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By Catriona Kirkwood, Harvey Sandhu, Claire Saad, Zan Johar, Shano Roshani, Jeffery Bowman, Valentina Khrypta and Nicholas Brown
Buccal or Lingual
Buccal: This is when the cusps of the lower teeth occlude buccal to the buccal cusps of the corresponding upper teeth.
Lingual: This is when the buccal cusps of the lower teeth occlude inside the lingual cusps of the upper . teeth.
Posterior Crossbite - These are crossbites of the molar and premolar regions. One tooth can be in crossbite or a whole sextant can be in crossbite.
Aetiology of Crossbites
Dental Skeletal Soft tissues
Dental
Crowding Presence of supernumerary Trauma Prolonged retention of primary teeth Premature loss of primary dentition
Skeletal components
Smaller maxillary to mandibular intermolar
dental width ratio Increased lower face height Excessive abnormal mandibular growth laterally
Soft tissues
Non-nutritive sucking habbit Pacifier Both pacifiers and digit sucking beyond
age 4 associated with development of posterior crossbites. Others: Upper airway obstruction Neonatal intubation
intercuspation, mandible may displace laterally Centre line shift in lower arch towards displacement side Unilateral crossbites with no displacement can be due to a skeletal asymmetry
sutural expansion at the mid-palatal suture Indicated for patients with transverse maxillary deficiency 4mm Commonly used to correct posterior crossbites Treatment carried out during or before the pubertal growth spurt An expander is cemented to premolars+molars The desired expansion obtained by consecutive activation
in the molar and 3.2 mm in the canine regions obtained immediately after treatment of children with unilateral posterior crossbites Possible side-effects include formation of midline diastema, changes to nasal morphology, continual relapse
Quad Helix
Stainless steel
appliance used with 4 active springs Causes expansion in maxillary arch Appliances bonded to both maxillary 6s Use to treat mild malocclusions
Hard to make
adjustments after cementation Cant be used in lower arch Effects patient speech in early stages Inefficient in providing any distalization of posterior arches.
Treatment of Anterior XB
Deciduous Dentition Self correction may occur therefore treatment is delayed. Mixed Dentition Removable appliances-if there is sufficient space available, sufficient overbite + tilting movements required. Wait until permanent dentition is established if not possible. Permanent Dentition Treatment is with fixed appliances. Insufficient overbite to retain central incisors-consider moving lower incisors lingually to increase the overbite. In a crowded arch- extraction of the displaced tooth
Deciduous Dentition Removal of premature contacts may prevent posterior crossbites in the mixed/2 dentition. If not effective-an upper removable expansion plate can expand the upper arch and reduce risk of posterior crossbite occurring in the 2 dentition. Mixed Dentition Spontaneous correction of crossbites does not occur. Treatment tends to be delayed till 2 dentition so malocclusion can be corrected in one episode. Permanent Dentition One tooth displacement- treatment using fixed appliances relieving crowding where/if necessary. Consider extraction of the tooth. Cross elastics used if correction of the XB requires opposite movement of the opposing tooth. Has potential for relapse-alternative means of retention/more comprehensive treatment considered. All the teeth in a buccal segment involved(usually with displacement) treatment is to expand the upper arch to fit around the lower arch using a URA with a midline screw/quadhelix appliance (QH). The QH is more successful and treatment is quicker. A little relapse is to be expected therefore slightly over expand but note that stability is aided by good cuspal interdigitation. Successful treatment of a unilateral buccal crossbite with displacement can potentially prevent TMJD.
Bilateral Buccal Crossbite Often accepted unless the upper buccal segment teeth are tilted palatally. Treatment requires rapid maxillary expansion (RME). Relapse may cause a unilateral buccal XB with displacement. RME expansion takes approximately 19 days and needs retaining. Common in patients with repaired cleft lip and palate. Treat by expansion using a quadhelix to stretch the scar tissue.
Lingual Crossbite (Scissors bite) Single tooth displacement can be extracted or fixed appliances can align the affected tooth relieving crowding where/if necessary. Severe cases- treatment involves palatal movements of the upper teeth with buccal movements of the lower teeth with a fixed appliance. Lingual XB associated with a Class II skeletal pattern is treated using a functional appliance (twin blocks) followed
Quadhelix
End Result
References
Harrison J.E, Ashby D. Orthodontic
Cochrane Database of Systematic Reviews 2001 D. Gill, F. Naini, M. McNally, A. Jones. The managment of transverse Maxillary deficiency. Dental Update 2004; 31: 516523
treatment for posterior crossbites.