Crossbites and Openbites

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Questions and Answers

What is a primary aim of the lecture regarding crossbites and openbites?

  • To discuss the ethical considerations in orthodontic referrals.
  • To detail the etiology and management strategies. (correct)
  • To analyze the economic impact of orthodontic treatments.
  • To explore historical treatments of malocclusion.

Anterior open bite is characterized by which of the following conditions?

  • Excessive overlapping of the incisors.
  • Misalignment of the molars.
  • Increased overjet.
  • Lack of vertical overlap between the upper and lower incisors. (correct)

Upward rotation of the maxilla contributes to an open bite by primarily affecting which dimension?

  • The anteroposterior position of the mandible.
  • The inclination of the molars.
  • The transverse width of the palate.
  • The vertical relationship of the anterior teeth. (correct)

How does tongue thrust swallowing contribute to the development of an anterior open bite?

<p>By exerting anterior force against the incisors during swallowing. (C)</p> Signup and view all the answers

What dental factor is associated with the development of an anterior open bite?

<p>Under-eruption of anterior teeth. (D)</p> Signup and view all the answers

Management of open bite related to habits involves?

<p>Using a habit breaking appliance. (D)</p> Signup and view all the answers

What is the primary purpose of using high-pull headgear in the context of skeletal open bite management?

<p>To change the inclination of the maxillary plane. (C)</p> Signup and view all the answers

In cases of skeletal Class II malocclusion with an open bite, how do thick posterior bite blocks within a twin block appliance aid in correction?

<p>By intruding the molars. (D)</p> Signup and view all the answers

Posterior crossbite is characterized by which of the following?

<p>A discrepancy in the buccolingual relationship of upper and lower posterior teeth. (B)</p> Signup and view all the answers

How does a constricted V-shaped maxilla contribute to the development of crossbite?

<p>By creating insufficient space for the eruption of permanent teeth. (B)</p> Signup and view all the answers

What dental factor contributes to posterior crossbite?

<p>Improper inclination of posterior teeth. (D)</p> Signup and view all the answers

What is the primary aim of managing skeletal posterior crossbites in growing individuals?

<p>To allow transverse expansion of the mid-palatal suture. (C)</p> Signup and view all the answers

When using a rapid palatal expander (RPE) for correcting posterior crossbites, what is the typical activation protocol?

<p>Turned two times per day to achieve overcorrection. (C)</p> Signup and view all the answers

Which appliance is utilized in slow palatal expansion?

<p>Quadhelix appliance. (B)</p> Signup and view all the answers

What is the primary mechanism by which cross elastics with fixed appliances correct a posterior crossbite?

<p>Dental tipping. (D)</p> Signup and view all the answers

What is a key difference between managing severe skeletal crossbites in adults versus in children?

<p>Adults often require surgically assisted rapid palatal expansion. (B)</p> Signup and view all the answers

Anterior open bite is characterized by:

<p>A lack of vertical overlap between the upper and lower incisors. (A)</p> Signup and view all the answers

What is the effect of downward rotation of the mandible on the anterior teeth?

<p>It contributes to an anterior open bite. (A)</p> Signup and view all the answers

What is the dental factor that often contributes to anterior open bite?

<p>Under-eruption of anterior teeth. (D)</p> Signup and view all the answers

Which appliance is related to the management of habits?

<p>Habit breaking appliance. (B)</p> Signup and view all the answers

What is the goal of high-pull headgear regarding open bite management?

<p>Changing the inclination of the maxillary plane. (B)</p> Signup and view all the answers

Thick posterior bite blocks, used within a twin block appliance, correct what?

<p>Intruding the molars. (D)</p> Signup and view all the answers

Which characteristic defines posterior crossbite?

<p>The buccolingual relationship of the upper and lower posterior teeth is a problem. (D)</p> Signup and view all the answers

How does V-shaped maxilla cause crossbite to form?

<p>Making the permanent teeth lack space. (A)</p> Signup and view all the answers

Which of the dental issues is related to the formation of posterior crossbite?

<p>The inclination of posterior teeth is incorrect. (B)</p> Signup and view all the answers

What is the main purpose behind managing a skeletal posterior crossbite during a patient's growth?

<p>Transversely widening, and expanding, the mid-palatal suture. (D)</p> Signup and view all the answers

How should a palatal expander be used with a patient?

<p>Turning it twice a day to overcorrect. (C)</p> Signup and view all the answers

What device would you recommend is used to slow palatal expansion?

<p>Quadhelix. (B)</p> Signup and view all the answers

By what process do cross elastics correct a posterior crossbite?

<p>Dental tipping. (C)</p> Signup and view all the answers

In terms of severe skeletal crossbites, what's a key difference between treating adults vs. children?

<p>Adults often require surgically assisted rapid palatal expansion. (C)</p> Signup and view all the answers

What is the primary characteristic of an anterior open bite?

<p>A lack of vertical overlap between the upper and lower incisors. (A)</p> Signup and view all the answers

How does downward rotation of the lower jaw typically affect the position of the front teeth?

<p>It contributes to an anterior open bite. (C)</p> Signup and view all the answers

Which dental condition is associated with the development of an anterior open bite?

<p>Under-eruption of the anterior teeth. (C)</p> Signup and view all the answers

In a patient with an anterior open bite, excessive tongue thrusting during swallowing primarily affects:

<p>The position and alignment of the incisors. (B)</p> Signup and view all the answers

A patient presents with a posterior crossbite affecting the molars on both sides of the mouth. What is the most likely skeletal characteristic contributing to this condition?

<p>Narrowness of the maxillary arch relative to the mandibular arch. (C)</p> Signup and view all the answers

If a child has a posterior crossbite attributed to a thumb-sucking habit, what change in the maxillary arch form is most likely?

<p>A constricted and V-shaped arch. (B)</p> Signup and view all the answers

An adult patient has a severe skeletal open bite. What treatment approach is most likely required?

<p>Orthognathic surgery. (C)</p> Signup and view all the answers

A 7-year-old child presents with an anterior open bite and a history of prolonged thumb-sucking. Which of the following interceptive orthodontic appliances is most appropriate?

<p>A habit-breaking appliance. (C)</p> Signup and view all the answers

Which of the following statements best describes the relationship between open-mouth posture and the development of anterior open bite?

<p>Open-mouth posture can result in over-eruption of posterior teeth and increased incidence of anterior open bite. (B)</p> Signup and view all the answers

Flashcards

Anterior Open Bite

A malocclusion where there is a lack of vertical overlap between the upper and lower incisors.

Skeletal Etiology of Open Bite

Upward rotation of the maxilla or downward rotation of the mandible.

Soft Tissue Factors in Open Bite

Resulting from large tongue or tongue thrust swallowing.

Open-Mouth Posture

Results in over-eruption of posterior teeth, leading to anterior open bite.

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Dental Factors in Open Bite

Under-eruption of anterior teeth, over-eruption of posterior teeth, or excessive proclination of anterior teeth.

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High Pull Headgear

Headgear that changes maxillary plane inclination to manage skeletal open bite.

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High Pull Chin Cup

Chin cup that changes mandibular plane inclination to manage skeletal open bite.

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Twin Block appliance

Used with thick posterior bite blocks to allow molar intrusion and correct open bite.

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Habit Breaking Appliance

An appliance that aids in stopping habits like thumb sucking.

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Posterior Bite Blocks

Posterior intrusion to manage dental open bite.

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Mini-screws

Posterior intrusion to manage dental open bite.

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Extrusion of anterior teeth

Bring anterior teeth down to close open bite.

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Surgical Open Bite Correction

Orthognathic surgery to correct severe skeletal open bite in adults.

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Posterior Crossbite Definition

A discrepancy in the buccolingual relationship of the upper and lower teeth

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Skeletal Cause of Crossbite

Narrow upper arch, mismatch of arch widths

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Thumb Sucking effects on the palate

It is associated with constricted V-shaped maxilla and high vaulted palate due to hyperactivity of buccinator muscle.

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Local cause of crossbite

Crowding, where one or two teeth are displaced from the arch

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Inclination Issues Lead to Crossbite

Improper inclination of the posterior teeth.

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Crossbite & Cleft Lip/Palate

Associated with cleft lip and palate.

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Skeletal Crossbite Aim

Allow transverse expansion of the mid-palatal suture.

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Age of fusion

The suture should be opened " it ossifies at the age 13-15 years”

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What is RPE?

Hyrax expander

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Rapid Palatal Expansion - speed

2 times/day =0.5 mm/day until overcorrection is achieved

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Slow expansion appliance

Quadhelix appliance

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Quad helix rotations

Can allow expansion anterior and posterior and can help to correct molar rotations

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Slow Expansion Device

Removable appliance with mid-palatal screw

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Fixed appliance elastics

Cross elastics with fixed appliances

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Orthognathic Surgery for Crossbite

Severe skeletal crossbites in adults

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Study Notes

Aims of Lecture

  • To detail the aetiology and management of crossbites and openbites

Objectives

  • Classification and aetiology of crossbites
  • Classification and aetiology of anterior and posterior open bites
  • When to refer patients with these conditions
  • General management options for crossbites and openbites in different age groups

Anterior Open bite

  • There is a lack of vertical overlap between the upper and lower incisors

Etiology of Open Bites

Skeletal factors

  • Upward rotation of the maxilla
  • Downward rotation of the mandible
  • Increased lower facial height and MMP angles

Soft Tissue Factors

  • A large tongue is a significant factor.
  • Tongue thrust swallowing.
  • Open-mouth posture due to nasal obstruction or habit leads to over-eruption of posterior teeth and a greater incidence of anterior open bite.

Dental Factors

  • Under-eruption of anterior teeth
  • Over-eruption of posterior teeth
  • Excessive proclination of anterior teeth

Management of Open Bites

Skeletal Open Bite

  • High pull headgear can change the inclination of the maxillary plane using 250-400 gm per side to induce skeletal changes
  • High pull chin cup can change the inclination of the mandibular plane
  • Twin block: this can be used in skeletal Class II cases with open bite, with thick posterior bite blocks allowing for molar intrusion and correction of the open bite

Habits

  • Habit breaking appliance.
  • Refer to BDS7116 Interceptive Orthodontics 2 for more.

Dental Open Bite

  • Intrusion of posterior teeth with posterior bite blocks
  • Mini-screws
  • Extrusion of anterior teeth

Severe Skeletal Open Bite

  • Surgical correction (orthognathic surgery) is needed in adults

Posterior Crossbites

  • A discrepancy in the buccolingual relationship of the upper and lower teeth
  • The transverse relationship of the arches is described in terms of the position of the lower teeth relative to the upper teeth
  • A narrow upper arch "mismatch of the width of the arches" may be present, and often involves many teeth bilaterally
  • Refer to BDS7108 Malocclusion Class III

Soft Tissue Factors

  • Thumb sucking is associated with a constricted V-shaped maxilla and high vaulted palate due to hyperactivity of the buccinator muscle

Dental Factors

  • Crowding is most common local cause, with one or two teeth displaced from the arch
  • Improper inclination of the posterior teeth

Etiology

  • Can be associated with cleft lip and palate

Management of Skeletal Posterior Crossbites

  • Transverse expansion of the mid-palatal suture is the aim
  • The suture should be opened before it ossifies at 13-15 years
  • Rapid palatal expansion “RPE” using a Hyrax expander turned 2 times/day = 0.5 mm/day until overcorrection is achieved

Management of Dental Posterior Crossbites

  • Slow palatal expansion by a Quadhelix appliance
  • A W arch appliance can allow anterior and posterior expansion, and correct molar rotations
  • Removable appliance with mid-palatal screw
  • Cross elastics with fixed appliances

Severe Skeletal Crossbites

  • Surgically assisted rapid palatal expansion in adults

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