Anterior

Cross-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 obt
ain maximum intercuspation may lead to an anteri
or cross bite

Rob Veis; 2008

Etiology

Skeletal cross-bite
 Genetic
 Due to deficient anterior growth of max
illa
 Excessive abnormal mandibular growt
h 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 maxillar
y or mandibular anterior teeth occurs as they erup
t, while the other teeth are usually in a normal occ
lusal 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 an
d 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 t
o edge with the molars separated but in an Angle Cla
ss I relation.
 Occlusal interference  anterior shift of the mandibl
e
 In CR or in a relaxed postural position normal facia
l 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 occ
lusal interferences

Major PW & Glover K; 1992

Characteristics

Skeletal cross-bite
 Maxillary incisors  proclined
 Mandibular incisors  retroclined
 ANB  the maxilla is relatively retracted or the man
dible 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 recessi
on of the investing tissues surrounding the mal
-opposed teeth
 Occlusal trauma
 Enamel abrasion or fractures of the anterior te
eth
 Development of abnormal chewing and swallo
wing 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 a
bnormality
 TMJ dysfunction.
 Early correction  canines and premolars into Cla
ss 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 in
clination
 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 fav
ourable 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  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
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

 Treatment of anterior cross-bites

Compomer / Resin-composite slope with Acetate crown

Croll & Helpin; 2002
Croll 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
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