MANAGEMENT OF

CROSSBITE

INTRODUCTION

Crossbites are term used to describe abnormal occlusion in transverse plane.

The term is also used to describe reverse

overjet of one or more anterior teeth.

NORMALCROSSBITESCISSORS BITE ORTELESCOPIC BITEis present when one or more of the adjacent posterior teeth are either positioned completely buccally or lingually to the antagonistic teeth and exhibit a verticaloverlap

DEFINITION

GRABER has defined cross bites as a condition where one or more teeth may be abnormally malposed buccally or lingually or labially with reference to opposing tooth or teeth.

CLASSIFICATIONBased on their location as:

ANTERIOR CROSSBITE and

POSTERIOR CROSSBITE

CLASSIFICATIONAccording to number of teeth involved

Anterior crossbite is again classified as

SINGLE TOOTH CROSSBITE and

SEGMENTAL CROSS BITE

Posterior Crossbite may be further classified according to the existence of the crossbite as

UNILATERAL CROSSBITE and

BILATERAL CROSS BITE

CLASSIFICATION Based on the location of etiologic factors asDENTAL CROSSBITEUsually result from arch length discrepancy or an abnormal path of eruption

SKELETAL CROSSBITE Due to malpositioning or malformation of jaws.This can be inherited(as in ClassIII skeletal pattern), congenital(Cleft lip and palate) or due to trauma at the time of birth(unilateral ankylosis of TMJ)

FUNCTIONAL CROSSBITEDue to presence of occlusal interferences

ETIOLOGY Persistence of a deciduous tooth Crowding or abnormal displacement of one or more

teeth Retarded development of maxilla in sagittal as well

as transverse direction Narrow upper arch Collapse of the upper arch Unilateral hypo or hyper plastic growth of any jaws Sagittal discrepancies of the jaws such as forwardly

positioned mandible. Presence of habits such as thumb sucking and

mouth breathing.

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 If left untreated, it can cause growth modifications and dental compensations May eventually lead to a permanent deviation and craniofacial asymmetry. Associated with an increase in condylar deviation and temporomandibular joint sounds

RATIONALE FOR EARLY INTERCEPTIVE TREATMENT

Interference with growth

of the middle third of the face Abnormal speech patterns Loss of arch integrity Periodontal disease Undesirable esthetics Root resorption of central incisors

CORRECTION OF ANTERIOR CROSS BITE

CORRECTION OF ANTERIOR CROSS BITE

INCLINED PLANE APPLIANCE

(CATALANS APPLIANCE) One of the simplest and most

effective means of correcting the lingual crossbite of a maxillary incisor is the use of an acrylic or cast metal inclined plane that is cemented to the mandibular incisors opposing to the tooth in crossbite.

INCLINED PLANE APPLIANCE(CATALANS APPLIANCE)

The lower inclined plane is constructed at an angle of 45 degee to the maxillary occlusal plane.

Cross bite gets corrected very fast and the appliance should not be kept in place for more than six weeks

If there is an open bite tendency the use of a guide plane is contraindicated.

INCLINED PLANE APPLIANCE(CATALANS APPLIANCE) ADVANTAGES1. Ease of fabrication2. Rapidity of correction using functional and muscle forces3. Lack of soreness or looseness of teeth during movement4. Rarity of relapse.DISADVANTAGES1 Strong limitation on diet during the wearing of the appliance2 Creation of a temporary speech defect 3 Tendency to create an anterior open bite if the appliance is left in

place too long.4 Possibility of the appliance becoming loose and requiring

recementation because of the strong occlusal stresses upon it.5 Imperfect alignment of the malposed tooth when the appliance is

removed.The dentist must rely on autonomous adjustment for the balance of correction

CORRECTION OF ANTERIOR CROSS BITEHAWLEY RETAINER WITH AUXILLARY SPRINGS

The most frequently used appliance for minor anterior crossbite treatment.

Acrylic palatal coverage and wire clasps

The auxilliary spring or Double cantilever springs activated to exert labial forces on and move the maxillary incisors.

CORRECTION OF ANTERIOR CROSS BITEHAWLEY RETAINER WITH AUXILLARY SPRINGS

The acrylic can be extended to create posterior bite plates to reduce the overbite and raise the bite.

CORRECTION OF ANTERIOR CROSS BITE APEX SPRING APLLIANCE

CORRECTION OF ANTERIOR CROSS BITEFACE MASK OR FACE MASK ALONG WITH RME

Anterior cross bite due to anactual skeletal deficiency of the maxilla can be corrected using a protraction facemask(reverse headgear).

If the maxilla is narrow a Rapid Maxillary Expansion screw can beUsed to aid in the transverse Expansion of the maxilla

CORRECTION OF ANTERIOR CROSS BITE CHIN CUP APPLIANCE Anterior cross bite due to a prominent

mandible can be corrected using a chin

cup appliance.

Chin cup appliance redirect the growth

of the mandible, and tends to rotate the

mandible backward and downward.

CORRECTION OF ANTERIOR CROSS BITEFRANKEL III APPLIANCE

Designed to activate muscle function to guide anterior growth of the maxilla(Stretches the soft tissue envelop around the maxilla stimulating its anterior growth)

Redirect growth of the mandible posteriorly.

Must be worn at least 14 hours/day

Effectiveness in controversy

Not the ideal choice for treatment of skeletal class III.

CORRECTION OF ANTERIOR CROSS BITE SCREW APPLIANCES

Acrylic appliances incorporating various size screws can be used to correct either individual tooth or segmental cross bites.MICRO SCREWS, MINI SCREWS OR MEDIUM SCREWS can be used for the purpose.

CORRECTION OF ANTERIOR CROSS BITE FIXED APPLIANCEFixed appliance can deliver slow light

continuous forces to correct single tooth or segmental anterior teeth cross bite at practically any age.

CORRECTION OF POSTERIOR CROSS BITE

CORRECTION OF POSTERIOR CROSS BITE COFFIN SPRINGIn1875 Coffin found the coffin spring

Capable of correcting cross bite in young developing dentition.

Appliance is removable and usually well tolerated.

Expansion produced is slow.

Disadvantage is that frequent activation is needed.

CORRECTION OF POSTERIOR CROSS BITE SCREW APPLIANCESVarious types of screws can be used to correct single tooth or segmental posterior tooth cross bites

CORRECTION OF POSTERIOR CROSS BITE

NITI PALATAL EXPANDERThese are nickel titanium wire shapes which are

attached to ligual sheath that are welded to molar bands cemented to maxillary first permanent molars.

Apply light continuous pressure on the mid palatal suture.

Self activated

Requires no adjustments

CORRECTION OF POSTERIOR CROSS BITE QUAD HELIX

In1947 Rickets introduced the quad helix Fixed Quad helix is soldered to molar bands cemented on first

permanent maxillary molars.Reactivation using three pong pliers is done without removing

the appliance.The appliance produce slow expansion in adolescent and adult

patients and skeletal effects in preadolescents.

Forces generated can be increased or decreased depending upon the amount of activation.

CORRECTION OF POSTERIOR CROSS BITE W-ARCH APPLIANCEUse to correct the bilateral constriction in primary dentition. Made of steel wire soldered to molar bands. The lingual wire should contact the teeth involved in cross bite & extend not more than 1-2mm distal to banded molars to eliminate soft tissue irritation. Lingual wire should remain 1-1.5 mm away from marginal gingival & the palatal tissue. Accelerates the rate of normal expansion of the mid palatal suture in a young child. The appliance delivers proper forces levels when opened 3-4 mm wider than passive width & should be adjusted to this dimension before being inserted.

CORRECTION OF POSTERIOR CROSS BITEFIXED RAPID PALATAL EXPANSION(RPE)

Rapid palatal expansion appliance can be used to correct posterior cross bite by expanding the arch bilaterally by opening the mid palatal suture.

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)

CORRECTION OF POSTERIOR CROSS BITE RAPID PALATAL EXPANDER is of

HYRAX TYPE and HAAS TYPE

More flexible than Haas expander.This again is of two types BANDED and BONDED

More tissue irritation. Haas expander uses acrylic pads and heavy lingual wires to apply pressure to both the teeth and the palatal tissue

CORRECTION OF POSTERIOR CROSS BITEFIXED ORTHODONTIC APPLIANCESCan be used for correction of posterior cross bite.

CROSS ELASTICS can be used to bring about correction of individual tooth cross bites in the posterior segment.

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