Dental Problems

Anterior Cross Bite-Overview

An anterior cross bite is an abnormal labiolingual relationship between one or more maxillary and mandibular anterior teeth. In this article, there is a brief discussion on the anterior cross bite. Read on to know more.

Classification of cross bite:

Cross bite is classified into two types:

  1. Anterior: Unilateral – True
  2. Posterior: Bilateral -Functional

Etiology:

It can be dental, skeletal or a combination of the two.

Anterior cross bite:

  1. Traumatic injuries to the primary dentition that cause a lingual displacement of the permanent tooth bud.
  2. Supernumerary tooth.
  3. A inadequacy of arch length causing the lingual deflection of the permanent tooth during eruption.
  4. A habit of biting the upper lip.
  5. A functional cross bite caused due to premature tooth contact during centric closure.
  6. Skeletal:

    an anterior cross bite of skeletal origin generally results from an excessive abnormal mandibular growth that produces a true class III malocclusion. It has got a genetic background.

The modalities of treatment for anterior cross bite:

A differential diagnosis must be made to determine whether the problem is of skeletal or dental origin. The prognosis is much better if a plain dental problem exists.

Other factors that need to be evaluated are as follows:

  • Axial inclinations of the upper and lower incisors
  • The absolute size of the mandible and maxilla and their relationship to each other and to cranial base
  • Profile of the patient
  • The molar and cuspid occlusion
  • The extent of root formation (if root formation is not complete lighter forces to be applied)
  • Adequate mesiodistal space should be available
  • Sufficient over bite for retention purpose

Corrective measures and appliances:

  • a. Occlusal equilibration:

    Correction of a pseudo class III anterior cross bite may require only the removal of premature tooth contacts by incisors.

  • b. Tongue blade therapy:

    it is ideally suited for cases where a simple one tooth anterior dental cross bite exists, with the teeth in the early stages of eruption. Using the lower incisor as the fulcrum, the locked tooth can be pushed out by placing the tongue blade 45 degrees behind the tooth. It should be used 1-2 hours daily for 10-14 days.

  • c. Lower inclined plane:

    This was introduced by Catalan. Treatment of dental anterior cross bite involving one or two teeth may be accomplished by using a cemented lower acrylic inclined plane. The inclined plane should be contoured and polished at a 45 degree angle to the long axis of the lower incisor teeth prior to cementation. The steeper the angle, greater the force applied.
    It has the disadvantages that are mentioned below:

    • The possibility of opening the bite by wearing it longer the two or three weeks.
    • Exact amount of labial movement is unpredictable and uncontrollable.
  • d. Stainless steel crown:

    A reverse stainless steel crown is best suited for single tooth cross bites in which the lower mandibular incisor has been previously displaced labially.

  • e. Composite inclines:

    Another simple technique is to build up a composite incline on the lower teeth directly in the patient’s mouth. Croll (1999) has suggested the use of a bonded compomer slope based on the assumption that a compomer having less strength than a composite can be easily removed when desired.

  • f. Removable Hawley appliance:

    A maxillary Hawley appliance with Z springs incorporated into the acrylic resin is useful in the correction of a dental anterior cross bite involving single or more than one tooth. Retention can be obtained by the use of ball clasps, Adams or C type clasps. Movement of the inlocked incisors is accomplished by activating the springs 1.5mm to 2mm every one or two weeks. Patients are instructed to wear the appliance 24 hours a day. If the bite is deeper than normal, or if correction is taking longer than expected, then a slight opening of the bite may be desirable by means of a bite plane.

  • g. Fixed appliances:

    Lingual arch may sometimes be indicated in case of space control programs. Auxiliary springs can be used along with the lingual or palatal arches for the purposes of correcting the cross bites.

The above article discusses briefly about the

anterior cross bite

.

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