior crossbite due to maxillary retrognathism. Anterior crossbite due to mandibular prognathism. Anterior crossbite due to maxillary retrognathism and mandibular prognathism.
- 16. Dental cross bite: Causes of anterior dental cross bite 1. Lingual eruption path of maxillary anterior teeth. 2. Trauma to deciduous dentition in which there is displacement of tooth buds 3. Retained deciduous causing lingual eruption of permanent teeth. 4. Supernumerary teeth. Functional Cross bite: Habitual forward positioning of mandible (pseudo class III)
- 17. DIAGNOSIS 1. History 2. Clinical Examination 3. Study Models 4. Radiograph 1. Lateral cephalogram (for anterior cross bite) 2. PA view of cephalogram (for posterior cross bite) Patient with anterior skeletal cross bite (Lateral cephalogram)
- 18. [A] MANAGEMENT OF ANTERIOR CROSSBITE In 4 stages [I] In primary [II] In mixed [III] In permanent [IV] In post dentition dentition dentition permanent dentition
- 19. [I] IN PRIMARY DENTITION: (Preventive orthodontic) Elimination of the factors that may lead to the anterior cross bite Eg – Removal of occlusal prematurities Extraction of supernumerary tooth before they cause displacement of other tooth. Habit breaking appliance.
- 20. [II] IN MIXED DENTITION: Interceptive orthodontics (In 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.
- 21. (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. It is placed inside the mouth contacting the palatal aspect of the maxillary teeth. 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.
- 22. 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. (2) Catlan’s appliance or lower anterior inclined plane Indications - Used only in those cases where the cross bite is due to a palataly placed max incisors. (Constructed at 450 angulations on the lower anterior teeth by acrylic or cast metal).
- 23. 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 Anterior open bite 5) Can not be given if Mandibular incisors are malaligned Mandibular incisors are periodontally compromised
- 24. [3] Double cantilever spring / z-spring Indication Used when anterior cross bite involving 1 or 2 max. anterior teeth. Pre-treatment Disadvantage Effective only when there is During treatment enough space for aligning the teeth. Post-treatment
- 25. (4) Screw appliance (i) Micro screw Used on individual tooth Multiple micro screw can be used to correct individual tooth in segmental cross bite (ii) Mini screw Capable of moving up to 2 teeth (iii) Medium screw Used to correct segmental cross bite (iv) 3-D screw (3-dimensional screw) Capable of correcting posterior as well as anterior cross bite
- 26. [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 Protraction face mask or Reverse head gear If maxilla is narrow RME screw also used for transverse expansion.
- 27. [6] Frankel III appliance Used to correct skeletal class III Malocclusion. [7] Chin cap appliance Used to correct or prevent the anterior cross bite due to a prominent mandible. Chin cap appliance rotate mandible backward and downward.
- 28. [III] IN PERMANENT DENTITION (In Adolescent & Adult) (1) Screw appliance Mini screw May be used to correct single Medium screw tooth or segmental cross bite. Adequate space is required to correct the anterior cross bite Otherwise results will be compromised (2) Fixed Appliance Used to correct single tooth or multiple tooth [IV] IN POST PERMANENT DENTITION Surgical orthodontist (After the active growth is complete)
- 29. [B] MANAGEMENT OF POSTERIOR CROSS BITE [1] CROSS BITE ELASTICS Indication Single tooth cross bite involving molars can be treated by elastics Elastics are stretched b/w the max palatal surfaces and mandibular buccal surface. [Worn day & night & treatment should not be continued for more than a weeks because elastics can extrude the teeth]. [2] COFFIN SPRING Omega shaped wire appliance is capable of correcting cross bite in the young developing dentition. Expansion produced is slow & bilaterally symmetrical.
- 30. [3] QUAD HELIX APPLIANCE A spring that consists of 4 helices Being soldered to the molar bands that are commented generally on the first permanent max. molars. Capable of dentoalveolar expansion of the molar as well as premolar region (slow expansion). It can be reactivated by 3 prong wires without having to be removed.
- 31. (4) R.M.E. Hyrax screw (5) NiTi expanders Nickel titanium wire shapes NiTi expander place in a cleft Welded to molar bands that case are cemented to the maxillary permanent molars (6) Fixed orthodontic Appliance Used for correction of posterior cross bite