Cross Bite

Dr Mouayad F. Zwain
Definition

• crossbite is defined as a condition

where one or more teeth may be
abnormally malposed buccally or
lingually or labially with reference
to the opposing tooth or teeth.
Classification of Crossbite

• I. According to their location in the arch

• A. Anterior crossbite
• 1. Single tooth crossbite
• 2. Segmental crossbite
Classification of Crossbite
• I. According to their location in the arch

• B. Posterior crossbite
• 1. Single tooth crossbite
• 2. Segmental crossbite.

• 1. Unilateral posterior crossbite

• 2. Bilateral posterior crossbite.
Posterior crossbites are classified into the following three
types, based on the extent of crossbite:
• 1. Simple posterior crossbite: Simple posterior crossbite
is referred to as a condition where buccal cusps of one
or more maxillary posterior teeth occlude lingual to
buccal cusps of the mandibular teeth.
• 2. Buccal non-occlusion (Scissor bite): Here the palatal
cusps of maxillary teeth in occlusion are placed buccal to
the mandibular posterior teeth, referred to as buccal
non-occlusion .
• 3. Lingual non-occlusion: Here the maxillary posterior
tooth or teeth are placed completely palatal to the
lingual aspect of the mandibular posterior teeth, i.e. the
buccal cusp of the maxillary tooth is palatal/ lingual to
the lingual cusp of the mandibular posterior teeth .
Classification of crossbite based on structure involved.
• Crossbite can be classified into following three types based on structure involved:
• 1. Dental crossbite
• 2. Skeletal crossbite
• 3. Functional crossbite.(Displacement: on closing from the rest position the
mandible encounters a deflecting contact(s) and is displaced to the left or the
right, and/or anteriorly, into maximum interdigitation.)
Etiology of Crossbite
A variety of factors acting either singly or in combination can lead to
the development of a crossbite.
Local causes
The most common local cause is
• Etiology of Dental Crossbite
crowding where one or two teeth are
• I. Anomalies of number of teeth displaced from the arch.
1. Supernumerary teeth Posteriorly, early loss of a second
2. Missing teeth. deciduous molar in a crowded mouth
• II. Anomalies of tooth shape may result in forward movement of the
upper first permanent molar, forcing the
• III. Anomalies of tooth size
second premolar to erupt palatally. Also,
1. Microdontia retention of a primary tooth can deflect
2. Macrodontia. the eruption of the permanent successor
leading to a crossbite.
 Skeletal
• A crossbite of the buccal segments
may be due purely to a mismatch in
the relative width of the arches, or to
an anteroposterior discrepancy, which
results in a wider part of one arch
occluding with a narrower part of the
opposing jaw.
• For this reason buccal crossbites of an
entire buccal segment are most
commonly associated with Class III
malocclusions,
• Anterior crossbites are associated with
Class III skeletal patterns.
 Skeletal
• and lingual crossbites are associated with Class II malocclusions.

Bilateral scissors bite in combination

with forced distal occlusion.
 Skeletal
• Crossbites can also be associated with true skeletal asymmetry and/or
asymmetric mandibular growth.
Soft tissues
• A posterior crossbite is often associated with a digit-sucking habit,
mouth breathing, etc. as the position of the tongue is lowered and a
negative pressure is generated intra-orally.
Other causes
These include cleft lip and palate, where growth in the width of the
upper arch is restrained by the scar tissue of the cleft repair.
Trauma to, or pathology of, the temporomandibular joints can lead
to restriction of growth of the mandible on one side, leading to
asymmetry.
Treatment

• Correction of Anterior Crossbite:

• I. Correction of anterior crossbite
in the preadolescent age group:
The following appliances are used
to correct the anterior crossbite in
the preadolescent age groups:
1. Tongue blade
2. 2. Catlan's appliance or lower
anterior inclined plane
Treatment
• I. Correction of anterior crossbite in
the preadolescent age group:
3. Removable orthodontic appliances
such as:
a. Removable orthodontic appliances
with double cantilever spring or "Z"
spring
b. Removable orthodontic appliances
with expansion screw
4. Orthopedic appliances: a. Face mask
along with RME b. Chin cup appliance
5. Myofunctional appliance such as
Frankel III appliance.
Treatment
• I. Correction of anterior crossbite in
the preadolescent age group:
3. Removable orthodontic appliances
such as:
a. Removable orthodontic appliances
with double cantilever spring or "Z"
spring
b. Removable orthodontic appliances
with expansion screw
4. Orthopedic appliances: a. Face mask
along with RME b. Chin cup appliance
5. Myofunctional appliance such as
Frankel III appliance.
Treatment
• II. Correction of anterior crossbite
in adolescents and adults:
• 1. Removable orthodontic
appliances:
Removable orthodontic appliances
with expansion screw (mini
expansion screw or medium
expansion screw).
• 2. Fixed orthodontic appliances.
Treatment
• Correction o f posterior
crossbites
• 1. By removable orthodontic
appliance, which are as follows
• a. Removable orthodontic
appliances with expansion screw
• b. Removable orthodontic
appliances with coffin spring.
Treatment

• Correction o f posterior
crossbites:
• 2. By fixed orthodontic
appliance
• a. Fixed orthodontic appliance
with RME
• b. Fixed orthodontic appliance
with cross elastics
• c. Quad helix appliance.