Correction of crossbite in adults. What is the danger of crossbite and how to fix it. Video - Cross bite of teeth. Treatment with Star Smile caps

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 effective correction occlusion, allow you to return the correct symmetry and aesthetics to the appearance at any age.

What does it represent?

Cross-type occlusion is one of the 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, which have different clinical characteristics and methods of treatment.

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 some decrease in the bottom. 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 is certain symptoms manifestations and Clinical signs. It is on them that the dentist determines the method of treatment. But, in addition to special signs, there are also general ones by which you can determine the intersecting bite on your own.

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 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 most that can worry is appearance with this 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 is caused by uneven and overload on the temporomandibular joint;
deformity and displacement of the cervical vertebrae;
constriction of the respiratory and circulatory tracts.

Diagnostics

The diagnosis of crossbite begins with 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 detailed receipt anamnesis, 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 correct setting 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 treating 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. Recovery normal occlusion 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:

Angle apparatus;
kappa aligners;
braces;
Katz crowns;
surgical intervention.

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 jaw muscles . During 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 material of manufacture 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 partial or total absence tooth.

Correction with braces

Braces are non-removable devices designed to alignment of occlusion by mechanical action on the dentition. After the dentist conducts an examination and eliminates the impossibility of applying 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 take a long time 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 accept natural look 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 the following video, we will be clearly shown how the crossbite is corrected with the help of orthodontic plates:

Surgical method

IN extreme cases when they don't 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.

Crossbite is dental disease, during which the lower jaw is displaced relative to the upper. As a result of this, the dentitions intersect.

In medicine, this is also called oblique or lateral bite, laterodeviation, laterogeny, etc. The most severe form. It is quite rare, but in relation to other occlusion disorders, it needs complex treatment.
Pathology covers 2–3% of adults and 1–1.5% of children.

Laterogeny brings a lot of trouble to a person in the physical and psychological aspects, which leads to the need to study the causes of the occurrence, as well as methods of treating the disorder.

Causes

The etiology of crossbite is most often associated with a hereditary factor or a certain habit. Also, pathology may not act as individual disease, and be one of the symptoms of jaw, hemiatrophy, ankylosis of the TMJ. In such cases, the restoration of the bite is combined with the elimination of the underlying disorder.

As a rule, lateral bite leads to:

Modern classification

The features of the manifestations of crossbite are influenced by the individual structure of the maxillofacial apparatus and the root causes of the development of pathology. The anomaly may affect one or both sides of the jaw bones, and may be symmetrical or asymmetrical.

Also, pathologies can be exposed to the anterior or lateral part of the dentition. The anomaly may concern one tooth, several or the entire lateral segment. It is very important to correctly diagnose the type of laterogeny, since the treatment regimen depends on this fact.

Orthodontists divide the lateral bite into the following types:

buccal. It is not difficult to diagnose. As a result of impaired occlusion, swallowing and chewing functions change, food intake causes difficulties. The lower jaw may not move, there is an expansion of the row of teeth in the lower jaw or a narrowing of the row of teeth in the upper jaw on one or both sides. Sometimes the jaw moves to the side diagonally or between the central incisors under the middle of the nose.
Lingual. Affects one or both sides of the jaw. It happens that the lateral teeth are closed. It is manifested by the expansion of the row of teeth in the upper row and narrowing in the lower.
Buccal-lingual. The most common form and is treated with difficulty. Has the most severe symptoms and is not difficult to diagnose. Cross bite in this case always combined with the displacement of the lower jaw to the side, resulting in a distortion of the shape of the face.

The last type of pathology is divided into:

dentoalveolar- manifested by underdeveloped or, conversely, overly developed dentoalveolar jaw arches;
gnathic- characterized by deviations (pathological narrowing or expansion) in the development of the jaws;
articular- displacement of the lower jaw to the right or left.

Characteristic symptoms

In the case of laterogeny, the symptoms are expressed as:

asymmetry and deformation of the face (the chin is shifted to the right or left, upper lip sinks, with a curvature of the chin Bottom part persons with opposite side flattens);
displacement of the jaw in a horizontal plane with a wide open mouth;
uneven abrasion of molars;
pain, crunching in the joints of the jaws, if the mouth opens;
intersection of the teeth of the upper and lower rows in one or two places.

Pathology also leads to functional changes:

chewing function is disturbed;
the mucosa is constantly injured due to its biting;
there is a decrease in the mobility of the lower jaw;
diction is broken;
discomfort occurs.

Diagnostic criteria and techniques

It is important to correctly and timely diagnose the crossbite and the form of the anomaly, since the treatment depends on it. Mandatory diagnostics includes:

Visual inspection. The disease is easily determined visually by the clinical picture.
Collection of anamnesis. The patient is found out the presence of injuries, strokes and other causes that could provoke the pathology. When determining a crossbite in children, it turns out the presence of deviations during gestation and during childbirth.
Functional trials. Most often they resort to the test according to Ilyina-Markosyan, with the help of which pathological displacement lower jaw. The anomaly is being studied in calm state, with widely open mouth, when talking, etc.

Often additional X-ray examination is required. Namely:

After the examination, the orthodontist makes a decision to refer the patient to the maxillofacial surgeon, pediatrician, ENT and speech therapist.

Correction of pathology

Correction of crossbite can begin at any stage of development of the disorder, but a favorable prognosis directly depends on timely diagnosis.

The treatment regimen is individual and depends on the type and severity of the disease, age category patient and cause.

The purpose of therapeutic measures and methods of dealing with pathology differ depending on the age category of patients. In childhood, it is required to slow down the development of the disorder and return the growing bones to normal rhythm development. For this you need:

wean the child from certain habits (sucking nipples and fingers, putting a pen under the cheek during sleep);
make sure that when chewing there is a uniform load on both sides of the jaws;
prevent diseases of the nose, mouth and throat;
to give milk teeth a flat surface, if lateral movements of the jaw are difficult;
do special gymnastics;

Sudden crossbite often requires surgical intervention. From 5–6 years old, removable plate devices are prescribed, having an expanding screw and a sectoral cut.

With the help of a screw, the pathologically altered part of the dentition expands. The muscles of the jaws are put in order with the use of buccal and labial pads. In the same way soft tissues move away from the teeth to prevent unwanted pressure.

Frenkel regulator

Specialists resort to the use of the Frenkel regulator, the Andresen-Goipl activator, the Persin activator, the Biedermann apparatus and other structures.

When the filming equipment does not bring positive result when a child reaches 10–12 years old, frame devices are used, made individually for the size of the jaw. The device is attached using orthodontic rings. The device is adjusted by a doctor.

In the treatment of crossbite in adults, the size of the jaw is corrected and deformities are leveled. The patient is usually placed or the above frame expanders. If the dentition is narrowed, one or more teeth may be removed.

Minor deformations are corrected with. Significant pathologies involve the use outside oral systems– head cap, which has a chin rest and rubber traction.

When a crossbite is difficult to correct with conventional methods, specialists resort to mechanical orthopedic appliances- Angle apparatus and Katz crown.

Case history and photo of a patient diagnosed with crossbite before and after treatment

retention period

After the treatment of lateral occlusion, there is a need to consolidate the result. In some cases, there is a natural retention and the use of special devices is not required.

Sometimes the patient needs to wear or from six months to 3 years.

Each retention device must be: comfortable, removable, invisible and stable.

In addition, it is necessary to constantly be under the supervision of a doctor.

Consequences and prevention

Treatment of pathology is necessary to prevent:

malignant tumors in oral cavity as a result of permanent injury inside cheeks and lips with teeth;
tooth wear due to increased load on them;
noticeable asymmetry of the face;
pain in the TMJ area;
difficult jaw mobility;
headaches;
diseases of the gastrointestinal tract, which leads to impaired chewing function;
mental problems associated with the unaesthetic appearance of the face.

To avoid pathology, it is necessary to childhood fight provoking habits and regularly visit a dentist in order to prevent any disease of the oral cavity or start its treatment in time.

Lesson #11

I. Subject: Etiology, classification, clinical picture, diagnosis and treatment various forms cross occlusion.

II.Target: Get knowledge about the etiology, classification, clinical picture of various forms of cross-occlusion, learn how to apply diagnostic and treatment methods.

When studying this topic, the student must:

Know: etiology of cross occlusion; facial and dentoalveolar signs, functional disorders associated with cross occlusion.

Be able to: determine the types of cross occlusion, according to the classifications

YES. Kalvelis, MGMSU, WHO; apply clinical and special research methods for the diagnosis of cross-occlusion; draw up a comprehensive plan of modern methods of treatment of various forms of cross occlusion, depending on the period of formation of the child's bite.

Own: Skills in diagnosing cross occlusion and principles of its treatment.

Sh.Issues of input control.

Reasons for the formation of cross occlusion.

Facial signs of cross occlusion.

Types of cross occlusion.

Clinical functional tests for the diagnosis of cross occlusion (according to L.V. Ilyina - Markosyan).

Functional disorders in cross-occlusion.

Measurement results of diagnostic models of jaws with cross occlusion.

The results of X-ray profilometry according to Schwarz with cross occlusion.

Modern methods of treatment of cross occlusion, depending on its type and the period of formation of the bite of the child.

IV. Lesson content:

It is known that one of the signs of orthognathic occlusion is the correct ratio of the lateral teeth in the transversal plane. In orthognathic bite, the buccal tubercles of the upper lateral teeth overlap the same-named tubercles of the lower lateral teeth, at the same time, the lingual tubercles of the upper lateral teeth are in contact with the longitudinal fissures of the lower lateral teeth. This sign must be supplemented by the presence of dense fissure-tubercle contacts in the sagittal plane between the teeth. This ratio is violated in the presence of cross occlusion.

Cross occlusion refers to anomalies in the transversal plane and is characterized by a violation of the correct ratio of the lateral teeth in this plane. As a rule, a real bite anomaly can be the result of an anomaly in the position of individual teeth of the lateral segment of the upper and lower jaws in the form of narrowing of the jaws. And, finally, it may be the result of a lateral displacement of the lower jaw.

Cross occlusion classification:

Dentoalveolar

Gnathic

articular

Buccal

Lingual

Combined

Each form can be with a displacement of the lower jaw and without a displacement of the lower jaw.

According to F.Ya. Khoroshilkina, M.Yu. Malygina et al. (1982, 1990) distinguish several types of cross occlusion:

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 displacement of the lower jaw to the side. In turn, the displacement of the lower jaw can be parallel to the midsagittal plane and diagonal.

Classification of cross occlusion according to L.S. Persin (1989):

vestibulocclusion

palatine occlusion

linguistic occlusion

Cross occlusion can be unilateral or bilateral. With unilateral palatine occlusion, there is a unilateral narrowing of the upper dentition or jaw. With bilateral palatine occlusion, there is a bilateral symmetrical or asymmetric narrowing of the upper dentition or jaw. The listed signs of palatinoocclusion can be combined with the displacement of the lower jaw parallel to the midsagittal plane or diagonally. With a combination of signs with and without displacement of the lower jaw, combined cross-occlusion is distinguished. With linguo-occlusion, there may be a unilateral or bilateral narrowing of the lower dentition. With vestibulocclusion - expansion of the upper or lower dentition or jaw (unilateral or bilateral).

Clinic. The clinical manifestations of cross-occlusion are varied and depend on the specific form. Common to the indicated nosological form of anomaly of occlusion is a 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. With a combination of cross occlusion with a displacement of the lower jaw to the side, there may be a violation of the function of the TMJ. The clinical picture of buccal cross occlusion without displacement of the lower jaw is characterized by asymmetry of the face without displacement of the pogonion point (the most prominent point of the chin) in relation to the median plane, which coincides with the median line between the incisors on both jaws. If it does not match, the topography of the frenulum of the lips and tongue is specified. The degree of violation of morphology during occlusion may be different. The buccal buds of the upper lateral teeth may be in contact with the same-named cusps of the lower lateral teeth or may not be in contact with the lower teeth at all. In buccal cross occlusion with mandibular displacement, there is usually facial asymmetry and displacement of the pogonion point relative to the midsagittal plane. This asymmetry progresses with age. The median line between the incisors in occlusion does not match. When the lower jaw is displaced, the ratio and contact of the lateral teeth in the occlusion is disturbed. Palpation examination of the temporomandibular joint during function reveals a pronounced movement of the articular head on the side opposite to the displacement. Often on the side of displacement there is an increase in tone. In order to clarify the displacement of the lower jaw to the side, it is advisable to use clinical tests according to L.I. Ilyina-Markosyan, A.P. Kibkalo (1970), namely her 3rd and 4th trial. The patient is offered to open his mouth wide and study t facial signs (3rd test). After that lower jaw set in the usual occlusion, and then in the position of central occlusion, facial features are assessed, their improvement or deterioration, the degree of displacement of the lower jaw, narrowing or expansion of the dental incisors, etc. (4th test). Lingual cross occlusion is characterized by impaired chewing function due to hypotension of the masticatory muscles, blocking the lower jaw and disturbing its lateral movements.

Diagnostics. Orthodontic diagnosis is made on the basis of clinical and laboratory methods and research. When studying diagnostic models of the jaws, it is advisable to use the methods of Nanse, Gerlach, Schmuth to eliminate the suspicion of a lack of space for the front teeth on both jaws when the center line between the incisors in the state of occlusion does not match. Of great importance in laboratory diagnostics is the use of the method of studying diagnostic models of the jaws according to the Pohn method, which allows diagnosing narrowing or expansion of the jaws in case of cross occlusion. Unilateral narrowing of the jaws can be diagnosed by measuring the distance from the lateral teeth to the line of the median palatine 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 in direct projection allows us to clarify the asymmetrical structure of the facial bones. By studying the linear and angular parameters in the transversal plane, one can identify the cause of cross-occlusion, clarify the topography of the left and right half of the skull in the vertical and transversal plane, as well as the magnitude of the lateral or diagonal displacement of the lower jaw. Often, cross occlusion can be combined with a shortening of the mandibular branch on the side of displacement and a violation of the location of the pogonion point.

Treatment. aim orthodontic treatment cross occlusion is the normalization of the ratio of the dentition in the transversal plane. Ways to achieve it are different in different age periods.

During the period of temporary and mixed dentition elimination of etiological factors is shown (see section "Etiology"), normalization of the act of chewing (eating solid food). It is necessary to use myogymnastics when combining cross occlusion with displacement of the lower jaw. With an early loss temporary teeth prosthetics is shown to maintain the correct occlusal contact of the teeth in the vertical and transversal plane. With indications for orthodontic instrumental treatment, devices are used that separate the bite and contribute to the expansion of the narrowed dental arch. In the period of temporary occlusion, the use of vestibular plates of Krause, Schoncher and other structures is indicated. It is possible to use a plate for the upper jaw with a vestibular arch and an inclined plane in the posterior region to limit the lateral movement of the lower jaw. 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, remember to separate the dentition before activating the screws and springs. In the formed temporary occlusion and in the period of mixed occlusion, the use of double-maxillary hortodontic devices is indicated. With a unilateral narrowing of the upper dentition, elements that move the lateral teeth are added to the Andresen-Hoyplyad activator design: 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 applying the Frenkel function regulator. In case of vestibulocclusion, the buccal shields of the function regulator are made in such a way that they touch the buccal surface of the lateral teeth of the lower jaw and do not come into contact with the buccal surface of the upper lateral teeth. For the treatment of lingual cross-occlusion, buccal shields are made in reverse. This contributes to the growth of the apical basis of the jaws in the transverse plane and the elimination of cross-occlusion. 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 side of displacement, the force of the elastic should be less than on the opposite side.

In constant bite shows the use of non-removable mechanically acting orthodontic appliances in combination with compactosteotomy, extraction of individual teeth for orthodontic indications, the use of extraoral active orthopedic systems. When narrowing the dentition, Angle's apparatus can be used in the form of an expansive arch, fixed in tubes soldered to the rings on the supporting molars, more often than the first permanent ones. If there is a correct position 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 occlusion must be separated using removable hortodontic 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, or retention devices are used. 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 cross occlusion depends on its form (dental-alveolar, gnathic), type (buccal, lingual, combined), age of the patient, period of initiation of orthodontic treatment, severity of morphological and functional disorders in the dentofacial region.

Current control issues

Choose one correct answer:

Anomalies of occlusion in the transversal direction include

cross occlusion

deep occlusion

open disocclusion

mesial occlusion

Violations of the transversal dimensions of the dental arches can be studied by the method

Korkhauz

Palatinoocclusion is a displacement

lower posterior teeth oral

upper lateral teeth buccal

Linguistic occlusion refers to

Vestibulocclusion refers to

sagittal anomalies of occlusion

vertical anomalies of occlusion

transversal anomalies of occlusion

Constant sleep on one side with a hand under the cheek leads to

uniform narrowing of the dentition

uniform expansion of the dentition and displacement of the lower jaw forward

unilateral narrowing of the dentition and displacement of the lower jaw to the side

Vestibulo-occlusion is a displacement

lower or upper posterior teeth to the buccal side

lower or upper lateral teeth to the oral side

only the upper lateral teeth to the oral side

Muscles that push the lower jaw forward and take it to the opposite side

facial muscles

temporalis muscle

suprahyoid

chewing, lateral and medial pterygoid

For the treatment of cross-occlusion with a lateral displacement of the lower jaw, occlusal linings of the double-maxillary devices are made

on the offset side

on the opposite side

on both sides

do not do

A diagnostic method that makes it possible to judge the symmetry of the development of the right and left halves of the lower jaw

TRG - lateral projection

TMJ tomogram

TRG - direct projection and orthopantogram

Linguistic occlusion is a displacement

upper posterior teeth oral

lower posterior teeth oral

upper lateral teeth buccal

Treatment method at diagnosis: cross occlusion due to uniform narrowing of the upper dentition

lengthening of the upper dentition;

elongation of the lower dentition and expansion of the lower dentition

shortening of the lower dentition and expansion of the upper dentition

expansion of the upper dentition

expansion of the upper and lower dentition

Devices are used to treat cross occlusion

removable with a screw, an inclined plane in the posterior part of the dentition

Frenkel function regulator, Andresen-Heupl activator;

edgewise technique

all answers are correct

Facial signs of unilateral palatine occlusion

asymmetrical, proportional face, straight profile

the face is symmetrical, proportional, retracted cheeks, straight profile

the face is symmetrical, the height of the lower third of the face is increased

Treatment of cross occlusion with displacement of the lower jaw to the side in a 4-year-old child involves manipulations

grinding of cusps of temporary teeth

control examination 2 times a year until the complete change of teeth

correction of the width of the dentition

Signs of cross occlusion are described in relation to

sagittal plane

transversal plane

vertical plane

Transversal anomalies include types of anomalies of occlusion

deep

open

mesial

cross

Choose multiple correct answers:

Varieties of cross occlusion

buccal
lingual
combined
open

As a result of the habit of putting your hands under your head during sleep and putting pressure on the lower jaw,

flattening of the jaw on the pressure side

change in the tone of the muscles of the mandible

narrowing of the upper jaw

lateral displacement of the mandible

narrowing of the upper dentition

Most common cause of cross occlusion

the habit of moving the jaw to the side;

thumb sucking habit

lazy chewing

infantile type of swallowing

destruction of dental crowns

Maxillofacial pathology leading to the formation of cross-occlusion

TMJ pathology

damage to the growth zones of the lower jaw in trauma

osteomyelitis of the angle of the mandible

short frenulum of the tongue, macroglossia, hypertrophy of the palatine tonsils

V. Literature:

Pediatric therapeutic dentistry. National leadership / ed. V. K. Leontiev, L. P. Kiselnikova. - M. : GETAR - Media, 2010. - 890 p.

Persin, L. S. Dentistry of children's age. – Ed. 5th / V. M. Elizarova, S. V. Dyakova - M .: Medicine, 2003. - 640 p.

Persin L.S. Orthodontics. - 2007. - 360 p.

Persin L.S. Classification of dentoalveolar anomalies // Ortodent-info. - 1998. - No. 1. - S. 3-5.

Crossbite due to the discrepancy between the width of the upper and lower dentition in the transversal direction.

In a crossbite, the buccal tubercles of the upper lateral teeth fit into the longitudinal grooves of the lower teeth or slip past them on the lingual side. The reverse relationship of the upper and lower dentition most often begins from the canines, sometimes from the incisors. Distinguish unilateral and bilateral crossbite (Fig. 288).

Reichenbach, Karkhauz and others consider only one-sided reverse relationship of dentition to be a crossbite. If there is a bilateral crossbite, including the frontal area, then in these cases they speak of progeny. Clinical practice shows that progeny and crossbite are quite closely related. Crossbite can be caused by narrowing of the upper jaw, expansion of the lower jaw, displacement of the lower jaw to the side, or a combination of these signs.

L. V. Ilyina-Markosyan distinguishes two types of crossbite:

1) crossbite without displacement of the lower jaw to the side. The ratio of the dentition in the lateral areas according to the first class of Angle;
2) crossbite with lateral displacement of the lower jaw. This variety is often a unilateral anomaly of the third class according to Angle and, according to the author, can be considered as a variant of the second form of false progeny, i.e. forced bite.

In addition to the shift of the lower jaw to the side parallel to the midsagittal plane, cases are described in the literature when the lower jaw is shifted to the side diagonally (diagonal displacement of the lower jaw). With such a cross bite, the lower lateral teeth of one side, being in an inverse relationship, are located more distally than on the other. The ratio of the jaws is sharply asymmetric, occlusion and appearance are significantly impaired. Brückl and Reichenbach point out that crossbite is more often observed varying degrees diagonal displacement of the lower jaw than its displacement to the side parallel to the midsagittal plane. A. El Nofeli calls the ratio of the dentition, in which the buccal tubercles of the upper lateral teeth fit into the longitudinal grooves of the lower ones, calls not just a cross, but a buccal cross bite. In the literature, it is also known as vestibulocclusion (Fig. 287, a). The author calls lingual crossbite such a relationship when, with an excessively wide upper jaw or a sharply narrowed lower (evenly or asymmetrically), the upper lateral teeth partially or completely slip past the lower ones on one or both sides (Fig. 287, c). With this form of crossbite, there is a sharp violation of occlusion and a change in the shape of the lower dental arch.

Given the wide variety of crossbite clinics, it is advisable to single out the following forms.

The first form is the buccal crossbite:

1. Without displacement of the lower jaw to the side:

a) unilateral, due to unilateral narrowing of the upper jaw or expansion of the lower, or a combination of these signs;
b) bilateral, due to bilateral symmetrical or asymmetric narrowing of the upper jaw or expansion of the lower, or a combination of these signs.

2. With the displacement of the lower jaw to the side:

a) parallel to the midsagittal plane;
b) diagonally.

3. With a combination of signs of the first and second varieties - mixed buccal crossbite.

The second form is the lingual crossbite:

1. One-sided, due to an unevenly expanded upper dentition or an unevenly narrowed lower one, or a combination of these features (see Fig. 288).
2. Bilateral, due to an excessively wide upper jaw or a sharply narrowed lower jaw, or a combination of these features.

The third form - mixed (buccal-lingual) crossbite, is due to a combination of signs of varieties of buccal and lingual crossbite.

In all forms of crossbite, chewing function is significantly impaired. With a lingual crossbite, the possibility of lateral movements of the lower jaw is excluded. There is also a speech disorder. With a buccal crossbite with a displacement of the lower jaw to the side, the normal function temporomandibular joints, which in the future may be the cause of their disease in the form of deforming arthrosis.

The following factors can contribute to the occurrence of a crossbite: heredity, wrong position during sleep (putting hands, fists or pillows under the cheek), bad habits, impaired nasal breathing, atypical position of the rudiments of individual teeth, diseases of early childhood (rickets), a violation of the sequence of teething, their incorrect articulation, not worn tubercles of milk teeth, delay tooth changes, early destruction and removal of primary molars, trauma, osteomyelitis, inflammatory processes in the region of the temporomandibular joint.

The treatment of a crossbite depends on its shape and the age of the patient. Basically, in case of crossbite, treatment is aimed at leveling the discrepancy between the upper and lower dentition in the transversal direction (unilateral or bilateral expansion of the upper or lower dentition, moving the lower jaw: to the correct position or a combination of these measures).

In order to develop a rational treatment plan for buccal crossbite, it is first necessary to establish its type, i.e., whether there is a displacement of the lower jaw to the side.

In a buccal crossbite without displacement of the lower jaw, there is usually a narrowing (unilateral or bilateral) of the upper dentition or an expansion of the lower, and the midline between the central incisors coincides. However, there may be a discrepancy, for example, with a close position of the front teeth, with their displacement. In these cases, it is useful to pay attention to the location of the frenulums of the upper and lower lip, tongue, or navigate by appearance .. With a crossbite without displacement of the lower jaw, one-sided or bilateral flattening of the middle part of the face and upper lip (face asymmetry) is noted, however, if you draw a mid-sagittal plane across the face, then both halves will be equally distant from it does not reveal the displacement of the chin to the side.

Great value for differential diagnosis It has x-ray examination temporomandibular joints. With a cross bite without displacement of the lower jaw, both articular heads are located symmetrically in the articular fossae and most often in their depth.

With a buccal crossbite with a displacement of the lower jaw to the side, a mismatch of the median line between the upper and lower central incisors is usually noted, Brückl, Reichenbach and others believe that for correct diagnosis(regardless of whether there is a lateral displacement of the lower jaw or not), clinically one should be guided not by the frenulum of the upper and lower lips, but by the frenulum of the tongue, which is usually located in the midsagittal plane. For this purpose, a radiograph of the lower jaw is also used, on which the location of the spina mentalis is clearly visible (the spina mentalis is located in the middle of the lower jaw). If the base of the frenum of the tongue or spina mentalis with the dentition is displaced away from the mid-sagittal plane drawn along the face, then we can assume that there is a lateral (lateral) displacement of the lower jaw. On radiographs of the temporomandibular joints with a crossbite with a displacement of the lower jaw to the side, an asymmetric arrangement is noted articular heads in the articular fossae.

There is also a sharp violation of the configuration of the face in the form of its asymmetry: the chin is shifted to the side in relation to the midsagittal plane, the upper lip of this side is retracted and the lower part of the face is flattened on the opposite side. The angles of the lower jaw are usually turned up to 135-140°.

On the radiograph of the face, an uneven (asymmetric) development of the facial bones of the right and left sides in the vertical and transversal direction, and especially the lower jaw, is established. Her chin is shifted in the direction in which the jaw is displaced. There is also a shortening of the body of the lower jaw of this side and its branches.

For the treatment of buccal crossbite in milk period a number of preventive and therapeutic measures are being taken: strengthening general condition body, normalization of nasal breathing, elimination bad habits, sanitation of the oral cavity, grinding of unworn tubercles of milk teeth, myogymnastics, separation of the bite on crowns or mouthguards. When the lower jaw is displaced to the side, a one-sided pressure extraoral bandage is used in combination with bite separation, a plate with an inclined plane in the lateral area. At sharp narrowing upper jaw (unilateral or bilateral), expansion plates are used with screws or springs located in the middle of the plate or closer to one side. In this period, it is useful to use activators various designs. In the milk period with lingual crossbite, due to excessive growth of the upper jaw, it is possible to apply a pressure extraoral bandage to this area, expand the lower dentition (when it is narrowed) while simultaneously separating the bite. It is also advisable to use activators.

During the period of early mixed dentition, the above-mentioned measures are used, often in combination.

In later mixed and permanent dentition, in buccal crossbite with lateral displacement of the lower jaw, it is useful to use Katz guide crowns on the canines and premolars of the upper jaw on the side in which the lower jaw is displaced, or on lower molars from the opposite side. During this period, intermaxillary oblique traction is also used by means of two Angle arcs and rubber traction (Fig. 289, a). With the help of these devices, the lower jaw is set in the correct position, restructuring takes place muscle tone and the position of the articular heads in the articular fossae is normalized. For this purpose, you can also use a plate on the upper jaw with a screw or spring and bite pads in the area of the lateral teeth. With the help of such a device, the upper jaw is expanded (one-sided or two-sided), and the bite pads, simultaneously with the separation of the bite, keep the lower jaw in the correct position. The use of this device is indicated at any age.

Treatment of buccal crossbite without displacement of the lower jaw in this period is reduced to bite separation and unilateral or bilateral expansion of the upper dentition using removable or non-removable orthodontic appliances.

Positive results in the treatment of varieties of buccal-crossbite with late removable and permanent dentition (also in adults) can be achieved by using devices No. 1 and 2 of our design (Fig. 289, b). As a certain area of the upper jaw expands, the vestibular spring-lever, located on the movable part of the plate and adjacent to the lower lateral teeth from the vestibular side, separates the bite and gradually moves the lower jaw to the correct position (if necessary, the vestibular spring-lever is activated). There is a slow restructuring of muscle tone and normalization of the position of the articular heads in the articular fossae. At the same time, to some extent, the alveolar ridge the corresponding side of the mandible, and the teeth lean orally. In the treatment of buccal crossbite without displacement of the lower jaw, the vestibular spring-lever only contributes to the separation of the bite and the oral inclination of the corresponding lower teeth. If additional expansion of a certain area of the upper jaw is required during treatment, it is useful to use apparatus No. 2. In this apparatus, the vestibular spring-lever is located on the fixed part of the plate and serves mainly to keep the lower jaw in the correct position (if necessary, pressure achieve some inclination of the lower teeth in the oral direction).

Based on the clinical picture of the buccal crossbite (the ratio of the dentition on the side of the reverse overlap, the degree of narrowing of the upper jaw or the expansion of the lower jaw, its lateral displacement are taken into account), both devices or one of them are designed and used accordingly.

Treatment of lingual crossbite in late mixed and permanent dentition is carried out by expanding the lower dentition. The elimination of crossbite in adults often requires a combination of the orthodontic measures described above with prosthetics.

Crossbite should be eliminated as early as possible (especially buccal with a displacement of the lower jaw to the side) in order to avoid asymmetric formation and development of parts of the facial skeleton and temporomandibular joints. It is necessary to treat all forms of crossbite at any age in order to improve the functions of chewing, breathing, speech, change the appearance and create conditions for rational prosthetics for defects in the dentition. Special attention it is necessary to turn to the treatment of buccal crossbite associated with the displacement of the lower jaw to the side in order to prevent the occurrence of deforming arthropathies.

With a pronounced crossbite and at an older age, when orthodontic or prosthetic measures do not guarantee the achievement of a successful functional and aesthetic result, surgical intervention is performed.

Crossbite is a kind of anomaly that manifests itself in the fact that in a person the lower and upper jaw bones are horizontally displaced in relation to each other. If people have such a defect, then the row of teeth located at the top intersects with the bottom. At the same time, the temporal joints of the human skull, its facial bones and the lower jaw may develop asymmetrically.

All this has Negative consequences in the form of disturbed chewing and respiratory functions problems with speech, traumatic occlusion (in dentistry, occlusion is any contact between the upper and lower rows of teeth). Therefore, such a defect must be corrected. This is a complex and lengthy matter, it is impossible to drag it out, we must begin in early age, as soon as a crossbite was discovered. Before and after photos clearly represent the difference in what was (anomaly of crossbite) and what became (corrected bite with braces).

This anomaly develops both in the lateral jaw areas and in the anterior part. The science of orthodontics defines several different forms of this pathology:

Buccal bite. At the same time, the contact of the lateral teeth is disturbed, chewing food is difficult. Often the jaw is displaced, but sometimes it remains absolutely in its place.
Lingual bite. It is characterized by the absence of contact of antagonistic teeth or by the closing of the lateral teeth, this is due to a narrowed or expanded row of teeth at the top. Such a bite happens both on one side and on both.
Buccal-lingual bite. It has three varieties: gnathic bite (when the jaw base is narrowed or expanded), dentoalveolar bite (when the dentoalveolar arches of the jaws are too weak or, conversely, strongly developed), articular bite (accompanied by a displacement towards the lower jaw).

Crossbite variant

What causes such a pathology

There can be a lot of reasons and they are all quite different:

at birth there is a cleft of the soft palate;
heredity (if one of the parents has a crossbite, then the child may suffer from this anomaly);
inflammatory processes in the body, in which the development and growth of the jaws is disrupted;
not quite the correct position of the child when he sleeps (very negative consequences can be from the seemingly banal, it would seem, putting folded hands or a fist under the cheek);
diseases that adversely affect the calcium-phosphorus metabolism in the child's body;
facial trauma;
during the rudimentary process of tooth growth, their laying is disturbed;
bad habits, so characteristic of babies (supporting cheeks with a fist, sucking a toy or fingers, biting lips);
premature or late fallout milk teeth;
bruxism (in the common people grinding or tapping teeth in a dream);
disordered uncoordinated work of chewing muscles;
hemiatrophy facial muscles(a disease in which one half of the face is reduced);
impaired breathing through the nose.

What threatens crossbite

If the treatment of this defect is not started in time, the consequences themselves can be different, unpleasant, sometimes even too serious. For example:

Since the food is chewed poorly, the work of the entire gastrointestinal tract is disrupted.
Problems with speech and not quite beautiful aesthetic appearance cause a number of complexes.
Much more often with such an anomaly occurs and develops periodontal disease and caries.
The process of breathing becomes difficult.
Severe headaches may appear.
Often there is inflammation of the throat.
Crossbite people are most susceptible to high blood pressure.

Cross bite in adults

Now it becomes clear and understandable why the urgent correction of crossbite in adults and children is so necessary.

How does this pathology manifest?

This defect has a very diverse and wide clinical picture.

Facial asymmetry in crossbite

First, limited motor function lower jaw. This leads to inadequate chewing of products entering the body, and to a disease such as periodontal disease. If you open your mouth wide, then the lower jaw shifts slightly (at the same time, it can be shifted both horizontally and diagonally).

Secondly, the symptoms are determined by the face. Very often this is manifested in its uniform change. The upper lip sinks, and the opposite part of the face flattens from below. The chin can be shifted to one side. There is an asymmetric front (facial) part of the skull.

What does a crossbite look like?

Thirdly, chewing function is disturbed, people with such a defect often bite their cheeks while eating. Pronunciation of sounds, speech is also violated.

To accurately diagnose a crossbite, an X-ray examination of the lower jaw and temporal joints will be required.

How to correct this anomaly in a child

Whatever the form of crossbite, the cause of its occurrence and the age of the patient himself, treatment should definitely begin immediately.

Cross bite before and after treatment

In a child, a crossbite can be corrected by taking the following steps:

first of all, it is necessary to get rid of bad habits (it is necessary to strictly forbid the baby to take fingers and toys in his mouth and suck them);
you need to monitor how the baby sleeps (if he puts his fist under his cheek, you need to carefully remove it);
for the oral cavity and nasopharynx, a therapeutic and health-improving complex of measures is carried out;
if milk children's teeth have tubercles, they need to be ground down, as they can interfere with lateral movements of the lower jaw;
as soon as a crossbite is detected in children, treatment should be prescribed experienced doctor(most often, the dentition is separated, if they are narrowed, special plates with springs and screws will be prescribed for expansion);
during the period of especially intensive growth of the jaws, they use Frenkel's function regulators, activators.

How to eliminate such a defect in an adult

Not only in early childhood, but already in more late age crossbite may occur. Treatment in adults most often consists in the use of orthodontic preparations. This special systems, with the help of which they expand or narrow a certain section of the dental arch, normalize the chewing muscles, and also put the lower jaw in place. Braces are placed on the teeth. How many they will have to wear depends on the severity of the anomaly.

Crossbite photo before and after treatment

If such a defect as a crossbite appeared suddenly and abruptly, surgery is likely to be required. Also, the operation is indicated for people who have this pathology hereditary or congenital.

When the bite is restored, it is very important to keep achieved result. It is advisable to use a retention apparatus (put on at night removable plates). Everything that the orthodontist recommends should be done regularly and accurately.

As you can see, crossbite is a pathology far from banal and harmless. To get rid of it takes time, patience, effort and endurance. Both the specialist doctor and the patient himself should treat the problem with understanding. But the beauty of the human face, the health of the body is much more important. You can be strong and be patient.

What does a crossbite look like Variant of a crossbite