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LECTURE 8INGRID REED DDS, MS

DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS

Anterior and Posterior Crossbites

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Anterior Crossbite

Dental – on or two teeth Abnormal axial inclination Retained primary tooth Crowding Usually Class I

Skeletal - Class III ANB <0° Look at molar relationship Take ceph

Pseudo Class III – shift due to interferences when end to end occlusion Check bite in CR vs. CO for interference

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Anterior Cross bite - Dental

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Anterior Crossbite - dental

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Anterior Crossbite - Dental

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Anterior Crossbite - Skeletal

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Anterior Crossbite - Skeletal

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Treatment – Dental anterior crossbite

Tongue bladeRemovable appliance with finger springFixed appliancesPossible extraction of adjacent deciduous

teeth

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Tongue blade

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Hawley with finger spring

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Hawley with finger spring

Assess space availableAlginate impressionPour in yellow stoneFabricate Hawley with clasps and finger spring

Bend finger spring so it unwinds in the direction it was wound

Build up molars to clear occlusionDeliver applianceActivate spring every few weeksSelf retaining

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Dental Anterior Crossbite

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Anterior crossbite of lateral incisors

Maxillary laterals usually erupt to the lingual if inadequate space

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Retention of Anterior Crossbites

Good overbite relationshipShould be self retainingTipping tooth forward – vertical change in

overbite

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Cleft Palate

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Cleft palate treatment sequence

TIME PROCEDURE

2-4 weeks Lip closure

12-18 months Palate closure

7-8 years Alignment of maxillary incisors, expansion of maxilla, as preparation for alveolar graft

7-9 years Alveolar bone graft (before eruption of lateral incisor, if present, or canine)

Adolescence Comprehensive orthodonticsLip /nose revision

Late adolescence

Orthognathic surgery?

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Cleft palate – orthodontic problems

Problems from repair –not cleft itself Lip repair – constriction across anterior of maxilla –

anterior crossbite Palate repair – constriction laterally – posterior

crossbite

Problems from cleft Maxillary incisors erupt rotated and in crossbite Lateral incisor and/or canine in area of cleft missing

or impacted Cleft area doesn’t have bone for eruption – alveolar

graft needed

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Early permanent dentition treatment

Correct maxillary incisors Rotations Crossbite Position

Expand maxillaAlveolar bone graft

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Unrepaired cleft - TG 1-24-03

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TG 1-24-03

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TG 1-24-03

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TG 7-25-07

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TG 10-25-08

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TG 10-25-08

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TG 10-25-08

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Early Permanent Dentition Treatment

Canine & premolar on cleft side – malalignedClose spaces if missing teethPosition teeth as need for prosthetics Dental implants are not appropriate for cleft

areas

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Orthognathic surgery - cleft palate patients

Males > femalesGrowth – return of anterior and/or lateral

crossbites Usually deficient maxillary growth Normal mandibular growth

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•SKELETAL

•DENTAL

Posterior Crossbites

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Posterior Crossbite

Posterior crossbite – position of maxillary molars Bilateral maxillary lingual crossbite Unilateral maxillary lingual crossbite

Asymmetric maxillary arch Unilateral mandibular buccal crossbite

Normal maxilla Asymmetric mandible

Maxillary buccal crossbite

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Why does this crossbite exist?

Bilateral maxillary palatal crossbite Maxilla narrow - skeletal basis Dental arch narrowed – skeletal width correct

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Rapid Palatal Expander

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Posterior Crossbites

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Dental Posterior Crossbite

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Oral habits – disruptive to occlusion

Thumb suckingFinger suckingTongue thrustNail bitingLip bitingLip sucking

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Thumb (finger) sucking - phases

Phase IBirth to 3 years

Normal , especially associated with weaning. Usually self eliminated.

Phase II3 to 6 or 7 years

3-4 years: mild displacement of primary teeth; normal lip & cheek pressure will restore teeth to usual position if sucking stopsAfter eruption of permanent incisors: if sucking persists, stop habit and start orthodontic treatment to correct tooth displacement.Constricted maxilla: least likely to correct spontaneously

Phase III Thumb sucking may be a sign of psychological problemsTalk to childAppliance to help child

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Thumb (finger sucking)

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Effects of thumb sucking

Tongue lowered to accommodate thumbCheek pressure

Greatest at corners of mouth More constriction at canines V- shaped palate Lingual movement of maxillary molars Mandibular molars unchanged Anterior teeth and premaxilla can be moved

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Cheek

Tongue

Malocclusion due to sucking habit

Lower incisors

Lingual displacement

Upper incisors

Labial displacement

Maxillary arch

Narrow

Interarch relation

Anterior open bite

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Treatment

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Crib

Treatment – palatal expander

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Reference

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Contemporary Orthodontics, 4th Contemporary Orthodontics, 4th Edition Edition

William R. ProffitWilliam R. ProffitHenry W. Fields Jr.Henry W. Fields Jr.David M. SarverDavid M. Sarver

Pages: 68, 147-149, 175-176 ,224-226, 244-248,437-443, Pages: 68, 147-149, 175-176 ,224-226, 244-248,437-443,

559-560, 622559-560, 622