Cross bite (2)

CROSS BITECROSS BITE
www.indiandentalacademy.comwww.indiandentalacademy.com

 IntroductionIntroduction
 DefinitionDefinition
 ClassificationClassification
 Tx of ACBTx of ACB
 Tx of PCBTx of PCB
 conclusionconclusion

IntroductionIntroduction
 Abnormal occlusion in the T/S planeAbnormal occlusion in the T/S plane
 ““ REVERSE OVER JET ”REVERSE OVER JET ”
 Distinction b/w skeletal & dental CB impDistinction b/w skeletal & dental CB imp
 Unilateral PCB-likely maxi / mandiUnilateral PCB-likely maxi / mandi
skeletal asymmetryskeletal asymmetry
 ACB-multiple teeth-assoc skeletalACB-multiple teeth-assoc skeletal
 CB- early Tx- IIndry effectsCB- early Tx- IIndry effects

DefinitionDefinition
 GraberGraber
““ Condition where one / more teeth mayCondition where one / more teeth may
be abnormally malposed buccally /be abnormally malposed buccally /
lingually / labially with reference to thelingually / labially with reference to the
opposing tooth / teeth “opposing tooth / teeth “

 MoyersMoyers
 ““ abnormal B-L (labio-lingual)abnormal B-L (labio-lingual)
relationship of the teeth”relationship of the teeth”

Scissors biteScissors bite
““ Mandibular dentitionMandibular dentition
completely contained withcompletely contained with
in the maxillary dentition “in the maxillary dentition “
(buccal non-occlusion)(buccal non-occlusion)
 Common – PM area (classCommon – PM area (class
II div 1)II div 1)
 BRODIE SYNDROME –BRODIE SYNDROME –
rare, all lower teeth lingualrare, all lower teeth lingual
to maxi teeth- retrusiveto maxi teeth- retrusive
mandi / large maxillamandi / large maxilla

ClassificationClassification
 Based on location :Based on location :
I. ACB - Single toothI. ACB - Single tooth
SegmentalSegmental
II. PCB – UnilateralII. PCB – Unilateral
BilateralBilateral

 Based on nature :Based on nature : ( Moyers 1988)( Moyers 1988)
 Dental CBDental CB
 Functional / Muscular CBFunctional / Muscular CB
 Skeletal CBSkeletal CB

ACBACB
 Lingual position ofLingual position of
the maxi ant teeththe maxi ant teeth
irt mandi ant teethirt mandi ant teeth
 Single / segmentalSingle / segmental
 Decidous & PermaDecidous & Perma
teethteeth

PCBPCB
 Abnormal T/S relation U/L post teethAbnormal T/S relation U/L post teeth
 Disharmony in jaw widthDisharmony in jaw width
 Unilateral / bilateralUnilateral / bilateral
 Prevalence – 2-16%,mainly uni CBPrevalence – 2-16%,mainly uni CB

Functional /muscular CBFunctional /muscular CB
 lllr to dental – no clear cut difference,lllr to dental – no clear cut difference,
significant muscular adjustmentsignificant muscular adjustment
 Occlusal interferences – mandi shiftOcclusal interferences – mandi shift
during jaw closureduring jaw closure
 Pure muscular CB – young childrenPure muscular CB – young children
Tx – occlusal equilibriumTx – occlusal equilibrium

Skeletal CBSkeletal CB
 Aberrations in bony growth & /Aberrations in bony growth & /
morphologymorphology
 Asymmetric growth of maxi / mandiAsymmetric growth of maxi / mandi
 Disharmony in jaw widthsDisharmony in jaw widths
 Hereditary /trauma – developmentHereditary /trauma – development
 Ant / postAnt / post

 Skeletal PCB – common,narrowSkeletal PCB – common,narrow
maxillamaxilla
 Functional shift – masticationFunctional shift – mastication
 Pt may have- TMDPt may have- TMD

EtiologyEtiology
 Prolonged retention of decidous teeth-singleProlonged retention of decidous teeth-single
tooth CBtooth CB
 Crowding – TSALD – CBCrowding – TSALD – CB
 Habits – TS,MB – lowered tongue posture-Habits – TS,MB – lowered tongue posture-
narrow maxilla – CBnarrow maxilla – CB
 Retarded growth of maxilla (sagittal &T/S)Retarded growth of maxilla (sagittal &T/S)
 Collapsed maxilla – CPCollapsed maxilla – CP
 Unilateral hypo / hyperplastic growth of any jawUnilateral hypo / hyperplastic growth of any jaw

Factors that canFactors that can
influence Tx of ACBinfluence Tx of ACB
 Ant CR-CO shiftAnt CR-CO shift
 Over biteOver bite
 Arch lengthArch length
 Torque of maxi incisor rootTorque of maxi incisor root
 Alignment of mandi teethAlignment of mandi teeth
 RetentionRetention

Ant CR-CO shift :Ant CR-CO shift :
 CB with ant functional shift –CB with ant functional shift –
 Pseudo class IIIPseudo class III
edge-to edge U/L incisors in CRedge-to edge U/L incisors in CR
 If No shift – True class III,If No shift – True class III,
no incisal contactno incisal contact
maxi retrusion/ mandimaxi retrusion/ mandi
protrusionprotrusion www.indiandentalacademy.comwww.indiandentalacademy.com

 Imp to differentiate skeletal & dentalImp to differentiate skeletal & dental
CB- Tx, prognosis of Tx, stabilityCB- Tx, prognosis of Tx, stability
 Pseudo class III – short Tx time, goodPseudo class III – short Tx time, good
retentionretention
 True class III – difficult Tx, retention,True class III – difficult Tx, retention,
long time - surgerylong time - surgery

Over bite :Over bite :
 Influence –Tx, retentionInfluence –Tx, retention
 ACB asso deep OB - easy Tx &ACB asso deep OB - easy Tx &
retentionretention
 Little / no OB – difficult to Tx &Little / no OB – difficult to Tx &
retention- best Tx fixed appliancesretention- best Tx fixed appliances

Arch length :Arch length :
 ADEQUATE SPACE – must for TxADEQUATE SPACE – must for Tx
 If no space – appliance (eg:open coilIf no space – appliance (eg:open coil
spring, bite plane)spring, bite plane)

Alignment of mandi teeth :Alignment of mandi teeth :
 DELAYED- until upper incisorDELAYED- until upper incisor
correctioncorrection
 Premature alignment –complicates TxPremature alignment –complicates Tx

Torque of maxi incisor root :Torque of maxi incisor root :
 As roots placed lingualy- after TxAs roots placed lingualy- after Tx
>labial inclination of tooth>labial inclination of tooth
 A labial inclined tooth- slips to CB thanA labial inclined tooth- slips to CB than
normal toothnormal tooth
 Torque root labially – up side downTorque root labially – up side down
bracketbracket

Retention :Retention :
 ADEQUATE OBADEQUATE OB
 NORMAL INCLINATION OF TXNORMAL INCLINATION OF TX
TEETHTEETH
 Evaluate – 2-3 wksEvaluate – 2-3 wks
 Stable – no retention if no- retentionStable – no retention if no- retention

TreatmentTreatment
Diagnosis:Diagnosis:
 Clinical examinationClinical examination
 PhotographsPhotographs
 Study castStudy cast
 Radiographs – ceph, occlusalRadiographs – ceph, occlusal

Note :Note :
 CB – dental / functional / skeletalCB – dental / functional / skeletal
 Skeletal-deficient maxilla / large mandiSkeletal-deficient maxilla / large mandi
 Single tooth / segmentalSingle tooth / segmental
 functional shiftfunctional shift
 ADEQUATE SPACE – for TxADEQUATE SPACE – for Tx

DENTAL CB :DENTAL CB :
 Single/multipleSingle/multiple
 Crowding /Crowding /
prolonged retentionprolonged retention
of pri teethof pri teeth

Tx :Tx :
 ADEQUATE SPACEADEQUATE SPACE
 Developing CB – disking / Xn of primaryDeveloping CB – disking / Xn of primary
teeth (for space)teeth (for space)

TOUNGE BLADETOUNGE BLADE
 Developing single toothDeveloping single tooth
CBCB
 ADEQUATE SPACE,ADEQUATE SPACE,
FLAT WOODENFLAT WOODEN
STICKSTICK
 Stick on palatal surfaceStick on palatal surface
& incisor margin of& incisor margin of
lower tooth –as fulcrumlower tooth –as fulcrum
 Upwards & forwardsUpwards & forwards
-constant pr-constant pr
 1-2 hrs for 10-14 days1-2 hrs for 10-14 days

APPLIANCE THERAPY :APPLIANCE THERAPY :
 After eruption of incisors in CBAfter eruption of incisors in CB
 RemovableRemovable
 Fixed- effective & in severe CBFixed- effective & in severe CB

RemovableRemovable
appliances :appliances :
 ACB –one / twoACB –one / two
teethteeth
 Z-spring & post biteZ-spring & post bite
planeplane
 A jack screw & aA jack screw & a
post bite planepost bite plane

 Bite plate-if deep biteBite plate-if deep bite
 Full time wearFull time wear
 Slightly over corrected & retention –Slightly over corrected & retention –
correct OB achievedcorrect OB achieved
 Disadv :Disadv :
 Pt compliance,oral hygeinePt compliance,oral hygeine
 Poor design – prolong Tx timePoor design – prolong Tx time

Inclined planesInclined planes
LOWER ANT INCLINED PLANE /LOWER ANT INCLINED PLANE /
CATALAN’S APPLIANCE :CATALAN’S APPLIANCE :
 Simple & effectiveSimple & effective
 Maxi teeth- single/segmentMaxi teeth- single/segment
 Acrylic / cast metalAcrylic / cast metal
 Adequate space & OBAdequate space & OB
 Catalan’s- cemented inclined planeCatalan’s- cemented inclined plane

 Inclined plane - 45Inclined plane - 4500
to occlusal planeto occlusal plane
 Only CB toothOnly CB tooth
should contactshould contact
 Tx- not > 6wksTx- not > 6wks
(supraeruption of(supraeruption of
post )post )
 If not-tongue bladeIf not-tongue blade
10-14days10-14days

Acrylic / metal :Acrylic / metal :
 CementationCementation
 Full time – during meals alsoFull time – during meals also
 Check up-every wk, check occlusionCheck up-every wk, check occlusion
 Not to open bite > 4-5mm - incre VD-Not to open bite > 4-5mm - incre VD-
muscle fatiguemuscle fatigue
 Soft dietSoft diet

MOA :MOA :
 Guide the eruptingGuide the erupting
tooth to erupt intooth to erupt in
normal positionnormal position
(guide plane)(guide plane)
 ““ All forces ofAll forces of
occlusionocclusion
(swallowing, speech )(swallowing, speech )
transmitted to the anttransmitted to the ant
teeth ”teeth ”

ADVANTAGES:ADVANTAGES:
 Easy fabricationEasy fabrication
 Tx- rapid,functionalTx- rapid,functional
& muscle forces& muscle forces
 Lack of soreness /Lack of soreness /
loose teeth duringloose teeth during
TxTx
 Rare relapseRare relapse
DISADVANTAGEDISADVANTAGE
S:S:
 Dietary restrictionsDietary restrictions
 Speech defectSpeech defect
 AOB- if >6wksAOB- if >6wks
 Breakage &Breakage &
frequentfrequent
cementationcementation

Types: figTypes: fig
 Cast inclineCast incline
 Inclined crownInclined crown
 Banded inclineBanded incline

Cast incline :Cast incline :
 Cast crown – Ag / AuCast crown – Ag / Au
 454500
to OPto OP
 No under cutsNo under cuts
 Ag solder – reinforce crownAg solder – reinforce crown

Inclined crown :Inclined crown :
 Long metal crown -1-2mm mre incisaly
 0.006x0.200’’ molar band material welded
/ soldered on lingual side
 Band material – inclined plane 450
 Reinforce crown- Ag solder

Banded incline :Banded incline :
 Variant of inclined crownVariant of inclined crown
 Preformed / s.s bandPreformed / s.s band
 0.006x0.200’’ weld lingually-labial side0.006x0.200’’ weld lingually-labial side
inlined planeinlined plane

OPPENHEIM SPLINT :OPPENHEIM SPLINT :
 ModificationModification
cementing typecementing type
inclined planeinclined plane
 Covers oclusalCovers oclusal
surface of post teethsurface of post teeth
 Activ – reducingActiv – reducing
occlusal surface ofocclusal surface of
acrylic-1mmacrylic-1mm

FIXED APPLIANCES :FIXED APPLIANCES :
Effective, for severely displaced incisorsEffective, for severely displaced incisors
 Maxillary lingual arch with fingerMaxillary lingual arch with finger
springs (whip spring)springs (whip spring)
 2x4 appliance2x4 appliance

Maxillary lingual arch withMaxillary lingual arch with
finger springs (whip spring):finger springs (whip spring):
 Simple, young/Simple, young/
preadolescent-preadolescent-
compliance problemcompliance problem
 A guide wire also onA guide wire also on
incisorsincisors
 ActivationActivation
-3mm/month-1mm TM-3mm/month-1mm TM
 After Tx-can beAfter Tx-can be
modified as retainermodified as retainer
 Disadv:breakage & oralDisadv:breakage & oral
hygienehygiene

 Fixed appliance post bands & antFixed appliance post bands & ant
bonded attachments with a flexiblebonded attachments with a flexible
round wire :round wire :
 In mixed dentition –crowding,rotationsIn mixed dentition –crowding,rotations
& more perma teeth in CB& more perma teeth in CB

2x4 appliance :2x4 appliance :
 Gives facial tippingGives facial tipping
& lingual root& lingual root
torque to maxitorque to maxi
incisorsincisors
 Arch wire –Arch wire –
asymmetric V-bendasymmetric V-bend

Asymmetric V-bendAsymmetric V-bend
> moment to incisors & sliding thro molar tube> moment to incisors & sliding thro molar tube
Facial tipping of incisorsFacial tipping of incisors
OJOJ
If arch wire is tied back / cinched to molars –If arch wire is tied back / cinched to molars –
lingual torque to incisorslingual torque to incisorswww.indiandentalacademy.comwww.indiandentalacademy.com

 Begg light wire : multi loop arch wireBegg light wire : multi loop arch wire
 PEA : brackets are bonded inverted inPEA : brackets are bonded inverted in
order to torque the roots labiallyorder to torque the roots labially
RETENTION :RETENTION :
 For 1-2mosFor 1-2mos
 Removed if sufficient OB is presentRemoved if sufficient OB is present

Skeletal ACBSkeletal ACB
Face mask / face mask with RME :Face mask / face mask with RME :
 Due to retrusive maxilla- protraction faceDue to retrusive maxilla- protraction face
maskmask
 If narrow maxilla – RME simultaneouslyIf narrow maxilla – RME simultaneously

Chin cup :Chin cup :
 To redirect the mandible growth-To redirect the mandible growth-
prevent or correct ACBprevent or correct ACB
Frankel type III appliance:Frankel type III appliance:
 Correct developing class IIICorrect developing class III
 Pri / early mixed dentitionPri / early mixed dentition
 Stimulates ant growth of maxilla &Stimulates ant growth of maxilla &
inhibits mandibular growthinhibits mandibular growth

Tx of PCBTx of PCB
Factors that can influence Tx of PCB:Factors that can influence Tx of PCB:
 B-L inclination of teethB-L inclination of teeth
 Lateral shift during mandi closureLateral shift during mandi closure
 Estimate of expansion neededEstimate of expansion needed
 Age of patientAge of patient
 Vertical changesVertical changes

B-L inclination of teeth :B-L inclination of teeth : most impmost imp
upper molars :upper molars :
 if abnormally inclined lingualy –if abnormally inclined lingualy –
advantageadvantage
Tx – tipping teeth buccalyTx – tipping teeth buccaly
 If molars inclined buccaly - narrowIf molars inclined buccaly - narrow
maxillamaxilla
Tx - RMETx - RME

Lower molars :Lower molars :
 Abnormal buccal inclination –Abnormal buccal inclination –
favorablefavorable
Tx – moves lingual positionTx – moves lingual position
 Abnormal lingual inclination –Abnormal lingual inclination –
discrepancy in jaw widthsdiscrepancy in jaw widths

Lateral shift during mandiLateral shift during mandi
closure:closure:
 Unilateral PCB – mandi shift towardsUnilateral PCB – mandi shift towards
CB in COCB in CO
 Lateral functional shift- CB usuallyLateral functional shift- CB usually
bilateral- easy Txbilateral- easy Tx

Estimate of expansion needed :Estimate of expansion needed :
Functional shifts- involving perm 1Functional shifts- involving perm 1stst
molars & post teeth obtained by-molars & post teeth obtained by-
 Diff of width b/w buccal grooves ofDiff of width b/w buccal grooves of
mandi 1mandi 1stst
molars & MB cusp tips ofmolars & MB cusp tips of
maxi 1maxi 1stst
MM
 Adding to this diff 2/3mm for overAdding to this diff 2/3mm for over
correction of CBcorrection of CB

If expansion ,If expansion ,
 4 /<4mm upper molars inclined4 /<4mm upper molars inclined
lingualy-Quad helix,W-lingualy-Quad helix,W-
spring,TPA,SWAspring,TPA,SWA
 5-12mm-ME with jack screw5-12mm-ME with jack screw
 >12mm- combination of jack screw &>12mm- combination of jack screw &
surgical ortho Txsurgical ortho Txwww.indiandentalacademy.comwww.indiandentalacademy.com

Age of patient :Age of patient :
 PCB uni /bilateral with functional shift –PCB uni /bilateral with functional shift –
best to treat in children & youngbest to treat in children & young
adolescentsadolescents
 Unilateral PCB with functional shift – Tx inUnilateral PCB with functional shift – Tx in
pri / mixed /perma dentitionpri / mixed /perma dentition
 Early –bestEarly –best
 Late- TMDsLate- TMDs

 Older adolescents & adults – mid palatalOlder adolescents & adults – mid palatal
suture ossified,tendency to relapsesuture ossified,tendency to relapse
- Surgically assisted jack screw expansion- Surgically assisted jack screw expansion
 Adults – bilateral CB with no functionalAdults – bilateral CB with no functional
shift – NO Tx, as compromiseshift – NO Tx, as compromise
if Tx- by tipping U/L molars- >relapseif Tx- by tipping U/L molars- >relapse

Vertical changes :Vertical changes :
 During Tx – ant OB as teeth in newDuring Tx – ant OB as teeth in new
occlusionocclusion
 Temporary – returns to pre TxTemporary – returns to pre Tx
conditioncondition

Tx of PCBTx of PCB
Depends on underlying cause,Depends on underlying cause,
 Skeletal – narrow maxilla –commonSkeletal – narrow maxilla –common
wide mandible – rarewide mandible – rare
Tx- orthopedic (maxillary expansion)Tx- orthopedic (maxillary expansion)
 Dental CB –Dental CB –
Tx- moving teeth with lighter forcesTx- moving teeth with lighter forces

Unilateral PCB :Unilateral PCB :
 Children – commonChildren – common
 Bilateral constriction of maxillaBilateral constriction of maxilla
 Mandi shift / jaw asymmetryMandi shift / jaw asymmetry
CB due to Mandi shift should be Tx early, toCB due to Mandi shift should be Tx early, to
avoidavoid
 Undesirable soft tissue growth modificationUndesirable soft tissue growth modification

 Dental compensation – less space forDental compensation – less space for
teeth in constricted maxillateeth in constricted maxilla
 Dental abrasion of pri & permaDental abrasion of pri & perma
teethallows normal development ofteethallows normal development of
occlusionocclusion
 Difficult diagnosis –for inter archDifficult diagnosis –for inter arch
relationshiprelationship
 Normal path of closure,TMDsNormal path of closure,TMDs
 Early Tx –more stableEarly Tx –more stable

Tx PCB:Tx PCB:
3 main objectives :3 main objectives :
 EQUILIBRATION- to eliminate mandiEQUILIBRATION- to eliminate mandi
shiftshift
 EXPANSION- for constrictedEXPANSION- for constricted
maxilla - maxi arch widthmaxilla - maxi arch width
 DENTAL CORRECTION- to correctDENTAL CORRECTION- to correct
intra arch asymmetriesintra arch asymmetries

Tx in pri / early mixedTx in pri / early mixed
dentition:dentition:
 PCB- mainly occlusalPCB- mainly occlusal
interference by C’sinterference by C’s
 Careful diagnosis-Careful diagnosis-
dental/mandi shiftdental/mandi shift
 Tx –occlusaTx –occlusa
equilibration of C’sequilibration of C’s
 Interceptive – QuadInterceptive – Quad
helix,W-archhelix,W-arch

In mixed dentition (preadolescents):In mixed dentition (preadolescents):
 Skeletal / dental , uni / bilateralSkeletal / dental , uni / bilateral
 Check for functional shiftCheck for functional shift
 Skeletal- Tx earlySkeletal- Tx early
 Quad helix, W-arch – commonQuad helix, W-arch – common
 True Skeletal CB- surgical +orthoTrue Skeletal CB- surgical +ortho
 Tx Skeletal CB- dental compensation-Tx Skeletal CB- dental compensation-
unstable,relapseunstable,relapse

Bilateral PCB :Bilateral PCB :
 Maxi constriction / mandi expansion /Maxi constriction / mandi expansion /
combinationcombination
 Children & pre adolescents –fullChildren & pre adolescents –full
buccal segment / one or more teethbuccal segment / one or more teeth
 Dental CB- cross elastics / arch wiresDental CB- cross elastics / arch wires
( Tipping the teeth in to correct axial( Tipping the teeth in to correct axial
relationship )relationship )

 Mild skeletal CB- camouflage dentalMild skeletal CB- camouflage dental
TxTx
 Quad helix, W-arch – common(moreQuad helix, W-arch – common(more
dental & less skeletal changes)dental & less skeletal changes)
 Skeletal correction- RMEsSkeletal correction- RMEs

Perma dentition :Perma dentition :
 Age & maxi expansionAge & maxi expansion
 Expansion-before midpalatal sutureExpansion-before midpalatal suture
fusion (15-16yrs)fusion (15-16yrs)
 RME- less response after 16yr(fusion ofRME- less response after 16yr(fusion of
suture& hard &soft tissue resistance )suture& hard &soft tissue resistance )
 Easy expansion - adolescenceEasy expansion - adolescence
 Adults –surgically assisted RME /Adults –surgically assisted RME /
orthognathic-maxi osteotomyorthognathic-maxi osteotomy

AppliancesAppliances
CROSS BITE ELASTICS:CROSS BITE ELASTICS:
 Elastics on buccal & lingual attachmentElastics on buccal & lingual attachment
 Reciprocal actionReciprocal action
 Full time wear (except meals)-changeFull time wear (except meals)-change
dailydaily
 Tx time- 8-15 wksTx time- 8-15 wks
 Reinforcing anchorage-’ Reinforcing bar ’Reinforcing anchorage-’ Reinforcing bar ’
 Pt cooperation impPt cooperation impwww.indiandentalacademy.comwww.indiandentalacademy.com

 Molar CB – maxi 2Molar CB – maxi 2ndnd
commoncommon
 16-20 wks16-20 wks
 Occlusal adjustmentOcclusal adjustment
(ML cusp maxi)(ML cusp maxi)
 Retention : selfRetention : self
retaining, continueretaining, continue
Elastics for few hrs,Elastics for few hrs,
few days –stabilityfew days –stability
 Adv effect –Adv effect –
EXTRUSION OFEXTRUSION OF
TEETHTEETH

REMOVABLEREMOVABLE
APPLIANCES :APPLIANCES :
 Acrylic plate with a wireAcrylic plate with a wire
spring or jack screwspring or jack screw
 Skeletal expansion –Skeletal expansion –
questionablequestionable
 Tx- pri / early mixedTx- pri / early mixed
dentition- favorabledentition- favorable
 Disadv-pt compliance,Disadv-pt compliance,
less forceless force

SCHWARTZSCHWARTZ
PLATE :PLATE :
 Active expansionActive expansion
plate with a screwplate with a screw
for ACBfor ACB
Y-PLATE:Y-PLATE:
 For both Ant & postFor both Ant & post
expansionexpansion

W-archW-arch
 Fixed, in bilateralFixed, in bilateral
constriction ofconstriction of
maxillamaxilla
 Pri / mixed dentitionPri / mixed dentition
 Skeletal & dentalSkeletal & dental
 0.036” s.s, soldered0.036” s.s, soldered
to molar bands,1-1.5to molar bands,1-1.5
away from palateaway from palate

 Activation : IO/EO, opening bendsActivation : IO/EO, opening bends
Ant bending- post XpnAnt bending- post Xpn
Post bending – ant XpnPost bending – ant Xpn
 Xpn- 2mm/monXpn- 2mm/mon
 Tx - 2-3mosTx - 2-3mos
 Retention -3mos as passive applianceRetention -3mos as passive appliance

Quad helixQuad helix
 Flexible version ofFlexible version of
W-archW-arch
 HelicesHelices
(2+2),flexibility&(2+2),flexibility&
range of actionrange of action
 0.038”s.s0.038”s.s
 Soldered molarSoldered molar
bands, away palatebands, away palate
 pri / early mixedpri / early mixed
dentitiondentition www.indiandentalacademy.comwww.indiandentalacademy.com

 Ant bridge – reminder for TS habitAnt bridge – reminder for TS habit
(PCB with TS- best indication)(PCB with TS- best indication)
 Palatal bridge – b/w ant & post helicesPalatal bridge – b/w ant & post helices
 Free ends – outer arms –on palatalFree ends – outer arms –on palatal
surfacessurfaces
 Activation: IO/EO-3 prong plierActivation: IO/EO-3 prong plier
 Dental & skeletal XpnDental & skeletal Xpn

Effect of maxi Xpn using Quad helix duringEffect of maxi Xpn using Quad helix during
deciduous & mixed dentition –AJO 1981deciduous & mixed dentition –AJO 1981
 Tx of functional PCB,same effect in bothTx of functional PCB,same effect in both
 in inter canine & inter molar widthin inter canine & inter molar width
 Xpn in 2 wksXpn in 2 wks
 Total tx time 3-6mosTotal tx time 3-6mos

AMEX appliance for Tx of true uniAMEX appliance for Tx of true uni
CB: AJO-DO 2002;122:164-73CB: AJO-DO 2002;122:164-73
 Uni CB in 18 pts,14yrs- corrected inUni CB in 18 pts,14yrs- corrected in
3.3 mos (2.5-4mos)3.3 mos (2.5-4mos)
 in inter canine,PM & inter molar archin inter canine,PM & inter molar arch
width significantlywidth significantly
 Buccal tipping,effective in Uni CBBuccal tipping,effective in Uni CB

 Conventional Xpn apliance- expandConventional Xpn apliance- expand
arch bilaterallyarch bilaterally
 AMEX- move selected teeth onAMEX- move selected teeth on
constricted sideconstricted side

 0.036” s.s wire-0.036” s.s wire-
Quad helix typeQuad helix type
aplianceapliance
 2 helixes & force2 helixes & force
arm on teeth in CBarm on teeth in CB
 ‘‘VerticalVertical
stopper’(anchorstopper’(anchor
unit) on non CBunit) on non CB
side solderedside soldered

 Activation : EOActivation : EO
 Expanding force arm by 8mm,keepingExpanding force arm by 8mm,keeping
arms parallelarms parallel
 Reactivation at 4wks till CB correctedReactivation at 4wks till CB corrected
 Adv :effective in uni CB than conventionalAdv :effective in uni CB than conventional
 Well tolerable by ptsWell tolerable by pts
 Less pt complianceLess pt compliance

COFFIN SPRING :COFFIN SPRING :
 1.25 mm wire1.25 mm wire
 Omega shapedOmega shaped
wire,free ends inwire,free ends in
acrylicacrylic
 Dento alveolar &Dento alveolar &
skeletal in youngsskeletal in youngs
 Activ-pullingActiv-pulling
manuallymanually

RME :RME :
 Hyrax,hass typeHyrax,hass type
 JACK SCREW-JACK SCREW-
active element inactive element in
plateplate
 Controlled toothControlled tooth
movementmovement
 Disadv-heavyDisadv-heavy
forces,rapid-forces,rapid-
damage teethdamage teeth

 Ni Ti expanders:Ni Ti expanders:
 Niti wire,diff sizesNiti wire,diff sizes
 Attached to molarsAttached to molars
 Slow Xpn –dental inSlow Xpn –dental in
adolescents &adolescents &
adultsadults

Functional appliancesFunctional appliances
Activator:Activator:
 Less effective than-Xpn actviveLess effective than-Xpn actvive
plates,jack screwplates,jack screw
 Acrylic surface should contact teethAcrylic surface should contact teeth
 Jack screw also incudedJack screw also incuded
 Single tooth / multiple-with springs inSingle tooth / multiple-with springs in
applianceappliance

TWIN BLOCK :TWIN BLOCK :
 in narrow maxillaryin narrow maxillary
arch-Class II div 1arch-Class II div 1
 Xpn screwXpn screw

RetentionRetention
 Self retainingSelf retaining
 Stabilization for 3-4mos (passiveStabilization for 3-4mos (passive
appliance)appliance)
 ACB-sufficient OBACB-sufficient OB
 PCB - >chances relapse after Xpn-PCB - >chances relapse after Xpn-
elasticity of palatal tissue (palatalelasticity of palatal tissue (palatal
plate/heavy labial wire 0.036)plate/heavy labial wire 0.036)

 OVER CORRECTIONOVER CORRECTION
 ““ Xpn should be stopped when maxiXpn should be stopped when maxi
palatal cusps contacts with the lingualpalatal cusps contacts with the lingual
slopes of the buccal cusps of mandislopes of the buccal cusps of mandi
teeth “teeth “

ConclusionConclusion
 Its imp to distinguish CB dental /Its imp to distinguish CB dental /
functional / skeletal (uni / bilateral)functional / skeletal (uni / bilateral)
 Dental: segmental ACB –jawDental: segmental ACB –jaw
discrepancydiscrepancy
 Skeletal - ‘ constricted of maxilla ‘Skeletal - ‘ constricted of maxilla ‘
(children )(children )
 Tx- earliest to avoid IIndry effectsTx- earliest to avoid IIndry effects

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