Cross bite

By Assist. Prof. Dr. Hadi M Ismail

Thursday:
9:30AM – 11:00 AM Crossbite…………….
11:00 AM – 11:30 AM Coffee break………….
11:30AM – 1:30PM Palatal Expansion……..
1:30PM – 3:00PM Lunch Break ……..
3:00PM – 5:00PM Open Bite…..

Friday:
9:30AM – 11:00AM Open Bite
11:00AM – 11:30AM Coffee Break
11:30AM – 1:00PM Case Presentation
1:00 PM – 2:30PM
2:30PM – 5:00PM Case Presentation 07504533737
Crossbite: A deviation from the normal bucco-lingual relationship. May
be anterior/posterior &/or unilateral/bilateral.

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Buccal crossbite: Buccal cusps of lower premolars or molars occlude
buccally to the buccal cusps of the upper premolars or molars.

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Lingual crossbite: Buccal cusps of lower molars occlude lingually to the
lingual cusps of the upper molars.

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Lingual crossbite
Buccal crossbite

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Buccal crossbite Lingual crossbite

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Displacement: on closing from the rest position the mandible encounters a
deflecting contact(s) and is displaced to the left or the right, and/or
anteriorly, into maximum interdigitation

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 Etiology of crossbite
1. Local causes
The most common local cause is crowding where one or two teeth are displaced
from the arch. For example, a crossbite of an upper lateral incisor often arises
owing to lack of space between the upper central incisor and the deciduous
canine, which forces the lateral incisor to erupt palatally and in linguo-occlusion
with the opposing teeth. Posteriorly, early loss of a second deciduous molar in a
crowded mouth may result in forward movement of the upper first permanent
molar, forcing the second premolar to erupt palatally. Also, retention of a
primary tooth can deflect the eruption of the permanent successor leading to a
crossbite
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2. Skeletal
Generally, the greater the number of teeth in crossbite, the greater is the skeletal
component of the aetiology. A crossbite of the buccal segments may be due purely to
a mismatch in the relative width of the arches, or to an anteroposterior discrepancy,
which results in a wider part of one arch occluding with a narrower part of the
opposing jaw. For this reason buccal crossbites of an entire buccal segment are most
commonly associated with Class III malocclusions, and lingual crossbites are
associated with Class II malocclusions. Anterior crossbites are associated with Class III
skeletal patterns. Crossbites can also be associated with true skeletal asymmetry
and/or asymmetric mandibular growth.
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3. Soft tissues
A posterior crossbite is often associated with a digit-sucking habit, as
the position of the tongue is lowered and a negative pressure is
generated intra-orally mouth breathing as well .
4.Rarer causes
These include cleft lip and palate, where growth in the width of the upper
arch is restrained by the scar tissue of the cleft repair. Trauma to, or
pathology of, the temporomandibular joints can lead to restriction of
growth of the mandible on one side, leading to asymmetry.

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 Types of Crossbite
1.Anterior crossbite
An anterior crossbite is present when one or more of the upper incisors is in
linguo-occlusion (i.e. in reverse overjet) relative to the lower arch. Anterior
crossbites involving only one or two incisors.

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2. Posterior crossbites
Crossbites of the premolar and molar region involving one or two teeth or an
entire buccal segment can be subdivided as follows:

A. Unilateral buccal crossbite with displacement

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B .Unilateral buccal crossbite with no displacement
This category of crossbite is less common. It can arise as a result of deflection
of two (or more) opposing teeth during eruption, but the greater the number
of teeth in a segment that are involved, the greater the likelihood that there is
an underlying skeletal asymmetry

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C. Bilateral buccal crossbite
Bilateral crossbitesare more likely to be associated with a skeletal
discrepancy, either in the anteroposterior or transverse dimension, or in
both.

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D .Unilateral lingual crossbite
E. Bilateral lingual crossbite (scissors bite)

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 Management of anterior cross bite

Removable appliances

Z Spring
Double Z spring
T spring

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The removable appliance incorporating palatal springs, like Z. spring if one incisor is in

crossbite and R.Z. spring or anterior segmental screw for two or more maxillary incisors to

achieve labial movement. Sometimes lower removable appliance with an active labial bow is

used for lingual movement of mandibular incisors. The appliance should have multiple clasps

for good retention. A removable appliance of this type requires nearly full-time wear to be

effective and efficient. Posterior biteplate to reduce the overbite while the crossbite is being

corrected usually is unnecessary unless the overbite is exceptionally deep. Whenever

Posterior biteplate is used, it should be adjusted to just enough overbite clearance for the

forward provide movement of the maxillary incisors. At the end of treatment, adequate 20
 Early treatments with proven benefits

Crossbite

Yasa 10 Years old

Early treatments with proven benefits

Yasa Mohammed
Early treatments with proven benefits
 Maili Zhilwan
Anterior crossbite
Maili Zhilwan
Maili Zhilwan 2019
Pseudo class III
2.Fixed Appliance
Note: Sever crossbite caused by skeletal discrepancy can be controlled during growth by
growth modification appliances, such as protraction face mask. If the skeletal factor were
not managed during the growth period, an orthognathic surgery will be needed
 Appliances Used to Correct Posterior Crossbite

1.Removable Appliances :
A simple removable appliance with a T-spring can correct posterior crossbite of single tooth like the
premolars.
Upper removable appliance with a midpalatal jackscrew and buccal capping can be used in the treatment
of posterior crossbite involving all or segment of posterior teeth which are being tilted palatally. It mostly
used in the treatment of posterior crossbites of small magnitude in children and young adolescents.
Coffin spring can be used in arch expansion in anterioposterior and transverse direction.

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 2.Fixed Appliances

The Cross-elastic is a simple fixed appliance useful in the

correction of unilateral posterior crossbites consists of
two banded or bonded attachments on upper and lower
teeth in crossbite. Most effective when the upper tooth is
inclined lingually and the lower tooth is inclined buccally.
The elastics may extrude the teeth causing an opening of
the bite

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Rapid maxillary expansion
Involves a screw appliance comprising bands attached to
64|46 and connected to a midline screw. The object is to
expand the maxilla by opening the midline suture and is
therefore more successful in younger patients. Large
forces are required to accomplish this—the screw is
turned 0.2mm twice a day for about 2 weeks. Over-
expansion is necessary as the teeth relapse about 50%
under soft-tissue pressure.

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Quad helix
is a very efficient fixed slow expansion appliance. The quad helix appliance can also be adjusted to give more
expansion anteriorly or posteriorly as required and can also be used to de-rotate rotated molar teeth. When
active treatment is complete, it can be made passive to aid retention of the expansion. A quad helix is
fabricated in 1 mm stainless steel wire and attached to the teeth by bands cemented to molar tooth on each
side. Pre-formed types are available which slot into palatal attachment welded onto bands on the molar and
can be readily removed by the operator for adjustment. However, the appliance can also be custom-made in a
laboratory. The usual activation is about half a tooth width each side Over-expansion can occur readily if the
appliance is over activated, and therefore its use should be limited to those who are experienced with fixed
appliance.

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