Posterior crossbite refers to an abnormal transverse relationship between the upper and lower posterior teeth, where the mandibular buccal cusp occludes buccal to the maxillary buccal cusp. Posterior crossbites can be classified based on etiology, number of teeth involved, unilateral/bilateral involvement, and extent. Management depends on whether the crossbite is dental, skeletal, or functional in nature, and involves appliances like Coffin springs, W-arches, quad helix, and rapid maxillary expansion to correct the underlying discrepancy. Early treatment of posterior crossbites is important to allow for proper arch development and prevent future malocclusions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Elastics in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Elastics in orthodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Posterior crossbite in_primary_and_mixed_dentition_-_etiology_and_management_...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Posterior crossbite in_primary_and_mixed_dentition_-_etiology_and_management_...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Buccolingual malrelationship of upper and lower
teeth.Anterior or posterior (unilateral or bilateral) with or
without mandibular displacement.
Buccal crossbite: Lower teeth occlude buccal to
corresponding upper teeth .
Lingual crossbite (scissors bite): Lower teeth occlude
lingual to palatal cusps of upper teeth.
Occlusion is defined as the contact relationship of the teeth in function or parafunction.
Malocclusion is defined as the misalignment of teeth and jaws, or more simply, a "bad bite". Malocclusion can cause a number of health and dental problems.
Cross bite
Definition: failure of the two dental arches to occlude normally in bucco-lingual or labiolingual direction due to:
1- Localized problem of tooth position or alveolar growth
2- Gross disharmony between maxilla and mandible
Anterior cross bite:
= can be present in primary as well as permanent dentition
= it may involve one or more teeth
= it is one of the most common malocclusion present in children
= it should be treated immediately because it is very rarely to self-correcting
= it can be predisposing to the development of class III malocclusion if two or more teeth are involved
Causes:
= over retained deciduous teeth
= crowding
= cleft palate
Posterior cross bite:
Caused by prolonged retention of deciduous molar
= the most common type of posterior cross bite is usually when the buccal cusps of maxillary posterior teeth occlude lingual to the buccal cusp of opposing mandibular teeth
= in a majority of posterior cross bite cases, both the opposing teeth are out of position
Therefore, the treatment consists of reciprocal movement of both teeth
The cross bite may involve one or more than one tooth and it may be unilateral or bilateral
The cross bite may originate in: dentition, craniofacial skeleton, and temporomandibular musculature
Types of cross bite:
1- Dental:
This condition involves only the localized tipping of a tooth or teeth and does not affect the size or shape of the basal bone
Muscular adjustment is always being made to provide an adequate accommodative occlusion
The midline coincides when the jaws are a part and diverge as the teeth come into occlusion
The most important diagnostic single point will be a symmetry of the dentoalveolar arch
2- Muscular:
This group includes all problems in malfunction of the dentofacial musculature
Any persistent alteration in the normal synchrony of the mandibular movement or muscle contraction may result in distorted growth of facial bones or abnormal position of the teeth
A simple lip sucking habit may give raise to class II dentition and profile. The sucking habit itself is a complicated neuromuscular reflex involving many muscles of the face, temporomandibular articulation and tongue
N: B:
= continued sucking may narrow the maxillary dental arch, this contraction of the maxillary arch give raise to another complicated neuromuscular habit pattern, mandibular retraction
= the narrowing of the maxillary arch results in tooth interference, and the mandible is then shifted posteriorly by the muscles to position of better occlusal function which is called compulsive disto-occlusion (Hotz)
= there is no clear cut differentiation between the dental and muscular type except for treatment, that for dental, teeth must be moved but in muscular, the adjustment often be gained by occlusal equilibration, which permits changes in the muscular reflexes governing mandibular positioning
3- Osseous:
= Aberrations in bony growth may give raise to cross bite in two ways:
1- A symmetric growth of maxill
Wisdom Global Islamic Mission വിതരണം ചെയ്യുന്ന ജീവിതം എന്തിനു വേണ്ടി എന്ന വിഷയത്തിൽ ഉള്ള പുസ്തകത്തിന്റെ ONLINE കോപ്പി ഫ്രീ ആയി DOWNLOAD ചെയ്യാം ..ഷെയർ ചെയ്യുക
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. POSTERIOR CROSSBITE IN PRIMARY AND MIXED DENTITION: ETIOLOGY AND MANAGEMENT DR SHABEEL PN http://hi-dentfinishingschool.blogspot.com/ http://www.apexiondental.com/ DEPARTMENT OF PEDIATRIC DENTISTRY
2. DEFINITION OF CROSSBITE According to Graber: A condition where one or more teeth may be malposed abnormally-buccally or labially or lingually with refernce to opposing tooth or teeth. Other definition: -A deviation of the normal faciolingual relationship of teeth of one arch with those of opposing arch when the two dental arches are brought into centric occlusion OR -Abnormal occlusion in the transverse plane OR -Reverse overjet of one or more teeth
3. INTRODUCTION Under normal circumstances- maxillary arch overlaps mandibular arch both labially and buccally. But when mandibular teeth (single tooth or a segment of teeth) overlap maxillary teeth labially or buccally depending upon their location in the arch a crossbite is said to exist
4. CLASSIFICATION OF CROSSBITES (1) According to the location in the arch Anterior Posterior (2) According to the nature of crossbite Skeletal Dental Functional crossbite crossbite crossbite
5. POSTERIOR CROSSBITE -This refers to an abnormal transverse relationship between upper and lower posterior teeth. - In normal circumstances –mandibular buccal cusps occlude in the central fossae of maxillary posterior teeth. - In posterior crossbite case – mandibular buccal cusp occlude buccal to maxillary buccal cusp. PREVELANCE: In a study (By Kutin and Hawes) involving 515 children, 3-9 years of age :- the prevelance of posterior crossbite in primary and and mixed dentition is 1:13 or 7.7%
6. CLASSIFICATION OF POSTERIOR CROSSBITES (1) According to the number of teeth involved single tooth segmental crossbite tooth crossbite (2) According to existence on one/both sides of arch unilateral bilateral (3) According to etiologic factor skeletal dental functional
7. (4) According to extent of crossbite Simple Buccal Lingual posterior non occlusion non occlusion crossbite crossbite crossbite Buccal cusp of one/more The maxillary posteriors occlude Maxillary posteriors teeth occlude lingual to entirely on buccal aspect of occlude entirely on the buccal cusp of mandibular posteriors.Also known as lingual aspect of mandibular teeth SCISSOR BITE mandibular posteriors
8. ETIOLOGY Based on etiologic factors responsible for crossbite: CROSSBITE Dental Skeletal Functional
9. Dental crossbites - Generally, single tooth/segmental crossbite. - No threat to general health of the patient - Problems arising are – periodontal/ esthetic in nature. - Usually result from faulty eruption pattern with no irregularity in the basal bone. - Once the teeth erupt – the occlusion locks them into position and drives them even further into a crossbite relationship.
10. Etiology of dental crossbite are :- 1) Anomalies in tooth number supernumerary teeth missing teeth 2) Anomalies in tooth size microdontia macrodontia 3) Anomalies in tooth shape 4) Premature loss of deciduous/ permanent teeth 5) Prolonged retention of deciduous teeth 6) Delayed eruption of permanent teeth 7) Abnormal eruption path 8) Ankylosis
11. SKELETAL CROSSBITE - It results from discrepancy in structure of maxilla and mandible or – malposition of the jaw. - A basic discrepancy in the width of arches is noted. - A narrow maxillary arch or a wide mandibular arch often assosciated with a buccal crossbite. - They cause appreciable damage to a person’s health and personality.
12. Etiology of skeletal crossbites 1) Retarded development of maxilla. 2) Narrow upper arch. 3)Forwardly placed mandible. 4) Unilateral hypo/hyperplastic growth of any jaw. 5) Hereditary (Class III skeletal malocclussion). 6) Congenital ( Cleft lip and palate). 7) Trauma at birth (forcep injury leading to ankylosis of TMJ.) 8) Trauma during growth (ankylosis of TMJ and retardation of growth in traumatized bone). 9) Trauma after completion of growth (malunion of fracture segments). 10) Habits such as prolonged thumb sucking and mouth breathing. Because they cause lowered tongue position ,thus tongue no longer balances the forces exerted by the buccal group of musculature, which leads to narrowing of upper arch leading to posterior crossbite. 11) According to RUTRICK – the use of traditional slender type of pacifiers can cause crossbite.
13. Functional crossbite - An acquired muscular reflex pattern during closure of mandible is involved in functional crossbite. - Presence of occlusal interferences can result in deviation of mandible during jaw closure. - Other causes are : early loss of decidous teeth decayed teeth ectopically erupted teeth. - Thus a functional crossbite results from the mandibular shifting into an abnormal but often a more comfortable position.
14. MANAGEMENT In normally growing mandible, posterior crossbites should be treated as early as possible to allow the normal growth and development of the dental arches and the TMJ. Posterior crossbite management IN PRIMARY IN MIXED DENTITION DENTITION
15. In primary dentition - Posterior crossbite in primary dentition is usually as a result of constriction of the maxillary arch which often results from an active digit or pacifier habit. - Determine whether there is an associated mandibular shift. Mandibular shift present not present treatment is implemented treatment is delayed until the to correct the crossbite permanent first molars erupt If the first permanent If the first permanent molar erupts into crossbite molar erupts normally Treatment is initiated Treatment is not indicated until (if no other malocclusion exists) the permanent premolars erupt
16. In mixed dentition - Posterior crossbite correction in mixed dentition can be difficult and confusing. - The clinician should rely on a well documented database to determine whether a skeletal/dental correction is necessary. - And in areas where mandibular shift is present it should be managed as soon as possible to prevent soft tissue and dental compensation. Posterior dental crossbite Generalized Localized Unilateral Bilateral
17. The various treatment modalities for posterior crossbite are :- 1) Occlusal equilibrium. 2) Coffin spring. 3) Cross elastics. 4) Soldered W –arch (Porter appliance). 5) Quad Helix. 6) Removable appliance. 7) Rapid maxillary expansion (RME). 8) Ni-Ti expanders. 9) Oral screening. 10) Fixed orthodontic appliances.
18. OCCLUSAL EQUILIBRIUM - A dental, bilateral, lingual crossbite in primary and mixed dentition may be simply corrected by removing the occlusal interferences usually in the cuspid area. - This may be sometimes needed to be accompanied by some appliance.
19. COFFIN SPRING - It was designed by Walter Coffin. - It is a removable, omega shaped wire appliance - It produces slow and bilaterally symmetrical expansion. - It consists of omega shaped wire of 1.25 mm diameter placed in mid palatal region. - Free ends of omega are embedded in an acrylic plate that covers the slopes of the palate. - It brings about dento alveolar expansion. - However, it is capable of skeletal changes when used in mixed dentition with a good retention.
20. CROSS ELASTICS - It is used to treat localized crossbites. - Select, fit and burnish appropriate band to maxillary and mandibular teeth. - Solder hooks or button to the bands- - - on palatal surface of the maxillary teeth and on buccal surface of the mandibular teeth. - After these bands are welded and cemented rubber elastics is attached on the hooks as shown in fig. - The rubber elastics used are – heavy rubber elastics, 0.25 i.e. 3/16 inch and 6 ounce elastic
21. - The elastic should be worn full time except while eating. - Change it atleast once per day. - The elastics are worn until the crossbite is slightly over corrected . - Crossbites are ususally corrected within 3-4 months (with continuous wearing of elastics). - Major change will be reflected in position of the maxillary molar because of the cancellous nature of the maxillary alveolar bone compared with denser bone around mandibular molar. - Advantage - Usually no need of retentive appliance - Disadvantages – Needs patient’s co operation and is technically more difficult.
22. SOLDERED W – ARCH (PORTER APPLIANCE) - It is an efficient appliance for the correction of posterior crossbite as well as a reminder appliance in some posterior crossbites assosciated with thumb sucking. - Preformed stainless steel bands are adapted to the most distal tooth involved. - W-arch is constructed of 0.036-0.040 inch steel wire- contoured to the arch. - Wire is made free of tissue by 1-2 mm. - Anterior extension of the wire should touch only the teeth that must be moved buccally. - W-arch is expanded about 4mm wide than its passive width or so that one arm of “ W” is resting over central grooves of teeth when the other arm is in proper position.
23. - The appliance is cemented during active treatment. - Activate the appliance by slightly opening the palatal loop with a corresponding adjustment in the molar loop area. - The appliance activation:- intra orally or extra orally. - Appliance expands the arch approx 1mm/side/month. - Activated every 3-4 weeks until crossbite is slightly over corrected. - Retainer used for additional 3 months.
24. Modification : UNEQUAL W-ARCH - Used in case of true unilateral crossbites. - It has long and short arms. - Short arm- touches only the teeth to be moved. - Long arm – touches as many contralateral teeth as possible. - The idea behind the unequal W-arch is to pit the movement of a large number of teeth against movement of small number of teeth. - The side with smaller number of teeth – more movement side with larger number of teeth - less movement.
25. QUAD HELIX - Introduced by Currier and Austerman, 1993. - The quad helix is a spring that consists of 4 helices- 2 helices in the anterior palate and 2 helices near solder joint in the posterior palate . - It is capable of dento alveolar as well as skeletal expansion. PROCEDURE : Fit bands to either primary second molars or the permanent first molars. Take a complete arch impression. Remove the bands from teeth and seat them in proper position Seal in place and make a working cast of stone Use a 0.032 stainless steel wire, this stainless steel wire contacts all posterior teeth, anterior aspect of wire is just distal to primary canines, the contact is close to, but not touching the soft tissue at cervical margin, the loops or helixes and palatal portion should be 2-3 mm distal to banded teeth Secure the wire to working cast,solder the wire to molar bands.
26. - Activate the appliance prior to cementation. - Activation is done intra orally - using triple beak plier extra orally – using hand. - Activation is done in 2 steps : Step 1 – Activate the posterior helical loops, moving the free wires buccally. Step 2 – Activate the anterior helical loops moving the molar bands buccally.
27. - When the wire has been activated the lingual surface of molar bands will be above the central fossa of the molars. - The anterior portion of wires will be above the canine cusp tip . - The appliance produces slow expansion - Crossbite corrected in 4-6 months. - Retain the same appliance for further 3 months. - The quad helix can be used simultaneously with full bonded appliance therapy. Modification – UNEQUAL QUAD HELIX Same as unequal W- arch Used to correct unilateral crossbites
28. REMOVABLE APPLIANCES - Lateral maxillary expansion is achieved with a parallel expansion screw housed in upper acrylic plate. - The appliance should have excellent tissue contact and anchorage with clasps on teeth. - Provide acrylic relief – palatal to anterior teeth. - The labial bow should be passive; when expansion occurs-bow becomes activated. - A full turn is achieved with 4 turns of a key. - The conventional expansion schedule– ¼ turn every 3-4 days. - Correction is dental only. - It causes bilateral expansion. - Relapse potential is high.
29. RAPID MAXILLARY EXPANSION - Rapid maxillary expansion is indicated for severe cases of bilateral crossbites where correction requires skeletal expansion . - It involves the splitting of the mid palatal suture orthopaedic increase in maxillary width. - It can easily occur in a growing child (< 9 years). - The appliance uses a mid–palatal screw (Hyrax) – soldered to bands on the first permanent molars and primary molars. RME screw Banded RME Cemented RME.
30. - The screw is activated a quarter turn twice each day. - Patient is monitored once a week. - It brings about 0.2-0.5 mm/day expansion . - The appliance produces a rapid expansion over 3-4 weeks . - Crossbite should be over corrected and then retained for atleast 3 months with the same applaince.
31. NICKEL TITANIUM EXPANDERS - They bring about slow expansion (dental changes). - They require less adjustments than conventional stainless steel quad helix appliances. - Molar bands are cemented to maxillary first permanent molars welding is done. Ni–Ti wire shapes are attached to lingual sheath of welded molar band. - Various sizes are available and need to be selected depending on : - the amount of expansion desired - pre treatment width of the palate
32. - Cooling the expander it gets constricted it gets inserted into lingual tubes on the maxillary molars. As it warms to body temperature it becomes springy exerts continuous force on teeth arch expansion
33. ORAL SCREEN/VESTIBULAR SCREEN - Introduced by Newell in 1912. - It is a myofunctional appliance – that takes form of a curved acrylic shield placed in labial vestibule. PRINCIPLE : It works on the principle of force application + force limitation . i.e. to apply the forces of circumoral musculature to certain teeth OR to relieve those forces from teeth therefore allowing them to move due to forces exerted by tongue It works on principle of “PASSIVE EXPANSION”
34. INDICATIONS : To intercept habits – mouth breathing thumb sucking tongue thrusting lip/cheek biting To treat mild disto-occlusions. To perform muscle exercise to help correction of hypotonic lip and cheek muscles. CONTRAINDICATIONS : In children with nasal obstruction or respiratory distress
35. PROCEDURE : Take upper and lower impressions and pour working models Casts are occluded in normal intercuspation and sealed Extend vestibular screen into sulcus– (where mucosal tissue reflects) Posteriorly extend the appliance upto distal margin of the last erupted molar. Note : The material used is SELF CURE/HEAT CURE acrylic resin. The patient is made to wear the appliance at night and 2-3 hours during the day time and maintain lip seal .
36. MODIFICATIONS : Hotz modification – made up of additional metal ring . Patient with tongue thrust – additional screen placement on lingual aspect In Mouth breathers – vestibular screen with a number of holes which are gradually decreased
37. FIXED ORTHODONTIC APPLAINCES - Fixed orthodontic appliances can be used for correction of posterior crossbites. - The arches can be kept slightly expanded depending upon the movement required. - Cross elastics can be used to bring about correction of individual tooth crossbite in posterior segment. - Fixed orthodontic appliance are ideal for accurate placement of teeth in a dental arch as they provide a three dimensional control over the tooth.
38. CONCLUSION The early and correct diagnosis of posterior crossbite is essential to prevent the forthcoming occlusal discrepancies in the permanent dentition. Adequate curative measures and treatment modalities should be advocated to correct the posterior crossbite
39. REFERENCES 1) S.I. Bhalajhi – Orthodontics-The Art and Science 2) Gurkeerat singh – A Textbook of orthodontics. 3) Mc Donald RE, Avery DR, Dean JA -- Dentistry for the child and adolescence. 4) Angus C Cameron – Handbook of Pediatric Dentistry. 5) Pinkham, Casammassimo, McTigue, Nowak – Pediatric Dentistry Infancy Through Adolescence.