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LE CT U R E 7
IN G R ID R E E D D D S , M S
Anterior and PosteriorCrossbites
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D E P A R T M E N T O F O R T H O D O N T ICS &D E N T O F A CIA L O R T H O P E D ICS
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Anterior Crossbite
y Dental one or two teeth
{ Abnormal axial inclination
{ Retained primary tooth
{ Crowding
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y Skeletal - Class III ANB
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Anterior Crossbite - Dental8
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Anterior Crossbite - Skeletal9
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Anterior Crossbite - Skeletal10
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Treatment Dental anterior crossbite
y Popsicle stick
y Removable appliance with finger spring
y Fixed appliances
y Possible extraction of ad acent deciduous teeth
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Tongue blade12
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Hawley with finger spring14
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Hawley with finger spring
yAssess space available
y
Alginate impressiony Pour in yellow stone
y Fabricate Hawley with clasps and finger spring
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{ Bend finger spring so it unwinds in the direction it was wound
y Build up molars to clear occlusion
y Deliver appliance
yActivate spring every few weeks
y Self retaining
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Hawley with finger spring
yAssess space available
yAlginate impression
y Pour in yellow stone
y Fabricate Hawle with clas s and fin er s rin
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{ Bend finger spring so it unwinds in the direction it was wound
y Build up molars to clear occlusion
y Deliver appliance
yActivate spring every few weeks
y Self retaining
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Dental Anterior Crossbite18
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AN T ER I O R C R OS SB I TE
Case JH23
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8 years 0 months24
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Initial25
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8 years 4 months26
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Age 12 years
Anterior crossbite of lateral incisors
y Maxillary laterals usually erupt to the lingual ifinadequate space
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Retention of Anterior Crossbites
y Good overbite relationship
y Should be self retaining
y Tipping tooth forward vertical change in overbite
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Cleft Palate JB Start of Phase I33
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Initial34
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Initial35
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End of phase I36
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End of Phase 137
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Start of Phase II38
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Start of Phase II39
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Final Records40
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Final Records41
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Bilateral Cleft Palate43
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Cleft palate treatment sequence
TIME PROCEDURE
2-4 weeks Lip closure
12-18 mo nt hs Palate closure
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7-8 years Alignment of maxillary incisors, expansion of maxil la , aspreparation for alveolar graft
7-9 years Alveolar bone graft (before eruption of lateral incisor, ifpresent, or canine)
Adolescence Comprehensive orthodonticsLip /nose revision
Late adolescence Orthognathic surgery?
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Cleft palate orthodontic problems
y Problems from repair not cleft itself
{ Lip repair constriction across anterior of maxilla anteriorcrossbite
{ Palate repair constriction laterally posterior crossbite
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{ Maxillary incisors erupt rotated and in crossbite
{ Lateral incisor and/or canine in area of cleft missing orimpacted
{ Cleft area doesnt have bone for eruption alveolar graftneeded
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Early permanent dentition treatment
y Correct maxillary incisors
{ Rotations
{ Crossbite
{ Position
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y xpan max a
yAlveolar bone graft
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Unrepaired cleft - TG 1-24-0348
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TG 1-24-0349
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TG 1-24-03
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TG 7-25-0751
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TG 10-25-0852
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TG 10-25-0853
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TG 10-25-0855
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8/25/201057
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Orthognathic surgery - cleft palate patients
y Males > females
y Growth return of anterior and/or lateral crossbites{ Usually deficient maxillary growth
{
Normal mandibular growth
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SKELETAL
Posterior Crossbites61
DENTAL
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Posterior Crossbite
y Posterior crossbite position of maxillary molars
{ Bilateral maxillary lingual crossbite
{ Unilateral maxillary lingual crossbite
Asymmetric maxillary arch
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Normal maxilla
Asymmetric mandible
{ Maxillary buccal crossbite (Brodie Bite)
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Why does this crossbite exist?
y Bilateral maxillary palatal crossbite
{ Maxilla narrow - skeletal basis
{ Dental arch narrowed skeletal width correct
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Rapid Palatal Expander67
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Treatment palatal expander68
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Posterior Crossbites69
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Dental Posterior Crossbite71
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Oral habits disruptive to occlusion
y Thumb sucking
y
Finger suckingy Tongue thrust
y Nail biting
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y Lip biting
y Lip 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
stops
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er erup on o permanen ncsors: suc ng pers s s, s ophabit and start orthodontic treatment to correct toothdisplacement.Constricted maxilla: least likely to correct spontaneously
Phase III Thumb sucking may be a sign of psychological problemsTalk to child
Appliance to help child
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Thumb (finger sucking)75
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Effects of thumb sucking
y Tongue lowered to accommodate thumb
y
Cheek pressure{ Greatest at corners of mouth
{ More constriction at canines
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{ V- s ape pa ate
{ Lingual movement of maxillary molars
{ Mandibular molars unchanged
{ Anterior teeth and premaxilla can be moved
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Cheek
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Tongue
Malocclusion due to sucking habit
Lowerincisors
Lingualdisplacement
Upperincisors
Labialdisplacement
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ax ary arch
arrow
Interarchrelation
Anterior openbite
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Treatment79
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Crib
Reference80
Contemporary Orthodontics, 4th EditionContemporary Orthodontics, 4th Edition
William R. ProffitWilliam R. Proffit
Henry W. Fields J r.Henry W. Fields J r.
DavidM SarverDavidM Sarver
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..
Pages: 68, 147Pages: 68, 147--149, 175149, 175--176 ,224176 ,224--226, 244226, 244--248,437248,437--443,443,
559559--560, 622560, 622