Crossbite in adults treated with crowns. Why is crossbite dangerous and how to fix it. How to eliminate such a defect in an adult

The problem of malocclusion has always been a problem for many people. big problems and discomfort. This pathology prevents normal daily activities and chewing. In addition, it spoils the appearance of the smile and interferes with normal conversation. Bite pathologies can vary, but crossbite is considered especially problematic. With this disorder, there is a horizontal displacement of the upper and lower jaw bones in relation to each other. If you do nothing and do not apply effective means treatment, then in the future this pathology can lead to serious disorders.

Attention! Overbite or cross-type occlusion is one of the abnormal developments of the dental system. With this pathological malocclusion, a change in the shape and size of one of the two jaws is observed, which as a result causes a displaced crossing of the closing units of the dentition.

What forms are there?

Crossbite is a pathology of the closure of the dentition, characterized by a discrepancy in the size and shape of the teeth in the transverse direction, manifested in facial asymmetry, speech defects, biting the mucous membrane of the cheeks, and impaired chewing function.

Crossbite usually occurs in different forms. Moreover, each of its forms has certain characteristics that differ.

Buccal

During this disorder, a change in occlusion is observed, in which the buccal cusps overlap in the area of ​​the lateral parts of the teeth. The overlap can be either one-sided or two-sided.
The main factors in the appearance of this form of malocclusion may be an increase in the movable part of the jaw, and sometimes underdevelopment of the upper jaw may be observed.

Lingual

During the lingual type of crossbite pathology, a low degree of closure of antagonist teeth occurs or complete absence contacts. During partial closure, contact is observed between different tubercles.
The main provoking factor of this pathology is the lengthening or shortening of one of the jaws.

Buccal-lingual

This disorder may combine all or partial signs of the buccal and lingual appearance. Combined malocclusion is one of the most complex pathologies that can only be eliminated with the help of combined treatment methods.
Depending on the location of the pathological process, this type of disorder is divided into three types:

• Articular;
• Gnathic;
• Dentoalveolar.

Factors that cause crossbite

The reasons why this pathology may occur may be a large number of. This disorder can appear during a variety of hereditary disorders, traumatic injuries, various diseases and bad habits.

Heredity is genetic predisposition to the formation of a certain type of bite. Genes determine the structure of the tooth, its shape, and genetic factors also influence the risk of caries in certain areas of the teeth.

The main provoking factors may be the following reasons:

1. Hereditary predisposition;
2. If pathologies of tooth formation occurred during embryonic development;
3. The presence of a congenital discrepancy between the sizes of teeth and jaws;
4. Early loss or destruction of primary dentition;
5. Nasal breathing disorder;
6. The presence of inconsistency in the work process of the masticatory muscles;
7. The presence of carious lesions or tooth extraction in childhood;
8. If before this there was a late and inconsistent eruption of the primary units of the dentition, as well as the presence of cleft teeth;
9. Congenital pathological processes (for example, clefts of the soft palate);
10. Diseases of the jaw of an inflammatory nature;
11. Mineral metabolism disorder;
12. Complications of traumatic facial injuries;
13. Having problems with posture, scoliosis.

Quite often, bad habits that appeared in childhood can be factors in the occurrence of crossbite.

Symptoms

How to determine that there is a crossbite? What signs accompany this pathology? Different types This disease is accompanied by various signs and symptoms. Thanks to these symptoms, the doctor determines the presence of this particular form of occlusion and prescribes effective therapeutic therapy. But there are symptoms general view, which will help you identify the presence of this pathology.

Crossbite is a dental anomaly in which the lower jaw shifts to the side. The face becomes disproportionate, which is especially noticeable when smiling; it becomes clear that the teeth overlap.

As common symptoms The following signs may appear:

• The appearance of asymmetrical facial contours;
• The upper jaw moves slightly forward or backward;
• There is a slight shift of the chin to the side;
• There is a disproportion of the dentition in relation to each other;
• Problems with contact of opposite crowns during closure;
• The occurrence of a mismatch between the upper and lower bridles;
• Impaired diction.

What complications can there be?

Often patients do not see anything special about the fact that they have a cross type of occlusion. The only thing that can bother you during this period is external signs in the form of incorrect closure of the upper and lower jaw units. But, unfortunately, if you do not begin to eliminate this pathology in time, then unpleasant consequences and serious complications may ultimately arise. For this reason, many dentists and orthodontists recommend that you consult a doctor as soon as possible and begin taking all necessary measures to eliminate crossbite disorders.
What are the most common complications associated with cross-occlusion:

Features of the examination

Typically, a crossbite examination begins with the use of instrumental method, and also studying clinical picture. At the first appointment, the doctor performs auscultation of the TMJ and palpation. Using these diagnostic methods, the degree of functionality of the dental system is determined. In addition, for a more detailed examination and accurate diagnosis, other examination methods are used:

• Orthopantomogram;
• Radiography;
• Teleradiogram.

A teleroentgenogram is a panoramic image of the skull in lateral and frontal projections; it is obtained using the X-ray method and is used for postamology diagnostics and treatment planning.

After all examination methods have been carried out, the orthodontist, based on the data obtained, identifies the type of pathological process and determines an effective way to eliminate this disorder. At the last stage of diagnosis, the doctor examines the formed artificial jaw model. Sometimes in order to put it right final diagnosis Often you have to resort to the help of other specialists.

Features of therapeutic therapy

The main goal of treatment for this pathology is to completely restore the relationship of the teeth of both jaws. Crossbite correction is carried out using various types of structures and methods. The indications and use of certain treatment methods depend on the age of the patient, the type of pathological process and its degree of neglect.
The main condition for a successful treatment outcome is the complete elimination of all causes of the pathological process. Therefore, in order to completely eliminate all the causes and factors that caused malocclusion, the following effective treatment methods are used:

1. Myogymnastics;
2. The method of grinding the cutting area of ​​the tooth is used. This is necessary to align the closure line;
3. Use of removable prosthetic elements;
4. Application of instrumental therapy;
5. Use of systems with extraoral exposure;
6. Installation of dental arches;
7. Expanding type plates;
8. Installation of the trainer.

To treat crossbite and restore the integrity of the dentition, removable prosthetic elements are used (if one or more teeth are lost). They are fixed to natural teeth using hooks that cover the supporting teeth and can be externally noticeable.

In order to eliminate bite problems in permanent teeth The following methods can additionally be used:

• Engel apparatus;
• Aligners;
• Braces;
• Katz crowns;
• Surgical intervention.

Many orthodontists and patients claim that the most effective and efficient treatment methods are trainers, aligners, braces and surgical methods treatment.

Nuances of correction by trainers

The use of Trainers differs from other devices for malocclusion in that the bite is corrected by eliminating pressure on the teeth and tension in the muscle fibers.
Features of treatment using trainers:

1. At the first appointment, the doctor models the structure using a computer. Through the use of computer programs, everything is done with maximum precision;
2. The products are made from silicone material, which is the most convenient and practical;
3. The main use of trainers is at night. During the daytime, these devices only need to be worn for 1-3 hours;
4. Typically, treatment with trainers is carried out in several stages, and during each stage it is prescribed to wear products with a certain degree of rigidity, which is indicated by color;
5. Treatment begins with the use of the softest retainer, which is blue in color. Due to high degree elasticity ensures easy passage of the adaptation period;
6. At the last stage, retainers with the most severe degree, which is red, are used;
7. Each type of retainer must be worn for 7 months.

Retainers are a special orthodontic design that holds the teeth in the correct place. It is used post-course after a course of teeth correction using braces. They can be removable or non-removable, depending on the individual preferences of the person and the doctor’s recommendations.

Efficiency this method treatment accounts for 90% of cases. The cost of this treatment therapy is much cheaper than other methods of bite correction.

Features of using aligners to eliminate occlusion

Attention! Aligner aligners are a transparent structure made of transparent plastic material. A product of this type completely replicates all tooth shapes. The process of straightening teeth with the help of aligners is carried out due to long-term pressure to the problem area. In this case, the degree of pressure applied is quite low, so the patient experiences virtually no pain.

• Adaptation time is approximately 3 hours;
• When worn, there is no injury to the mucous layer;
• When in use, these products are not visible from the outside;
• Do not cause difficulties when performing hygienic and dental procedures.

Aligners are mouth guards for correcting malocclusion. They are made of inconspicuous transparent polymer, invisible to others, and do not spoil the aesthetic appearance of the smile.

This method of correcting malocclusion pathologies can be used even in children starting from the age of five. However, it has one significant drawback - aligners are not used if there is a partial or complete absence of a tooth.

Features of correction with braces

Important! Braces are a non-removable device that provides complete correction of malocclusions using mechanical influence on the teeth. As soon as the dentist performs necessary examination, identifies the presence of a pathological process, eliminates the reasons for the impossibility of using these products and consults with the patient on the selection of the necessary material for the manufacture of the structure.

1. Made from ceramic base;
2. Metal;
3. Made of sapphire material;
4. Made of plastic.

Installation Features:

• The entire process of installing braces is carried out by a dentist;
• First of all, the brackets are attached to the teeth with glue;
• Then an arch is made from a metal base, which has a memory effect, to the fixing element of each bracket. Due to this element, the basic alignment of the dentition is carried out;
• At the last stage, the device is secured and configured.

The disadvantage of these products is that when wearing these products there is a long period of adaptation, and sometimes it extends to the entire period of use of these structures. Treatment therapy lasts from 1 year to several years.
After the dentition is completely straightened and all defects disappear, the braces are removed. The structure is removed by squeezing it with special forceps. Sometimes small marks from braces remain on the surface of the crowns of the teeth, so after they are removed, the surface of the teeth is ground and polished.
However, wearing braces is not always permitted; there are cases when the use of these products is contraindicated. Contraindications include the following conditions:

1. Carious lesion;
2. Periodontitis;
3. Gingivitis;
4. Diseases of the skeletal system;
5. Various mental disorders;
6. Oncological tumors;
7. Pathologies of the circulatory system;
8. Endocrine system disorders.

Features of surgical treatment

Surgical treatment is used when conventional treatment methods are not effective.

Important! The method of therapeutic therapy consists of opening the palatal suture, after which rapid or slow expansion is performed using recommended hardware methods. In most cases, screw expanders are used, which are activated every day. After activation, slight pain may be observed, which usually disappears completely after an hour.

How is treatment done in children?

Features of the treatment of malocclusion pathologies in children have some differences from medical therapy in adults.
During the period of early mixed dentition, but usually not earlier than 5-6 years, treatment is used using removable plate devices with an expanding screw and a sectoral cut. As a result of using this device, the expansion screw will expand exactly the segment of the dentition that needs expansion.
Also, in addition to the device for correcting crossbite, the doctor can additionally add some components - buccal and labial pads, which ensure the normal condition of the muscle tissue in this place. In addition, these elements cause the process of removing soft tissues from dental units to prevent unwanted pressure that the tissues exert on the teeth.
For children, another type of device can be used to correct occlusion pathologies - the Frenkel function regulator. Through the use of this device, normalization of the myodynamic balance of the maxillofacial area is ensured.
Often in children this pathology may be accompanied by a violation of the closure of the first molars. For this reason, the orthodontist in these situations may recommend the use of devices such as the Andresen-Goipl activator and the Persin activator to eliminate class II and III anomalies.
If cross-curvature of the teeth is observed with a slight narrowing of the upper jaw, then in these situations the doctor may prescribe the use of expanding structures. The most effective device is considered to be the Biderman apparatus. This design allows for rapid palatal expansion. Activation of this device can be done at home by parents. Activation is done once every 7-10 days.

With a crossbite, a narrowing of the arch of the dentition occurs, which is associated with the genetic predisposition of the patients, and also possible breathing disorders (replacement of nasal breathing with oral breathing). To combat this type of jaw pathology, the Biederman apparatus is used.

How is treatment done in adults?

The following devices and treatments are commonly used to correct crossbites in adults:

• Individual fixed device with mechanical action. This device is used to both widen and narrow dental arches. In appearance, this device is an iron arc that covers the problem area on the vestibular side. The product is fastened to crown-caps, which are installed on the supporting units of the dentition. Bite restoration takes place over several years;
• Engel's apparatus. This device is used to widen the jaw. In appearance, this device is a curved arc that applies pressure from the lingual side. In order to achieve positive result While wearing this design, constant adjustment of the device is required. This product allows you to correct second-degree bite problems; it should be worn for at least 4 months;
• Katz crowns. These products are used for occlusion of the anterior dentition. This device is a loop that is fixed on metal crown. The principle of operation of this device is as follows: the loop is located on the lingual side at a certain angle in relation to the units with defects. As a result, constant pressure is placed on the teeth, which causes displacement;
• Braces. These are the most common and effective devices used for different types bite, including cross bite. This product consists of brackets and an arc, which is fixed inside the brackets. When wearing these products, pressure occurs on the dentition, which ensures its displacement.

The Katz guide crown is a non-removable orthodontic device with a functional guiding effect. It is a crown that is installed on a displaced tooth, with a guide plane made of wire loops soldered to it.

Preventive measures

Since the treatment of crossbite is quite long and does not always give 100% results, it is best to prevent the appearance of this pathology in a child from childhood. To do this, you should remember a few recommendations:

1. It is necessary to monitor the child's posture. Especially starting from the age of 7, when there is a period of rapid bone growth;
2. It is imperative that a child be taught how to properly brush his or her teeth from childhood;
3. Limiting the consumption of sweets;
4. Monitor the child’s behavior and prevent the development of bad habits - lying on the side, sucking fingers, making faces;
5. Timely elimination of all diseases of the ENT organs;
6. Compliance with preventive treatment of rickets, which can cause bone deformation;
7. Regular visits to the dentist.

Crossbite is a serious deformation of the dentition that can appear in early childhood. Therefore, it is important to monitor the condition of your child’s teeth from the moment they erupt. It is also best to go to the pediatric dentist who can conduct an examination and give useful recommendations for dental care. If it was not possible to avoid this pathology, then you should be prepared for the fact that the treatment will be lengthy and not always effective.

A cross bite is considered to be a bite characterized by the intersection (crossing) of the dentition when the jaws are closed. This pathology is often quite difficult to treat, and the duration of the necessary procedures and their success are largely determined by the severity of the clinical case and the reasons that, in fact, led to the occurrence of crossbite.

Be that as it may, it is important to understand that this requires adequate and timely treatment, since without appropriate orthodontic intervention very unpleasant and sometimes even dangerous consequences(We’ll also talk about them a little later).

The photo below shows examples of crossbite in a child and an adult:

Types of crossbite identified by orthodontists

There are several types of crossbite, and depending on the type of this pathology, the appropriate treatment plan may also vary.

So, let's see what types of crossbite doctors distinguish today.

Anterior crossbite is diagnosed when one or more teeth are in an abnormal position, most often tilted towards the tongue, thereby creating a reverse overlap. For example, one or two incisors can intersect crosswise.

The photo below shows an example of an anterior crossbite:

As a rule, a crossbite in the anterior region is combined with an abnormal mesial bite in the lateral dentition, or with the usual displacement of the lower jaw forward and the formation of a false crossbite. In the second case, it is important to understand why it is more convenient for the patient to move the lower jaw forward.

There is also a crossbite in the lateral region - the pathology is characterized by improper closure of premolars and molars (that is, 4, 5, 6 and 7 teeth, as well as wisdom teeth). As in the anterior region, with a crossbite of the lateral teeth, the anomaly can affect only one tooth, several, or even the entire lateral segment.

When diagnosing a crossbite in the lateral region, it is important to clarify in which direction the lower jaw is displaced, as well as whether the displacement is present only on one side of the dentition, or on both. Depending on this, orthodontists distinguish between unilateral and bilateral lateral crossbites.

In turn, unilateral crossbite can manifest itself in different ways, namely:

• Unilateral crossbite with a displacement towards the tongue (lingual bite). This type of crossbite often occurs due to crowding of teeth as a result of lack of space in the dental arch. Or in children with a delay in the replacement of primary teeth in the primary occlusion;
• Unilateral crossbite with a shift towards the cheek (buccal bite). This type of anomaly is quite rare; it can be, for example, caused by improper formation of tooth germs, which causes teeth to erupt outside the dentition towards the cheek. However, the more teeth that are in this type of malocclusion, the more likely it is that the cause of this type of crossbite is an asymmetry in the development of the jaws;
• And finally, a unilateral crossbite with a shift towards the palate (palatal bite). Diagnosed when one or more teeth in the lateral segment are tilted towards the palate. The causes of this type of occlusion may be macrodentia (excessively large teeth) and the absence of individual teeth. As a rule, pathology is more common with congenital malformations or injuries and diseases of the temporomandibular joint (TMJ).

An example of a unilateral crossbite in an adult:

Regarding bilateral crossbite, the most common cause This pathology is a discrepancy between the sizes of the dental arches. This is often combined with a pathological class II occlusion according to Engle and an anterior position of the upper jaw, which sometimes requires treatment to be referred to a maxillofacial surgeon for complete correction of the pathology.

On a note

Crossbite can be true or false. In the case of a true crossbite, the doctor makes this diagnosis taking into account the information obtained during the basic and additional methods examinations. A false crossbite occurs when the patient, for some reason, pushes the lower jaw into its usual position, thereby creating cross-blocking contacts.

Therefore, when examining a patient, it is very important to determine the position of the so-called central occlusion, that is, the position of the teeth that is convenient for this person at rest. To do this, the doctor asks the patient to open his mouth and, relaxing the lower jaw, calmly close his mouth without intentionally adjusting the position of the jaws (interestingly, not everyone succeeds in this the first time).

The second way to determine the central ratio is that the doctor places his thumbs on the skin landmarks of the corners of the lower jaw, the patient opens his mouth, throwing his head back slightly, the doctor asks the patient to relax the jaw, and, slightly shaking it and feeling the relaxation of the muscles, quickly moves the jaw upward without effort. This procedure is also usually repeated several times to ensure that the centric relation is achieved.

Causes of pathology

As a rule, crossbite is formed in childhood. There may be several reasons for this - let's look at the main ones in more detail.

• Bad habits in early childhood. In a child, the structures in the body are more pliable than in an adult, and the maxillofacial area is no exception. Even the slightest regular pressure sometimes contributes to the development of deviations. For example, the habit of sleeping on one side with an arm under the head, the habit of biting your lip, sucking fingers and other foreign objects, the habit of resting your cheek with your hand - all these daily repeated actions often contribute to the displacement of the lower jaw, individual teeth, and in some cases even violate normal height jaws;
  
• Ankylosis and arthritis of the TMJ. Ankylosis is the pathological fusion of joint elements with each other, which in the case we are considering limits the mobility of the lower jaw. This process can be the result of long-term arthritis, that is, an inflammatory process, or as a result of injury - for example, received when applying forceps during obstetrics. Treatment of ankylosis is usually very labor-intensive and requires long-term orthodontic treatment in a team with an oral and maxillofacial surgeon. Sometimes treatment takes 10 years or more - accordingly, the crossbite will be corrected gradually as the patient grows older. An example of a patient with ankylosis is shown in the photo below:
  
• Violations of the timing and sequence of teething. Each tooth should normally erupt in the dentition at a specific time and in a place specific to that tooth. If, for example, a tooth for some reason for a long time does not erupt, then existing teeth are often displaced in order to fill the void (to compensate for a defect in the dentition) - as a result, pathological contacts are created, which is the reason for the development of crossbite. And if teeth erupt much later, when the dentition has already been formed, then the “belated comrades” have to literally find a place for themselves where they can. For example, a tooth may erupt in the area of ​​the transitional fold of the gum, towards the lip, cheek or palate;
  
• Diseases of the ENT organs (frequent colds, nasal congestion, tonsillitis, adenoids). The fact is that pathological enlargement of the tonsils often leads to difficult nasal breathing, forced mouth breathing, which is directly related to the formation of a pathological bite. Inflammatory processes ear can affect the structures of the temporomandibular joint, since it is located in close proximity to the ears, and the partitions separating one formation from another are quite thin. Accordingly, inflammation in the middle ear can provoke arthritis, or, in more severe cases, ankylosis of the joint. That is why, with otitis media, sometimes patients note difficult, painful opening of the mouth and swelling just below the earlobe;
  
• Early loss of baby teeth. Removal of primary teeth due to caries and its complications quite often leads to the formation of crossbites and other types of abnormal bites. As they say, nature abhors a vacuum, and if free place, then the remaining milk teeth will fill it with themselves, tilting and shifting towards the defect, forcing the permanent teeth to erupt outside the dentition, either with a tilt or rotation along the axis;
  
• Congenital malformations (various syndromes). An example is the syndrome of the first and second branchial arches - this disease is hereditary, it is based on disturbances in the formation of these formations in the human embryo in the first weeks of its development in the womb. And as you know, it is from the gill arches that the structures of the maxillofacial region, the upper and lower jaw, are formed. The appearance of a patient with hemifacial microsomia (the scientific name of the disease) is presented in the photo below:
• Cleft lip and alveolar ridge of the palate can also cause crossbite. These birth defects child development is characterized by the presence of an anastomosis between the oral cavity and the nasal cavity, which significantly complicates the normal development of the child, his feeding, speech and bite formation. Treatment of children with cleft lip and alveolar ridge of the palate is a complex and long process, planned from the moment the pathology is detected in the fetus. After birth, the baby goes through certain stages of growth surgical treatment to correct the defect and close the anastomosis.
  

How is crossbite diagnosed?

Diagnosis of crossbite in a child begins with a routine external examination. In addition to the initial examination, the orthodontist must carefully collect an anamnesis of the child’s life and find out how the mother’s pregnancy and childbirth went.

It is also important to clarify whether there were any serious injuries, blows, falls, that is, factors that could affect the development of the maxillofacial area.

The second important diagnostic point is to determine the position of central occlusion using the methods described above, or using other methods, for example, using wax bite templates (orthopedists use this method for prosthetics in patients with complete or partial loss of teeth in order to properly make a prosthesis).

This is interesting

In rare cases, after dental prosthetics (that is, after orthopedic treatment), patients notice that their bite has become incorrect - for example, there may be signs of a crossbite. In other words, when using a prosthesis, contacts appear that block the normal closing of the jaws, which cause discomfort when speaking and chewing food. This may be a sign of a so-called artificially formed crossbite, and is a consequence of the fact that the doctor incorrectly determined the central relationship of the patient’s jaws.

Other mandatory methods for diagnosing bite pathologies, including crossbite, include functional tests. For example, the Ilyina-Markosyan test can be performed - this test allows you to assess the degree of pathological displacement of the lower jaw:

• First, the doctor evaluates the patient’s face at rest and during a conversation (to identify imbalances in muscle function and excessive tension);
• The patient is then asked to close his mouth and clench his teeth without opening his lips. This technique allows you to assess the habitual displacement of the lower jaw in one direction or another;
• Next, the patient is asked to open his mouth wide and pay attention to how much the lower jaw moves relative to the midline of the face;
• After determining the centric relation, the doctor evaluates how aesthetically the patient's face would improve in this position compared to his usual occlusion.

Among the additional diagnostic methods, X-ray examinations are mandatory:

• Orthopantomogram (in children over 5 years old). Allows you to evaluate the asymmetry of the bone structures of the jaws;
  
• Teleradiogram. Allows you to evaluate the patient’s skull as a whole and see which fragments of the jaw bones are shorter than others;
  
• X-ray of a child’s hand – performed in adolescence in order to understand what stage of bone growth the child is currently at (this can be important for choosing the best treatment plan);
• X-ray of the TMJ in the state of the patient's open and closed mouth is required by the doctor to make sure that the temporomandibular joint is not the cause of the crossbite.
  

What problems can arise with a crossbite?

Teeth that erupt outside the dentition and create cross-contacts can seriously injure the mucous membranes of the oral cavity during conversation and eating. Patients often complain of biting their cheeks and injuring their lips - in such cases, you should seek help from an orthodontist as soon as possible, since constant injury to soft tissues is dangerous and can lead to ulceration of the wounds and their suppuration. Moreover, if this process is long-term (chronic), then such injuries can degenerate into malignant formations of the oral cavity.

Further. Due to excessive pathological load on teeth in crossbite, there is a danger of increased wear of teeth, for example, the cutting edges of the incisors. Sometimes this problem is very acute, when a kind of “stump” remains from the teeth.

In severe cases, patients may be bothered by severe facial asymmetry, pain in the TMJ area and difficulty opening the mouth, and regular headaches.

If you study the reviews of adult patients, among other problems described, people sometimes note the inability to eat solid food and problems with the gastrointestinal tract (as a consequence of an unbalanced diet).

Parents of children with severe crossbite often note their excessive shyness, isolation, problems with communication, and low self-esteem, because in childhood any aesthetic defects very often result in ridicule from peers. In some such cases, in order to achieve a better treatment effect, the orthodontist may additionally recommend classes with a qualified psychologist who will improve the child’s emotional status.

Approaches to the treatment of pathology in children

Depending on the severity of the crossbite and the age of the child, treatment for the pathology can vary markedly.

In early mixed dentition (but usually not earlier than the child is 5-6 years old), the method of choice will be treatment with removable plate devices with an expanding screw and a sectoral cut. That is, the screw will expand exactly that segment of the dentition that needs such correction.

In addition, the doctor can include additional elements in the design of the device for correcting crossbite - buccal and lip pads to normalize the work of the muscles in this area, as well as to move soft tissues away from the teeth - in order to prevent unwanted pressure that tissues can exert on the teeth.

Generally speaking, an experienced orthodontist can include a wide variety of additional elements in the design of a removable appliance to increase the effectiveness of the treatment.

Functional devices such as the Frenkel function regulator work well when correcting crossbite: this device normalizes the natural myodynamic balance of the maxillofacial area.

In addition, crossbite is often associated with malocclusion of the first molars, so the orthodontist may suggest the use of devices such as the Andresen-Goipl activator and the Persin activator to treat class II and III anomalies.

On a note

Starting from the age of 10-12 years, if it was not possible to achieve the desired effect with removable equipment, you can use frame devices made individually according to the model of the child’s jaws. The frame apparatus is soldered to orthodontic rings selected by the orthodontist in advance. The doctor adjusts the device so as to enhance its effect on the desired side of the dentition.

If the upper jaw is significantly narrowed, the doctor can use expanding structures such as the Biederman apparatus for rapid palatal expansion (also with a screw, the activation mode is set by the doctor) to treat crossbite. Activation is carried out either by the parents or the patient himself, on average once every 7-10 days.

An example of such a device is shown in the photograph:

Sometimes crossbite correction is carried out in two stages, that is, treatment with the help of devices is preparatory stage to treatment with a bracket system, which works directly with the angles of the teeth, corrects excessive rotations and puts each tooth in its place in the jaw arch.

Treatment of crossbite in adults

In adult patients, treatment of crossbite usually begins with braces. It is also possible to use the frame expanding devices described above - in conjunction with the brace system, or before preparing for fixation of braces.

To correct the actual cross-overlapping at the stage of wearing rigid rectangular arches, the doctor additionally connects elastic cross-rods in the lateral and anterior parts of the dentition, which the patient wears for 12 hours a day and at night, removing them while eating.

Sometimes you can limit yourself to partial fixation of braces only on those segments of the dentition that need treatment.

On a note

If the severity of the pathology is severe, the orthodontist discusses with the patient the possibility of using orthognathic surgery. If the patient agrees to surgery, then the treatment plan is adjusted according to what exactly needs to be achieved for the surgeon to fully work.

Often patients immediately refuse this treatment method due to fear of surgery on the maxillofacial area. Then the orthodontist, as far as possible, corrects the pathology only by correcting the bite, however, the jaw bones remain in the wrong position.

Preventive actions

To prevent the development of crossbite in a child, it is important to fight the baby’s bad habits from infancy and regularly visit the pediatrician and dentist (caries on baby teeth must be treated in a timely manner).

At the age of 5-6 years, it is advisable to go for a consultation with an orthodontist in order to insure yourself and start treatment on time, if necessary. It is very important to monitor the formation correct posture child: a lot has been done scientific research, proving the relationship between persistent poor posture and pathological occlusion.

Play sports, take courses therapeutic massage. This will help to avoid many health problems, and not only with bite, because our body is a single whole, and everything in it is closely interconnected.

Be healthy!

(If you have personal experience correcting crossbite in yourself or your child - be sure to leave your feedback at the bottom of this page, in the comments field. Such information will be of great interest to those who are in a similar situation, but are just beginning their journey to a beautiful smile...)

Useful video: a girl talks about her case of crossbite correction

What you should know about bite correction at different stages of its formation

Crossbite is one of the most complex orthodontic pathologies. Of the total number of patients with malocclusion, only 2% have a crossbite.

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

How does it manifest?

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

Symptoms

TO main symptoms anomalies include:

• pronounced narrowing of the jaw arch;
• violation of contact between antagonist teeth;
• displacement of the lower jaw along the horizontal plane;
• overlap of the buccal cusps of the upper row with the lower ones;
• noticeable speech impairment, when pronouncing hissing and whistling sounds;
• injury to the mucous membrane;
• dysfunction of the temporomandibular joint, which is characterized by pain when talking and eating.

Facial features

In addition to intraoral changes, pathology also leads to change in facial proportions:

• the face has pronounced asymmetry;
• the center line of the upper lip does not coincide with the middle of the lower lip;
• the chin has a strong deviation;
• the angle of the upper lip on the side of the anomaly may recede. The opposite corner of the lips has a visible seal.

Classification

Crossbite has been divided into types, differing in clinical manifestation.

Buccal

With this type of pathology, a change in occlusion occurs with overlap of the buccal cusps in the lateral parts of the dentition. In this case, either one-sided or two-sided overlap can be observed.

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

Lingual

With the lingual type of crossbite, there is partial closure 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

The pathology combines all or partial signs of the buccal and lingual type. Combined bite refers to the most complex view, which can only be eliminated using combined techniques.

Depending on the location of the main changes, this type 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 also such a definition as true and false crossbite. By true we mean pathological changes occlusions caused by physiological disorders.

The definition of a false bite includes anomalies caused by a purposeful movement of the jaw forward or to the side, which the patient most often does unconsciously.

Causes

The appearance of this pathology can be caused by a variety of reasons, among which the most common are:

• a number of dental diseases, causing disruption development of the jaw apparatus;
• genetic factor
• hypotonicity of the muscles of the face and jaw;
• violation of metabolic processes. A special role here is played by phosphorus and calcium deficiency;
• discrepancy between the timing of the change of primary teeth to permanent ones;
• formed mouth breathing;
• early loss of baby teeth;
• injuries to the face and jaw;
• disturbance of position during sleep.

Possible complications

Crossbite is a serious abnormality can lead to a number of complications:

• Impaired breathing function, as a result of which nasal breathing is replaced by oral breathing.
• Dental problems: loosening and loss of teeth, rapid wear of enamel, caries, periodontal inflammation.
• Malfunction of the jaw joint, which can lead to its temporary blocking, the appearance of constant headaches, and increased pressure.
• Diseases of the gastrointestinal tract, which are provoked by a lack of quality chewing of food.

Diagnostic methods

Photos before and after crossbite treatment

To diagnose this pathology, a set of research methods are used at once, which make it possible to determine the degree of development of the anomaly.

Among all the methods, there are mandatory and additional ones, which are of a clarifying nature.

Mandatory

TO mandatory methods studies include:

• Visual inspection and patient interview.
• Determination of central occlusion using bite rollers.
• Functional tests, allowing you to accurately determine the degree of jaw extension.

Additional

As additional methods use the following:

• Orthopantomogram. Prescribed only to children over 5 years of age.
• Teleradiogram. Allows you to see the ratio of the sizes of the jaws in relation to each other and the rest of the elements of the skull.
• X-ray. For diagnosis, an X-ray examination of the patient’s TMJ and hand may be necessary. X-ray of the hand helps to evaluate general state bones.

Treatment

Depending on the age category of patients, different techniques can be used to correct an abnormal bite.

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

In children

During the mixed or primary dentition, the following showed the greatest effect: correction methods:

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

  Trainers are two-jaw molded mouthguards designed to be worn only while sleeping.

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

  The maximum effect when wearing trainers can be achieved when treating malocclusion at the age of 5 to 10 years.

• Myogymnastics. Aimed at solving the problem of malocclusion 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 shifts.
• Grinding away part of a tooth which interferes with normal jaw movement. Most often, this method is used when it is impossible to fully perform lateral movements.

  To ensure that the patient does not 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 single or a group of teeth. The method will be effective only for unexpressed changes in the bite.
• Treatment with orthodontic appliances. For this, a wide variety of devices are used: Janson bionator, Frenkel regulator, Klammt activator and others.

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

Metal arches are bent in such a way as to exert the maximum permissible pressure on the child’s teeth.

Plastic parts act as a base or inclined planes. Such systems require constant correction, which is carried out by tightening or disconnecting the regulatory elements.

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

In adults

Correction of crossbite in adults is carried out using fixed-type devices or surgical intervention.

The following methods have shown good results::

• Individual non-removable mechanical impact device. It is used for both widening and narrowing of dental arches.

  It represents a curved arch that covers the problem area of ​​the dentition from the vestibular side. The arch is attached to crown caps installed on the abutment teeth.

  This device allows you to restore your bite in several years, but cannot restore facial symmetry.

• Engle's apparatus. Used only for jaw expansion. The device is a curved arc that applies pressure from the lingual side.

  To obtain the effect, in this case, regular adjustments to the design are required. The device allows you to correct class II malocclusion pathologies, and visible results can be seen after 4 months of wear.

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

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

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

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

  Correction occurs due to constant pressure of the arc on the dentition. Now, for the treatment of bite, you can choose the most different models, among which there are those capable of correcting the most complex type of bite.

• Compactosteotomy. Prescribed to expand the dental arch. The operation involves a direct impact on bone tissue jaw, by perforating it to achieve separation.

  During the procedure, the dentist forms a thin groove on the jaw connecting the holes, then sutures the mucous membrane. Correction occurs by replenishing the separated bone and expanding the walls of the groove.

  This type of treatment is used only for complex pathologies that cannot be treated with hardware.

What measures can be prescribed to correct crossbite, watch the video:

Prognosis and prevention

According to patient reviews, with the right treatment, the bite can be corrected in 1–3 years.

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

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

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

• Eliminate bad habit Constantly sucking your thumb or pacifier.
• Bring your child to the dentist regularly.
• Treat general illnesses in a timely manner.
• Monitor the quality of your oral hygiene.
• Form correct posture.

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We treat crossbite without surgery or tooth extraction!

Crossbite with displacement of the lower jaw is one of the most common occlusion anomalies.

Signs of crossbite

Normally, the upper teeth should “encircle” (overlap) the lower row of teeth both in width and length. If this does not happen, and the “girth” does not work out when the upper teeth are inward or behind the lower ones, then they talk about crossbite. It can be in the frontal area (the upper incisors are behind the lower ones), then the bite is also called “reverse” ( reverse incisal occlusion). Or maybe in the side areas.

In this case, a crossbite can be unilateral (the upper teeth are inward from the lower teeth on only one side) or bilateral (the upper teeth are inward from the lower teeth on both sides).

Causes of crossbite

The cause-and-effect chain of crossbite in adults is as follows:

1. Skull deformities (plagiocephaly).
2. Posture disorders.

The consequence of the first two reasons is:

1. Underdevelopment (narrowing) of the upper jaw or its incorrect position.

As a result, deformation of the upper jaw occurs. Which can be bilateral (symmetrical) or unilateral (asymmetrical).

The consequence (as a result) of deformation of the upper jaw is:

1. Forced position (position) of the lower jaw.

The lower jaw “looks” for a comfortable position when the sizes of the upper and lower dentition do not match and “moves” to the side. At the same time, in addition to unilateral crossbite, facial asymmetry is also observed.

Complications of crossbite

Different lengths of the articular condyles on the right and left on the OPTG.

It is advisable to identify and eliminate cross-occlusion in childhood. In this case, it is not worth waiting until the teeth have all erupted or anything else (as many doctors advise) - this is fraught with consequences, since the incorrect (forced) position of the lower jaw creates conditions for blocking the growth of the condylar (articular) process of the lower jaw and, over time , facial asymmetry, caused by the difference in the length of the articular processes, can firmly fix (perpetuate) the incorrect position of the lower jaw already at the bone level. And then only the operation...

Diagnosis of crossbite

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Allows you to identify deformation of the dentition and jaws and its extent.

Bifurcation of the contour of the body of the lower jaw on the lateral TRG.

1. Analysis of teleroentgenograms (TRG).

   TRG analysis in the lateral projection, which is a mandatory element of the initial diagnosis, can already reveal indirect signs of crossbite.
   For example, here is a “bifurcation” of the contour of the lower jaw, which may indicate a forced position of the lower jaw.

But since the crossbite anomaly is not in the sagittal plane, a more accurate and targeted method for determining the cause of the crossbite is the analysis of TRG in the direct (frontal) projection.

Computed tomography (CT) of the skull(a better and more modern way than TRG).

CT allows you to most accurately determine the level and extent of deformation of both cranial bones and jaws. Since CT, unlike x-rays(TRG), covers more than one plane, but allows you to look at the situation in three planes at once (three-dimensionally, in “3d”).

By the way, if there is a suspicion of their difference, it is better to determine the length of the articular processes also by CT.

.

Allows you to determine the most correct (optimal and functional) position of the lower jaw for the patient.

Crossbite correction

As can be seen from the causes of crossbite in adults and children, crossbite itself is not a diagnosis at all. But rather a consequence. A consequence of other, deeper and more general problems of the dental system and the whole organism as a whole. Therefore, it is not the crossbite itself that needs to be treated, as such, but the treatment should be etiotropic. That is, it should be aimed at eliminating the immediate cause of crossbite with displacement of the lower jaw.

At the Orto-Artel clinic, when eliminating crossbite, we work “on all fronts” (for all reasons).

And in this work I would like to note main stages of treatment:

Orthodontic removable plate for the development of the upper jaw.

Developing an underdeveloped upper jaw.

If we are talking about symmetrical narrowing, a regular orthodontic plate will do.. True, there are nuances in its use, so we do not recommend repeating the treatment without knowing the “secrets”. Or a non-removable expander (this also has its own nuances).

If the underdevelopment is asymmetrical, then first we use devices like A.L.F or Crozat in order to eliminate asymmetry and only then carry out development.

Mouth guard (splint, orthotic) to normalize the position of the lower jaw.

1. With the development of the upper jaw At the same time, we fight against the incorrect (forced) position of the lower jaw. Let's normalize its position.

   For this a special mouth guard or another name is used - splint or orthotic.

Very often, dentists diagnose dental pathologies in patients. In children, as they grow older, these phenomena can lead to malocclusion and occlusion defects.

Among the 30% of people with such problems, 3% have a crossbite, due to which, in addition incorrect location teeth in a row, the patient’s face does not look aesthetically pleasing, as it acquires asymmetry.

Currently, there are methods that will help correct or reduce the manifestation of this problem.

Crossbite is characterized by a discrepancy between the sizes of teeth and their shapes in the transverse direction. This anomaly is expressed in a displaced intersection of the jaws.

In addition to external asymmetry, patients have speech defects, impaired chewing function, and constant cheek biting.

The treatment is carried out by an orthodontist. Actions to eliminate pathology are carried out comprehensively over a long period of time.

Classification

There are several types of crossbite, which differ in characteristics that require a unique approach and choice of methods and means for treatment. Dentists highlight:

1. Buccal bite. Its peculiarity is the narrowing of the upper fixed jaw and the expansion of the lower movable jaw. It can appear on one or both sides at once. In this case, displacement of the jaw bone is possible. Chewing food is difficult due to a defect in occlusion.
2. Lingual. Expressed in a reduced lower jaw and an enlarged upper jaw. The closure of the teeth of the upper and lower rows can occur without contact with each other. The defect extends to both one and two sides.
3. Buccal-lingual. Includes characteristics of the two types described. Dentists divide this bite into gnathic (excessive development or underdevelopment of the jaw), dentoalveolar (narrowing or widening of the jaw arches), articular (displacement to one side of the movable jaw).

Causes

The causes of crossbite formation are still being studied today. But all of them can be divided into two categories - congenital and acquired.

Main congenital causes:

1. Hereditary predisposition. Among these diseases are various syndromes. For example, disturbances in the formation of gill arches in the embryo in the first weeks of the mother’s pregnancy.
2. Improper formation of the temporomandibular bones. Leads not only to crossbite, but also to problems with the vestibular apparatus and motor skills.
3. Cleft palate. A congenital defect in which a child is born with an anastomosis between the nasal and oral cavities.
4. Defective dentition rudiments.

Among those purchased:

1. Birth injury. Damage during childbirth can affect the improper formation of the child's jaw.
2. Uneven teething and early tooth loss. Occurs due to impaired metabolism.
3. Bruxism- strong squeezing of the jaw during sleep, which is likely to cause injury to the oral cavity, abrasion of enamel and the formation of a defective bite.
4. Bad habits in early childhood. Regular pressure exerted by the baby on the maxillofacial part contributes to the development of pathologies. For example, this could be frequent lip biting, incorrect sleeping position, or finger sucking.
5. Chronic diseases respiratory system . Such diseases include sinusitis and sinusitis.
6. Musculoskeletal diseases. These include arthritis, rickets and osteomyelitis.

Diagnostics

The actions of a specialist in identifying crossbite begin with conducting an instrumental examination and studying the results.

The dentist determines the condition of the dental system using the method of palpation of the temporomandibular joint and its auscultation. To compile a more detailed clinical picture, an orthopantomogram, teleroentgenogram and radiography are used.

Based on the research, the doctor specifies the type of defect and prescribes a method of treatment and correction.

To obtain a complete picture and establish a diagnosis, you may need to consult a pediatrician or therapist, as well as a neurologist.

The video presents material about the diagnostic signs of crossbite.

Correction methods

With the help of treatment prescribed by an orthopedist, it is possible to achieve a uniform arrangement of the dentition in relation to each other on the lower and upper jaw.

Treatment methods and time depend on the type of abnormal bite, the degree of neglect of the problem and the age of the patient.

Trainers

This method consists of correcting the bite by relieving tension in the jaw muscles and pressure on the teeth.

Trainers are a silicone structure modeled on a computer to suit the individual characteristics of the patient’s oral cavity.

They are mainly intended for use while sleeping. Thus, they remain invisible to others. During the daytime, they must be worn for 1 to 3 hours.

Treatment is carried out in stages, using trainers of different material hardness, each of them is marked with a specific color.

To achieve the result, soft and then more rigid structures are used first.

Each type of trainer requires about 7 months to wear. The effect is noticeable in 90% of cases. The cost of trainers is about 4-5 thousand rubles.

Braces

This device remains on the teeth permanently for an extended period of time. It helps align the occlusion by applying pressure to the teeth.

Braces can be made of ceramic, metal, or plastic. One of the disadvantages of the braces system is that it takes a long time for the patient to get used to them. Treatment lasts at least a year. Sometimes the wearing period takes 5-7 years.

Dentists consider this correction method effective. The price for installing braces is on average 18 thousand rubles.

Orthodontic plates

The structures are removable orthodontic appliances made of metal wire and soft plastic. To correct serious pathologies, the device may have additional elements. For example, hooks holding it.

It is mainly used by dentists to correct bite defects in children under the age of 12-15 years. This is due to the fact that their impact is small to help an adult.

The devices are quite effective for children. The wearing period varies, but on average ranges from one to two to three years.

The cost of records varies depending on their configuration. The approximate price is 15 thousand rubles or more.

Aligners

The orthopedic design follows the contour of the teeth. Made from transparent plastic. Elimination of bite pathology occurs due to the pressure of the aligners on problem sectors.

The device does not cause pain, as it is created based on impressions of each patient’s jaw. Dentists advise wearing aligners for 20 hours a day. It is necessary to replace the structure every 2 weeks.

Among the advantages of the devices are easy adaptation, elimination of damage to the oral mucosa, and invisibility to others.

Can be used even for children. However, this treatment method is not suitable for patients who are missing even one tooth.

Depending on the extent of the problem, wearing can last from 3 months to two years. Aligner aligners are expensive - their installation will cost from 60 to 150 thousand rubles.

Surgical method

In difficult cases, when usual means unable to help, doctors use surgical methods.

They consist of making an incision in the upper palate and expanding the jaw using operating devices. Screw expanders are often installed, with which the dentist periodically expands the upper palate. After this, the patient experiences pain for an hour.

The result of treatment is visible within two to three months.

However, this surgical intervention can only be performed up to 20 years of age, since in older people ossification of the palatal suture occurs.

Complications

Often people who have been diagnosed with a crossbite find nothing wrong with it other than being unattractive. appearance. But untimely correction of the pathology can lead to a number of serious complications.

The most common of them:

• diseases of the digestive system;
• unclear diction;
• respiratory dysfunction;
• frequent dental caries;
• causing injury to the tongue and mucous membranes of the cheeks;
• difficulties in installing prostheses and implants;
• development of problems with the cardiovascular system;
• damage to tooth enamel, the appearance of excessive sensitivity;
• the appearance of pain in the head due to pressure on the temporomandibular joint;
• displacement and deformation of the vertebrae.

Prevention

To avoid acquired crossbite, it is necessary to monitor his sleeping position from the first months of a child’s life. In addition, care should be taken to ensure that the baby does not put foreign objects into his mouth.

You should regularly take your child to the dentist for timely treatment of caries, since pulling out teeth leads to displacement of neighboring units.

Posture is also important. Researchers have long proven the relationship between spinal curvature and the appearance of malocclusion.

About effective methods For correction and prevention of malocclusion, watch the video.