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


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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 ,or call

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  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  • 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.
  • 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.
  • 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
  • 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 any jaws
  • 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.
  • 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
  • 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
  • 10. Management • SKELETAL COSS BITE management in • pre adolescent children-primary &early mixed dentition. 2.Palatal expansion in late mixed dentition • Adults • SURGICAL correction
  • 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.
  • 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.
  • 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.
  • 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.
  • 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
  • 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.
  • 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 2mm per month
  • 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
  • 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.
  • 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 • for patient
  • 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.
  • 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
  • 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
  • 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.
  • 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 single teeth for pressure on
  • 26. Disadvantages • Only outward tipping of teeth • patient cooperation is essential • force levels decline especially if patient is not activating properly
  • 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.
  • 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
  • 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
  • 30. Magnetic expansion • • • • • • Types ;Platinum cobalt Al-Ni-Co Ferrite Cr-Co- Fe Samarium Cobalt Neodymium-Iron-boron
  • 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
  • 32. Advantage • • • • • Minimum patient cooperation less pain &discomfort continuous force exerted treatment time reduced less periodontal disturbances,root resorption &caries • no friction
  • 33. contd • Less chair side time • better force • better directional force control
  • 34. Disadvantage • Suffer tarnish &corrosion which is cytotoxic • cost • bitterness. • Bulk of magnet in space limiting application • bio effects of static magnetic field
  • 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
  • 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.
  • 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
  • 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.
  • 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.
  • 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 maxillary structures in the posterior region.
  • 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
  • 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
  • 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
  • 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
  • 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.
  • 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
  • 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
  • 48. Thank you Leader in continuing dental education