MANAGEMENT OF CROSS
BITES

www.indiandentalacdemy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacdemy.com
Introduction
• Crossbites are term used to describe
abnormal occlusion in transverse plane. The
term is also used to descr...
Definition
• GRABER has defined cross bites as a
condition where one or more teeth may be
abnormally malposed buccally or ...
Classification.
• Based on their location as:
Anterior :single tooth or segmental
Posterior:unilateral or bilateral
• Base...
Etiology
• Persistance of a deciduous tooth
• Crowding or abnormal displacement of one
or more teeth
• Retarded developmen...
Contd
• Sagittal discrepancies of the jaws such as
forwardly positioned mandible.
• Presence of habits such as thumb sucki...
Classification by the
characteristics of mal occlusion
• Evaluation of facial proportion &esthetics
• Evaluation of allign...
Management
•
•
•
•
•
•
•

Management of dental cross bite
management of skeletal cross bite
DENTAL CROSS BITE management i...
Management
• SKELETAL COSS BITE management in
• pre adolescent children-primary &early
mixed dentition. 2.Palatal expansio...
Management in the primary
dentition
• Anterior cross bite: removing the
interferences by occlusal grinding or
extracting t...
Early mixed dentition period
• ACB: Lingually trapped inciors can be
corrected by extracting the adjacent canines
if suffi...
contd
• PCB: Both removable & fixed appliance is
used. The maxillary arch should be over
expanded and then held passively ...
Contd
• 3 basic approaches to the treatment of PCB
in children
• equilibration to eliminate mandibular shift
• expansion o...
History of expansion appliance
• 1875 Coffin found the coffin spring
• 1902 Pierre Robin introduced jack screw
• 1924 maxi...
COFFIN SPRING
• Made of 1.25 mm SS wire
• differential expansion in molar & pre molar
regions.
• Disadvantages: unstable ,...
W- Arch
• Constructed of 36 mil steel wire soldered to
molar bands
• move both primary &permanent teeth
&accelerate the ra...
Quad helix
• Constructed with 38 mil steel wire
• Helices in the anterior plate helps in
stopping a sucking habit.
• Indic...
Indications
• Crossbites in which upper arch need to be
widened
• thumb sucking or tongue thrusting cases
• cleft palate c...
Disadvantages
• Excessive tipping of teeth buccally
• movement are not long enough & hence not
retained long enough.
• Res...
Cross elastics
• Typically run from lingual of upper molar
to buccal of lower . For scissors bite
opposite is followed.
• ...
NITI palatal expander
• It is a tandem loop ,temperature activated
palatal expander.
• Apply light continuous pressure on ...
Advantages
•
•
•
•
•
•
•

Little clinical manipulation
absence of lab work
reduced treatment time
exerts light continuous ...
ELSAA
• Expansion & Labial Segment Alignment
Appliance
• used for the purpose of expansion and labial
segment alignment pr...
Eccentric screws
• For fanwise maxillary expansion
• Consists of two parts - hinge & special
screw
• Types 1. Wipla expans...
Disadvantages
• Only outward tipping of teeth
• patient cooperation is essential
• force levels decline especially if pati...
Hybrid expanders
• Hilger’s palatal expander- James .J.Hilger1991
• rigid midpalatal dysjunction ( nance button
& screw) w...
Slow expansion screw
• Introduced by FARRAR
• Piere robin introduced the jack screw & was
incorporated by A.M Schwartz in ...
Types of screws
•
•
•
•
•

240 types are available
some of them are ; 1. Wiese screws
2.Pullscrew
3. HAUSER spring action ...
Magnetic expansion
•
•
•
•
•
•

Types ;Platinum cobalt
Al-Ni-Co
Ferrite
Cr-Co- Fe
Samarium Cobalt
Neodymium-Iron-boron
www...
contd
• Studies were conducted by Vardimon et al
on female macaca facicularis monkeys
• magnetic expansion from tooth band...
Advantage
•
•
•
•
•

Minimum patient cooperation
less pain &discomfort
continuous force exerted
treatment time reduced
les...
contd
• Less chair side time
• better force
• better directional force control

www.indiandentalacdemy.com
Disadvantage
• Suffer tarnish &corrosion which is
cytotoxic
• cost
• bitterness.
• Bulk of magnet in space limiting
applic...
Management in late mixed
dentition period
• ACB- best method for tipping maxillary &
mandibular teeth out of cross bite is...
Skeletal cross bite correction in
Pre-Adolescent children
• Corrected by opening the mid palatal suture
• Growth at this s...
contd
• A fixed banded or bonded jack screw appl
can be used.
• Advantages ; 1. One can apply heavy force
if needed. 2.Ext...
Functional Appliance
• These appliance incorporate some
components to expand the maxillary
arch,either intrinsic force-gen...
Expansion in late mixed dentition
• As age increases, the sutures becomes more
& more tightly interdigitated and opening i...
Rapid Palatal Expander
• It involves appliance activation of at least
0.5 mm daily
• The force is transmitted immediately ...
A P MAXILLARY
DEFICIENCY
• Children under the age of 8 this treatment
can be accompolished with a face mask that
obtains a...
contd
• Approximately 12 ounces of force is
applied for 14 hours per day
• elastics should be fastened to the splint
betwe...
Mandibular Excess
• Extra oral force applied via chin cup
restrain excessive growth of the mandible
• Two ways to use chin...
Ideal patient for chin cup
treatment
• A mild skeletal problem, with the ability to
bring the incisors end to end or nearl...
Combined surgical & orthodontic
treatment
• For patients whose orthodontic problems
are so severe that neither growth
modi...
Indications
• Some problems that could have been treated
with orthodontics alone in children become
surgical problem in ad...
Conclusion
• Diagnosis is the golden key to success. A
case of cross bite can be deceptive . So,it is
always mandatory to ...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacdemy.com
Upcoming SlideShare
Loading in …5
×

Management of cross bite /certified fixed orthodontic courses by Indian dental academy

2,123 views

Published on



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

0 Comments
6 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,123
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
19
Comments
0
Likes
6
Embeds 0
No embeds

No notes for slide

Management of cross bite /certified fixed orthodontic courses by Indian dental academy

  1. 1. MANAGEMENT OF CROSS BITES www.indiandentalacdemy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacdemy.com
  3. 3. 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. www.indiandentalacdemy.com
  4. 4. 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. www.indiandentalacdemy.com
  5. 5. Classification. • Based on their location as: Anterior :single tooth or segmental Posterior:unilateral or bilateral • Based on the nature of the cross bites Skeletal Dental Functional www.indiandentalacdemy.com
  6. 6. Etiology • Persistance of a deciduous tooth • Crowding or abnormal displacement of one or more teeth • Retarded development of maxilla in sagittal as well as traneverse direction • Narrow upper arch • Collapse of the upper arch • Unilateral hypo or hyper plastic growth of www.indiandentalacdemy.com any jaws
  7. 7. Contd • Sagittal discrepancies of the jaws such as forwardly positioned mandible. • Presence of habits such as thumb sucking and mouth breathing can cause lowered tongue position. www.indiandentalacdemy.com
  8. 8. Classification by the characteristics of mal occlusion • Evaluation of facial proportion &esthetics • Evaluation of allignment &symmetry • Evaluation of skeletal&dental relationship in the transverse plane of space. • Evaluation of skeletal&dental in the anterior plane of space www.indiandentalacdemy.com
  9. 9. Management • • • • • • • Management of dental cross bite management of skeletal cross bite DENTAL CROSS BITE management in primary dentition early mixed dentition late mixed dentition permanentdentition www.indiandentalacdemy.com
  10. 10. Management • SKELETAL COSS BITE management in • pre adolescent children-primary &early mixed dentition. 2.Palatal expansion in late mixed dentition • Adults • SURGICAL correction www.indiandentalacdemy.com
  11. 11. Management in the primary dentition • Anterior cross bite: removing the interferences by occlusal grinding or extracting the primary incisor. • Posterior cross bite: if the inter molar width is satisfactory, grinding primary canines to eliminate deflective contact. If both molar &canine width are narrow, expansion of the upper arch is indicated. www.indiandentalacdemy.com
  12. 12. Early mixed dentition period • ACB: Lingually trapped inciors can be corrected by extracting the adjacent canines if sufficient space is not available. If sufficient space is available a maxillary removable appliance is usually the best mechanism to correct a simple anterior cross bite that requires tipping movement. www.indiandentalacdemy.com
  13. 13. contd • PCB: Both removable & fixed appliance is used. The maxillary arch should be over expanded and then held passively in this over expanded position for approximately 3months before it is removed. www.indiandentalacdemy.com
  14. 14. Contd • 3 basic approaches to the treatment of PCB in children • equilibration to eliminate mandibular shift • expansion of the constricted maxillary arch • re positioning of individual teeth to deal with intra arch asymmetries. www.indiandentalacdemy.com
  15. 15. History of expansion appliance • 1875 Coffin found the coffin spring • 1902 Pierre Robin introduced jack screw • 1924 maxillary crozat appliance by HC Pollack • 1947 Rickets introduced the quad helix • 1960 RPE by Angell • 1993 nickel titanium palatal expander byWendell.v .Ardnt www.indiandentalacdemy.com
  16. 16. COFFIN SPRING • Made of 1.25 mm SS wire • differential expansion in molar & pre molar regions. • Disadvantages: unstable ,lack control in the molars,frequent activation needed , force applied varies. www.indiandentalacdemy.com
  17. 17. W- Arch • Constructed of 36 mil steel wire soldered to molar bands • move both primary &permanent teeth &accelerate the rate of normal expansion of the mid palatal suture. • Activated by simply opening the apices of W • Expansion should continue at the rate of www.indiandentalacdemy.com 2mm per month
  18. 18. Quad helix • Constructed with 38 mil steel wire • Helices in the anterior plate helps in stopping a sucking habit. • Indicated for the correction of crossbite & finger sucking habit. • Forces are produced when the appliance is widened by 3to 8 mm • 3 months of retention is recommended www.indiandentalacdemy.com
  19. 19. Indications • Crossbites in which upper arch need to be widened • thumb sucking or tongue thrusting cases • cleft palate conditions either unilateral or bilateral • cases of class 2 & class 3 conditions in which the upper arch need to be widened. www.indiandentalacdemy.com
  20. 20. Disadvantages • Excessive tipping of teeth buccally • movement are not long enough & hence not retained long enough. • Restriction of tongue space so tongue function is hampered • intermittent forces • frequent activations are required • uncomfortablewww.indiandentalacdemy.com for patient
  21. 21. Cross elastics • Typically run from lingual of upper molar to buccal of lower . For scissors bite opposite is followed. • Indicated for a short period to correct simple cross bite • effective in correction of unilateral cross bites. www.indiandentalacdemy.com
  22. 22. NITI palatal expander • It is a tandem loop ,temperature activated palatal expander. • Apply light continuous pressure on the mid palatal suture. • Self activated • action is due to niti’s shape memory &transition temperature effects www.indiandentalacdemy.com
  23. 23. Advantages • • • • • • • Little clinical manipulation absence of lab work reduced treatment time exerts light continuous forces requires no adjustments comfortable & minimal patient co operation it has a safety system &helps the patient to mitigate the pressure response www.indiandentalacdemy.com
  24. 24. ELSAA • Expansion & Labial Segment Alignment Appliance • used for the purpose of expansion and labial segment alignment prior to treatment by functional appliance • until 4-6 months into the functional treatment ,the previous ELSAA must be worn when ever the functional appliance is out of mouth. www.indiandentalacdemy.com
  25. 25. Eccentric screws • For fanwise maxillary expansion • Consists of two parts - hinge & special screw • Types 1. Wipla expansoion screw 2. G mullers anterior & posterior fan wise expansion 3. Screws meantwww.indiandentalacdemy.com single teeth for pressure on
  26. 26. Disadvantages • Only outward tipping of teeth • patient cooperation is essential • force levels decline especially if patient is not activating properly www.indiandentalacdemy.com
  27. 27. Hybrid expanders • Hilger’s palatal expander- James .J.Hilger1991 • rigid midpalatal dysjunction ( nance button & screw) with flexible( Quad helix) alveolar tipping type of appliance. www.indiandentalacdemy.com
  28. 28. Slow expansion screw • Introduced by FARRAR • Piere robin introduced the jack screw & was incorporated by A.M Schwartz in 1930 • equal division of the plates will provide reciprocal anchorage • screw when turned 90degre will drive the parts of the plate apart by .2mm www.indiandentalacdemy.com
  29. 29. Types of screws • • • • • 240 types are available some of them are ; 1. Wiese screws 2.Pullscrew 3. HAUSER spring action screw 4.3d screw of Bertoni www.indiandentalacdemy.com
  30. 30. Magnetic expansion • • • • • • Types ;Platinum cobalt Al-Ni-Co Ferrite Cr-Co- Fe Samarium Cobalt Neodymium-Iron-boron www.indiandentalacdemy.com
  31. 31. contd • Studies were conducted by Vardimon et al on female macaca facicularis monkeys • magnetic expansion from tooth banded or pallatally pinned appliance delivered ideal forces compared to jack screw appliance • Daredilier et al used mid palatal repelling magnets expansion device to produce both dental &skeletal changes www.indiandentalacdemy.com
  32. 32. Advantage • • • • • Minimum patient cooperation less pain &discomfort continuous force exerted treatment time reduced less periodontal disturbances,root resorption &caries • no friction www.indiandentalacdemy.com
  33. 33. contd • Less chair side time • better force • better directional force control www.indiandentalacdemy.com
  34. 34. Disadvantage • Suffer tarnish &corrosion which is cytotoxic • cost • bitterness. • Bulk of magnet in space limiting application • bio effects of static magnetic field www.indiandentalacdemy.com
  35. 35. Management in late mixed dentition period • ACB- best method for tipping maxillary & mandibular teeth out of cross bite is using finger spring, double helical cantilever ,Z spring along with an anterior bite plate to prevent any hindrance to tooth movement • Fixed appliances are also used for the correction. Eg maxillary lingual arch with finger springs.Use of posterior bands &anterior bonded attachments with a round www.indiandentalacdemy.com
  36. 36. Skeletal cross bite correction in Pre-Adolescent children • Corrected by opening the mid palatal suture • Growth at this suture continues in most children until late teens & then ceases • less force is required to open the suture in primary &early mixed dentition period • W-ARCH ,Quad Helix & Jack screw appliance are used .They deliver less than 2 pounds of force. www.indiandentalacdemy.com
  37. 37. contd • A fixed banded or bonded jack screw appl can be used. • Advantages ; 1. One can apply heavy force if needed. 2.Extinguish habit by the virtue of appliance bulk. 3.Control vertical growth and posterior eruption if the occlusal surface are with bite blocks www.indiandentalacdemy.com
  38. 38. Functional Appliance • These appliance incorporate some components to expand the maxillary arch,either intrinsic force-generating mechanism like springs & jack screws or buccal sheilds to relieve buccal soft tissue pressure. www.indiandentalacdemy.com
  39. 39. Expansion in late mixed dentition • As age increases, the sutures becomes more & more tightly interdigitated and opening it becomes eventually difficult.Avery heavy force is required to open the suture.10 - 20 pounds of pressure. • A fixed appliance is required because the force magnitude is large enough to displace removable appliance. www.indiandentalacdemy.com
  40. 40. Rapid Palatal Expander • It involves appliance activation of at least 0.5 mm daily • The force is transmitted immediately to the teeth & then to the suture. • 10 -20 pounds of pressure is applied • the expansion occurs faster & to a greater extent in the anterior portion of the palate because of the buttressing effect of the other www.indiandentalacdemy.com maxillary structures in the posterior region.
  41. 41. A P MAXILLARY DEFICIENCY • Children under the age of 8 this treatment can be accompolished with a face mask that obtains anchorage from the forehead and chin &exerts force on the maxilla via elastics that attach to maxillary splint producing tooth movement and displacement of the maxilla • in older children above 9 this produces dental movement &very little skeletal www.indiandentalacdemy.com
  42. 42. contd • Approximately 12 ounces of force is applied for 14 hours per day • elastics should be fastened to the splint between the canine &primary first molar area • Ideal patient are: normally positioned or retrusive incisors,but not protrusive.Normal or short, but not long, anterior facial vertical dimensions www.indiandentalacdemy.com
  43. 43. Mandibular Excess • Extra oral force applied via chin cup restrain excessive growth of the mandible • Two ways to use chin cup : • First is to apply force on a line directly through the mandibular condyle • Second is to orient the line of force application below the mandibular condyle www.indiandentalacdemy.com
  44. 44. Ideal patient for chin cup treatment • A mild skeletal problem, with the ability to bring the incisors end to end or nearly so • short vertical face height • normally positioned or protrusive ,but retrusive lower incisors www.indiandentalacdemy.com
  45. 45. Combined surgical & orthodontic treatment • For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution surgical realignment of the jaws or repositioning of the dento -alveolar segments is the only possible treatment. www.indiandentalacdemy.com
  46. 46. Indications • Some problems that could have been treated with orthodontics alone in children become surgical problem in adults • Conditions that intially look less severe for eg.5mm reverse over jet, can be seen even at an early age to require surgery www.indiandentalacdemy.com
  47. 47. Conclusion • Diagnosis is the golden key to success. A case of cross bite can be deceptive . So,it is always mandatory to think before we leap into conclusion, whether it is cross bite of a true nature or pseudo. To achieve better treatment finish,crossbites should be dealt as soon as detected & the choice of armamentarium can be left to clinicians discretion www.indiandentalacdemy.com
  48. 48. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacdemy.com

×