LEARNING OBJECTIVES

Describe the dental and skeletal problems in transverse

and horizontal plane

Differentiate the various types of cross bites

Explain the different methods of treating anterior

cross bite
 CROSS BITE
It is a mismatch between upper & lower dentition in AP or
transverse plane

Anterior X-Bite;
Posterior X-bite (lateral); it may be unilateral or bilateral
Single Tooth / Segmental X-bite;
Buccal X-bite; When lingual cusps of upper teeth are
present buccal to the buccal cusps of lower teeth
Lingual X-bite; When buccal cusps of upper teeth are
present lingual to the buccal cusps of lower teeth
Scissors bite; When whole of the buccal segment is in
complete lingual or buccal cross bite (X-BITE)
 ETIOLOGY
Cross bites may be skeletal or dental
Both genetic & environmental factors may cause cross bite

• Local factors may be one or two teeth displaced by

crowding, out of arch e.g.; a displaced upper lateral incisor
• Prematurities during mixed dentition stage
• Cleft lip & palate may cause both AP & transverse X-bites
• All of the suckling habits (e.g.; thumb or bottle sucking)
• TMJ dysfunctions or disorders (unilateral or bilateral)
• In mid face deficiencies or mandibular prognathism
(normally posterior X-bite is related with Class II &
anterior X-bite is related with class III problems)
• Genetic factors can mismatch the skeletal bases in AP or
transverse plane (e.g.; Brode’s syndrome, in which lower
arch is much narrower as compared to upper normal arch)
 ANTERIOR X-BITE
If dental X-bites are not treated during growing stages, they
will lead into skeletal X-bite (Orthodontic emergency)

• Lingually placed deciduous incisor or permanent incisor

may lead into anterior X-bite (Developing X-bite)
• Sometimes prematurities develop during transition phase
of mixed dentition, resulting into functional X-bite (it may
develop from habitual X-bite)
• True skeletal X-bite may be differentiated from functional
X-bite
 DIFFERENCE B/W TRUE &
FUNCTIONAL (Pseudo) X-BITE

• In True or skeletal anterior X-bite, the mandible is unable

to drawn back to centric occlusion, or to edge to edge
position, while
• In Functional X-bite, one’s mandible can be drawn back to
centric occlusion or to edge to edge position
• Cephalometrics can also show –ve value of ANB, in case of
True X-bite, while ANB is in normal range in Pseudo X-
bite
 POSTERIOR X - BITE

• X- bite in posterior region involving one or two teeth or

whole of the buccal segment
• Unilateral buccal cross bite with displacement; it involves
unilaterally one or two teeth or whole of the segment & that
on closure from rest position, the buccal segment teeth meet
cusp to cusp & in order to achieve maximum
intercuspation, patient displaces his mandible to right or
left (normally a mid line shift is seen to the displaced side)
• Bilateral buccal cross bite; is one of the common x-bite
seen, associated with a skeletal discrepancy in transverse
plane (usually associated with habits)
 DIFFERENCE B/W SKELETAL &
DENTAL POSTERIOR X - BITE

• Skeletal X- bite may be due to maxilla or mandible, i.e.

either jaw may be wider or narrower than the opposite one
or vice versa
• There is dento-alveolar compensation in case of skeletal X-
bite, e.g.; in narrow maxilla, the posterior teeth will try to
compensate & buccaly flare to be occluded with opposite
dentition
 DIAGNOSIS

• History & clinical examination

• Radiographs (lateral ceph., PA (frontal ceph.)
• Study casts
• Photographs

• Normally diagnosis is made on study casts by getting inter-

molar distance
• Mesio-palatal cusp of maxillary 6 occludes in the central
fossa of the mandibular 6, so inter-molar distance is
calculated from mesio-palatal cusp of one molar to the
opposite one & the magnitude of cross bite is calculated by
adding 1-2 mm of over correction
 MANAGEMENT OF ANTERIOR
X - BITE
• Primary Dentition; Mostly it is related with skeletal class
III problems, which will be studied later, while dental X –
bite is rarely seen
• Wooden spatulas are used at this stage for dental x- bites
• Mixed Dentition; One or two lingually erupting maxillary
incisors may lead into anterior X- bite & if this X- bite is
not treated soon, will lead into skeletal X- bite (orthodontic
emergency), following designs may be used
• Removable appliance with Z-springs
• Anterior inclined planes
• Utility segmental arches
• Anterior expansion screws
MANAGEMENT OF ANTERIOR
X - BITE
 MANAGEMENT OF FUNCTIONAL
X - BITE
• Eliminate the prematurities by selected grinding of teeth
• Removal of the habitual x – bite by some psychotherapy or
some exercise trainer appliance
• Timely removal of deciduous teeth & guiding the occlusion
specially in mixed dentition stage
 MANAGEMENT OF ANTERIOR
X - BITE
• Fixed orthodontic mechanics
• The skeletal anterior X – bites will be dealt with class III
malocclusions
• Permanent Dentition; The approach is almost same except
there are limited cases that are selected for such mechanics,
because mostly dental X- bite in this age is established into
skeletal X - bite
 FURTHER STUDY

Contemporary Orthodontics by William

R. Proffit 5th Ed

Crossbite
anterior crossbite, 6f
buccal crossbite (X-occlusion), 8-9
classification, 402
correction, 536-540, 596
through the bite elastics, usage, 631-
632
determination, 403
posterior crossbite, existence, 6f
Email; ufat.bashir@riphah.edu.pk