Correction of cross bite

Bite or occlusion is the position of the teeth of the upper and lower jaw at the time of the closing. Normally during the process of closing the upper dentition overlaps the lower one by(for) one third. A deviation from the norm is called an occlusal anomaly or malocclusion. Cross bite is a bite pathology in which the overlap between the upper and lower teeth is disrupted so that in some parts or single teeth of the lower jaw are covered the corresponding upper teeth. If the overlap is broken at least in the area of one tooth, then this is already considered a cross bite or cross ratio in the area of one tooth.

Crossbite in the lateral section

Crossbite in the anterior sectionе

Types of crossbites

Crossbite is classified according to several factors:

  1. By location in the oral cavity:
    • In the lateral section(area)
    • In the anterior section. The protruding lower jaw in the anterior area sometimes indicates as mesial occlusion.
    • «Scissor» bite, in which the upper teeth completely overlap the lower teeth.
  2. By overlapping the dentition:
    • Buccal occlusion, in which the lower jaw overlaps the upper jaw on one or both sides. An overlap is caused by an abnormally large mandible or a too narrow upper jaw.
    • Lingual occlusion, in which the upper jaw overlaps the lower jaw in whole or in part as a result of insufficient development of the lower jaw or wide upper jaw.
  3. By prevalence in the oral cavity:
    • Crossbite in the jaw area;
    • Cross ratio in the area of 1-2 teeth.

Signs of cross bite

An irregular crossbite is primarily determined visually. When the jaws are closed, individual teeth or groups of teeth in the lower arch overlap the corresponding teeth in the upper arch. The upper and lower teeth seem to "intersect" with each other.

Indirect symptoms of crossbite are facial asymmetry and chin displacement. These signs do not always appear, and if they do, they do not necessarily indicate a crossbite.

Crossbite is also associated with physical discomfort when teeth cling to each other. However, bite anomalies usually develop gradually throughout life, so a person gets used to the inconvenience and does not notice them.

Reasons for the appearance of a cross bite

Most often, bite pathology is formed from the early childhood during primary teeth or the change of baby teeth to permanent ones. The bite is formed both under the influence of factors independent of a person: the structural features and development of the jaws and teeth, and because of the child's bad habits or improper dental care.

  1. Incorrect development of the jaws due to heredity, lack of calcium, delayed eruption of permanent teeth, otolaryngological diseases (rhinitis, sinusitis).
  2. Violation of abrasion of primary teeth. Normally, baby teeth gradually wear off and bite evenly. If the primary teeth are not worn out, they interfere with the correct occlusion of the teeth: they slide and displace the entire jaw behind them.
  3. Early loss of primary teeth as a result of caries or natural loss provokes the displacement (unhinge)of the remaining teeth, abnormal growth of permanent ones and the consolidation of improper closure.
  4. Bad habits of the child. Sometimes children deliberately move their jaw to the side or touch their growing teeth with their tongue. Any unnatural mechanical pressure affects the final position of the teeth and jaw.

In adults, crossbite can be formed by facial trauma or poor quality prosthetics. While restoring teeth with crowns or veneers, it is important to take into account the anatomically correct position and size so that the orthopedic appliance does not interfere with the natural bite of the teeth.

Stages of cross bite formation

Malocclusion can develop into two forms, which affect the duration and technology of treatment.

  • Dentoalveolar bite is an abnormal position at the level of the teeth, with the normal size of the jaws. With such a bite, uneven teeth provoke a forced malposition of the jaw. In case of absence of treatment with this form of occlusion, then the jaw will grow under the wrong position and the bite will take on a skeletal shape.
  • Skeletal crossbite — Skeletal bite is an abnormal position of the teeth and jaws fixed at the level of the facial skeleton. This shape can be the result of uneven growth of the jaws or formed from a tooth-alveolar shape as a result of fixing an incorrect position.

Malocclusion at the level of the teeth is usually corrected more quickly. Sometimes it is enough to work with a bad habit or to grind the canines. Surgery may be required to correct the skeletal abnormality.

How to distinguish between forms of cross bite

The skeletal shape of a malocclusion can be determined visually.

Assess the position of the jaws when the mouth is opened. The midline of the upper and lower dentition should match. If the teeth slip and get into the wrong position only when they are closed, this is a pathology at the level of the teeth.

If the jaws and teeth visually stand crooked relatively to each other, even when the teeth are not closed, this is an anomaly at the skeletal level. With this form of bite, the asymmetry of the face is usually expressed, the mismatching midline of the dentition, disproportionate to the face of the chin (protruding or underdeveloped)

How to prevent cross bite formation?

ОIt is possible to stop the fixation of an incorrect bite only at the beginning of its development, that is, in childhood, during the period of primary bite and the change of baby teeth to permanent ones.

First of all, you need to pay attention to the following habits of the child:

  • Regularly sits with one hand on one side of the cheek;
  • Touches growing teeth with hands / tongue;
  • Deliberately puts the jaw in the wrong position;
  • Sleeps on a pillow that is too high or too low, which affects the position of the spine during sleep.

If the jaws do not close properly - with a tip to one side, the child should be shown to the orthodontist. The doctor will choose(recommend) devices for bite correction, if necessary, grind primary canines to a natural level, and give recommendations for home exercises and work with habits.

Typically, in the early stages in children, crossbite is treated quickly and without braces. Provided that the child wears removable appliances and follows the recommendations

Consequences of cross bite

In the initial stages of crossbite development, complications are usually associated with the speed and complexity of treatment: the longer the bite is not corrected, the more difficult it will have to be treated in the future.

  1. The bite is fixed in a skeletal form;
  2. Permanent teeth grow incorrectly;
  3. Uneven load on the joint, abnormal development of the joint and posture.

In the case of cross-occlusion of permanent teeth, teeth, gums and temporomandibular joint are subjected to constant uneven load. The risk of developing complications that require expensive treatment and the intervention of several specialists increases.

  1. Abrasion of teeth. The teeth touch each other unevenly, with irregular surfaces.
  2. Caries and tooth decay due to too much load on certain areas.
  3. Chipped teeth. The teeth close in the wrong position, cling to each other.
  4. Wedge-shaped defects - enamel cracks at the base of the teeth.
  5. Gum recession - reduction of gum tissue at the base of the teeth.
  6. Injuries of oral mucosa, which in chronic form increase the risk of cancer.
  7. Cracks, pain in the joint while opening and closing the mouth. In a serious form - pain in the cervical spine, headaches in the temporal lobes.
  8. Aesthetic deficiencies: uneven teeth, asymmetrical face, disproportionate chin,.

These symptoms appear individually and do not necessarily occur in full volume. However, any uneven load on the teeth increases the risk of tooth decay. With the correct bite, it is much easier to care for and maintain the health of the entire oral cavity.

How to fix crossbite

Correction of bite for children

Above, we indicated(mentioned) that the formation of a bite begins from childhood, so treatment in the early stages is much faster and easier.

The external manifestations of cross-occlusion can be determined visually, but the final diagnosis can be made only by an orthodontist. Therefore, if a child detects signs of improper closure, it is not recommended to self-medicate.

At the consultation, the doctor will conduct an examination, analyze the images(pictures) and draw up an individual treatment plan.

Possible methods of bite correction in children:

  • Grinding primary canines;
  • Orthodontic appliances: plates, two-jaw and one-jaw, removable and non-removable.
  • Partial braces system;
  • Apparatus and simulators for training muscles, lips, tongue;
  • Children's aligners ;
  • Exercises with a speech therapist.

To achieve the result, the orthodontist can prescribe a set of measures, including wearing apparatus, and muscle training, and classes with a speech therapist.

Bite correction for adults

In adults, crossbite is corrected in two ways, depending on the complexity of the pathology:

  1. Orthodontic treatment using braces or aligners. Standard orthodontic treatment lasts from 1.5 to 2.5 years, depending on the complexity of the bite and the chosen bracket system.
    If joint dysfunction occurs before or during treatment, an articular splint and joint exercises are added to the use of braces.
  2. Surgical bite correction is used to correct the abnormal size of the jaws. As a rule, one surgical intervention is not enough: an orthognathic surgeon corrects only the size of the jaw and asymmetry, and the braces already move the teeth, correcting their closure and position..

    If surgery is necessary, at first braces are installed to place the teeth in the correct position, and then surgery is done to correct the jaw. After the operation, the orthodontist details the dentition with the help of braces.

    Orthodontic treatment with surgery is usually completed faster because the teeth do not need to move in the bone for a long time.

In cases where surgery is contraindicated, and braces cannot put the teeth in an ideal position, incomplete correction is performed. Such a patient is under the supervision of an orthodontist during the retention period in order to avoid relapse.

Complications During Crossbite Treatment

During orthodontic treatment, the patient may show signs of joint dysfunction due to changes in the position of the teeth during closure and changes in the load on the joint. Such patients are prescribed gymnastics or apparatus to relieve joint pain and exercise muscles. Timely measures to eliminate TMJ problems prevent serious complications from developing.

Correction of cross-bite in the Konfidencia

At the Konfidencia clinic, we provide patient comfort and a competent professional approach at all stages of treatment, including in the retention period after the removal of braces.

Diagnostics

We pay considerable attention to the very first and most important stage of treatment - diagnosis.

To obtain high-quality CBCT images, we use a modern diagnostic 3D tomograph.

During diagnostics and at all stages of treatment, orthodontists conduct a photo protocol: all changes in the oral cavity are carefully recorded(written,documentated) and analyzed to track the dynamics of treatment and eliminate errors

Diagnostic cases are discussed at daily meetings of orthodontists to get the most complete picture of treatment with all the nuances.

Types of braces

Orthodontists are certified to work on a variety of braces and aligners. Our patients can choose the most convenient orthodontic apparatus for them:

Specialists

The Konfidencia orthodontic team consists of 15 qualified orthodontists, three of whom are opinion leaders of Ormco Corporation, an American manufacturer of braces. Dentists-orthodontists Badmaeva Anna Nikolaevna and Petrova Elena Aleksandrovna are specialists in the treatment of the joint.

In difficult cases, during the preparation of a treatment plan other specialists of the clinic (orthopedists, surgeons, therapists) participate to create a step-by-step plan for the improvement of the entire oral cavity.

We cooperate with a proven orthognathic surgeon and osteopath, to whom we refer patients with indications to surgery or for more detailed work with the joint.

Автор: Petrova Elena Aleksandrovna, Dentist-orthodontist, специалист по лечению ВНЧС

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Our clients results

Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.
Clinical case report #1. Class III malocclusion, crowding treatment and prosthetic preparation.

Problem: smile aesthetics and defect in bite function.
Diagnosis: the treatment of upper and lower jaw teeth misalignment and class III malocclusion, caused by increased mandible growth, and prosthetic preparation.
Therapy method chosen: orthodontic treatment using stainless steel self-ligating brackets Damon Q without teeth extraction..
Treatment time: 3 years.

 

Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.
Clinical case 2. Correction of the aesthetics of a smile and severe crowding of the dentition.

Problem:  Smile Aesthetics
Diagnosis: treatment of severe crowding of the dentition.
Selected treatment method: orthodontic treatment with brackets without tooth extraction using the Damon Q metal self-ligating bracket system.
Treatment term:  2,5 years.

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