Treatment of Crossbite

TREATMENT OF
CROSSBITE

INDIAN DENTAL ACADEMY
Leader in continuing dental education
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DEFINITION


Cross bite is a deviation of the normal bucco-lingual
relationship of the teeth of one arch with those of the
apposing arch



T.M GRABER
Cross bite is a condition where one or more teeth may
be malposed abnormally,bucally lingually or labially
with reference to the opposing tooth or teeth


CLASSIFICATION
According to their location in the arch
• Anterior Crossbite

• Posterior Crossbite
Unilateral Crossbite
BilaterialCrossbite

CLASSIFICATION
According to the number of teeth
involved
•Single tooth Crossbite

•Segmental Crossbite

CLASSIFICATION
Based On Etiological Factors Responsible For
The Crossbite
•Dental Crossbite
•Skeletal Crossbite
•Functional Crossbite

Dental Crossbite
•These are usually caused due to arch length discrepancy or
an abnormal path of eruption

Skeletal Crossbite
•These are primarily due to mal positioning or
malformation of the jaws
•These can be
 Inherited –Class III skeletal pattern
 Congenital –Cleft lip and palate cases
 Due to trauma at the time of birth

Functional Crossbite
These cross bites are usually caused due to presence

of occlusal interferences during the act of bringing the
jaws into occlusion

These can be caused by the early loss of deciduous

teeth, decayed teeth or ectopically erupted teeth


Buccal non occlusion:( scissors bite )
 This is a condition where the maxillary posterior teeth palatal

cusp are placed completely buccal to the mandibular posterior
teeth

Lingual non occlusion
 Here the maxillary posterior teeth are placed completely

palatal to the lingual aspect of the mandibular posterior teeth

Etiology of Crossbite
Anomalies of number
supernumerary teeth
missing teeth
Anomalies of tooth size

Anomalies of tooth shape

Premature loss of deciduous and/or permanent teeth
Prolonged retention of deciduous teeth

Delayed eruption of permanent teeth
Abnormal eruptive path
 Ankylosis
 Presence of habits such as thumb sucking and mouth breathing
can result in narrowing of the dental arch leading to posterior
Crossbite


CORRECTION OF ANTERIOR
CROSSBITE
In preadolescent age group
1. Use of tongue blade


Tongue blade can correct developing crossbite



It resembles a flat ice cream stick



It is placed inside the mouth contacting the erupting tooth
in Crossbite on its palatal aspect

Opposing mandibular tooth acts as fulcrum and the patient

is asked to rotate the oral part of the blade upward and
forward
The

proper use of tongue blade for an hour or two for 10 to
15 days is usually sufficient


2.Catlan’s appliance
 It is lower anterior inclined plane used to treat maxillary
teeth in Crossbite
 It has a 450 angulation which forces the maxillary teeth in
Crossbite to a more labial position

Prerequisites for use of inclined plane
 Enough space in maxillary arch to align the teeth/tooth
 Mandibular incisors should be well aligned to allow
appliance fabrication
 Developmental status of mandibular incisors should be such
that they can tolerate the forces generated

Advantages of Catlan's appliance
Ease of fabrication
Rapidity of correction using functional and muscle forces
Lack of soreness or looseness of teeth during treatment
Rarity of relapse


Disadvantages of Catlan's appliance
 The patient has difficulty in speech and chewing
 Appliance acts as anterior bite plane and prevents
posterior teeth from coming in contact
 Appliance cannot be given if mandibular incisors are
periodontically compromised
 Prolonged use of appliance can lead to anterior open bite
Possibility of appliance becoming loose and requiring
recementation because of strong occlusal stresses upon it


3.Face mask
 In cases of anterior crossbite due to an actual skeletal
deficiency of maxilla it is possible to mesialize the maxilla
using a protraction face mask
 If the maxilla is narrow a rapid maxillary expansion screw
can be employed simultaneously

Petit Face Mask


4.Functional regulator III
A FR III appliance can be used to correct developing class
III skeletal jaw structure
The appliance stretches the soft tissue envelop around the
maxilla stimulating its anterior growth as well as preventing
the mandible from growing any further anteriorly


5.Chin cup
 A chin cup can be used to redirect the growth of mandible
to prevent or correct the anterior crossbite due to a
prominent mandible
 Chin cup tends to rotate the mandible downward and
backward


CORRECTION OF ANTERIOR
CROSSBITE
In adolescent and adults
1.Jack screw


Mini or medium size screws can be used to correct single
tooth or segmental anterior Crossbite in adults



The patient should be cooperative enough to maintain and
activate the screw or at least get it activated at regular
intervals


2.Double cantilever spring:( Z spring )
• Anterior Crossbite involving one or two teeth can be
treated using a double cantilever spring provided there is
adequate space
• It consist double helix between two parallel arms and the
inferior arm extends as retentive component


•The parallel arms ca be activated as per the requirement to
either push the entire tooth labially or just the mesial or
distal aspect to correct a mesio-palatal/lingual or distopalatal/lingual rotation of the tooth respectively
•The spring should be used along with posterior bite plane


3. Fixed appliances
Labial arch wire with vertical spring loop
 Used to correct incisor lingual cross bite in case where

guide plane is contraindicated

 The lingually malposed incisor is ligated to the arch

wire

The vertical spring loops at the molar tubes are

opened to advance the arch wire
This exerts a labial vector of force o the ligated tooth

with the reciprocal force being directed against the
molars


CORRECTION OF POSTERIOR
CROSSBITE
1.Coffin Spring
 This is an omega shaped wire (0.9 mm ) in a removable

appliance used for expansion to correct the posterior cross
bite
 The expansion produced is slow and bilaterally

symmetrical
 If used in mixed dentition stage the appliance is capable of
producing skeletal changes


2.T Spring
T spring can be used for buccal movement of
premolars
It is made of 0.5 mm hard round stainless steel wire
Spring consist of t shaped arm whose ends are
embedded in acrylic
Spring is activated by pulling the free end of T
towards the intended direction of tooth movement


3.Jack screw
A jack screw can used in the removable plate to carry out

expansion to correct the posterior cross bite
The

patient should cooperative to maintain the appliance
and activate the screw or atleast get it activated at regular
intervals


4.Quad helix
It

is a fixed appliance soldered to the molar bands
cemented generally on the first permanent maxillary molars
It

can be reactivated using the three pong plier without
having to be removed from the oral cavity
It

is a versatile appliance and can be used with usual fixed
appliance therapy
It

can produce skeletal effects if given in preadolescent


5.Rapid maxillary expansion
Bilateral skeletal cross bite with a deep palate and narrow
maxilla can be treated by RME where the mid palatal suture
is split


It

incorporates a screw which is activated 0.5 – 1 mm/day

The

force level can build upto 10 to 20 pounds as the screw
is turned at this rate


The

RME screw can be incorporated in two type of
appliances: Banded RME and cemented RME
The

appliance produces rapid expansion in 3-4 weeks

After

expansion the appliance itself acts as retainer


6.Fixed appliances
The arch wires can be kept expanded or
constricted depending upon the movement required
Cross elastics
 Cross elastics can be used to bring about correction of

individual tooth cross bites in posterior segment


They require lingual attachments (spur, button )along with
the usual Buccal attachments


Bolstering

anchorage can be used to prevent to far buccal or
lingual movement of the teeth under the influence of cross
elastics

Bolstering anchorage

NITI Expanders
These are nickel titanium wires which can be attached to
the lingual sheath that are welded to the molar bands
cemented on the maxillary permanent first molars


Various sizes are available and need to be selected
depending upon the expansion desired and the
pretreatment width of the palate




It brings about slow expansion


Thank you
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Treatment of Crossbite

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