Anterior Crossbite in Primary and Mixed Dentitions.pptx

1. Anterior Crossbite in Primary and
Mixed Dentitions
Presenter: Mohammed F. Allahyani
R2, Pediatric Dentistry Program
Supervised By: Dr Ateet Kakti
Assistant Professor
Pediatric Dentistry Program
Department of Preventive Dentistry
Orthodontic Interceptive

2. Anterior Crossbite in Primary and Mixed Dentitions
Outline
• Definition
• Tongue Blade/Popsicle Stick Therapy.
• Lower Inclined Plane Palatal Spring Appliances (Removable Hawley or Fixed
Palatal Wire).
• Fixed Transpalatal Wires With Springs.
McDonald and Avery’s Dentistry for the Child and Adolescent, 11th edition. Chapter 23

3. Anterior Crossbite in
Primary and Mixed
Dentitions
Definition
• Dentoalveolar anterior crossbite
represents a linguoversion of one or
more maxillary anterior teeth with
resultant “locking” behind the opposing
mandibular teeth in full closure
• A deviation from the normal labio-lingual
relationship of the teeth of one arch with
those of the opposing arch.

6. Anterior Crossbite
• The anterior crossbite is usually an
acquired malocclusion resulting from
local etiological factors (e.g., arch
crowding) that interfere with the
normal eruptive positioning of the
maxillary anterior teeth.

7. Anterior Crossbite cont.
• In some cases, during closure movements, premature contacts due to the lingual malpositioning may result in a
forward mandibular deviation to effect full closure that “locks” the anterior segment in a crossbite posture involving
multiple teeth.
• Such an acquired muscular pattern is referred to as a pseudo-Class III malocclusion as the mandible shifts from
Class I to Class III relationships during closure

8. localized dentoalveolar anterior crossbites with or without
mandibular displacement
• Should be treated as soon as they are discovered.
• Delayed treatment can lead to serious complications such
 loss of arch dimensions and asymmetric midlines.
 Traumatic occlusion with stripping of gingival tissue on the labial aspect of the lower
tooth.
 Wear facets on involved incisors.
 Effect growth patterns if a functional shift is involved.

9. • Simple appliance designs are usually adequate to achieve correction of dentoalveolar anterior
crossbites.
• Diagnoses should be made with consideration of the following clinical findings:
1. Number of teeth involved.
2. Inclinations of maxillary and mandibular incisors.
3. Mandibular closure pattern and facial profile.
4. Familial appearance.
5. Cephalometric analysis.

10. Diagnosed in the transitional dentition
• Dentoalveolar anterior crossbites with or without mandibular displacement are usually approached from
the viewpoint that the primary discrepancy involves one or more maxillary anterior teeth in linguoversion.
• Any labial inclination of lower incisors is in response to the upper malpositioning.
• This simplifies treatment in that correction is directed toward labial movement of displaced maxillary
incisors to “jump” the bite.
• After normal maxillary incisor positions are achieved, the proclination of lower incisors is usually self-
correcting with the establishment of normal overbite and overjet.

11. Treatment approaches are of two general types
1. Passive incisal guides that, during mandibular closure, redirect or “leverage” maxillary
anterior inclinations in a labial orientation.
2. Active appliances that use directed orthodontic forces to achieve labial repositioning of
the maxillary anterior teeth

12. TONGUE BLADE/POPSICLE STICK THERAPY
• Cooperative children can often correct a localized anterior crossbite using the wedging effect of a
tongue blade.
• The procedure is done in 15- to 30-minute increments at a time for at least several hours of
engagement.

13. LOWER IINCLINED PLANE
An acrylic extension from the lower anterior
teeth designed to engage the incisal edges of
lingual displaced maxillary teeth during
closure applies pressure upon patient closure
that will direct the engaged tooth labially
into normal bite position.

14. PALATAL SPRING APPLIANCES
(REMOVABLE HAWLEY OR FIXED
PALATAL WIRE)
A Fixed or removable appliance
incorporating palatal springs provides the
best option for dental anterior crossbites that
are not amenable to tongue blade guidance.
A removable Hawley-type retainer modified
with auxiliary springs can reduce lingual
displacement of maxillary incisors, with
correction usually achieved in 6–12 weeks

15. FIXED TRANSPALATAL
WIRES WITH SPRINGS
• A transpalatal connector wire of
0.036- or 0.040-inch stainless-steel
soldered to banded molars that
incorporates a helical loop spring of
0.020-inch stainless-steel wire
provides a very effective method to
labialize maxillary incisors involved
in anterior crossbite.

16. Labial Edgewise Brackets and Arch wires
Edgewise mechanics are used when
multiple incisors are in crossbite,
palatal displacement and rotations
are severe, and adjacent tooth
movements are needed to adjust
anterior spacing

17. Study
(Rosa et al.) showed 84% spontaneous correction of anterior crossbites in
conjunction with rapid palatal expansion treatment in the mixed dentition.
This occurred whether or not the patients had an existing posterior crossbite
because all 50 patients studied exhibited maxillary crowding, but only 20 had a
posterior crossbite.

18. Thank you