Anterior CrossCross-bite

Chainarong Kaosampan
Chaoprayayomraj Hospital 16 September 2010

CONTENTS
1. Definition 2. Classification 3. Etiology 4. Clinical Features 5. Diagnosis 6. Management 7. Treatment 8. Conclusion

Definition:

An abnormal labio - lingual relationship between one or more maxillary & mandibular incisor teeth

Lee BD.; 1978

Classification of anterior cross-bites
The simple dental cross-bite € The functional or pseudo cross-bite € The skeletal cross-bite
€

Rob Veis; 2008

Etiology
Simple dental cross-bite 
 

Abnormal eruption of the permanent incisors Trauma to the primary incisors with displacement of the permanent tooth bud Delayed exfoliation of a primary incisor with palatal deflection of the erupting permanent incisor

Rob Veis; 2008

Etiology
Simple dental cross-bite 
   

Supernumerary anterior teeth Odontomas Congenitally abnormal eruption patterns Arch perimeter deficiency A habit of biting the upper lip

Rob Veis; 2008

Etiology
Functional cross-bite
Early occlusal interference  Habitual forward positioning of the mandible to obtain maximum intercuspation may lead to an anterior cross bite 

Rob Veis; 2008

Etiology
Skeletal cross-bite
Genetic  Due to deficient anterior growth of maxilla  Excessive abnormal mandibular growth in anteriorly  Combination 

Rob Veis; 2008

Characteristics
Simple dental cross-bite 
  

The cross-bite usually involves only one or two teeth The anterior posterior skeletal relationship is normal The facial profile is normal in CR and CO One or both of the arches is/are narrow

Major PW & Glover K; 1992 McEvoy ; 1983

Characteristics
Simple dental cross-bite  

The mandible has a smooth arc of closure into an Angle Class I molar and cuspid relationship, with a coincident CR and CO An abnormal axial inclination of either the maxillary or mandibular anterior teeth occurs as they erupt, while the other teeth are usually in a normal occlusal scheme

Graber; 1972 McEvoy ;1983 Moyers; 1973

Characteristics
Functional cross-bite
In CO: Incisors cross-bite  Molars Class III relationship  The maxillary incisors are generally retroclined and the mandibular incisors may be proclined  The gonial angle is average near 120 degrees 

Major PW & Glover K; 1992

Characteristics
Functional cross-bite
In CR the opposing incisors generally contact edge to edge with the molars separated but in an Angle Class I relation.  Occlusal interference anterior shift of the mandible  In CR or in a relaxed postural position normal facial profile convexity 

Major PW & Glover K; 1992

Characteristics
Skeletal cross-bite
In CR straight or concave profile  In CR & CO Class III molar relationship and an anterior cross-bite  The mandibular closure smooth without any occlusal interferences 

Major PW & Glover K; 1992

Characteristics
Skeletal cross-bite
Maxillary incisors proclined  Mandibular incisors retroclined  ANB the maxilla is relatively retracted or the mandible is positioned anteriorly  The gonial angle obtuse (130 -140 degrees) 

Major PW & Glover K; 1992

Diagnosis 
History  Clinical Examination  Study Models  Radiograph 
Lateral cephalogram  OPG

Patient with anterior skeletal cross-bite
Roc Veis; 2003

Management
The simple dental cross-bite The functional or pseudo cross-bite

Should be treated early

The skeletal cross-bite

Early treatment may not be successful

Management
Rationale for early treatment  

 

Exaggerated gingival inflammation and recession of the investing tissues surrounding the mal-opposed teeth Occlusal trauma Enamel abrasion or fractures of the anterior teeth Development of abnormal chewing and swallowing problems Major PW, Glover K; 1992
McEvoy; 1983 Payne RC; 1981 Croll TP; 1984

Management
Rationale for early treatment 
   

Abnormal growth of the maxilla and the mandible Development of a permanent class III dentofacial abnormality TMJ dysfunction. Early correction canines and premolars into Class I Improve the self esteem of the child
Major PW, Glover K;1992 McEvoy ;1983 Payne RC; 1981 Croll TP; 1984 Rabie AB; 2000

Management
The following steps should be included in a clinical examination 
    

Evaluate the number of teeth involved in the cross-bite and their inclination Examine the profile Examine the arc of closure Note the relative positions of the primary and permanent molars in both centric occlusion and centric relation Attempt to manipulate the mandible posteriorly to obtain a more favourable relationship with the maxilla Complete a space analysis
Roc Veis; 2003

Management 
Evaluate the number of teeth involved in the cross-bite and their inclination
- Dental cross-bite one or two teeth - Functional Class III maxillary Incisors retroclined and mandibular incisors proclined - Skeletal Class III maxillary incisors proclined and mandibular incisors retroclined

Management 
Examine the profile
- Rest position with their lips together but with their teeth out of contact. - Facial profile for any signs of a skeletal mandibular prognathism.

Management 
Examine the arc of closure
- Skeletal Class III smooth uninterrupted arc - Functional cross-bite anterior shift - Dental cross-bite may or may not shift forward

Management 
Note the relative positions of the primary and permanent molars in both CO and CR
- Skeletal Class III mesiocclusion maintained in CR & CO - Simple dental cross-bite flush terminal plane of the molars in both CR and CO - Functional pseudo-Class III shift to a Class III relationship

Management 
Attempt to manipulate the mandible posteriorly to obtain a more favourable relationship with the maxilla

-

Edge to edge position or nearly so skeletal or dental component.

functional rather than a

Management 
Complete a space analysis
Reducing the size of primary cuspids, extraction of the primary cuspids, and/or expansion of the arches

-

Treatment of anterior cross-bites

€ The

simple dental cross-bite € The functional or pseudo cross-bite

Treatment of anterior cross-bites

Selective griding

Treatment of anterior cross-bites

Use of tongue blade

Denamur TJ.; 1984

Treatment of anterior cross-bites

Lower anterior inclined plane

Treatment of anterior cross-bites

Reversed SSC

Croll TP.; 1996

Slide 30 Ortho9 ùâ øõè õ üúø éââúõ ìûì ú âââ ã å úõ úå ú âé âúú éé üî ùâ úé ø ö èâúã å
Nine, 1/11/2006

å

è

úâ

â ã ant. cx. bite å â

SSC â ûõ ú ã õå â ëü

ö è

active appliance ø å õ úì

è crown

ã é âõé âå â úâ õ õââ ú è ü õ

adapt preform crown

ëúé â incline slope ìèü û

úå ûû simple tipping ö úø ü ú âø ø èõ õèúúéè

÷ ë ú case ø crowding skeletal crossbite õ ú âé âúú èø ÷ úìö èã ö úèøõ

Treatment of anterior cross-bites

Compomer / Resin-composite slope with Acetate crown
Croll & Helpin; 2002 Croll TP.; 1996 Estreia et al.; 1991

Slide 31 Ortho10 é âã ã è SSC éè ü ú ë õø ú ú ìè ÷ü û öè õè úýü ö åú èâ öè õè ú âú ú â ÿ resin è

Croll & Helpin 2002 composite ùâ úé ö è ö â remove

â ë clear acetate crown éèé

âû compomer ú èé â chemical bone âû enamel ÷ â ã ant. cx. bite õ â õ ùâ â ã è õ å

è OJ/OB ø

öâö èé â

Estreia åô õø â ü úé â úø õ ûâ â damage ö ú periodontium
Nine, 1/5/2006

úé ú ú 15 ì ÿû

÷ â ã cx. bite õ

1 wk. õ

Treatment of anterior cross-bites

Bonded Resin-Composite Slopes

Bayraka, Tunca 2008

Treatment of anterior cross-bites

Removable appliance

Treatment of anterior cross-bites

Fixed appliance

R.M. SKEGGS & P.J. SANDLER; 2002

Treatment of anterior cross-bites
The skeletal cross-bite
€ € €

Growth modification Camouflage Orthognathic surgery

Treatment of anterior cross-bites
Growth modification

Protraction facemask ± RME

Treatment of anterior cross-bites
Growth modification

Chin cap appliance

Treatment of anterior cross-bites
Growth modification

Frankel III appliance

Treatment of anterior cross-bites

Camouflage

Jun Young Choi et al; 2008

Treatment of anterior cross-bites
Othognathic surgery

Conclusion
With proper diagnosis, the general dentist and the pediatric specialist can successfully treat simple and functional anterior cross-bites.

Thank you

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