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
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  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
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  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
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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
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  19. 19. 2. Dental and Habitual Acts:  Bonded resin-composite slopes [Bayrak S-2008] 20
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  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
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  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
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  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
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  32. 32.   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.   Tse CS. Correction of single-tooth anterior crossbite. J Clin Orthod 1997;31:188.,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.  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