ANTERIOR
CROSS BITE
in primary and mixe d
de ntition

www.indiandentalacademy.com
INTRODUCTION
• DEFINITION

According to Graber:
Cross bite is a condition where one
or more teeth may be abnormally
malpos...
Etiology of
anterior cross bite
in primary and mixed
dentition

www.indiandentalacademy.com
classification Based on the Etiologic Factor

ANTERIOR Cross
bite
Dental
Cross bite

Skeletal
Cross bite

www.indiandental...
Causes of anterior cross bite
• Dental causes
• Skeletal causes
• Causes of Functional cross bite

www.indiandentalacademy...
Dental causes
1. Traumatic injury to primary
dentition causes lingual
displacement of permanent tooth
bud
• Persistance of...
2.
3.
4.
5.

supernumerary tooth.
Habit of biting upper lip.
Cleft lip repair cases.
Arch length inadequacy.

Causing ling...
Skeletal causes
1. Genetic.
2. Due to deficient
anterior growth of
maxilla.
3. Excessive abnormal
mandibular growth in
ant...
Causes of functional cross bite
1. Habitual forward
positioning of the
mandible to obtain
maximum
intercuspation may
lead ...
1.Anterior

cross

bite

due

to

due

to

maxillary retrognathism.
2.Anterior

cross

bite

mandibular prognathism.
3.Ant...
Types of anterior
cross bite
• Ectopic incisors
• Skeletal class Ⅲ malocclusion
• Pseudo class Ⅲ malocclusion

www.indiand...
Ectopic incisors
# An incisor may erupt ectopically either
palatally in the maxilla or labially in the
mandible to a cross...
Skeletal class Ⅲ malocclusion
# An anterior cross bite may be associated
with a skeletal class Ⅲ discrepancy such
that, al...
Pseudo class Ⅲ malocclusion
# This pattern occurs where there is a habitual
mandibular closure pattern such that the mandi...
Single tooth anterior
cross bite

Segmental anterior
cross bite

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Management of
anterior cross bite in primary
and mixed dentition

www.indiandentalacademy.com
[I] IN PRIMARY DENTITION
Elimination of the factors that may lead
to the anterior cross bite
E.g.
 Removal of occlusal pr...
[II] IN MIXED DENTITION:
(In pre-adolescent age group)
Anterior cross bite should be treated
at an early stage.
Because
1....
2.if simple anterior cross bite is not
treated in early stage it may
progress into skeletal malocclusion that
later needs ...
(1) Use of tongue blade

Indications
 Used when a cross bite is seen at the time
the
permanent
teeth
are
making
an
appear...
Drawbacks of using tongue blade
 Only effective till the clinical crown not
completely erupted in the oral cavity.
 Used...
(2) Catlan’s appliance or lower anterior inclined
plane
Indications

- Used only in those

cases where the
cross bite is d...
Disadvantages of Catlan’s Appliance
1) Difficulty in speech & chewing
2) Patient cooperation required
3) Require frequent ...
[3] Double cantilever spring / z-spring
Indication
Used when anterior cross
bite involving 1 or 2 max.
anterior teeth.
Dis...
(4) Screw appliance

Micro screw
Used on individual
•
tooth
Multiple micro screw
•
can be used to
correct individual
tooth...
Medium screw
Used to correct
segmental cross bite

3-D screw
(3dimensional screw)
Capable of correcting
posterior as well ...
[5] Face mask (or face mask along with RME)

Indications
Used to correct skeletal anterior cross bite (Anterior cross bite...
[6] Chin cap appliance

 Used to correct or
prevent the anterior
cross bite due to a
prominent mandible.
 Chin cap appli...
[7] Frankel III appliance

Used to correct skeletal class
III Malocclusion.

www.indiandentalacademy.com
Conclusion
As the incidence of cross bite in primary
& mixed dentition increases patients having
functional & esthetic pro...
references
• Orthodontic :the art & science
by S. I. Bhalajhi
• A textbook of orthodontics
by Gurkeerat Singh
• A textbook...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Anterior cross bites in primary& mixed dentition /certified fixed orthodontic courses by Indian dental academy

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Anterior cross bites in primary& mixed dentition /certified fixed orthodontic courses by Indian dental academy

  1. 1. ANTERIOR CROSS BITE in primary and mixe d de ntition www.indiandentalacademy.com
  2. 2. INTRODUCTION • DEFINITION According to Graber: Cross bite is a condition where one or more teeth may be abnormally malposed buccaly or lingually or labially with reference to opposing teeth. www.indiandentalacademy.com
  3. 3. Etiology of anterior cross bite in primary and mixed dentition www.indiandentalacademy.com
  4. 4. classification Based on the Etiologic Factor ANTERIOR Cross bite Dental Cross bite Skeletal Cross bite www.indiandentalacademy.com Functional Cross bite
  5. 5. Causes of anterior cross bite • Dental causes • Skeletal causes • Causes of Functional cross bite www.indiandentalacademy.com
  6. 6. Dental causes 1. Traumatic injury to primary dentition causes lingual displacement of permanent tooth bud • Persistance of a deciduous tooth • Palatal deflection of its erupting successor • Single tooth anterior cross bite. www.indiandentalacademy.com
  7. 7. 2. 3. 4. 5. supernumerary tooth. Habit of biting upper lip. Cleft lip repair cases. Arch length inadequacy. Causing lingual deflection of permanent tooth during eruption. www.indiandentalacademy.com
  8. 8. Skeletal causes 1. Genetic. 2. Due to deficient anterior growth of maxilla. 3. Excessive abnormal mandibular growth in anterior region. 4. Combination of both 2 and 3. www.indiandentalacademy.com
  9. 9. Causes of functional cross bite 1. Habitual forward positioning of the mandible to obtain maximum intercuspation may lead to an anterior cross bite. 2. Pseudo class Ⅲ. www.indiandentalacademy.com
  10. 10. 1.Anterior cross bite due to due to maxillary retrognathism. 2.Anterior cross bite mandibular prognathism. 3.Anterior cross bite due to maxillary retrognathism and mandibular prognathism. www.indiandentalacademy.com
  11. 11. Types of anterior cross bite • Ectopic incisors • Skeletal class Ⅲ malocclusion • Pseudo class Ⅲ malocclusion www.indiandentalacademy.com
  12. 12. Ectopic incisors # An incisor may erupt ectopically either palatally in the maxilla or labially in the mandible to a cross bite relationship in centric occlusion. This may occur in the child with a balanced skeletal relationship. # Early treatment is only necessary, if there is a deviation on opening and or closing or if there is a traumatic occlusion or periodontal concern. www.indiandentalacademy.com
  13. 13. Skeletal class Ⅲ malocclusion # An anterior cross bite may be associated with a skeletal class Ⅲ discrepancy such that, although the incisors are positioned correctly within the alveolar ridges, they are in negative overjet on closing into centric occlusion with no deviation of mandibular closure. www.indiandentalacademy.com
  14. 14. Pseudo class Ⅲ malocclusion # This pattern occurs where there is a habitual mandibular closure pattern such that the mandible goes into a protrusive bite and thus cross bite of incisors avoiding traumatic occlusion with lingual position of one or more maxillary incisors. Thus anterior shift of the mandible can affect the growth of both the maxilla and the mandible with undesirable muscle adaptation. www.indiandentalacademy.com
  15. 15. Single tooth anterior cross bite Segmental anterior cross bite www.indiandentalacademy.com
  16. 16. Management of anterior cross bite in primary and mixed dentition www.indiandentalacademy.com
  17. 17. [I] IN PRIMARY DENTITION Elimination of the factors that may lead to the anterior cross bite E.g.  Removal of occlusal prematurities.  Extraction of supernumerary tooth, before they cause displacement of other tooth.  Habit breaking appliance. www.indiandentalacademy.com
  18. 18. [II] IN MIXED DENTITION: (In pre-adolescent age group) Anterior cross bite should be treated at an early stage. Because 1.If a cross bite present in the deciduous dentition, it may manifest in the mixed & permanent dentition as well. www.indiandentalacademy.com
  19. 19. 2.if simple anterior cross bite is not treated in early stage it may progress into skeletal malocclusion that later needs complicated orthodontic or surgical treatments. www.indiandentalacademy.com
  20. 20. (1) Use of tongue blade Indications  Used when a cross bite is seen at the time the permanent teeth are making an appearance in the oral cavity.  It is placed inside the mouth contacting the palatal aspect of the maxillary teeth. Upon slight closure of jaw the opposing side of the stick come in contact with the labial aspect of the opposing mandibular tooth acts as a fulcrum. This is continued for 1-2 hours for about 2 weeks. www.indiandentalacademy.com
  21. 21. Drawbacks of using tongue blade  Only effective till the clinical crown not completely erupted in the oral cavity.  Used only if sufficient space is available for the correction.  Patients cooperation is required. www.indiandentalacademy.com
  22. 22. (2) Catlan’s appliance or lower anterior inclined plane Indications - Used only in those cases where the cross bite is due to a palataly placed max incisors. (Constructed at 45 degree angulations on the lower anterior teeth by acrylic or cast metal). www.indiandentalacademy.com
  23. 23. Disadvantages of Catlan’s Appliance 1) Difficulty in speech & chewing 2) Patient cooperation required 3) Require frequent recementation 4) Catlance appliance also as a anterior bite plane Prevent the posterior teeth from coming into contact If prolonged use, Supra eruption of posterior teeth causes Anterior open bite. 5) Can not be given if Mandibular incisors are malaligned and are periodontally compromised. www.indiandentalacademy.com
  24. 24. [3] Double cantilever spring / z-spring Indication Used when anterior cross bite involving 1 or 2 max. anterior teeth. Disadvantage Effective only when there is enough space for aligning the teeth. Pre-treatment During treatment Post-treatment www.indiandentalacademy.com
  25. 25. (4) Screw appliance Micro screw Used on individual • tooth Multiple micro screw • can be used to correct individual tooth in segmental cross bite Mini screw Capable of moving up • to 2 teeth www.indiandentalacademy.com
  26. 26. Medium screw Used to correct segmental cross bite 3-D screw (3dimensional screw) Capable of correcting posterior as well as anterior cross bite www.indiandentalacademy.com
  27. 27. [5] Face mask (or face mask along with RME) Indications Used to correct skeletal anterior cross bite (Anterior cross bite due to actual skeletal deficiency of the maxilla Protraction face mask or Reverse head gear If maxilla is narrow RME screw also used for transverse expansion. www.indiandentalacademy.com
  28. 28. [6] Chin cap appliance  Used to correct or prevent the anterior cross bite due to a prominent mandible.  Chin cap appliance rotate mandible backward and downward. www.indiandentalacademy.com
  29. 29. [7] Frankel III appliance Used to correct skeletal class III Malocclusion. www.indiandentalacademy.com
  30. 30. Conclusion As the incidence of cross bite in primary & mixed dentition increases patients having functional & esthetic problems are becoming more common in dental practice. These patients requires special attention with regard to functional & cosmetic problems in primary stage because if they are ignored, later they may require more complicated treatment. In addition to good oral health promotion there is increased need for collaboration between dental & cosmetic professionals to provide safe and appropriate dental care for these patients. www.indiandentalacademy.com
  31. 31. references • Orthodontic :the art & science by S. I. Bhalajhi • A textbook of orthodontics by Gurkeerat Singh • A textbook of dentistry for the child & adolescence by Mc Donald & Dr. Avery. • Handbook of pediatric dentistry by Angus C. Cameron • Pediatric Dentistry infancy through adolescence by Pinkham, Casammassimo, www.indiandentalacademy.com Mc Tigue & Nowak
  32. 32. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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