4. • Name : I.Sridhar OP NO: 560853
• Age/sex : 8years/Male Address: Y.V.Lanka
• Accompanying person : Mother Date: 27/07/22
4
5. II. History :
• Chief complaint : Patient complains of irregularly placed since 2months
• History of present illness : -
• Past dental history : First visit
• Past medical history : No relevant history
• Drug history : No relevant history
5
6. • Family history : No relevant history
• Pre-natal history :
Natal history : No relevant history
Post natal history :
• Personal history : Brushes once daily with fluoridated (colgate) toothpaste
• Behaviour : Frankel’s positive
• Diet history : Not recorded
• Habits : No deleterious habits present
6
7. III. Clinical Examination :
Vital signs:
Blood Pressure: Not recorded
Pulse Rate: Not recorded
Temperature: Afebrile
Respiratory rate: Not recorded
7
8. General Examination :
• Built : Aesthetic Gait: well coordinated Posture : Erect
Extraoral examination :
• Facial symmetry : No gross facial asymmetry detected
• TMJ : No abnormality detected
• Lymph nodes : Not palpable
• Lips : competent
• Profile : convex
8
15. • Final diagnosis :
Over retained deciduous teeth -51,61
Angles class 1 malocclusion with Anterior crossbite -11,21
Chronic apical periodontitis-62
Dentinal caries-26
Deep retentive pit and fissures -16,36,46
15
17. What is occlusion and malocclusion
• OCCLUSION is defined as evenly placed row of teeth arranged in a graceful
curve with harmony between the upper and lower arches
–EH angle 1899
• MALOCCLUSION is defined as deviation from the ideal occlusion that may be
considered aesthetically unsatisfactory
–Houston et al 1992
17
18. ETIOLOGY OF MALOCCLUSION
White and Gardiners Classification
A. Dental Base Abnormalities
1.Antero-posteror Malrelationship
2.vertical Malrelationships
3.Lateral Malrelationships
4.Disproportion of size b/w teeth and basal bone
5.Congenital abnormalities
18
19. B. Pre-Eruption Abnormalities
1.Abnormalities in the position of developing tooth germ
2.Missing Teeth
3.Supernumerary Teeth and Teeth abnormal in form
4.Prolonged retention of Deciduous teeth
5.Large Labial Frenum 6.Traumatic Injury
C.Post-Eruption Abnormalities
1.Muscular Forces: a.Active Muscle Forces b.Rest Position of the Musculature
c.Sucking habits d.Abnormalities of path of closure
2.Premature Loss of Deciduous teeth
3.Extraction of Permanent Teeth
19
25. DEFINITION
• Cross bite is a term used to describe abnormal occlusion in the transverse
plane the term is also used to describe reverse overjet of one or more anterior
teeth.
• ‘Cross bite’ is a condition where one or more teeth may be malpositioned
abnormally-buccally/ labially or lingually with reference to apposing tooth or
teeth - Graber
• “An abnormal relationship of teeth or tooth to the opposing teeth, in which
normal buccolingual or labiolingual relationship are reversed
-American Association of Orthodontists Glossary
26. Classification of Cross Bite
Based on the Nature of position
Anterior Cross Bite
Posterior Cross Bite
• Anterior Cross Bite
Single Tooth Cross Bite
Segmental Tooth Cross Bite
• Posterior Cross Bite
Unilateral
Bilateral
27. According to Etiologic Factor
Skeletal Cross bite
Dental Cross bite
Functional Cross bite
According to extent
Single posture Cross bite
Buccal Non-occlusion
Lingual Non-occlusion
28. Skeletal Cross Bite
• Discrepancy in the size of the maxilla and mandible basal skeleton
• Narrow Upper Arch →Posterior Cross Bite
• Usually inherited & Developmental in origin
• Results from hormonal disturbance
• Either present in anterior or posterior segment
• Result - retarded maxillary growth or maxilla backwardly placed.
29. Dental Cross Bite
• localized in nature with one or more teeth abnormally related to that of
opposing arch.
• Lingual eruption path of the maxillary anterior
• Trauma to the deciduous dentition in which there is displacement of tooth buds.
• Delayed eruption of deciduous dentition and super numeracy teeth.
• Tooth material arch length discrepancies -crowding -lingual positioning of upper
teeth -dental Cross Bite.
30. Functional Cross Bite
• It caused by an occlusal interference that requires the mandible to shift either
anteriorly or laterally during Jaw closure in order to achieve maximum
occlusion.
• An acquired muscular reflex pattern during closure of the mandible is involved
in functional Cross Bite.
• Results from the mandibular shifting into an abnormal but often more
comfortable position→ this can present as a Unilateral Posterior Cross Bite
31. RISK FACTORS AND PREDICTORS OF CROSSBITE
OF CHILDREN
• Abstract.
Aim: was to determine the etiological risk factors and predictors of crossbite’ treatment of children.
Material and methods: 270 cases with crossbites and 255 controls with other malocclusions were
uniformly evaluated. The crossbites cases were divided in group I (anterior crossbite), group II
(posterior crossbite) and group III (anterior and posterior crossbites) and were compared between
them per Angle Class malocclusions, dysfunctional and dental causes, associations with other
discrepancies, as well by need and types of treatment. Binary logistic regression was used to find
risk factors and predictors.
Results: The mean age of cases was 10.25±2.770 years. There were found significant differences
between the groups of crossbites cases (p0.05).
Conclusion: The risk factors were dental furthermore; the predictors of treatment were adequate with
dentition, etiology and disorders at age identification, suggesting the contribution of practitioners in
intercepting this orthodontic emergency
31
Zegan, Georgeta et al. “RISK FACTORS AND PREDICTORS OF CROSSBITE AT CHILDREN.” Revista medico-
chirurgicala a Societatii de Medici si Naturalisti din Iasi vol. 119,2 (2015): 564-71.
32. Skeletal and Dental Contributions to Posterior Crossbites
• Abstract: The objective of this retrospective study was to compare skeletal and dental arch morphology of
children with posterior crossbites with a control group of children without posterior crossbites. The study
included 93 patients with a posterior crossbite (33 boys and 60 girls) and 97 patients without a posterior
crossbite (50 boys and 47 girls). Skeletal and dental characteristics between the two groups were compared
using measurements of dental casts, and lateral and posteroanterior cephalograms. Univariate analyses
revealed that seven characteristics were significantly different between the crossbite and noncrossbite
groups: mandibular plane angle, lower face height, skeletal maxillary to mandibular width ratio, maxillary
intermolar width, mandibular intermolar width, maxillary to mandibular intermolar width ratio, and
mandibular unit length. Using maxillary to madibular intermolar width ratio as the outcome measure, a
stepwise variable selection technique, analyzed all 190 patients and found only two variables significantly
associated with this measure: skeletal maxillary to mandibular width ratio and lower face height. The
coefficient of multiple determination for this model was only 13%, indicating that these two variables
accounted for only a small portion in the variation of the ratio between the maxillary and mandibular
intermolar widths
32
David allen . Skeletal and Dental Contributions to Posterior Crossbites. Angle Orthod 2003;73:515–524.
33. Anterior Cross Bite
• Definition : Malocclusion resulting from the lingual position of one or
more of the maxillary anterior teeth in relationship with the mandibular
anterior teeth when the tooth in centric relation occlusion.
• Intra-oral Features
Reverse overjet
Stripping of gingiva
Loosening of teeth
Abnormal abrasion of teeth
34. Prevalence rate
• Anterior dental crossbite has a reported incidence of 4–5% and usually
becomes evident during the early mixed-dentition phase.
• The prevalence of anterior crossbite was 2.14%
34
Major P, Glover K. Treatment of anterior cross-bites in the early mixed dentition. J Can Dent
Assoc. 1992;58:574–575
Ana De Lourdes etal. Anterior crossbite malocclusion: prevalence and treatment with a fixed inclined plane
orthodontic appliance. Brazilian journal of oral sciences. 2019
35. Prevalence of anterior cross bite in preadolescent orthodontic
patients attending an orthodontic clinic
Abstract
• Introduction: Anterior cross bite is a common malocclusion and early treatment is indicated. Determining its
prevalence is important to plan orthodontic services.
• Objective: To assess the prevalence and associated features of anterior cross bite in pre-adolescent patients attending an
orthodontic clinic.
• Methods: A hospital based cross sectional study was conducted. Seven hundred and twenty one consecutive patients
were examined for anterior cross bite. Anterior cross bite were recorded when maxillary incisor/s occluded lingually to
mandibular incisor/s in centric occlusion. Mandibular displacement, gingival recession, tooth mobility, presence of
posterior cross bite and skeletal pattern were also assessed.
• Results: Of the 721 patients, 193 (26.7%) had anterior cross bite. Twenty two (11.4%) had both anterior and posterior
cross bite. Among patients with anterior cross bite 62% had unilateral involvement and 38% had bilateral involvement.
One hundred (51.8%) had involvement of only one incisor while 64 (33.2%) had involvement of two incisors. Class 1
skeletal pattern was found in 103 (53.37%) patients with anterior cross bite, Class 2 skeletal pattern in 33 (17.1%) and
Class 3 skeletal pattern in 57 (29.53%). Mandibular displacement was present in 93 (48.19%) patients and 5 (2.5%)
showed tooth wear in anterior cross bite. Gingival recession was seen in 43 (22.3%) and tooth mobility of involved
lower incisors in 12 (6.2%).
• Conclusions: The prevalence of anterior cross bite is high in pre-adolescent patients attending an orthodontic clinic.
35
Vithanaarachchi, S N, and L S Nawarathna. “Prevalence of anterior cross bite in preadolescent orthodontic patients
attending an orthodontic clinic.” The Ceylon medical journal vol. 62,3 (2017): 189-192. doi:10.4038/cmj.v62i3.8523
36. A Study Assessing the Prevalence of Crossbite among Patients
Reporting for Orthodontic Treatment and its Association with
Different Factors
ABSTRACT
• Objective: To assess the prevalence of crossbite among patients reporting for orthodontic
treatment and its association with different factors.
• Materials and Methods: 980 subjects (490 men, 490 women) aged 5-45 years were evaluated to
determine the prevalence of crossbite in a South Indian population. The patients were
cŽ
ƒ
lassified accordingly into 3 dentition stages (primary, mixed and permanent), unilateral or
bilateral crossbite, anterior or posterior crossbite. The results were analysed using SPSS
version 22.
• Results: The overall prevalence of crossbite was found to be 8:30%. The most common age
group affected was 16-30 years old. Posterior crossbite was more prevalent with 72%. There
was a higher frequency of unilateral crossbite. There was a s‹
‰
•
‹
ignificanƒ
•
t association between the
type of crossbite and gender, with posterior crossbite more commonly in females, p=0.03.
• Conclusion: An increasing prevalence of crossbite was observed from the primary dentition
towards permanent dentition in this study.
36
Remmiya Mary Vargheseet etal, A Study Assessing the Prevalence of Crossbite among Patients Reporting for
Orthodontic Treatment and its Association with Different Factors, J Res Med Dent Sci, 2022, 10 (5): 83-87.
37. Anterior Skeletal Cross Bite
• Retarded development of maxilla → genetic & developmental disorders such as
craniofacial dysplasia, cleidocranial dysplasia, achondroplasia, cleft-palate,
congenital syphilis, down syndrome.
• Collapse of maxillary arch as seen in congenital defects such as cleft palate.
• Over development of mandible→ Craniofacial dysplasia
• Hormonal disturbances→ Aromegaly & Gigantism.
• Unilateral hypo or hypo-plastic growth of any of the jaws can cause Cross Bites
38. Anterior Dental Cross Bite
• Trauma to the deciduous dentition in which there is displacement of permanent tooth
buds.
• Prolonged retained deciduous tooth may defect its erupting successor in a palatal
direction and may result in single tooth interior Cross Bite.
• Arch length tooth material discrepancies can result in development of crowding and
defect of one or more teeth leading to dental Cross Bites.
• Missing of permanent tooth especially the upper lateral incisor may sometimes result in
anterior segment Cross Bite
39. Diagnosis
Routine clinical Examination
• Careful examination of models and cephalometric analysis to determine the nature of
Cross Bite, whether skeletal, dental or functional.
• Presence of occlusal interference & functional shifts exists between centric relation
and centric occlusion.
40. How to differentiate between a dental and a skeletal cross
bite
• Dental evaluation:
We must observe if the Class III molar relation is accompanied by an underjet.
If the incisors are in edge to edge relation and the lower incisors are retroclined,
we must suspect a compensated Class III malocclusion, meaning that the upper
incisors are proclined and the lower incisors are retroclined to compensate the
skeletal discrepancy.
In case there is an underjet, this must be confirmed with a functional evaluation.
Pseudo-Class III malocclusion is characterized by the presence of an anterior
crossbite due to a forward functional displacement of the mandible
. 40
41. Why is it Important to Treat, and Not Ignore, a Crossbite?
The potential consequences of not treating a crossbite when a patient is young
include the possible eventual development of:
• Inappropriate jaw shifting
• Uneven jaw growth
• Wearing down of enamel
• Jaw pain
• TMJ
• Misaligned teeth
• Problems with chewing
• Headaches, earaches, and other pain
• Tooth decay
• Gum disease
• Tooth erosion
• Problems with speech
• Problems with breathing during
sleep
• Unnecessary stress on the jaw
muscles
• Possible neck, shoulder, and back
pain
• Teeth grinding and abnormal growth
• Asymmetrical growth of facial
features
41
42. Management of Anterior Dental Cross Bite
• Primary Dentition Stage:
Anterior Cross Bite when noticed can be resolved by removing the interferences
by occlusal grinding or by extracting the primary incisor which are in Cross
Bite relation.
• Mixed Dentition Period:
Maxillary lateral incisors bind to erupt lingually and may be tapped if there is no
enough space. In such cases, extracting the primary canine prior to complete
eruption of lateral incisor leads to spontaneous correction of Cross Bite.
If sufficient space is available a maxillary removable appliance is the best
mechanism to correct anterior cross Bite that requires tipping movement.
developing cross bite can be treated with tongue blade therapy or Catalans
appliance therapy.
43. • Permanent dentition period
If sufficient space is available a maxillary removable appliance is the best
mechanism to correct anterior cross Bite that requires tipping movement.
Developing cross bite can be treated with tongue blade therapy or Catalans
appliance therapy .
Fixed appliances can be given to correct anterior cross bites if the reverse over jet
is not more than 1-2 mm
44. Tongue blade therapy
• It is used in developing single tooth anterior cross bite prior to complete eruption.
• There should be sufficient space in the arch to accommodate the tooth in cross bite
after resolving the cross bites.
• The tongue blade is a flat wooden stick resembling an ice cream stick. One end of it
is placed inside the mouth, contacting the palatal aspect of the upper tooth that is in
cross bite.
• The blade is made to rest on the mandibular tooth that is in cross bite which acts as a
fulcrum.
45. • The patient is asked to apply force downwards and
backwards of the free end so that the oral part of
the blade behind the palatal aspect of upper teeth
exerts force in upward and forward direction
• This action thrusts the upper teeth in forward
direction and relieves it from the cross bite
• The patient is asked to do this exercise for a total
period of 1-2 hours for about 10-14 days by which
time the tooth will be pushed out.
46. Catlan’s appliance or lower anterior inclined plane
• Intercept the fully developed cross bite of single tooth of the upper arch that is of
recent origin.
• The inclined planes are usually made of acrylic but can also be fabricated with cast
metal.
• They are concerned onto the lower anterior teeth.
• The inclined plane is designed to have a 45°angulation to the long axis of the lower
anterior.
• Whenever the maxillary tooth in cross bite touches the inclined plane, a forward
directed force moves the tooth to a more labial position.
• The steeper the angle more the force generated.
47. • It is also indicated in cased where adequate space exists in the arch for alignment
of the maxillary teeth that are in cross bite.
• They are to be selectively used only in those cases of anterior crossbite which
have resulted from palatally displaced maxillary incisor but not due to that of
labially tipped mandibular anterior tooth.
• The Catlan’s appliance should not be placed for more than six weeks, otherwise it
may lead to open bite.
48. Indications
• Normal or excessive overbite and adequate space in the arch to bring the incisor
into correct anteroposterior relationship with the opposing mandibular incisor used
only in cases where cross bite is due to palatally displaced maxillary incisor.
Contraindications
When cross bite is due to true mandibular prognathism.
If there is an end to end over bite or an open bite
48
49. Advantages
Ease of fabrication
Rapidity of correction, using functional and muscle forces.
Lack of soreness or looseness of the teeth during movement.
Rarely relapses.
Disadvantages
Patient has problems in speech during the therapy.
Strong dietary restrictions: soft and liquid for several days.
If used for long time (>6 weeks), leads to anterior open bite and TMJ problem.
50. Double cantilever spring(z spring)
• A double cantilever spring can be used to push
labial one or two maxillary anterior teeth that
are in cross bite.
• There should be adequate space in the arch to
accommodate the corrected position of the teeth
that were in cross bite.
• Bite plane is incorporated to relieve the locking
of the teeth that are in cross bite.
51. • Acrylic Plates with Screws:
A split acrylic plate with screw incorporated
can be used to treat anterior cross bites.
• Fixed corrective appliances :
Dental anterior crossbite involving one or two
teeth can be treated with fixed appliances using
multi-looped arch wires.
52. Management of Anterior Skeletal Cross bite
Mixed Dentition Period:
• Treatement of skeletal anterior crossbite during growth period takes the advantage of
growth modulation procedures .
• Cephalometric analysis should be carried out to locate the skeletal problem
• Anterior cross bite that occurs as a result of a retropositioned maxilla should be
treated with protraction face-mask or reverse-pull headgear.
• These facemasks help in protraction of the maxilla thereby normalizing skeletal
crossbite. Excessive mandibular growth leading to skeletal anterior crossbites can be
intercepted by use of chin cup.
53. Permanent Dentition Period
The skeletal anterior crossbites can be treated by camouflage by masking the
skeletal effects
Post Permanent Dentition
Comprehensive appliance therapy or/and surgical correction are required.
65. 65
Mandibular Occlusal View
Frontal View
Right Lateral View Left Lateral View
Maxillary Occlusal View
FOLLOW-UP INTRA-ORAL PHOTOGRAPHS ON 30/8/23
66. Anterior Crossbite in Centric
occlusion
Evaluate in Centric relation
Class I molar and canine relation with only
incisors in crossbite
Class I molar and canine relation
incisors can be brought edge to
edge
Class III molar and canine relation with
negative overjet
Class I malocclusion with only
dental crossbites
Mixed
Primary
Permanent
Pseudo-Class III malocclusion
Remove occlusal
interferences
Corrected
True Class III skeletal
malocclusion
No active treatment advised Primary
Mixed
Permanent
Post permanent
Interception by reverse
facemark/chin cap theory
Camouflage by masking the skeletal
effects
Orthognathic surgery
Remove interferrences
Interception by tongue blade therapy/
correction by Catlan’s appliance, removable
appliance with cantilever spring or fixed
appliance in severe cases
Fixed comprehensive therapy with
biteplanes relieving the occlusion
68. 68
Nikhila Amudala, Sandeep K, Satyam Martha
Exploring Management Techniques for Crossbite Correction: A Case Series Demonstrating Successful
Treatment Strategies.
Journal of Medical and Dental Science Research ,Volume 10~ Issue 4 (2023) pp: 68-74
69. 69
Prashanth Prakash and B. H. Durges
Anterior Crossbite Correction in Early Mixed Dentition Period Using Catlan’s Appliance: A Case Report
International Scholarly Research Network, 2011.
71. 71
S. Nagarajan M. P. Sockalingam , Khairil Aznan Mohamed Khan, and Elavarasi Kuppusamy .
Interceptive Correction of Anterior Crossbite Using Short-Span Wire-Fixed Orthodontic
Appliance: A Report of Three Cases. Case Reports in Dentistry 2018.
72. 72
Savitha N.S, Divyia Jayakumari, Krishnamoorthy
Treatment of anterior single tooth crossbite with fixed z -spring
International Journal of Current Research Vol. 8, Issue, 12, pp.43766-43768, December, 2016
73. References:
• Pediatric Dentistry: Infancy Through Adolescence ; Author, J. R. Pinkham,Edition 6
• Contemporary Orthodontics, Authors: William R. Proffit, 6th Edition
• David allen . Skeletal and Dental Contributions to Posterior Crossbites. Angle Orthod
2003;73:515–524
• Major P, Glover K. Treatment of anterior cross-bites in the early mixed dentition. J Can Dent
Assoc. 1992;58:574–575
• Ana De Lourdes etal. Anterior crossbite malocclusion: prevalence and treatment with a fixed
inclined plane orthodontic appliance. Brazilian journal of oral sciences. 2019
• Vithanaarachchi, S N, and L S Nawarathna. “Prevalence of anterior cross bite in
preadolescent orthodontic patients attending an orthodontic clinic.” The Ceylon medical
journal vol. 62,3 (2017): 189-192. doi:10.4038/cmj.v62i3.8523
• Zegan, Georgeta et al. “RISK FACTORS AND PREDICTORS OF CROSSBITE AT
CHILDREN.” Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi vol.
119,2 (2015): 564-71.
73
74. 74
• Nikhila Amudala, Sandeep K, Satyam Martha.Exploring Management Techniques for Crossbite Correction: A
Case Series Demonstrating Successful Treatment Strategies. Journal of Medical and Dental Science Research
,Volume 10~ Issue 4 (2023) pp: 68-74
• Prashanth Prakash and B. H. DurgesAnterior Crossbite Correction in Early Mixed Dentition Period Using
Catlan’s Appliance: A Case Report.International Scholarly Research Network, 2011.
• Ulusoy AT, Bodrumlu EH. Management of anterior dental crossbite with removable appliances. Contemp Clin
Dent. 2013 Apr;4(2):223-6. doi: 10.4103/0976-237X.114855. PMID: 24015014; PMCID: PMC3757887
• S. Nagarajan M. P. Sockalingam , Khairil Aznan Mohamed Khan, and Elavarasi Kuppusamy . Interceptive
Correction of Anterior Crossbite Using Short-Span Wire-Fixed Orthodontic Appliance: A Report of Three
Cases. Case Reports in Dentistry 2018.
• Savitha N.S, Divyia Jayakumari, Krishnamoorthy Treatment of anterior single tooth crossbite with fixed z -
spring International Journal of Current Research Vol. 8, Issue, 12, pp.43766-43768, December, 2016
