Crossbite. Diagnostic criteria and techniques

Cross occlusion- this is an anomaly of the closure of the dentition in the transverse direction, in which the upper or lower dentition is located vestibularly or orally relative to the opposite dentition, which has the correct shape and normal size. According to L.S. Persina distinguishes three types of cross occlusion: palatine occlusion, linguo-occlusion and vestibulo-occlusion. Perhaps their combination. Palatinoocclusion occurs as a result of hypodentia of the upper teeth, narrowing of the upper dentition, apical basis of the upper jaw. At the same time, the palatine tubercles of the lateral teeth of the upper jaw, when closing, contact not with the longitudinal fissures of the lower lateral teeth, but with their lingual tubercles, and if the anomaly is severe, they may remain without contacts. linguistic occlusion, formed by narrowing the lower dentition, characterized by the fact that the palatine tubercles of the upper lateral teeth are in contact with the buccal tubercles of the premolars and molars of the lower jaw. Vestibulocclusion is formed as a result of an increase in the size of the upper and lower dentition in the transversal direction. With vestibulocclusion, formed due to an increase in the transverse size of the lower dentition, there is a significant overlap of the upper lateral teeth with the lower ones. Each of these types can be one-sided and two-sided. It is possible to form cross-occlusion not as a result of a change in the size of the jaws, but with a habitual displacement mandible left or right. Then the same patient has vestibulo-occlusion or linguo-occlusion on one side and palatino-occlusion on the other. According to F.Ya. Khoroshilkina, M.Yu. Malygina et al. (1982, 1990) distinguish several types of crossbite:
- dentoalveolar, in which there is a narrowing or expansion of the dentoalveolar arch of one jaw or a combination of these disorders on both jaws;
- gnathic, in which there is a narrowing or expansion of the basis of the jaws;
- articular, in which there is a mixture of the lower jaw to the side. In turn, the mixing of the lower jaw can be parallel to the midsagittal plane and diagonal.
Cross occlusion may be accompanied by various anomalies of teeth, dentition, jaws, as well as anomaly of occlusion in other directions (sagittal and vertical). Often, unilateral palatine occlusion is combined with mesial occlusion and reverse incisal disocclusion, and linguo-occlusion is combined with distal and deep occlusion.
Etiology. hereditary predisposition, impaired calcium metabolism in the body (rickets, endocrine changes in the body), impaired neuro-reflex processes (uncoordinated activity, hypo- and hypertonicity chewing muscles, asymmetry of the tonic state of the right and left masticatory muscles), bruxism, bad habits (supporting the cheek with the hand, sucking fingers, cheeks, tongue, etc.), incorrect position of the child during sleep (on one side, putting the hand, fist under the cheek), when playing the violin, diseases of the nasopharynx, oral breathing, narrowing of the upper jaw as a result of a violation of the effect of the cartilage of the nasal septum on the growth zones of the upper jaw, curvature of the nasal septum, caries and its complications, early destruction and loss of milk molars; trauma, inflammatory processes in the area of ​​the alveolar processes and the jaw growth disorders caused by them, atypical location of the rudiments of the teeth and their retention, delay in the change of milk teeth by permanent teeth, violation of the sequence of teething, unwearied tubercle of the lower milk canine on one side of the jaw, uneven tooth contacts, cleft lip , alveolar process and palate.
Clinic. Violation of the aesthetics of the face due to its asymmetry. Violation of the transversal movements of the lower jaw leads to an incorrect distribution of masticatory pressure and periodontal disease. Often there is an injury to the mucous membrane of the cheek due to its biting. Patients may complain of a violation of the pronunciation of individual sounds. When combined with a crossbite with a displacement of the lower jaw to the side, there may be a violation of the TMJ function.
Diagnostics. Orthodontic diagnosis is made on the basis of clinical and laboratory research methods. When studying diagnostic models of the jaws, it is advisable to use the methods of Nanse, Gerlach, Schmut; PONA method that allows you to diagnose narrowing or widening of the jaws in case of crossbite. One-sided narrowing of the jaws can be diagnosed by measuring the distance from the lateral teeth to the line of the median palatal suture. With unilateral narrowing of the jaw, the distances to the right and left will be different.
The study of direct teleroentgenograms of the head makes it possible to clarify the asymmetric structure of the facial bones. Often, a crossbite can be combined with a shortening of the mandibular branch on the side of the displacement. In case of a crossbite with a mixture of the lower jaw, there is usually asymmetry of the face and a displacement of the pogonion point in relation to the midsagittal plane. In a crossbite without displacement of the mandible, the pogonion point is usually not displaced.


46 . Prevention and treatment of cross occlusion depending on the period of bite formation.

The goal of orthodontic treatment of crossbite is to normalize the ratio of the dentition in the transversal plane. In children with milk teeth and during their replacement it is necessary to fight against bad habits and mouth breathing, give hard food, prescribe therapeutic exercises, and grind off unworn tubercles of milk fangs that impede transversal (lateral) movements of the lower jaw. The blocking position of the jaws is eliminated with the help of a plate with a bite pad, expanding plates, a chin sling with a stronger rubber traction on the side opposite to the displacement of the lower jaw; plates with buccal and intraoral pads and a flap for the tongue or an inclined plane, a Frenkel function regulator, and a positioner are also used. In children with permanent teeth removal of individual teeth (usually the first premolar) and their polishing are possible. When carrying out instrumental treatment, mechanically operating devices are used, combining them with oblique intermaxillary traction. The expansion of the dentition is carried out with plates with screws and cut parallel to the palatine suture or with a sectoral cut and a screw, protracting springs and obligatory separation of the dentition. Good results are obtained by the use of a non-removable expander of the clasp design, as well as the Angle arc (stationary) with intermaxillary rubber traction. They use rings with hooks for oral-vestibular traction, plates with Napadov fixation, pads and hooks, positioners, and a bracket system.

The task of orthodontic treatment with unilateral palatine occlusion is the unilateral expansion of the upper dentition. First of all, it is necessary to separate the dentition with a plate on the upper jaw with a screw, occlusal linings in the lateral area on the side of the correct closure of the dentition. Imprints of antagonistic teeth are required, which allows you to increase the support. Due to the activation of the screw, one-sided expansion of the upper dentition occurs.
With bilateral palatine occlusion, the dentition is separated from both sides (without the presence of occlusal imprints). Due to the activation of the orthodontic screw or Coffin spring, a bilateral expansion of the upper dentition occurs. In the presence of orthodontic rings on the first permanent molars with special locks on the palatal surface of the rings, the impact of a spring steel quadro-helix palatal expander or a springy palatal expander made of a nickel-titanium alloy with "shape memory" is highly effective.
In case of vestibulocclusion due to excessive development of the upper dentition, a plate is made on the upper dentition with occlusal overlays and an elongated occlusal surface for contact with the lower dentition.
The transversal narrowing of the upper dentition is carried out due to the reverse activation of the screw (the screw is placed in the apparatus in the untwisted state) or a reduction in the size of the spring element. When combined with vestibulo-occlusion of the upper dentition and linguo-occlusion of the lower dentition, the task of treatment is to reduce the transversal size of the upper and expand the lower dentition. Treatment of cross occlusion permanent teeth more often carried out using edgewise technique. In this case, opening springs or compression springs are used, as well as cross-maxillary elastic traction.

AT 2. The goal of orthodontic treatment of crossbite is to normalize the ratio of the dentition in the transversal plane. The ways to achieve it are different in different age periods.
During temporary and mixed bite shows the elimination of etiological factors (see the section "Etiology"), the normalization of the act of chewing (the use of hard food) It is necessary to apply myogymnastics when combining a cross bite with a displacement of the lower jaw. With an early loss temporary teeth the prosthesis was shaken to maintain the correct occlusal contact of the teeth in the vertical and transversal plane.
When indications for orthodontic instrumental treatment, devices are used that separate the bite and contribute to the expansion of the narrowed dental arch.
During the period of temporary bite the use of vestibular plates KRAUSE, SCHONHER and other structures is shown. A maxillary plate can be used with ADAMSA clasps on the posterior teeth, a vestibular arch and a posterior plane to limit lateral movement of the mandible. To expand the narrowed dental arches, these plates are used with active mechanically acting elements that contribute to the expansion of the dentition: screws, springs. When expanding the dentition, one should remember the need to separate the dentition before activating the screws and springs.
In the formed temporary dentition and in the period of mixed dentition shows the use of two-jaw orthodontic appliances. With a unilateral narrowing of the upper dentition, elements that move the lateral teeth are added to the design of the ANDRESEN-HOYPLE activator: springs, levers, pushers. The occlusal pads in the apparatus are kept on the side of the correct ratio of the lateral teeth. Good treatment results can be obtained by using the Frenkel function regulator. In buccal crossbite, buccal function regulator shields are made so that they touch the buccal surface of the mandibular posterior teeth and do not come into contact with the buccal surface of the upper posterior teeth. For the treatment of lingual crossbite, buccal shields are made in the opposite way. This contributes to the growth of the apical basis of the jaws in the transversal plane and the elimination of crossbite.
To enhance the therapeutic effect of these devices, it is necessary to use extraoral active orthopedic systems in the form of a head cap with a chin sling and rubber traction of various sizes. On the mixing side, the elastic force should be less than on the opposite side.
In constant bite the use of non-removable mechanically acting orthodontic appliances in combination with compact osteotomy, the removal of individual teeth for orthodontic indications, the use of extraoral active orthopedic systems is shown.
When narrowing the dentition, you can use the ENGLE apparatus in the form of an expansive fixed arch and tubes soldered to the rings on the supporting molars, more often than the first permanent ones. If there is a correct location of the first permanent molars, which can be clarified using the Pohn method, but the dentition is narrowed in the region of the premolars, then the following tactics are used. Angle's stationary archwire is fixed in tubes on the abutment molars, then the premolars are moved towards the archwire by activating ligatures that fix the premolars to the archwire.
If there is a displacement of the lower jaw to the side, the use of oblique intraoral elastic bands, fixed to the stationary Angle arcs with hooks, is indicated. It should be remembered that the bite must be separated using removable orthodontic plates with occlusal linings.
In permanent occlusion after orthodontic treatment, consolidation of the achieved results is shown. For this purpose, rational prosthetic treatment is carried out.
During prosthetics, particular importance should be attached to the correct position of the lower jaw in relation to the mid-sagittal plane.
The prognosis for the treatment of a crossbite depends on its form (dental-alveolar, gnathic), type (buccal, lingual, combined), the age of the patient, the period of initiation of orthodontic treatment, the severity of morphological and functional disorders in the dentofacial region.

47. Permanent bite. periods of formation. Features of teeth, dental arches and their relationship. Risk factors for the occurrence and development of dental anomalies.

The dentition during this period is characterized by the following parameters: the number, groups and size of teeth, the shape and type of closure of the dentition. The number of teeth is 28, 14 on each jaw and 7 on each half of the jaw. Groups of teeth - incisors (1, 2), canines (3), premolars (4, 5), molars (6, 7, 8?)! Normally, there is a certain relationship between the mesiodistal dimensions of the teeth and the size of the dentition. The shape of the upper dentition is a semi-ellipse, the lower one is a parabola. In this period, the formation of the roots of permanent teeth ends.


For the physiological bite of permanent teeth, the following signs are characteristic:

The upper lateral teeth overlap the lower ones to the depth of the longitudinal fissure, and in the frontal area upper incisors overlap the lower incisors by no more than y and between them there is a cutting-tubercular contact; the palatine cusps of the upper molars are in contact with the longitudinal fissures of the lower molars (Fig. 13.5);

Each tooth has two antagonists (except for the upper last teeth and lower central incisors, which have one antagonist each);

Each tooth of the upper jaw antagonizes with the same tooth of the lower jaw and the back tooth, and each tooth of the lower jaw antagonizes with the same tooth of the upper jaw and the front tooth; anterior buccal cusp top first the molar is in contact with the transverse (intertubercular) fissure of the lower tooth of the same name;

The median line runs between the central incisors;

On the upper jaw, the dentition is larger than the alveolar arch, and the latter is larger than the basal arch;

On the lower jaw - the reverse relationship: the basal arch is larger than the alveolar, and the alveolar - more than the dentition;

Teeth touch with contact points on approximal surfaces;

The height of the crowns decreases from the central incisors to the molars (canines are an exception);

upper teeth inclined vestibular, and the lower ones are located vertically;

The first molars are closed as follows: the mesio-buccal tubercle of the first molar of the upper jaw is located in the intertubercular fissure of the same-named molar of the lower jaw.

Risk factors for the occurrence and development of dental anomalies. hereditary predisposition, impaired calcium metabolism in the body (rickets, endocrine changes in the body), impaired neuroreflex processes (uncoordinated activity, hypo- and hypertonicity of the masticatory muscles, asymmetry of the tonic state of the right and left masticatory muscles), bruxism, bad habits (supporting the cheek hand, sucking fingers, cheeks, tongue, etc.), incorrect position of the child during sleep (on one side, placing a hand, a fist under the cheek), diseases of the nasopharynx, oral type of breathing, narrowing of the upper jaw as a result of a violation of the impact of the cartilage of the nasal septum on growth zones of the upper jaw, deviated septum, caries and its complications, early destruction and loss of milk molars; trauma, inflammatory processes in the area of ​​the alveolar ridges and the jaw growth disorders caused by them, atypical location of the rudiments of the teeth and their retention, delay in the change of milk teeth by permanent ones, violation of the sequence of teething,

48. BIOMECHANICS.
The phenomenon of bone tissue remodeling under the influence of a constant or intermittent force applied to the teeth.
Bone tissue is always in a state of renewal. In the process of growth in the bone, the processes of increasing the volume of bone density predominate. At the age of 22-27 years, resorption and bone formation are in a state of equilibrium. From the age of 25, physiological resorption predominates. By the end of life, the volume and density of bone tissue decreases.
Phases of tooth movement:
1. Resting phase.
2. The activation phase.
3. Phase of resorption.
4. Reverse phase.
5. Formation phase.

1. Teeth experience physiological and pathophysiological stress. There is constant movement.
2. Under the influence of the load, biochemical reactions occur: on the surface of odontoblasts (the border of the alveolar bone and periodontium) there are receptors (proteins) for the cellular protein activator, when the activator binds to the receptor, the reaction starts. Gene expression is responsible for the synthesis of iosteoprotegerin activators, which is under load control and is also humorally regulated. All this is controlled by prostaglandins.
3. The release of inflammatory mediators occurs from periodontal vessels. In the absence of periodontal (sclerotic) teeth move more slowly, the longer the duration of endotherapy, the worse, because. there is no remodeler. textile.

Pressure zone, 2 mechanisms:
a) immediate type - narrowing of the periodontal gap - immediate deflection of the periodontal gap - piezoelectric impulse ( electricity multidirectional action) - a catalyst for osteoclasts.
b) biochemical - when squeezing the periodontal gap - narrowing of the lumen of blood vessels - the release of inflammatory mediators that catalyze osteoclastogenesis.
Tension zone:
a) periodontal fibers are stretched, osteoblastic reaction predominates, thus. the tooth moves in the direction of resorption, and osteogenesis occurs on the opposite side (the newly formed bone is less dense).
Because resorption and osteogenesis are separated in time, the teeth become more mobile than before treatment.
1. The phase of primary movement (due to the elastic properties of the periodontium) the first 3 days.
2. The delay phase, up to 30-60-90 days, there is no clinical. pronounced movement, preparation of the bone for remodeling, the younger the patient, the shorter this phase.
3. Phase of active movement - the number of osteoclasts increases, resorption has begun.

All objects have a center of mass - this is the point through which the applied force must pass for linear (without rotations) movement of a free object, i.e. the center of mass is the "balance point" of an object. The localization of the center of resistance of the tooth depends on the length and morphology of its root, the number of roots and the amount of supporting bone tissue. The center of resistance of a single-rooted tooth with a normal level of alveolar bone is 1/4-1/3 of the distance from the cement-enamel border to the root apex. the center of resistance for maxillary movement is located slightly below the infraorbital foramen, and for the intrusion of the upper anterior teeth, the center of resistance will be located distally relative to the roots of the lateral incisors. In orthodontics, the main defining moment is force, since it is thanks to it that the movement of teeth occurs. Force is defined as the action applied to a body and is equal to mass times acceleration due to gravity (F = ta). The units of force are newtons (N) or g (mm/s). The strength of ego is a vector, and it is determined by vector characteristics, the vector has a magnitude and a direction. The direction of the vector describes its line of action, orientation and point of origin (application). Vectors can be combined with each other. Since a vector has magnitude and direction, it is impossible to characterize a complex vector by simple arithmetic addition of its constituent vectors. The summation of vectors can be done by joining the beginning of the first vector and the end of the last attached vector. The sum of two or more vectors is called resulting and the resulting vector - resulting. Quantifying the resulting vector requires trigonometric calculations. Orthodontic forces are most often applied at the crown of the tooth, so the forces usually do not pass through the tooth's center of resistance. Forces that do not pass through the center of resistance of the tooth, in addition to linear displacement, cause rotation of the tooth under the action of moment of force. Moment of force is the tendency to create rotational movement. It is determined by multiplying the magnitude of the force by the magnitude of the perpendicular dropped from the line of action of the force to the center of resistance. The direction of the moment is found by rotating the line of action of the force around the center of resistance towards the point of application. Moment is measured in grams per millimeter (newtons per millimeter). The magnitude of the moment of force is determined by two variables - the magnitude of the force and the distance. Both of these variables can be effectively changed clinically to obtain the desired ratio of forces.

Couple moment. A pair is two parallel forces of the same magnitude, acting in opposite directions at a certain distance (i.e. with different lines of action). The value of a pair is found by multiplying the magnitude of the forces by the distance between them and is measured in grams per millimeter. The direction of rotation is determined by the rotation of the line of action of one force around the center of resistance towards the point of application of another force. The vapors induce a net rotational moment around the center of resistance, regardless of where they are applied to the object. Pairs in orthodontics are often referred to as applied torque. Torque is a frequent synonym for moment (moment of forces and couple moment) in orthodontics. Bending the archwire or tilting the bracket slot are methods of obtaining torque, i.e. their value describes the shape of the archwire or bracket. The correct unit for torque is gram times millimeter (force times distance).

Cross bite is a transversal, or transverse, dental anomaly, in which there is a discrepancy and suppression of the dentition and / or jaws in the horizontal plane. Crossbite has several types. It is buccal, lingual and combined.

The buccal type (bucca means "cheek") is characterized by a narrowing of the upper dentition and / or jaw and an expansion of the lower dentition and / or jaw. In the lingual variety, the upper dentition and / or jaw, on the contrary, are too wide, and the lower ones are narrow. The last, combined, type is characterized by all of the above pathologies. Moreover, each type of anomaly can be both with and without displacement, as well as one- and two-sided. Correct closure between the front and back teeth with a crossbite, of course, does not occur.

Reasons for development

Cross bite can be both congenital and acquired. The first variety includes anomalies received “by inheritance” from parents or from grandparents, or formed at one of the stages of pregnancy.

Acquired curvatures occur as a result of various injuries or malunion bones after a fracture; due to mouth breathing and infantile swallowing; from biting the lip and propping up the cheek and chin with the fist; due to wrong position child during sleep, as well as due to rickets and scoliosis.

Interesting fact!

According to well-known Russian dentists, crossbite occurs one and a half times more often in people with poor posture than in patients with a straight back.


An important role in the development of cross pathology is played by untimely loss of teeth and their abnormal eruption. Poor oral hygiene in children leads to multiple inflammatory processes and, as a consequence, to early fallout milk teeth and damage to the rudiments of the molars. As a result, the dentition is formed incorrectly, the growth of the jaws is disturbed, which leads to improper closure. Prolonged absence of teeth in adults also causes the development of transversal anomalies.

In order to avoid all of the above problems, you should carefully monitor the health of your teeth and replace lost ones in a timely manner with prostheses, when it comes to children and adolescents, and implants, when it comes to adults.

Cross bite - treatment in adults and children

Timely prevention helps to avoid the development of anomalies, but what if a crossbite has already formed? The choice of treatment method depends on several factors: the type of curvature, its degree, as well as the age of the patient. Thus, crossbite is best corrected in children.


How to correct crossbite in children?

If a child is diagnosed with a crossbite, the first step is to get rid of the cause of its occurrence, that is, wean the baby from bad habits, buy him the right pacifier and bottle, and make sure that he does not sleep in the same position. An older child should be given solid food more often and made to chew longer on the deformed side. In case of early unilateral curvature, grinding of some teeth can also help, but only at the initial stage of the anomaly.

Crossbite due to improper development jaws, can be eliminated with a pressure bandage and various palatal expanders. However, these designs should be used with extreme caution. Too much strong pressure on the jaw can lead to noticeable deformities of the chin and face. If the crossbite has developed due to untimely loss of teeth, then the first step is to restore them and only then proceed to next step treatment.

Interesting fact!

Palatal retractors can also be used in adulthood, but only until the palatal suture is “ossified”, that is, up to 18-22 years. For older people, the seam is opened by surgery.


In case of serious anomalies, along with the equipment described above, functional equipment is also used, for example, an Andresen-Hoypl activator with a one- or two-sided pelotom - a small plate that is located under the tongue; Frenkel function regulator, as well as Katz crowns. Plates and trainers allow normalizing the position and size of the dentition during the period of milk and mixed dentition, and after 12 years - braces and aligners. To eliminate anomalies in permanent occlusion, several other techniques are used.

Correction of crossbite in adults

Correct crossbite in adults helps combined orthodontic treatment, which often includes orthognathic surgery, which not all dentistry in Moscow can offer. However, surgery is not required in all cases. For example, an anomaly formed at the level of the dentition can be eliminated with braces or aligners.

IN extreme cases, for example, when a patient has severe crowding, and there is not enough space in the jaw, doctors resort to the extraction of teeth - mostly fours or eights.

People with a twisted jawbone are referred for an osteotomy, a surgery to correct bone deformities. It is carried out under general anesthesia, after which the patient stays in the hospital for some time. It must be understood that the surgical stage does not cancel the wearing of orthodontic structures. That is, in order to correct a crossbite, the patient will have to wear braces or caps both before and after the operation.

Why correct a crossbite?

Even initial stage anomalies sooner or later develop into severe and lead to sad and even dangerous consequences. All owners of crossbite, regardless of the type of anomaly, have a pronounced asymmetry of the face. For people with a buccal variety of crossbite, in addition to all the above deformities, an increase in the lower jaw is also characteristic, and for patients with a lingual one, a flattening of the chin. As for the combined anomaly, it includes all of the above symptoms at once. In addition, owners of a crossbite can be recognized by a retracted upper or lower lip and speech defects.

However this pathology threatens not only with problems with aesthetics - the functions of chewing and digestion are disturbed, as well as muscle hypertonicity, headaches and dysfunction of the temporomandibular joint. In addition, bite sooner or later becomes traumatic and damages soft tissues oral cavity. Bacteria enter the formed wounds, due to which they develop severe inflammation and periodontal disease. Therefore, leaving everything as it is is not the best idea.

Dental pathology is a very common phenomenon. Often they lead to the development of incorrect occlusion. About 30% of patients have malocclusion, in 3% of them it is cross.

In people with such a defect, a feeling of inferiority is often revealed, which prevents adaptation in society. Modern methods of effective correction of occlusion, allow you to return correct symmetry and aesthetics appearance any age.

What does it represent?

Cross type occlusion is one of abnormal developments dental system. It is characterized by a change in the shape and size of one or two jaws, leading to a displaced crossing (crossing) of interlocking dentition.

This form of bite is the rarest of all pathological forms and requiring a long complex treatment. Correction deals with a special section of dentistry - orthodontics.

Forms

In dentistry, there are several forms of crossbite that have different clinical characteristics and treatments.

Basic forms:

  • buccal. It is characterized by narrowing of the fixed jaw and expansion of the movable jaw both on one side and on both sides. This form of occlusion can be with or without jaw displacement. In the process of chewing, the buccal surface of the teeth of the two jaws is blocked;
  • lingual. It differs by an increase in the mobile upper jaw and a slight decrease in the lower. May cover two or one side. The connection of the jaws occurs with the obstruction of the upper crowns of the lower buccal tubercles by the palatal surface;
  • mixed. It includes a combination of the above types of bite of the intersecting type.

Symptoms

For any form of cross occlusion, there are specific symptoms and clinical signs. It is on them that the dentist determines the method of treatment. But apart from special features, there are also general ones by which you can determine the intersecting bite yourself.

General symptoms:

  • facial asymmetry;
  • the upper jaw is shifted slightly forward or backward;
  • the chin has some offset to the side;
  • dentitions are disproportionate to each other;
  • violation of the contact of opposite crowns when closing;
  • discrepancy between the upper and lower frenulum;
  • change in phonetic speech articulation.

Causes

There are many reasons why a crossbite occurs. Conventionally, they are divided into two groups: congenital and acquired.

Congenital causes:

  • defective laying of the rudiments of the dentition;
  • genetic predisposition;
  • abnormal development of the temporomandibular system;
  • palatine cleft;
  • macroglossia.

Acquired Causes:

  • birth injury;
  • metabolic disorders that lead to uneven teething and premature tooth loss;
  • extensive caries lesions;
  • some habits - holding a finger in the mouth, resting the cheek on the fist, etc .;
  • incorrect posture during sleep;
  • diseases of the musculoskeletal system (rickets, poliomyelitis, osteomyelitis, arthritis);
  • pathology of the upper respiratory tract(sinusitis, sinusitis);
  • hemiatrophy.

Possible Complications

Often, patients do not see anything wrong with the fact that they have intersecting occlusion. The maximum that can bother is the appearance with such a pathology. Unfortunately, this attitude is not justified, since a defect that is not corrected in a timely manner often causes a number of serious consequences.

The most common complications:

  • diseases of the stomach and digestive tract;
  • impaired respiratory function;
  • incorrect diction, related incl. with displacement of the lower jaw;
  • dental pathologies (periodontitis, caries);
  • mucosal injury;
  • complicating the procedure of prosthetics and implantation;
  • metabolic disorder that leads to diabetes, hypertension and autoimmune diseases;
  • active abrasion of tooth enamel;
  • antispasmodic articular and headache, which causes uneven and excessive load on the temporomandibular joint;
  • deformity and displacement of the cervical vertebrae;
  • constriction of the respiratory and circulatory tracts.

Diagnostics

Diagnosis of crossbite begins with an instrumental examination and study clinical picture. At the first appointment, the dentist performs auscultation of the TMJ and palpation, which determines the functionality of the dental system. For a detailed medical history, an orthopantomogram, radiography and a teleroentgenogram are performed.

After that, the orthodontist specifies the type of pathology and determines the method of correction. In conclusion, he carefully studies the formed diagnostic model of the jaw. For the correct diagnosis, it is often necessary to resort to the consultation of other specialists (therapist, pediatrician, neurologist, etc.).

Therapy for children and adults

Photo: crossbite before and after treatment

The goal of the treatment of this pathology is to restore the uniform ratio of the dentition of both jaws.. Crossbite correction is performed different methods and designs. Indications depend on the age of the patient, the type of pathology and the degree of its neglect.

Basic condition successful therapy is to eliminate the causes of the disease. To restore the normal occlusion of temporary and replacement teeth, the most acceptable methods are:

  • myogymnastics;
  • grinding of the cutting part of the tooth, to align the closure line;
  • removable prosthetics;
  • instrumental therapy (Frenkel regulator, Janson bionator, etc.);
  • systems of extraoral influence;
  • dental arches;
  • expansion plates;
  • trainers.

To change the shape of the bite of permanent teeth, common methods are:

Of the entire extensive list of these methods, the most effective are: trainers, mouthguards, braces and surgery.

Correction by trainers

Trainers differ from other methods in that correction of occlusion occurs by eliminating pressure on the teeth and tension of the jaw muscles. During the initial appointment, the dentist conducts a design simulation using a computer. This allows you to make them in strict accordance with the characteristics of the dentition.

The manufacturing material is silicone. Trainers are used mainly at night. During the day, they are given 1-3 hours to wear. Restoration of occlusion by this method is phased. Each device has its own degree of rigidity, which is indicated by its own color.

Treatment starts with the softest trainer blue color. Its high elasticity helps to easily pass the adaptation period. The bite correction ends with the most rigid design in red. Wearing each type of trainers lasts about 7 months.

Bite correction by this method is effective in 90% of cases, while its cost is much lower than that of braces.

Restoration of occlusion with kappa-aligners

Mouthguards-aligners are a transparent plastic structure that completely repeats the contour of the dentition. happens due to constant pressure to the problematic sector. The degree of pressure is negligible, so the device does not cause pain.

During the initial visit, the dentist makes impressions of the teeth and conducts a virtual 3D modeling of the dentition, according to which a set of aligners will be made.

For the entire course, depending on the complexity of the situation, 10 to 50 kappas are required. The design must be worn for at least 20 hours a day. Every 14 days the aligner is successively replaced with a new one.

Treatment with kappa is very different in duration. In some cases, it takes only 3 months, and sometimes more than 1 year. During the correction procedure, it is necessary to visit the dentist every 2 months. Aligners have many advantages:

  • the adaptation period takes no more than 3 hours;
  • exclude mucosal trauma;
  • visually almost invisible;
  • do not complicate hygienic and dental procedures.

This technique can be used even in children of five years of age. But still, it has a significant drawback - the impossibility of using it with a partial or complete absence of a tooth.

Correction with braces

Braces are non-removable devices designed to alignment of occlusion with mechanical impact on the dentition. After the dentist conducts an examination and excludes the impossibility of using this method, a consultation is held on the choice of material for the manufacture of the structure.

Basically, braces are installed:

  • ceramic;
  • metal;
  • sapphire;
  • plastic.

The system is installed by a dentist. First, he attaches the braces themselves to the teeth with a special adhesive. Further, a metal arc with a memory effect is applied to the fixing element of each bracket. It is she who gives the effect of straightening. Finally, the doctor adjusts the device.

Getting used to such a design can have a long period and even extend to the entire time of wearing. Treatment with this method takes from 1 year to several years.

After achieving the desired effect, the braces are removed by squeezing them with special forceps. In order for the surface of the crowns to take on a natural look, the teeth are ground and polished.

Correction of bite using this technique is very effective and does not require high costs. But it is worth noting that braces have a number of contraindications:

  • caries;
  • periodontitis;
  • gingivitis;
  • diseases of the skeletal system;
  • psychical deviations;
  • oncology;
  • diseases of the circulatory system;
  • endocrine pathologies.

IN next video we will be clearly shown how the crossbite is corrected with the help of orthodontic plates:

Surgical method

In extreme cases, when they do not help therapeutic methods using surgical intervention. It consists in opening the palatine suture, and rapid or slow expansion of the jaw using the recommended hardware methods.

Most often, screw expanders are used for opening, which are activated daily. After activation, there may be small pain that pass within an hour.

The final result can be achieved in 2-3 months. To fix the results, retainers are used.

Modern orthodontists consider crossbite to be one of the most difficult types of its violation. In this case, the patient's teeth are displaced relative to each other in the transverse direction. In other words, with a crossbite, the lower jaw is shifted to the side relative to the upper.

This type of malocclusion not only contributes to the formation of various kinds, but can seriously affect the patient's health. Therefore, it must be taken seriously, making a diagnosis in a timely manner and doing everything possible to this violation to correct.

Anomaly in the form of a crossbite is rare, as it occurs only in 2-3% of cases. Crossbite is also called by the terms: "endo-occlusion", "lateroposition".

In a normal bite, the teeth of the upper row should overlap the lower row of teeth by 30%. Only under this condition is the normal function of the jaw apparatus preserved. With a crossbite, this condition is not met, which leads to physiological disorders in the functions of food processing (chewing, swallowing) and speech. Cross bite has the following varieties:

  • Buccal view, in which there is a violation of the closing of the lateral teeth, leading to disorders in the function of chewing food. This type is accompanied by various displacements or narrowing of the jaw of the dentition.
  • Lingual view, when the lateral teeth are closed to each other by various tubercles, and sometimes there is no closure of the teeth at all. This displacement can be one or two-sided, with a decrease or expansion of the teeth of the upper or lower row.
  • Combined (combined) type, accompanied by a combination of disorders in the development of the jaw with its narrowing or expansion. With this form, biting of the oral mucosa, speech disorders, facial asymmetry are frequent.

Causes of crossbite in children

There can be many reasons for a cross bite. This can lead to various hereditary disorders, injuries, diseases or bad habits that a person may have had at some stage in his life.

Most common causes are:

  • hereditary predisposition;
  • violation of the laying of teeth in the embryonic period;
  • congenital discrepancy between the size of the teeth and jaws;
  • early loss or destruction of milk teeth;
  • disturbed nasal breathing;
  • inconsistency in the work of masticatory muscles (for example, with cerebral palsy, with nervous tics);
  • caries or extraction of teeth in childhood;
  • late or inconsistent eruption of milk teeth, cleft teeth;
  • Availability congenital pathologies(cleft palate);
  • inflammatory diseases of the jaw;
  • violations of mineral metabolism;
  • consequences of facial injuries;
  • posture problems, scoliosis.

Often the cause of the appearance of a crossbite is bad habits that took place in childhood (the habit of biting nails, sucking fingers, grimacing, biting the cheeks, putting the palms under one cheek, etc.).

Complications

If you treat such a violation lightly and do not start treatment on time, then a crossbite can lead to many serious complications in terms of health and appearance. In this case, an imbalance in the growth of the jaws occurs, when the facial bones are deformed, leading to a violation of the main functions of the jaw apparatus. Complications of a crossbite include:

  • in children, due to a violation of the closure of the jaws, the habit of breathing through the mouth is formed, which leads to respiratory diseases;
  • the risk of early tooth loss due to accelerated enamel wear, periodontal damage and excessive stress on the teeth, manifested in the appearance of dental pathologies (caries, periodontal disease);
  • asymmetry or violation of the shape of the face;
  • the occurrence of incorrect pronunciations of sounds in children;
  • disturbances in chewing food, frequent biting of the cheeks;
  • in adolescents and adults, frequent pressure surges, constant headaches are possible.

Do not neglect the treatment of this pathology. An untreated crossbite not only violates the aesthetics of a person's appearance, but can also seriously harm his health.

Often, such a pathology contributes to the appearance of an inferiority complex due to an unpleasant appearance and speech disorders, which requires treatment by a psychotherapist.

Diagnostics

To correctly diagnose a crossbite, doctors take into account many factors.

Usually, a specialist examines the patient, listens to his complaints, paying attention to typical manifestations (disorders of diction, discomfort when chewing food, facial asymmetry, etc.). The degree of jaw mobility, the nature of their displacement, the ratio of teeth during chewing are also determined. Often, patients are prescribed x-rays of the face with temporal and mandibular joints.

Correction of crossbite in children and adults

Treatment of a crossbite is considered to be a rather lengthy and time-consuming process. It is produced various methods, depending on the degree of pathology and age of the patient. Often, it is necessary to involve neurologists, speech therapists, otolaryngologists in the treatment of such a bite pathology.

It is important to put correct diagnosis and begin treatment of crossbite before the age of 15 years of the patient.

However, treat similar pathology possible and necessary.

As long as the child's deformity concerns only milk teeth, the treatment of malocclusion is most effective.

At the same time, they try to eliminate the bad habits of the baby, which led to such a deformation. Remediation if necessary oral cavity child, polish the deformed surface of milk teeth. At the first signs of the appearance of deformation, children's orthodontists use methods of separation of the dentition.

With a significant deformation of the bite, special dental plates with screws are used, which contribute to the expansion of the dentition. In difficult cases, during intensive growth bones, adolescents sometimes use various functional devices with springs and screws on caps (Frenkel's activator, Katz's crowns, Angle's arch, etc.), which correct improper closing of the jaws.

Currently, the treatment of this occlusion pathology has ceased to be unpleasant and painful due to the introduction of braces. With the help of braces, crossbite is eliminated in adults and adolescents. They can be installed by inner surface jaws, and then the plates will not be visible. With the help of braces, you can set your teeth in a central position, correct the tone of the masticatory muscles, expand or narrow sections of the dental arches. They try to correct a crossbite as early as possible before it leads to the development of facial asymmetry.

In adults, the treatment of crossbite is more difficult and less effective.

In addition to the use of fixed systems in the form of braces, sometimes it is necessary to remove part of the deformed teeth. If it is impossible to correct the crossbite conservatively, with a pronounced asymmetry of the face, adults may be recommended surgical treatment with various methods corrections.

Often, after the end of treatment, patients are advised to continue wearing a retention device, which helps to consolidate the result of the treatment. After removing the braces, patients often wear removable plates that are worn at night.

Prevention

It takes a long time to treat a crossbite and is not always 100% successful. Therefore, it is much more efficient and easier to monitor the child and prevent the appearance of this pathology.

In this case, the following preventive measures will be effective:

  • control of the child's posture, especially from the age of 7, during rapid growth bones;
  • teaching the child proper brushing of teeth, limiting sweets;
  • preventing the child from developing bad habits (lying on one side, sucking fingers, grimacing, etc.);
  • timely treatment of ENT diseases;
  • prevention of rickets, as an ailment that contributes to bone deformation;
  • timely visit to the dentist.

Parents need to take seriously the destruction of milk teeth in children, treat them in a timely manner, preventing early loss.

In some cases, prosthetics of prematurely lost milk teeth are carried out in order to prevent the appearance of a pathological bite.

Each child must be shown to the orthodontist and make sure that the formation of the jaw apparatus is going on correctly. Cross bite is difficult to treat, requiring a lot of patience, diligence and diligence for both the patient and the doctor. And simple preventive measures will prevent the development of malocclusion in a child, getting rid of the long and painful treatment of this pathology.

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Cross bite is one of the most difficult orthodontic pathologies. Of the total number of patients with malocclusion, only 2% have an overbite.

The anomaly requires complex multi-stage treatment. A in some cases, the situation can only be corrected with the help of surgery.

How is it manifested?

This pathology can almost always be determined by the appearance of a person. In addition, it has a number of distinctive intraoral features.

Symptoms

TO main symptoms anomalies include:

  • pronounced narrowing of the jaw arch;
  • violation of the contact of antagonist teeth;
  • displacement of the lower jaw along the horizontal plane;
  • overlapping of the buccal tubercles of the upper row, lower ones;
  • a noticeable violation of speech, with the pronunciation of hissing and whistling sounds;
  • mucosal injury;
  • dysfunction of the temporomandibular joint, which is characterized by pain when talking and eating.

Facial signs

In addition to intraoral changes, pathology also leads to changing the proportions of the face:

  • the face has a pronounced asymmetry;
  • central line upper lip does not coincide with the middle of the bottom;
  • the chin has a strong deviation;
  • the corner of the upper lip from the side of the anomaly may sink. The opposite corner of the lips has a visible seal.

Classification

Crossbite was divided into types that differ in clinical manifestation.

buccal

With this type of pathology, a change in occlusion occurs with overlapping of the buccal tubercles in the lateral sections of the dentition. In this case, both unilateral overlap and bilateral overlap can be observed.

The cause of the pathological disorder in this case, is an increase in the mobile jaw, and in rare cases, underdevelopment of the upper.

Lingual

With the lingual type of crossbite, there is a partial closing of the antagonist teeth or a complete absence of their contact. With partial closure, contact occurs between different tubercles.

The cause of the defect is the lengthening or shortening of one of the jaws.

Buccal-lingual

Pathology combines everything, either partial signs buccal and lingual. The combined bite is one of the most difficult types that can be eliminated only using combined techniques.

Depending on the localization of the main changes, this species is divided into 3 forms:

  • articular;
  • gnathic;
  • dentoalveolar.

What is meant by true and false?

In addition to the listed types and forms, in orthodontics there is such a definition as true and false crossbite. By true, we mean pathological changes in occlusion caused by physiological disorders.

Under the definition of a false bite, there are anomalies caused by the purposeful extension of the jaw forward or to the side, which the patient most often does unconsciously.

Causes

To provoke the appearance of this pathology can the most different reasons , among which the most common are:

  • a number of dental diseases, causing violation development of the jaw apparatus;
  • genetic factor
  • hypotension of the muscles of the face and jaw;
  • violation metabolic processes. Phosphorus and calcium deficiency plays a special role here;
  • inconsistency in the timing of the change of milk teeth to permanent ones;
  • formed mouth breathing;
  • early loss of milk teeth;
  • face and jaw injuries;
  • sleep disturbance.

Possible Complications

Crossbite is a serious anomaly that can lead to a number of complications.:

  • Impaired respiratory function, as a result of which nasal breathing is replaced by oral breathing.
  • Dental problems: loosening and loss of teeth, rapid abrasion of enamel, caries, inflammation of the periodontium.
  • Violation of the jaw joint, which can lead to its temporary blockage, the appearance of constant headaches, increased pressure.
  • Diseases of the gastrointestinal tract, which provokes the lack of quality chewing of food.

Diagnostic methods

Photos before and after the treatment of crossbite

For the diagnosis of this pathology, a complex is immediately used research methods, which allow you to determine the degree of development of the anomaly.

Among all methods, mandatory and additional, which are clarifying, are distinguished.

Mandatory

TO mandatory methods studies include:

  • visual inspection and questioning the patient.
  • Definition central occlusion using bite pads.
  • Functional trials, allowing you to accurately determine the degree of jaw extension.

Additional

As additional methods use the following:

  • Orthopantomogram. It is prescribed only for children from 5 years.
  • Teleroentgenogram. Allows you to see the ratio of the size of the jaws in relation to each other and other elements of the skull.
  • x-ray. Diagnosis may require x-ray examination of the patient's TMJ and hand. X-ray of the hand helps to assess general state bones.

Treatment

Depending on the age category patients, different techniques can be used to correct malocclusion.

For children, most often use methods that are gentle on the jaw apparatus. In adults, the jaw bones are fully formed and difficult to correct, so more severe techniques are used for treatment.

In children

During a mixed or milk dentition, the following have shown the greatest effect: correction methods:

  • Trainers. They allow not only to completely restore the correct occlusion, but also to eliminate myofunctional disorders.

    Trainers are two-jaw molded mouthguards designed to be worn only during sleep.

    To increase efficiency, the device is worn for about 2 hours during the day. The main corrective action is performed by special dental canals and labial arches.

    The maximum effect when wearing trainers can be achieved in the treatment of bite at the age of 5 to 10 years.

  • Myogymnastics. It is aimed at solving the problem of improper occlusion in children under 6 years of age. The therapy includes a number of special exercises that train the muscles of the jaw apparatus, due to the tone of which, the bite is shifted.
  • Grinding part of a tooth that interferes with normal jaw movement. Most often, this method is used when it is impossible to fully perform lateral movements.

    In order for the patient not to feel discomfort in the future, the grinding site is treated with a remineralizing composition and, if necessary, covered with a composite.

  • Prosthetics. They are used only if the cause of the anomaly is the absence of a single or group of teeth. The method will be effective only with unexpressed bite changes.
  • Treatment with orthodontic appliances. For this, a wide variety of devices are used: the Janson bionator, the Frenkel regulator, the Klammt activator and others.

All devices have a similar design. They consist of corrective metal arc, plastic inserts and various adjusting devices (screws, springs, etc.).

Metal arcs are bent in such a way as to exert the maximum allowable pressure on the child's dentition.

The plastic parts act as a basis or inclined planes. Such systems require constant correction, which is carried out by tightening or disengaging the control elements.

This method allows you to correct occlusion in children under 12 years of age.

In adults

Correction of crossbite in adulthood is carried out using devices of a fixed type, or surgical intervention.

A good effect was shown following methods :

  • Individual non-removable apparatus of mechanical action. It is used for both expanding and narrowing the dental arches.

    Represents a curved arc that spans problem area dentition from the vestibular side. The arc is attached to the crown-caps mounted on the abutment teeth.

    This device allows you to restore the bite in a few years, but cannot restore the symmetry of the face.

  • Angle apparatus. It is used only for the expansion of the jaw. The device is a curved arch that applies pressure from the lingual side.

    To obtain the effect, in this case, regular adjustment of the structure is required. The device allows you to correct the pathology of the occlusion of the II degree, while the visible result can be seen after 4 months of wearing.

  • Katz crowns. Used to correct occlusion in the anterior jaw. The device is a loop fixed on a metal crown.

    The length of the loop will depend on the number of wrong standing teeth. The principle of operation is as follows: the loop is placed on the lingual side at a certain angle to the corrected units.

    This provides a constant pressure under which displacement occurs. Katz crowns showed good results in the correction of a group of up to 6 teeth.

  • braces- is one of the most effective ways crossbite correction. The system is a complex consisting of brackets and an arc, which is fixed in them.

    Correction occurs due to the constant pressure of the arch on the dentition. Now, for the treatment of occlusion, you can choose a variety of models, among which there are those that can correct the most difficult type of occlusion.

  • Compactosteotomy. Appointed to expand the dental arch. The operation implies a direct impact on bone tissue jaw, by perforating it to obtain separation.

    During the procedure, the dentist forms a thin groove on the jaw connecting the holes, then sutures the mucous membrane. Correction occurs due to the replenishment of the disconnected bone and the expansion of the walls of the groove.

    This type of treatment is used only for complex pathologies that are not amenable to hardware treatment.

What activities can be prescribed to correct a crossbite, see the video:

Forecast and prevention

According to patients, with the right treatment, it is possible to correct the bite in 1-3 years.

Correction of occlusion in childhood can take from 6 months to 1.5 years. Treatment of adults has a longer period and ranges from 1.5 to 3 years.

In both cases, after the correction, a long retention period will be required to consolidate the result.

To avoid the formation of a crossbite, it is necessary to pay attention to the development of the jaw apparatus from the moment the first teeth of the child appear:

  • Eliminate bad habit constantly suck on a finger or a pacifier.
  • Take your child to the dentist regularly.
  • Stop general diseases in a timely manner.
  • Monitor the quality of oral hygiene.
  • Form the correct posture.

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