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1/12/2014 1. 2 3 4 5 6 7 LECTURE 8 INGRID REED DDS, MS DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS Anterior and Posterior Crossbites 1/12/2014.

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Presentation on theme: "1/12/2014 1. 2 3 4 5 6 7 LECTURE 8 INGRID REED DDS, MS DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS Anterior and Posterior Crossbites 1/12/2014."— Presentation transcript:

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8 LECTURE 8 INGRID REED DDS, MS DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPEDICS Anterior and Posterior Crossbites 1/12/2014 8

9 Anterior Crossbite Dental – on or two teeth Abnormal axial inclination Retained primary tooth Crowding Usually Class I Skeletal - Class III ANB <0° Look at molar relationship Take ceph Pseudo Class III – shift due to interferences when end to end occlusion Check bite in CR vs. CO for interference 1/12/2014 9

10 Anterior Cross bite - Dental 1/12/

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12 Anterior Crossbite - dental 1/12/

13 Anterior Crossbite - Dental 1/12/

14 Anterior Crossbite - Skeletal 1/12/

15 Anterior Crossbite - Skeletal 1/12/

16 Treatment – Dental anterior crossbite Tongue blade Removable appliance with finger spring Fixed appliances Possible extraction of adjacent deciduous teeth 1/12/

17 Tongue blade 1/12/

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19 Hawley with finger spring 1/12/

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21 Hawley with finger spring Assess space available Alginate impression Pour in yellow stone Fabricate Hawley with clasps and finger spring Bend finger spring so it unwinds in the direction it was wound Build up molars to clear occlusion Deliver appliance Activate spring every few weeks Self retaining 1/12/

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23 Dental Anterior Crossbite 1/12/

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28 Anterior crossbite of lateral incisors Maxillary laterals usually erupt to the lingual if inadequate space 1/12/

29 Retention of Anterior Crossbites Good overbite relationship Should be self retaining Tipping tooth forward – vertical change in overbite 1/12/

30 Cleft Palate 1/12/

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33 Cleft palate treatment sequence TIMEPROCEDURE 2-4 weeksLip closure monthsPalate closure 7-8 yearsAlignment of maxillary incisors, expansion of maxilla, as preparation for alveolar graft 7-9 yearsAlveolar bone graft (before eruption of lateral incisor, if present, or canine) AdolescenceComprehensive orthodontics Lip /nose revision Late adolescenceOrthognathic surgery? 1/12/

34 Cleft palate – orthodontic problems Problems from repair –not cleft itself Lip repair – constriction across anterior of maxilla – anterior crossbite Palate repair – constriction laterally – posterior crossbite Problems from cleft Maxillary incisors erupt rotated and in crossbite Lateral incisor and/or canine in area of cleft missing or impacted Cleft area doesnt have bone for eruption – alveolar graft needed 1/12/

35 Early permanent dentition treatment Correct maxillary incisors Rotations Crossbite Position Expand maxilla Alveolar bone graft 1/12/

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37 Unrepaired cleft - TG /12/

38 TG /12/

39 TG /12/

40 TG /12/

41 TG /12/

42 TG /12/

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44 TG /12/

45 Early Permanent Dentition Treatment Canine & premolar on cleft side – malaligned Close spaces if missing teeth Position teeth as need for prosthetics Dental implants are not appropriate for cleft areas 1/12/

46 Orthognathic surgery - cleft palate patients Males > females Growth – return of anterior and/or lateral crossbites Usually deficient maxillary growth Normal mandibular growth 1/12/

47 SKELETAL DENTAL Posterior Crossbites 1/12/

48 Posterior Crossbite Posterior crossbite – position of maxillary molars Bilateral maxillary lingual crossbite Unilateral maxillary lingual crossbite Asymmetric maxillary arch Unilateral mandibular buccal crossbite Normal maxilla Asymmetric mandible Maxillary buccal crossbite 1/12/

49 Why does this crossbite exist? Bilateral maxillary palatal crossbite Maxilla narrow - skeletal basis Dental arch narrowed – skeletal width correct 1/12/

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53 Rapid Palatal Expander 1/12/

54 Posterior Crossbites 1/12/

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56 Dental Posterior Crossbite 1/12/

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58 Oral habits – disruptive to occlusion Thumb sucking Finger sucking Tongue thrust Nail biting Lip biting Lip sucking 1/12/

59 Thumb (finger) sucking - phases Phase I Birth to 3 years Normal, especially associated with weaning. Usually self eliminated. Phase II 3 to 6 or 7 years 3-4 years: mild displacement of primary teeth; normal lip & cheek pressure will restore teeth to usual position if sucking stops After eruption of permanent incisors: if sucking persists, stop habit and start orthodontic treatment to correct tooth displacement. Constricted maxilla: least likely to correct spontaneously Phase III Thumb sucking may be a sign of psychological problems Talk to child Appliance to help child 1/12/

60 Thumb (finger sucking) 1/12/

61 Effects of thumb sucking Tongue lowered to accommodate thumb Cheek pressure Greatest at corners of mouth More constriction at canines V- shaped palate Lingual movement of maxillary molars Mandibular molars unchanged Anterior teeth and premaxilla can be moved 1/12/

62 1/12/ Cheek Tongue

63 Malocclusion due to sucking habit Lower incisors Lingual displacement Upper incisors Labial displacement Maxillary arch Narrow Interarch relation Anterior open bite 1/12/

64 Treatment 1/12/ Crib

65 Treatment – palatal expander 1/12/

66 Reference 1/12/ Contemporary Orthodontics, 4th Edition William R. Proffit Henry W. Fields Jr. David M. Sarver Pages: 68, , , , , , , , 622


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