Crossbite Diagnosis Treatment

This guide organises possible treatment options for a crossbite diagnosis. The document is a treatment planning tool to assist you assist how to best treat patients. Treatments are graded by complexity, ranked by the orthodontic technique required, as a guide to the efficacy of treatment and enable providers to select cases that best matches their ability to apply advanced techniques. In this regard, it is particularly useful for dentists who are just beginning to provide clear aligner treatment.

Disclaimer

As doctors are solely responsible for the treatment they’re providing their patients, they should understand their limits and not hesitate to consult a specialist for further guidance when required. Note when applying this guide only general, high-level information on how each isolated condition might be treated is provided. The relationships between different conditions that exist in the majority of patients are not addressed. In this regard, always consider each patient’s individual dental and periodontal condition, restorative needs, facial proportions, and age when considering treatment options.

Crossbite

Crossbite

Crossbite occurs when the maxillary teeth are buccal or lingual to their normal position with respect to the mandibular teeth. It is important to identify the underlying cause of the crossbite to treat it correctly.

Dental crossbite is characterised by the displacement or buccal/lingual tipping of teeth causing these teeth to be positioned more buccally or lingually with respect to the teeth in the opposing arch. Dental crossbites usually appear to be unilateral. However, they can also be bilateral, appearing as unilateral due to mandibular shift. In a maxillary lingual crossbite, the maxillary teeth in crossbite are tipped palatally so that the palatal cusps are much higher compared to the buccal cusps.

Skeletal crossbite is characterised by a narrow maxillary arch and/or a wide mandibular arch. The long axes of the teeth appear to be normal in this situation. However, the arches are not coordinated due to a discrepancy in arch size. A skeletal crossbite requires surgical correction in most adult cases. Teen patients may be corrected with rapid palatal expansion.

Dental or skeletal crossbites often occur in conjunction with a mandibular shift which can be both in transverse or A-P planes. The shift is due to the occlusal interferences caused by the crossbite. These interferences force the patient to shift the mandible to the side or forward for better function.

Dental

• Anterior

Advanced tooth and/or retract opposite Novice (0-15 cases)

Anterior crossbites are corrected by moving the displaced teeth into the correct position. This can be in either or both arches. It is important to ensure that adequate interproximal space exists around the crossbite to ensure adjacent teeth do not hinder the movement into the correct final position. Review the treatment plan for space around the tooth as the crossbite is being jumped. In severe deep bites the use of a bite plate in the opposing arch to aid in opening the bite may be helpful. In cases in which a tooth is severely lingually positioned, some sectional fixed treatment may be necessary to upright the root and correct the long axis in a bucco/lingual direction.

• Posterior

Buccal

Maintain crossbite, aesthetic alignment Novice (0-15 cases)

Alignment can be achieved without correcting the crossbite in mild to moderate crowding cases if the patient declines surgical skeletal correction.

Expansion and/or constriction of other(s) Experienced (16-50 cases)

Buccally displaced posterior teeth can be corrected by lingual movement with or without buccal movement of the opposing teeth. It is important to ensure there is enough space for this correction. Some posterior crossbites can benefit from distalisation as well as IPR to provide the space required for this correction. Enamelopolasty may be necessary to remove final occlusal interferences present at the end of treatment. The use of a bite plate may facilitate the crossbite correction depending on the amount of crossbite correction. A crossbite that involves all of the posterior teeth up to the canine should be treated cautiously. Factors to be considered are the amount of crossbite, the number of teeth in crossbite and the patient’s periodontal health.

Lingual

Expansion and/or constriction of other(s) Experienced (16-50 cases)

Lingually displaced teeth can be corrected by expanding them to their correct positions. Constriction of the opposing teeth may also be indicated. It is important to ensure there is enough space for this correction. Some posterior crossbites can benefit from distalisation as well as IPR to provide the space required for this correction. Enamelopolasty may be necessary to remove any occlusal interferences present at the end of treatment. The use of a bite plate may facilitate the crossbite correction depending on the depth of the bite.

Skeletal

• Anterior

Anterior (see 8. Class III)

It is important to determine whether an anterior crossbite is dental or skeletal, because skeletal correction requires skeletal treatment in addition to alignment. It is also important to check for functional shifts because the bite relationship can settle into a different bite once the anterior interference is removed. If anterior, see Class III treatment options.

• Posterior

Surgical expansion followed by Proligner for alignment Advanced (>50 cases)

Skeletal crossbite is characterised by a narrow maxillary arch and/or a wide mandibular arch. The long axes of the teeth appear to be normal in this situation. However, the arches are not coordinated due to a discrepancy in arch size. A skeletal crossbite requires surgical correction in most cases. Surgical treatment can be followed up with Proligner treatment for general alignment.

Non-surgical, limited Tx. See Dental Tx options

Limited treatment to align the anterior teeth can be done with Proligner for mild to moderate crowding cases.