This document discusses the management of anterior and posterior crossbites. It emphasizes the importance of a thorough analysis prior to any treatment, including evaluating the tooth-to-tooth relationships in centric relation and the impact of changing vertical dimension. For anterior crossbites, conservative approaches like occlusal equilibration, orthodontics, and restorations are preferred but orthognathic surgery may be needed for skeletal discrepancies. Posterior crossbites should also be thoroughly analyzed before correction, ensuring the teeth can disclude properly and are harmonious with surrounding structures. The goal of any treatment is to establish a stable, functional and comfortable occlusion.

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Learn from yesterday.
Live for today, hope for tomorrow.
The important thing is
NOT TO STOP QUESTIONING
Good Morning

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MANAGEMENT OF CROSSBITE

3. Content
• Introduction
• Anterior cross bite
• Analysis
• Problem associated with
anterior crossbite
• Pseudoprognathism
• Why increasing VDO
work?
• Surgical correction
• TMD’S AND Anterior
crossbite
• Posterior crossbite
• Evaluating posterior
crossbite
• Restoring the posterior
crossbite
• Conclusion
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4. Malocclusion
• An occlusion in which there is a malrelationship between
the arches in any of the planes or in which there are
anomalies in tooth position, number, form and
developmental position of teeth beyond normal limits.
Houston WJ. Walther’s Orthodontic Notes, 4th ed
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5. What do we think about when someone says
“Cross bite”???
Treatment Planning is very Important!!!!!
Don’t change what is right to fix
what is wrong…
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6. CROSS BITE
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Based on location
Anterior crossbite Posterior crossbite
Based on nature
Skeletal Dental Functional

7. Complete Treatment Planning is the goal…
“90% of cases that fail, fail not during the
restorative phase but in the treatment
planning phase”.
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8. ANTERIOR CROSSBITE
Consider This....
NEVER TREAT AN ANTERIOR CROSSBITE
WITHOUT FIRST ANALYSING THE
TOOTH-TO-TOOTH REALTIONSHIPS AT THE
SELECTED VERTICAL DIMENSION IN
CENTRIC REALTION….
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9. Consider This....
1) IS THE ANTERIOR CROSSBITE THE RESULT OF
MANDIBULAR PROGNATHISM OR MAXILLARY
DEFICIANY
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10. 2) WHAT IS THE ANTERIOR RELATIONSHIP IN CENTRIC
RELATION? IF IT IS END TO END IN CENTRIC
RELATION,HOW MUCH VERTICAL DISPLACEMENT
OF THE CONDYLE IS THERE IN MAXIMAL
INERCUSPATION??
3) DO THE ANTERIOR TEETH NEED TO BE RESTORED
BECAUSE OF WEAR OR APPEARANCE??
Consider This....
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11. 4) IS THE CROSSBITE AN ESTHETIC PROBLEM? CAN
THE ANTERIOR TEETH BE RESTORED END TO END??
Consider This....
5) THE IMPORTANCE OF VERTICAL DIMENSION IN
CROSSBITE PROBLEM IS CRITICAL. CLASS III
PATIENT OFTEN RESPOND UNFAVOURABLY TO
INCREAING THE VERTICAL DIMENSION OF
OCCLUSION??
6) ANTERIOR GUIDANCE IS NOT A PROBLEM AS
ANTERIOR CROSSBITE PATIENT DONOT PROTRUDE.
THEY HAVE VERTICAL ENVELOPE OF FUNCTION.
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12. Consider This....
7) DISCLUSION OF THE BALANCING SIDE SHOULD BE
ACHIEVED BY GROUP FUNCTION OF THE WORKING
SIDE POSTERIOR TEETH
8) ORTHOGNATHIC SURGERY IS OFTEN THE
TREATMENT OF CHOICE FOR CORRECTON OF
FACIAL PROFILE PROBLEMAND CAN RESULTS
GOOD OCCLUSAL RELATIONSHIP
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13. CORRECTIVE OR PREVENTIVE???
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16. WHAT HAPPENS WHEN THIS GUY WALKS IN
THE DOOR???
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17. No anterior guidance
No centric contact on anterior
teeth
Esthetics
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18. PSEUDOPROGNATHISM
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20. Stabilize the occlusion than restoration
Open the bite
Accomplish the "crossover"
Refine the anterior relationship
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21. COMBINATION APPROACH
Shortening the anterior teeth
Removable appliances
Permanent restorations should not be started for at least two
months after completion of the tooth movement.
Provisional plastic bridges as retainers
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22. Make sure that there is sufficient alveolar
Bone labially
Stresses exerted on the teeth are reversed.
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23. HOW TO GET IN TROUBLE…..
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•Improvement of anterior alignment in a
crossbite always requires an increase in VDO ...
never a decrease
•All occlusal problems should be evaluated on
diagnostic casts that have been mounted with a
facebow record in centric relation.

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So Unmounted Casts Have No Place In Analysis Of
Crossbite Problems

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Why increasing the VDO work???

28. • Eliminate occlusal interferences on the casts
• Complete wax-up of all anterior teeth should also be
accomplished.
• The necessity for complete preoperative analysis is
probably the greatest in anterior crossbite problems
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•The crossbite is still present, but there is no deviation.
•This is the treatment of choice for solving TMJ problems in many
crossbite patients with centric interferences if the contour changes are
minimal.
•It may be wise in some patients to add a stop on the lingual of the lower
incisors.

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The conservative approaches for resolving Anterior
crossbite problems can be summarized as follows:
1. Selective shaping and occlusal equilibration
2. Orthodontic repositioning of the teeth within the
present bone framework
3. Restorative reshaping
4. A combination of the above procedures

31. • It is almost always possible to provide comfort, function,
and stability to anterior crossbite relations with one or
more of the above procedures.
• But it is not always possible to satisfy the esthetic
requirements of some patients
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32. • Increasing the VDO causes the lower incisors to arc back
more in line with the upper anterior teeth. It also separates
the lower teeth from the interfering upper labial inclines that
force the mandible forward, so the occlusion can be
reconstructed into a centric relation harmony
• If the increased VDO is established with equal-intensity
centric contacts on all teeth, there will be a favorable
prognosis
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33. Opening the bite is a logical choice
if:
• An acceptable end-to-end relationship can be achieved at
the incisors in harmony with centric relation.
• The required increase in VDO is acceptable.
• The posterior segments require restoration for other
reasons.
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34. 1. Live with the prognathism with fairly good assurances that the
dentition can be maintained.
2. Select a surgical correction.
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SURGICAL CORRECTION
Resection through the ramus
Horizontal resection of the maxilla
Sectional osteotomies

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Before surgery is attempted, the TMJs must be in optimum
position and alignment, and the occlusal relationship must
be predetermined in relation to a verifiable centric relation.
Planning for surgery requires that casts must be mounted
with a facebow in centric relation, and any changes in arch
position must be related to that three-dimensional
alignment.

37. TMJ DISORDER AND ANTERIOR
CROSSBITE
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• Interferences to centric relation must be eliminated.
• Surgical correction
• A compromise treatment utilizing an occlusal centric relation
splint at increased VDO may be the only practical approach to
getting the patient out of pain.

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POSTERIOR CROSSBITE
QUESTIONS ASK BEFORE CORRECTING CROSSBITE???

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1. Are the teeth ideally situated in the alveolar process?
2. Would a change in tooth position benefit tooth-to-muscle
harmony or is the relationship in harmony with the
tongue and perioral musculature??
3. Can the lower posterior teeth disclude as they move
toward the tongue???
Leave it alone

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Analysing cusp fossa realtionship
Confusing balancing side disclusion

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A crossbite relationship is the correct relationship for ideal axial forces if
the skeletal base is larger on the mandible…

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Is such a crossbite relationship incorrect???

43. OBSERVATIONS SHOULD BE MADE
• Tooth-to-bone relationship in the same arch
• Relationship of the teeth to the tongue and cheeks
• Occlusal relationship
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44. Tooth-to-bone relationship in the same arch
• Are the teeth ideally situated in the alveolar process?
• Would the tooth-to-bone relationship be improved if the
mandibular teeth are moved lingually or the maxillary
teeth buccally?
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45. Relationship of the teeth to the tongue and cheeks
• Are the teeth in harmony with normal tongue and cheek
pressures, or have they been moved into the crossbite
relationship by abnormal muscle patterns or habits?
• If deviate tongue or cheek patterns have moved the teeth
into a malrelationship, is it possible to correct the
abnormal habit pattern?
• Would a change in tooth position or contour benefit the
tooth-to-muscle harmony or the overall stability?
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46. Occlusal relationship
• If the occlusal relationship causes stresses to be
directed favorably up or down the long axes.
• If the occlusal contours permit favorable distribution
of lateral forces in excursive movements.
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RESTORE IT………..
Upper inclines that face the cheek or lower inclines that face
the tongue should never contact in lateral excursions
When the lower posterior teeth move toward the tongue, they
must disclude
CROSSBITES ARE NO EXCEPTION

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Lower lingual cusps & upper buccal cusps become the functioning cusps.
Posterior group function
Lower lingual cusps contact the lingual inclines of the upper
buccal cusps
Disclude the opposite-side balancing inclines.

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53. We must become an expert at answering
this question!!
We must be good at asking one question......
However…..Why????
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Conclusion

54. • It is almost always possible to provide comfort, function, and
stability to anterior crossbite relations with one or more of the above
procedures
• If the increased VDO is established with equal-intensity centric
contacts on all teeth, there will be a favorable prognosis
• Posterior crossbite relationship can be every bit as stable, functional,
comfortable, and esthetic as its more normal counterpart.
• The equilibration of crossbite relationships, as with other
relationships, should provide noninterfering closure into centric
relation.
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Conclusion

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