Anterior Crossbite

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A short brief presentation about the condition of crossbite in orthodontics, specifically the anterior crossbite. This was presented in the advanced educational seminar at RCsDP.

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Anterior Crossbite

  1. 1.   Definition of Crossbite.  Classification of Crossbite (Two Classifications).  Anterior Crossbite:   Definition.   Prevalence.   Management.  When to Refer? 2
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  3. 3. Crossbite is a condition that describes amalposed labiolingual relationship betweenone or more maxillary and mandibular teeth.[Bayrak S-2008] 4
  4. 4. 5
  5. 5. Based on Location Based on Etiology 6
  6. 6. [Elsevier-2008]. Anterior Location Posterior 7
  7. 7. [Elsevier-2008]. Etiological Factor Dental Functional Skeletal Habitual Acts Pseudo Class III 8
  8. 8. 1.  Skeletal:   Genetic predisposition (Inheritance).   Embryological defective development.2. Dental:   Lingual eruption path of maxillary anterior teeth.   Trauma to deciduous dentition in which there is displacement of tooth buds.   Retained deciduous causing lingual eruption of permanent teeth.   Supernumerary teeth. 9
  9. 9. 3.  Functional: a. Habits: o  Digital or pacifier sucking habits. o  Oral Respiration. o  Low Tongue Position. o  Stomach Sleeping Posture. o  Tongue Thrusting. b.  Pesudo Class III: o  Class I skeletal relationship. o  Insuffecient maxillary overjet and incisor interference. o  Multi-tooth anterior crossbite may result from a functional shift of the mandible in an effort to avoid anterior interference in centric relation and to achieve maximum intercuspation. 10
  10. 10. 11
  11. 11.   Anterior crossbite is defined as a malocclusion resulting from the lingual positioning of the maxillary anterior teeth in relationship to the mandibular anterior teeth. [Tsai HH-2001].  This condition is also referred to as “Under-bite” or “Reversed Overjet”. 12
  12. 12. 13
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  14. 14.   The prevalence of Class III malocclusion varies among different ethnic groups. [Ngan P-2005].  In Asian societies, the frequency of Class III malocclusions is higher due to a large percentage of patients with maxillary deficiency. [Ngan P-2005].  The incidence in Caucasians ranges between 1% and 4%. [Newman GV-1956] 15
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  16. 16.   The period of mixed dentition offers the greatest opportunity for occlusal guidance and interception of malocclusion. [Bayrak S-2008]  If delayed to a later stage of maturity, treatment may become more complicated. [Tse CS-1997] 17
  17. 17.   Choice of treatment depends upon the cause: 1. Skeletal: Can be controlled during growth by growth modification appliances, such as: Protraction facemasks . Protraction facemask therapy has been advocated in the treatment of Class III patients with maxillary deficiency. [Ngan P-1992], [McNamara JA-1987], [Turley P-1988]. If skeletal factors were not managed during the growth period, an orthognathic surgery will need to be the alternative treatment modality. 18
  18. 18. 19
  19. 19. 2. Dental and Habitual Acts:  Bonded resin-composite slopes [Bayrak S-2008] 20
  20. 20. 21
  21. 21.   Reversed stainless steel crowns. The chief disadvantage of this method is the difficulty in adapting a preformed crown to fit the tooth in crossbite. Furthermore, the reversed stainless steel crown is an unaesthetic treatment that is often rejected by children and their relatives. [Croll TP-1996], [Croll-1999]. 22
  22. 22.   Removable acrylic appliances with posterior bite opening platforms and anterior finger springs for labial tipping of maxillary teeth. [Jacobs SG-1989]. 23
  23. 23. 24
  24. 24.   Tongue Blade/Depressor. The tongue blade can also be an effective method of treatment during the early phase of eruption; however, it requires total cooperation from the patient, which in most cases is difficult to obtain. [Deam JA-2000]. 25
  25. 25.   Lower acrylic inclined-bite-plane is another effective treatment method; however, it requires a laboratory phase, which increases the price of treatment, and the cement used with this type of appliance may cause gingivitis. [Croll TP-1988], [Croll-1988]. 26
  26. 26.   Conventional orthodontics.  Screw appliances.  Removal of occlusal discrepancies.  Extraction of supernumerary teeth. 27
  27. 27. 28
  28. 28.   Class III patients should be full evaluated at the age of seven for the best chance at a successful non-surgical correction. [Bui H.-2010].  Not only can it eliminate or reduce the need for a surgical approach. It will also improve the psychological well-being and appearance of the patient during the adolescent year. [Bui H.-2010]. 29
  29. 29.   Patients with anterior dental crossbite show: [Olsen CB-1996]   Normal anterior-posterior skeletal relationship with a smooth path of mandibular closure.   Angle Class I relationship.   Coincident centric occlusion and centric relation. 30
  30. 30. 1.  Refer when the case is diagnosed to be of a skeletal etiology.2.  Complicated cases.3.  Advanced and can no longer be handled by a GP.4.  Malocclusion has been diagnosed late and it can’t be modified by a GP. 31
  31. 31. 32
  32. 32.   http://www.crossbite.com/DefinitionofCrossbite  http://www.bracesinfo.com/glossary.html  Turley P: Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear. J Clin Orthod 5:314-325,1988.  McNamara JA: An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 9:598-608, 1987.  Ngan P, Wei SHY, Hagg U, et al: Effects of headgear on Class III malocclusion. Quintessence Int J 23:197-207, 1992. 33
  33. 33.   Peter Ngan: Early Timely Treatment of Class III Malocclusion. Seminar in Orthodontics 11:140–145, 2005.  Chi H. Bui: Class III Malocclusion” Can early treatment make a difference” July/August 2010.  Tsai HH. :Components of anterior crossbite in the primary dentition. ASDC J Dent Child 2001;68:27-32.  Sule Bayrak: Treatment of Anterior Dental Crossbite Using Bonded Resin-Composite Slopes: Case Reports. European Journal of Dentistry October 2008 - Vol.2 34
  34. 34.   http://azur-orthodontics.com/extra-oral.php  Tse CS. Correction of single-tooth anterior crossbite. J Clin Orthod 1997;31:188.  http://www.orthosale.com/?pg=products,view-details, 357,69,Protraction+Face+Mask  Olsen CB. Anterior crossbite correction in uncooperative or disabled children. Case reports. Aust Dent J 1996;41:304 309.  Deam JA, McDonald RE, Avery DR. Managing the Developing Occlusion. In: McDonald RE (ed). Dentistry for the Child and Adolescent. 7th ed. London; Mosby, 2000:677-741. 35
  35. 35.   Croll TP, Lieberman WH. Bonded compomer slope for anterior tooth crossbite correction. Pediatr Dent 1999;21:293-294.  Croll TP. Correction of anterior tooth crossbite with bonded resin-composite slopes. Quintessence Int 1996;27:7-10.  Croll TP, Riesenberg RE. Anterior crossbite correction in the primary dentition using fixed inclined plane II. Quintessence Int 1988;1:45-51.  Croll TP, Riesenberg RE. Anterior crossbite correction in the primary dentition using fixed inclined plane I. Quintessence Int 1988;1:847-853. 36
  36. 36.   Jacobs SG. Teeth in crossbite: the role of removable appliances. Australian Dent J 1989;34:20-28.  http://www.sinclairorthodontics.co.uk/labtolab.html  Newman GV: Prevalence of malocclusion in children 6-14 years of age and treatment in preventable cases. Am J Dent Assoc 52:566-575, 1956. 37

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