Crossbite asymmetry of the face. Photos before and after braces, correction

Crossbite is a pathological occlusion in which the lower teeth overlap the corresponding upper incisors. Violation of closure even in the area of ​​one tooth is a sign of abnormal development of the jaw apparatus. The advanced stages of crossbite are accompanied by deformation of the facial bones and the appearance of asymmetry.

Crossbite reasons

Crossbite develops gradually as the upper and lower jaws develop. The first signs of pathological occlusion are found in early childhood during the natural replacement of milk teeth with permanent incisors and molars. Facial asymmetry is considered a severe complication of crossbite when a child or already an adult has not received dental treatment to restore the correct position of the jaws.

The following are the most common causes of crossbite in children and adults:

• hereditary predisposition to abnormal development of the upper and lower jaw;
• Eating foods with low calcium levels
• chronic diseases of the paranasal sinuses (sinusitis, sinusitis, frontal sinusitis);
• too late teething in early childhood;
• slow erasure of milk teeth, which led to improper closure of the upper and lower jaw;
• carious damage to a large number of teeth with their further loss and impaired occlusion;
• consequences of a jaw fracture or complications arising after severe trauma to the facial bones;
• poor-quality prosthetics of those parts of the jaw apparatus, in the area of ​​which there are no healthy teeth;
• incorrectly performed restoration of half-destroyed teeth with the use of crowns and veneers.

The first prerequisites for the formation of a cross bite are laid in early childhood, when one or several negative factors affect the child's jaw apparatus. The sooner the reasons provoking the wrong occlusion are found, the more chances are for the complete elimination of dental pathology.

Symptoms

According to their manifestation, the signs of cross bite are divided into facial and oral. Symptoms of abnormal occlusion are determined by the orthodontist during the preliminary examination of the patient.

Facial signs

There are the following facial signs of cross bite in adults and children of different age groups:

• the upper and lower jaw are incorrectly positioned in relation to each other;
• the chin protrudes forward, or it has signs of underdevelopment;
• there are asymmetric changes in the right and left sides of the facial disc;
• the lower part of the chin is bent to the side;
• the presence of asymmetry causes excessive tension of the facial muscles, which can be manifested by various speech defects.

The severity of facial signs directly depends on the stage of pathological occlusion and the number of teeth involved in the formation of a crossbite. In especially severe cases, it is possible to change the lower shape of the face, the development of concomitant diseases of the jaw apparatus and joints.

Oral signs

The presence of oral signs of cross-bite is determined even in the absence of facial asymmetry.

Based on the results of a dental examination, the patient has the following symptoms:

• one or several lower incisors overlap the upper ones;
• the middle line in the area of ​​the upper and lower row of teeth does not coincide (the parameters of the deviations are directly proportional to the severity of the abnormal occlusion);
• at the moment of closing the jaws, the teeth slide off, and then take the wrong position in relation to each other;
• the lower and upper teeth have a curved arrangement;
• even with closed jaws, a person's mouth remains open all the time.

During the diagnostic examination of the patient, the orthodontist simultaneously takes into account the facial and oral signs of cross-bite. Based on the results of the dental examination, an appropriate decision is made on the tactics and scheme of further treatment.

Crossbite pathogenesis

The mechanism for the formation of a cross bite depends on the factors that influenced the human jaw apparatus. In 90% of cases, pathological occlusion of this type is the result of improper formation of the upper and lower jaw in childhood, when there is an age-related change of milk teeth to permanent ones.

The pathogenesis of crossbite is influenced by the factor of negative heredity, when such an anomaly is present in one of the blood relatives. In adults who initially had correct occlusion, the occurrence of pathological jaw closure is the result of severe facial trauma or the consequence of dental errors during the treatment of one or more teeth.

Classification and stages of development of crossbite

Crossbite (facial asymmetry is a complication of abnormal occlusion) is classified as 2 main stages, which are accompanied by deformational changes in the structure of the jaw apparatus. The table below describes in detail the stages of the formation of this pathology.

Crossbite stages	Characteristics of the development of incorrect occlusion
Dental alveolar	This stage of crossbite formation is characterized by improper closure of the upper and lower jaw at the level of the teeth. In this case, initially curved molars and incisors provoke further abnormal formation of the jaw apparatus. The dental alveolar stage of occlusion requires the immediate start of the therapeutic process to align the crooked teeth. Otherwise, crossbite will cause deformation of the facial skeleton and asymmetry of muscle tissue.
Skeletal	The presence of the skeletal stage of this occlusion indicates that a person has advanced pathological changes in the jaw apparatus. The formation of a cross bite occurred due to the incorrect location of the upper and lower jaw, caused by the curvature of the dentition, and also fixed at the level of the facial bones. The development of the skeletal stage of abnormal occlusion may be a consequence of the uneven growth of the jaw apparatus in early childhood or adolescence. Correcting cross bite is a very difficult task at this stage. The pronounced asymmetry of the face disrupts the work of muscle tissues responsible for chewing function, speech, the implementation of the swallowing reflex, the mobility of the zygomatic-orbital joints.

Orthodontists, who are involved in the correction of pathological occlusions, focus on the early diagnosis of a dental problem, as well as the beginning of treatment during the formation of the bite.

Timely elimination of negative factors affecting the jaw apparatus, grinding of the canines of the upper jaw, allow preventing the transition of pathology to the skeletal stage. Delay with the start of the therapeutic process at the orthodontist will require more radical methods of treatment in the form of surgery.

Complications of cross bite

Crossbite (facial asymmetry causes muscle dysfunction) promotes development accompanying complications in the form of damage to the outer shell of the teeth, injury to the structure temporomandibular joints.

On the part of hard tissues of teeth and periodontium

There are the following negative consequences for hard tissues of teeth and periodontium, which arise under the influence of cross-bite:

• rapid abrasion of root teeth (this complication is provoked by uneven contact of the upper and lower dentition);
• certain parts of the jaw apparatus are exposed to excessive stress, which leads to their faster wear and tear, damage to the outer shell of the teeth with further development of caries;
• deep cracks in the enamel of the anterior incisors, which cause painful sensations and also become an aesthetic defect;
• the formation of excess plaque and mineral deposits, the removal of which requires professional cleaning by the dentist.

Complications caused by the consequence of cross-bite are accompanied by progressive curvature of the teeth, which initially provoked the dentoalveolar stage of this occlusion. Damaged areas of the jaw apparatus require high-quality dental treatment.

Muscle dysfunction

Crossbite with signs of facial asymmetry causes the following muscle tissue dysfunctions:

• excessive tension of the circular muscle of the oral cavity to the right or left side;
• periodic spasms of the facial muscles;
• feeling of numbness or tingling in the area of ​​muscle skewing;
• compaction of those areas of the muscles that have been affected by asymmetry.

Adults and children with cross-bite symptoms that have caused muscle dysfunction have difficulty chewing rough food, reproduction of fast speech, it is difficult for them to open their mouth wide at an appointment with an otolaryngologist or dentist.

Changes in the temporomandibular joint

The presence of a cross bite creates an additional load on the temporomandibular joint, which causes the following changes in its work:

• pain when opening the mouth or eating rough food;
• clicks and crunching inside the joint;
• the development of a local inflammatory process;
• premature wear of the connective tissue;
• swelling of the right or left joint, depending on which side the lower jaw is curved.

Complications in the form of pathological changes in the temporomandibular joint can provoke acute tissue inflammation, and the treatment of data pathological consequences requires the simultaneous use of drugs, orthodontic equipment and surgical operations.

Why does facial asymmetry develop with cross bite?

The development of facial asymmetry caused by cross bite is provoked by severe deformity of the chin with further tension of the muscle tissues. The stronger the curvature of the lower jaw, the more pronounced the distortion of the muscles in the oral cavity and cheeks. Similar changes in appearance are characteristic of the skeletal stage of crossbite. The lack of adequate treatment leads to the aggravation of this pathology.

Cross bite diagnostics

An orthodontist examines patients with signs of cross-bite. The following diagnostic methods are prescribed for adults and children:

• visual inspection of the oral cavity;
• palpation of the upper and lower jaw;
• X-ray of the facial bones;
• a picture of the upper and lower jaw using a special computer device that creates a three-dimensional model of the patient's jaw apparatus;
• orthopantomography.

Patients who are indicated for a surgical operation are assigned additional studies in the form of a general analysis of urine, peripheral and venous blood, an ECG. Based on the results of the diagnosis, a further treatment regimen is determined.

At what age can the bite be corrected?

Correction of cross bite is indicated for children from the age of 7 years. It is believed that the elimination of pathological occlusion must be carried out until the moment when the child turns 15 years old. In patients of this age group, the jaw apparatus is at the stage of active development, which facilitates the process of therapy.

Crossbite treatment

Crossbite (facial asymmetry appears gradually as the skull bones are deformed) is treated with orthodontic appliances or surgery.

Orthodontic therapy

The use of this method of treatment is indicated for children diagnosed with a dentoalveolar stage of occlusion. The following types of orthodontic appliances are installed on top of the surface of the curved dentition:

• braces;
• metal plates;
• removable mouthguards;
• children's aligners.

If necessary, additional grinding of the canines of the upper jaw is carried out to form an anatomically correct bite. The alignment of the teeth helps to stop the further progression of cross-occlusion, and also prevents dental complications.

Surgical therapy

Surgical treatment is indicated for children and adults with the skeletal stage of crossbite. In this case, surgery is performed using general anesthesia. The surgeon removes the deformed tissues of the jaw, gives the facial bones the correct position. In especially severe cases, fixing metal structures are used to consolidate the therapeutic result. Additional wearing of the orthodontic system may be required after successful surgery.

How to correct facial asymmetry

Postoperative correction of facial asymmetry is carried out using the following techniques:

• daily massage of muscle tissue;
• injection of botox and hyaluronic acid injections;
• warming up muscles with dry heat to activate local blood circulation;
• stimulation of the facial muscles with electrical impulses (this procedure should be carried out by a qualified cosmetologist).

Eliminating the signs of facial asymmetry requires regular work with muscle tissues that have been negatively affected by crossbite. The process of complete restoration of the appearance can take from 1 to 2.5 years.

Anchoring phase after therapy

Crossbite (facial asymmetry is diagnosed based on the results of a preliminary examination by an orthodontist) requires long-term and complex treatment. To consolidate the positive results of therapy, the following rules must be observed:

• do not sleep on a pillow that is too high or too low;
• get rid of the habit of constantly touching the tip of the tongue to the inside of the upper or lower teeth;
• do not put the lower jaw in an initially incorrect position;
• do not support the cheek with your hand, causing it to bend to the right or left side;
• perform daily gymnastics to train and restore the facial muscles, which have undergone deformational changes due to asymmetry;
• do not eat too coarse or hard food, the effect of which can lead to displacement of the jaws with further restoration of abnormal occlusion;
• make sure that the bone tissues of the upper and lower jaw are not exposed to cold air masses (for example, if the patient with the skeletal stage of crossbite underwent surgery to restore the correct closure of the jaw apparatus);
• use fermented milk products, ocean and sea fish, chicken eggs, meat to enrich the body with a sufficient amount of calcium, phosphorus and other mineral components.

Patients who have received high-quality treatment from an orthodontist, have achieved a complete correction of cross-bite, should regularly undergo preventive examinations by this specialist. The schedule of scheduled examinations is drawn up by a doctor.

Errors in correcting cross bite

Apparatus and surgical treatment of cross-occlusion can be successful with full restoration of the functions of the jaws, or else it will cause a worsening of clinical symptoms.

In dental practice, there are the following most common mistakes that are made by orthodontists in the treatment of pathological occlusions of this type:

• incorrectly selected therapy tactics;
• excessive or insufficient grinding of the upper canines was performed, which did not bring the desired result in terms of the correct closing of the jaws;
• after removing the braces or orthodontic plates, the level of inclination of the teeth changed, and their edges began to protrude from under the upper lip;
• the upper incisors are no longer parallel to the lower lip;
• signs of deformation changes in the facial bones have been preserved.

The above defects are gross violations of the therapeutic protocol of the orthodontist, aimed at correcting cross-bite, as well as restoring full functions of the jaw apparatus. The presence of facial asymmetry, which remained after the treatment, also indicates potential errors. In this case, it will be necessary to undergo a repeated examination of the facial bones, muscle tissues, upper and lower jaw.

Forecast

The prospect of a complete elimination of crossbite is absolutely real if treatment by an orthodontist began in the early stages of the development of pathology. Abnormal occlusion of the dental alveolar type is amenable to hardware therapy with the use of braces, orthodontic appliances, and resurfacing of the lower part of the canines.

In this case, the correction of cross bite occurs without the development of negative complications for the jaw apparatus, facial bones and muscle tissues. Treatment started at the dental alveolar stage of occlusion guarantees a faster restoration of the normal closure of the teeth.

A neglected form of crossbite, when the disease has passed to the skeletal stage, reduces the chances of successful restoration of the jaw apparatus. In such a situation, the orthodontist, as well as his assistants, need to carry out complex treatment of the patient using the method of surgical intervention.

After the completion of the stage of surgical therapy, fixing manipulations are performed to fix the bones with orthodontic plates, bracket systems, and aligners. The risk of developing postoperative complications in the form of bone inflammation, infection of the operated areas of the jaw is not excluded. After the completion of complex treatment, residual signs of facial asymmetry may remain.

Crossbite is a consequence of improper development of the dentition, bones of the upper and lower jaw. This pathology is characterized by a violation of the closure of the incisors located opposite each other. This type of occlusion differs in that the lower teeth overlap the upper ones. Crossbite is formed in childhood, when milk teeth are naturally replaced with permanent incisors and molars.

The dental alveolar stage of this disease lends itself well to complex treatment using the methods of mechanical resurfacing of the canines, the imposition of braces and orthodontic plates. The complicated form of cross-bite passes into the stage of skeletal deformities, when the patient's chin shape changes, facial asymmetry develops.

Crossbite video

Cross bite. Causes. Consequences. Treatment: