Management Of Cross Bite Question And Answers

Management Of Cross Bite

 

Give the etiology and treatment modalities of incisor crossbite.
Answer. Crossbite is defined as the condition where one or more teeth may be abnormally malposed, buccally lingually, or labially concerning the opposing tooth or teeth. Graber

Etiology of Incisor Crossbite

Skeletal Factors

Skeletal incisor crossbite results due to excessive mandibular growth. It is genetic or inherited malocclusion.

Dental Factors

• A dental incisor crossbite is because of abnormal axial inclination of the maxillary incisors.
• Abnormal axial inclination is due to the following factors i.e.
  • Inadequate arch length, which leads to a lingual eruption of the permanent tooth.
  • The labial position of the supernumerary tooth.
  • Over retained primary tooth.
  • Lip biting habit.
  • Trauma to primary teeth or the permanent tooth bud.

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Functional Factors

An incisor crossbite also occurs due to functional interference of the mandible during closure. It is due to premature tooth contact and results in pseudo-class three malocclusion.

Treatment of Incisor Crossbite

Correction of incisor Crossbite in the preadolescent age group

The following appliances are used:

• Tongue Blade
  • Tongue blade therapy is used to treat the developing incisor crossbite by placing the wooden tongue blade behind the tooth in crossbite at an angle of about 60 degrees to the occlusal plane. The patient should exert force by biting on it using the lower teeth as a fulcrum for 5-10 minutes. Usually, the tooth will erupt into o normal position over some time.
• Catalan’s Appliance or Lower Anterior Inclined Plane
  • Catalan’s appliance is also called a “lower anterior inclined plane,” which explains the design of this appliance. Catalan’s appliance consists of an inclined plane cemented to the lower incisor.
• Fabrication
  • Acrylic resin or cast metal is used to fabricate Catalan’s appliances. The lower anterior inclined plane is designed in such a way that it is at 45 degree angle to the maxillary occlusal plane. Catalan’s appliance can be fabricated on a single lower anterior tooth for the correction of a single tooth crossbite or the whole anterior segment.
• Removable Orthodontic Appliances
  • Removable orthodontic appliances with “z” spring. Incisor crossbite involving one or two maxillary teeth can be treated by using a double cantilever spring or “z” spring.
    • In the case of single-tooth incisor crossbite, the “Z” spring on the tooth involved in crossbite can be used for correction of such a condition.
    • In the case of anterior crossbites involving two teeth in crossbite, the “Z” spring on two teeth is used to correct the anterior crossbite by involving a group of teeth by labial movement.
  • Removable orthodontic appliances with expansion screw:
    • Removable orthodontic appliance incorporates expansion screws of various types, which can be used to correct eithersingle-toothh crossbite or segmental tooth crossbite.
• Orthopedic Appliances
  • Face mask along with RME.A face mask (reverse headgear) is used in the treatment of skeletal anterior crossbite during the growth period before the cessation of growth. The facemask helps in the protraction of the retrognathic premaxilla, thereby normalizing the skeletal crossbite.
  • Chin-cup appliance
    • Chin-cup appliance is one of the orthopedic orthodontic aappliancesand and is used to redirect the growth of the mandible to prevent or correct the anterior crossbite due to excessive mandibular growth. The chin cup appliance tends to rotate the mandible posteriorly and inferiorly.
• Myofunctional Appliances
  • Frankel 3 appliance may be used to correct a developing class 3 skeletal jaw about anterior crossbite.

Correction of Incisor Crossbite in Adolescent and Adults

Removable orthodontic appliance incorporated expansion screw of either mini or medium, which may also be used to correct anterior crossbite, involving a single tooth or group of teeth in adults.

• Removable orthodontic appliances
  • Removable orthodontic appliances with mini screw:
    • Removable orthodontic appliance with incorporated mini screw type of expansion screw, which is used to correct the anterior crossbite involving up to two teeth in crossbite.
  • Removable orthodontic appliances with medium screw:
    • A removable orthodontic appliance with an incorporated medium screw can be used to treat anterior crossbite involving up to 4-6 teeth in crossbite.
  • Removable orthodontic appliances with 3D screws:
    • Removable orthodontic appliances with incorporated three-dimensional expansion screws in the midline can be used in the treatment of anterior crossbite associated with pseudo-class three malocclusions.
• Fixed orthodontic appliances
• Fixed orthodontic appliances can be used to correct incisor crossbite involving a single tooth or group of teeth.
• The in-locked teeth are pulled into their correct labial position by fixed appliances.