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Abstract

Cross bite is a condition where one or more teeth may be abnormally malposed bucally or lingually or labially with reference to the opposing tooth or teeth. Different techniques have been used to correct cross bite. This paper concerns orthodontic management of different types of cross bite. Orthodontic treatment carried out with pre-adjusted (Roth type 018 slot) fixed brackets with space management and alignment to accomplish the treatment. The esthetics and occlusion were maintained after retention. DOI: http://dx.doi.org/10.3329/bjodfo.v2i2.16162 Ban J Orthod & Dentofac Orthop, April 2012; Vol-2, No.2, 34-37
INTRODUCTION
Graber has defined cross bite as a condition where one or more
teeth may be abnormally malposed bucally or lingually or labially
with reference to the opposing tooth or teeth
1
. One or more of the
upper teeth biting on the inside of the lower teeth characterizes a
crossbite.
2
Cross bite can involve a single tooth or a group of
teeth. Cross bite can occur in the front and/or the sides of the
mouth. Cross bite is an occlusal irregular condition where a lower
tooth has a more buccal position than the antagonist upper tooth or
vice versa.
2
Cross bite can be classified as anterior or posterior.
Anterior cross bite is a malocclusion in which one or more of the
upper anterior teeth occlude lingually to the mandibular incisors;
the lingual malposition of one or more maxillary anterior teeth in
relation to the mandibular anterior teeth when the teeth are in
centric relation.
1-4
Posterior cross bite refers to an abnormal
transverse relationship between the upper and lower posterior
teeth. In this condition, instead of the mandibular buccal cusp
occluding in the central fossa of the maxillary posterior teeth
they occlude buccal to the maxillary buccal cusp. Thus posterior
cross bite occurs as a result of lack of co-ordination in the later-
al dimension between the upper and the lower arches.
1-4
The
majority of cross bites are caused by dental factors: a congeni-
tally-caused eruption pattern of the maxillary anteriors. Trauma
to the primary dentition may also lead to the displacement of the
primary or permanent tooth bud. Arch length discrepancy,
retained deciduous tooth, thumb sucking habit, nasal obstruction,
narrow maxilla and mouth breathing may cause cross bite.
1-4
Early correction of cross bites is recommended.
2-5
Cross bite should be corrected because it can:
• Cause premature wear of the teeth
• Cause gum disease including bone loss
• Cause asymmetrical development of the jaws
• Cause dysfunctional chewing patterns
• Make a person’s smile less attractive
TREATMENT OBJECT
Braces are a simple yet effective form of orthodontic treatment
and can generally be used to correct cross bite of the teeth. In
conjunction with the braces unilateral or bilateral expansion may
be required. To correct lock bite condition posterior bite plane is
also incorporated for cross bite correction. In some circum-
stances cross elastics are helpful. While many people are hesitant
to get braces because of their cosmetic nature and effect in social
life, the results generally outweigh the temporary effects.
Treatment objectives were to:
1. Level and align the arches.
2. Correct cross bite.
3. Maintain Class I canine and molar relationships.
4. Normalize the overbite and overjet.
5. Improve the gingival condition.
6. Maintain the profile.
7. Achieve long-term stability.
TREATMENT PROGRESS
Chief complaints and diagnosis were presented in Table 1.
Treatment was started with pre-adjusted (Roth type 018 slot)
brackets. A 0.012, 0.014 and 0.016 inch nitinol arch wire was
used for leveling and alignment. A 0.016 × 0.022 inch nitinol
arch wire was inserted for the final alignment and detailing.
Lastly a 0.016 × 0.022 inch stainless steel arch wire was used for
the alignment stabilization.
Case 1: Maxillary right central incisor was in cross bite position.
Total treatment duration was only 2 and half months. The patient
and her parents were fully satisfied (Figure 1).
Case 2: Maxillary left lateral incisor was in cross bite position.
Total treatment duration was 6 months. The patient and her par-
ents were happy after treatment (Figure 2).
Case 3: Maxillary right lateral incisor was in cross bite position
with high canine. Total treatment duration was 16 months. The
patient and her parents were fully satisfied after treatment
(Figure 3).
Case 4: Maxillary left lateral incisor was in cross bite position.
Posterior bite plane was incorporated for 1 month only. Total
treatment duration was 7 months. Fixed retainer was set on labi-
al surface due to insufficient space to set retainer on palatal sur-
face. Patient was happy after treatment (Figure 4).
Case 5: Maxillary left lateral incisor was in cross bite position
with high canine. Lower right lateral incisor was lingually placed
and the canine was buccally placed. All the 1st premolars were
extracted. Total treatment duration was 17 months. The patient
and her parents were happy after treatment (Figure 5).
34
1
Senior Lecturer, Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia
2
Associate Professor and Head,
Dept. of Orthodontics, Bangladesh Dental College
ABSTRACT
Cross bite is a condition where one or more teeth may be abnormally malposed bucally or lingually or labially with
reference to the opposing tooth or teeth. Different techniques have been used to correct cross bite. This paper con-
cerns orthodontic management of different types of cross bite. Orthodontic treatment carried out with pre-adjusted
(Roth type 018 slot) fixed brackets with space management and alignment to accomplish the treatment. The esthet-
ics and occlusion were maintained after retention.
Key words: Cross bite, space management, alignment, retention. (Bangladesh Journal of Orthodontics and
Dentofacial Orthopedics, Vol. 2, No. 2, April 2012, p 34-37).
Spectrum of cross bite management
Alam MK
1
BDS, PhD and Sikder MA
2
BDS, PhD.
Case 6: Maxillary right premolars and first molar were in cross
bite position. Unilateral expansion and cross elastics were used
to normalize this malocclusion. Total treatment duration was 20
months. The patient was satisfied after treatment (Figure 6).
Case 7: Mandibular right canine was in cross bite position while
the right incisors were in edge to edge bite position. Posterior
bite plane was incorporated for 2 months to correct the canine
cross bite. Total treatment duration was 18 months. The patient
was fully satisfied after treatment (Figure 7).
Case 8: Camouflage treatment was done to correct this skeletal
class III malocclusion. This case was treated without any extrac-
tion. Posterior bite plane and class III elastics were used. Patient
and his parents were informed about only dental correction. Total
treatment duration was 22 months. Patient and his parents were
fully satisfied after treatment (Figure 8).
Case 9: Maxillary left lateral incisor was in cross bite position.
Maxillary left central incisor was broken badly with faulty root
canal treatment. On examination there was a sinus near root apex
of that tooth. A periapical x-ray was taken. There was a periapi-
cal lesion and faulty root canal treatment was diagnosed.
Affected tooth had second degree mobility. Left central incisor
was extracted. Maxillary left lateral incisor was brought in occlu-
sion by braces incorporated with fixed lingual arch and soldered
spring. Total treatment duration was 9 months. Patient was happy
after treatment (Figure 9). When ideal occlusion was obtained,
all the appliances were removed. Fixed lingual type retainer was
set for retention prepared by coaxial wire and fixed by light cure
composite.
35
Alam MK and Sikder MA
Bangladesh Journal of Orthodontics and Dentofacial Orthopedics (BJO & DFO)
Vol. 2, No. 2, April 2012
36
Spectrum of cross bite management
Bangladesh Journal of Orthodontics and Dentofacial Orthopedics (BJO & DFO)
Vol. 2, No. 2, April 2012
DISCUSSION
If there is cross bite, the tooth/teeth can be moved with braces
into the correct position. Lock bite cases often require selective
bite plane. Once space is created, braces will move the tooth in
the line of occlusion with selective force mechanism and align
the tooth/teeth. A thorough clinical assessment and accurate
records are necessary. Treatment modalities will vary according
to the specific diagnosis. Clinical management of cross bite is
often challenging for the ortho¬dontist, particularly when the
tooth is in deep overbite, a bite plane can prevent interference
from the opposing arch. Cross bites are a prevalent condition in
children.
5-6
They represent a challenge to the clinician in both
diagnosis and treatment planning. Cross bites may be dental or
skeletal in etiology.
2,4
Anterior dental cross bite requires early
and immediate treatment to prevent abnormal enamel abrasion,
anterior teeth mobility and fracture, periodontal pathosis and
temporomandibular joint disturbance.
5-8
The main goal of treatment is to tip the affected tooth or teeth
labially/ buccally or lingually/ palatally to the point where a sta-
ble overbite relationship exists.
9
Relapse is usually prevented by
the normal overjet/overbite relationship that is achieved.
9
Correction of cross bite can help to prevent premature contact,
dental decay and periodontal disease by improving the ability to
remove plaque from the teeth.
10
CONCLUSION
These results achieved in these cases fulfill initial treatment
objectives and may be considered a success. From a functional
and esthetic perspective the patients and their parents are entire-
ly pleased with the outcome of treatment.
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1. Graber TM; Vanarsdall RL, Jr: Diagnosis and Treatment Planning in
Orthodontics, Orthodontics-Current Principles and Techniques,
1994; Mosby-Year Book, Inc.
2. Bishara SE. An approach to the diagnosis of different malocclusion.
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Orthodontics, Current Principles and Techniques. 3rd ed. St Louis:
Mosby, 2000;27–128.
4. Proffit WR and Fields, Jr. HW. Orthodontic treatment planning: from
problem list to specific plan.1992; 7:186-224.
5. Estreia F, Almerich J, Gascon F. Interceptive correction of anterior
crossbite. J Clin Pediatr Dent 1991;15:157-159.
6. Marrison JT. Fundamentals of Pediatric Dentistry. 3rd ed. London:
Quintessence Publishing Co, 1995:355.
7. Payne RC, Mauller BH, Thomas HF. Anterior crossbite in the pri-
mary dentition. J Pedod 1981;5:281-294.
8. Sexton T, Croll TP. Anterior crossbite correction in the primary den-
tition using stainless steel crowns. J Dent Child 1983;50:117-120.
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Australian Dent J 1989;34:20-28.
10. Croll TP. Fixed inclined plane correction of anterior crossbite of the
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37
Alam MK and Sikder MA
Bangladesh Journal of Orthodontics and Dentofacial Orthopedics (BJO & DFO)
Vol. 2, No. 2, April 2012
Corresponds to:
Mohammad Khursheed Alam
BDS (DU), PhD (Japan)
Senior Lecturer, Orthodontic Unit
School of Dental Sciences, Health Campus
Universiti Sains Malaysia
Email: dralam@gmail.com
... Heredity plays major roles as an etiologic factor for different type of malocclusion [1][2][3][4][5][6][7] . Anterior cross bite / single tooth crossbite is a malocclusion in which the lingual/palatal malposition of one or more maxillary anterior teeth in relation to the mandibular anterior teeth when the teeth are in centric relation [8][9][10] . According to British standards Incisor classification, in class III malocclusion the lower incisor edges lie anterior to the cingulum plateau or middle third of the palatal surface of the upper incisors. ...
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... In such cases, overjet is reduced or reversed [8][9][10] . Anterior CB / single tooth CB or group of anterior teeth CB is a MO in which the lingual /palatal malposition of one or more maxillary anterior teeth in relation to the mandibular anterior teeth when the teeth are in centric relation [11][12][13][14][15] . CM teeth are relatively common in dental patient and the objective of the dental specialist is to create a balanced, functional, and aesthetically acceptable dentition. ...
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... Most people have some degree of malocclusion and have strong hereditary component as an etiologic factor [1][2][3][4] . Anterior cross bite is a malocclusion in which the lingual malposition of one or more maxillary anterior teeth in relation to the mandibular anterior teeth when the teeth are in centric relation [5][6][7][8] . Malocclusion comes in many forms, and one of the most notable can be poorly positioned canines. ...
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... Conventional orthodontic treatment has been directed for minimizing the vertical maxillary growth by using headgear, retarding the mandibular growth with chin cups, or extruding anterior teeth with the help of vertical elastics. There are several methods that have been evaluated for treatment and/or retention of anterior open bite malocclusion including tongue crib therapy, posterior bite blocks, and functional appliances [2][3][4][5][6][7] . ...
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The role of removable appliances with springs for the treatment of teeth in anterior and posterior cross-bite is discussed. The indications for their use (that is, case selection), and their manipulation are examined. Cases are presented where removable appliances are the appliances of choice in the first stage of the correction of a posterior cross-bite, the final treatment being completed with fixed appliances. The ease of correcting and retaining various maxillary teeth which may be in cross-bite is discussed.
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The purpose of this paper was to evaluate a passive method to correct anterior crossbite of only one incisor by creating a composite inclined plane. A total of 15 children were selected, aged 6 to 8. The results at the end of one week showed that in all cases the incisor was in normal position.
Anterior crossbite in the pri-mary dentition
  • Rc Payne
  • Bh Mauller
  • Thomas
Payne RC, Mauller BH, Thomas HF. Anterior crossbite in the pri-mary dentition. J Pedod 1981;5:281-294
Fundamentals of Pediatric Dentistry
  • Jt Marrison
Marrison JT. Fundamentals of Pediatric Dentistry. 3rd ed. London: Quintessence Publishing Co, 1995:355.
Diagnosis and Treatment Planning in Orthodontics, Orthodontics-Current Principles and Techniques
  • Tm Graber
  • Rl Vanarsdall
Graber TM; Vanarsdall RL, Jr: Diagnosis and Treatment Planning in Orthodontics, Orthodontics-Current Principles and Techniques, 1994; Mosby-Year Book, Inc.
Orthodontic treatment planning: from problem list to specific plan
  • Wr Proffit
  • Fields
  • Jr
  • Hw
Proffit WR and Fields, Jr. HW. Orthodontic treatment planning: from problem list to specific plan.1992; 7:186-224.