Transverse Problems Flashcards
Anterior Crossbite
* Prevalence:—%
* Manifested in the — dentition
2.2% to 11.9
mixed
No Treatment?
(5)
- Esthetic problem
- Damage to the teeth in crossbite
through attrition - Gingival recession
- Loss of alveolar bone on lower incisors
- Excess mobility of lower incisors
affected by the crossbite
Differential Diagnosis
(4)
- Cephalometric evaluation
- Dental assessment
- Functional assessment
- Profile analysis
Differential Diagnosis
Ngan, et al., Pediatric Dednitry, 1997
* Dental assessment
* Class III molar relationship
- (-) overjet or end-to-end relationship with retroclined mandibular incisors (compensated
class III malocclusion) - If negative overjet, proceed to functional assessment
- Functional assessment
- Determine whether a — discrepancy exist
centric relation/centric occlusion (CR/CO)
- Functional assessment
- At CR, patient may have a Class — skeletal pattern, normal facial profile and Class —
molar relationship - At CO, patient may have a Class — skeletal and dental pattern
I, I
III
ANTERIOR
CROSSBITE
SKELETAL
Ceph:
Dental:
Profile:
Class III maxillo-mandibular
relationships
Severe proclination of upper
incisors
Severe retroclination of lower
incisors
Class III molar relationship
**MAY or MAY NOT be
present in Class III skeletal
Concave or straight **MAY
or MAY NOT be present in Class III skeletal
ANTERIOR
CROSSBITE
DENTAL
Ceph:
Dental:
Profile:
Class I or II maxillo-mandibular
relationships
Normal inclination/position or
severe retroclination/retrusion
of upper incisors
Severe proclination/protrusion
of lower incisors
Class I or II molar relationship
Presence of anterior functional
shift
*MAY or MAY NOT be
present in Class III dental
Straight or convex
Early Treatment of dental
anterior crossbite
* The most common etiologic factor for nonskeletal anterior crossbites is
…
* Focus the treatment plan on management of the total space situation, not
just the crossbite
lack of space for the permanent incisors
Early Treatment of dental
anterior crossbite
Management
(4)
- Extraction of adjacent primary teeth to provide necessary space
- Disking of teeth
- Opening space for tooth movement
- Determine whether tipping will provide appropriate correction
Early Treatment of dental
anterior crossbite
(3)
- Fixed inclined planes
- Reverse crown
- Maxillary lingual holding arch with springs
- Reverse crown
(2)
- A large permanent anterior tooth crown is
- reverse-cemented
- Maxillary lingual holding arch with springs
(2)
- Lingual eruption of maxillary lateral incisors in
- a crowded arch
Early Treatment of skeletal
anterior crossbite
* Must refer to orthodontist
* Objective is to
reduce the amount of dental compensation to skeletal;
discrepancy that are often associated with a more severe malocclusion in
late adolescence
Posterior Crossbite
Iodice, et al., Eur.J. Orthod. 2013; Contemporary Orthod. 5th Ed.
* Prevalence:
* –% of Hispanic population
* –% in African-American population
* –% among Caucasians
* Transverse maxillary deficiency:
7.3
9.6
9.1
narrow
maxilla relative to the rest of the face
Hidden Posterior Crossbite
* Compensatory changes in dentoalveolar
processes
(3)
- Tipping of maxillary teeth to the buccal
- Tipping of mandibular teeth to the lingual
- Uprighting teeth creates a dental crosbite
Unilateral Posterior
Crossbite
* May be a bilateral crossbite with a
functional lateral jaw shift as the
teeth from centric relation to centric
occlusion
* Key sign:
deviation of the mandibular
dental midline, relative to the
maxillary dental and skeletal midlines,
toward the side of the crossbite when
the teeth are in maximum
intercuspation
Posterior Crossbites due to
functional shifts
Sequelae:
(4)
- Compensatory changes in
the TMJ? - Modifications of soft tissue
growth? - Development of skeletal
asymmetries?
NO STRONG EVIDENCE - Attrition of teeth
Does not self
skipped
Posterior Crossbites
management
(7)
- Is the crossbite skeletal or dental?
- Is the crossbite unilateral or bilateral
- Is there a functional shift?
- If dental, which teeth are tipped and in which jaws?
- Should the treatment be initiated at this time or deferred to a later date?
- Should the problems be corrected?
- Can the problem be corrected or masked by treatment?
Management
* Simple dentoalveolar unilateral posterior
crossbite:
fixed or removable appliances
to move teeth
* W-arch, quadhelix (up to age 9 or 10)
* Jackscrew: relatively heavy force
that separates the partially
interlocked suture
Posterior Crossbites
management
* Early mixed dentition:
use
slow expansion
* Suture can be separated in
females up to age 16, and in
males up to age 18
* An occlusal radiograph is used
to assess the midpalatal
suture patency
Buccal Crossbites
(scissor bite)
(2)
- Buccal displacement of a maxillary posterior tooth, with or without
contact between the lingual surface of the maxillary lingual cusp and the
buccal surface of the mandibular antagonist’s buccal cusp. - A complete buccal crossbite (Brodie bite): a combination of excessive
maxillary width and a narrow mandibular alveolar process, although the
width of the mandibular base is usually normal.
Scissor bite
(3)
- Elastics
- Mandibular appliance to upright
posterior teeth - Lip bumper
