Download - Anterior Cross-bite conference on 16092010
Anterior Cross-bite
Chainarong KaosampanChaoprayayomraj Hospital16 September 2010
CONTENTS1. Definition
2. Classification
3. Etiology
4. Clinical Features
5. Diagnosis
6. Management
7. Treatment
8. Conclusion
An abnormal labio - lingual relationship between
one or more maxillary & mandibular incisor teeth
Definition:
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
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
Etiology
Rob Veis; 2008
Simple dental cross-bite
Supernumerary anterior teeth Odontomas Congenitally abnormal eruption patterns Arch perimeter deficiency A habit of biting the upper lip
Etiology
Rob Veis; 2008
Functional cross-bite
Early occlusal interference Habitual forward positioning of the mandible to
obtain maximum intercuspation may lead to an anterior cross bite
Etiology
Rob Veis; 2008
Skeletal cross-bite
Genetic Due to deficient anterior growth of
maxilla Excessive abnormal mandibular
growth in anteriorly Combination
Etiology
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; 1992McEvoy ; 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; 1972McEvoy ;1983Moyers; 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
History
Clinical Examination
Study Models
Radiograph Lateral cephalogram
OPG
Patient with anterior skeletal cross-bite
Diagnosis
Roc Veis; 2003
Management
The simple dental cross-bite
The functional or pseudo cross-bite
The skeletal cross-bite
Should be treated early
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 problemsMajor PW, Glover K; 1992McEvoy; 1983Payne RC; 1981Croll 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;1992McEvoy ;1983Payne RC; 1981Croll TP; 1984Rabie 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
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 functional rather than a skeletal or dental component.
Management
Complete a space analysis
- Reducing the size of primary cuspids, extraction of the primary cuspids, and/or expansion of the arches
Management
Treatment of anterior cross-bites
The simple dental cross-bite The functional or pseudo cross-bite
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
Treatment of anterior cross-bites
Compomer / Resin-composite slope with Acetate crown
Croll & Helpin; 2002Croll TP.; 1996
Estreia et al.; 1991
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
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