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51
Introduction.
Cross bite refers to transversal anomalies, which is one of the complex bite
anomalies. It is caused by the mismatch of transversal size and shape of the dentition
[1].
In the
scientific literature use different terms for characterizing cross-bite: oblique, lateral, buccal, vestib-
ular, and buccal- lingvoocclusion, lateral forced bite, cross-bite articular, laterognatia, laterogeny,
laterodeviation, laterodisgnatia, lateroposition, exo- and endoocclusion
[2].
Cross occlusion is one-
and two-sided. In the occurrence of cross-occlusion can be blamed as one dentition (upper or low-
er), and both dentition, as well as the jaw bones. Clinically, this form is manifested by the follow-
ing facial signs: facial asymmetry, which depends on the shape and severity of the anomaly, one-
or two-sided impairment, the degree and extent of the interruption of the dentition, the dental alve-
olar or skeletal anomaly; violation of the configuration of the face, the displacement of the chin in
the direction of the lips and chin obliquity.
In palatoccluses, palatine hillocks of the upper posterior teeth are projected when orally clos-
ing from the longitudinal fissures of the same lower teeth as a result of a decrease in the transverse
УДК 616-08+616.314.26:616-092
DIAGNOSIS OF CROSS-BITE IN ADOLESCENT CHILDREN
J. I. Durdiev, S. R. Abasniya
Bukhara state medical institute, Bukhara, Uzbekistan
Urgench branch of the Tashkent medical academy, Urgench, Uzbekistan
Keywords:
diagnostics, cross-bite, frequency of occurrence.
Таянч сўзлар:
кесишган тишлам, текшириш, учраш даражаси.
Ключевые слова:
диагностика, перекрестный прикус, частота встречаемости.
Cross bite refers to crossover anomalies. The reasons for the development of cross bite are diverse: inflamma-
tion and the resulting violation of jaw growth, reduction of chewing function or chewing on one side, violation of the
timing and sequence of teething, non-wrinkled tubercles of milk teeth and uneven contact of dental lines, violation of
nasal breathing, improper swallowing; common diseases associated with impaired calcium metabolism; congenital
clefts of the sky, impaired myodynamic balance, consequences of injuries. Common causes of cross-bite are disorders
in the musculoskeletal system, dysplastic diseases, systemic damage to the entire skeleton, including the dental appa-
ratus. Delayed diagnosis cross-bite increases the terms of treatment and social adaptation of the child.
ЁШ БОЛАЛАРДА КЕСИШГАН ТИШЛАМНИ ТЕКШИРИШ
Ж. И. Дурдиев, С. Р. Абасния
Бухоро давлат тиббиѐт институти
Тошкент Тиббиѐт Академияси Урганч филиали
Кесишган тишлам жағларнинг трансверзал йўналишидаги аномалиясига киради. Кесишган тишлам ри-
вожланиш сабаблари турлича бўлиши мумкин: яллиғланиш жараѐни ва шу сабабли суяк ўсишини бузилиши,
чайнов функциясини пасайиши ѐки бир тамонлама чайнаш, тишларнинг чиқиш муддати ва кетма-кетлиги бу-
зилиши, сут тишларнинг дўмбоқлари едирилмаганлиги ва бурундан нафас олишнинг бузилиши, нотўғри юти-
ниш; кальций алмашинуви бузилиши билан боғлиқ умумий касалликлар; туғма танглай кемтиклиги, жароҳат
асоратлари ва миодинамик баланс бузилиши. Кесишган тишлам ривожланишида умумий омиллар: таянч хара-
кат тизимида бузилишлар ва диспластик касалликлар сабаб бўлиши мумкин.
ДИАГНОСТИКА ПЕРЕКРЕСТНОГО ПРИКУСА У ДЕТЕЙ ПОДРОСТКОВОГО ВОЗРАСТА
Ж. И. Дурдиев, С. Р. Абасния
Бухарский государственный медицинский институт, Бухара, Узбекистан
Ургенчский филиал Ташкентской медицинской академии, Ургенч, Узбекистан
Причины развития перекрестного прикуса самые разнообразные: воспалительный процесс и обуслов-
ленное им нарушение роста челюсти, понижение жевательной функции или жевание на одной стороне, нару-
шение сроков и последовательности прорезывания зубов, нестершиеся бугры молочных зубов и неравномер-
ные контакты зубных линий, нарушение носового дыхания, неправильное глотание; общие заболевания, свя-
занные с нарушением кальциевого обмена; врожденные расщелины неба, нарушение миодинамического рав-
новесия, последствия травм. К общим причинам развития перекрестного прикуса относятся нарушения в
опорно-двигательном аппарате, диспластические заболевания, системное поражение всего скелета, в том чис-
ле и зубочелюстного аппарата.
J. I. Durdiev, S. R. Abasniya
Доктор ахборотномаси № 2—2019
52
dimensions of the upper dentition. At the same time, during the closing, the palatal hillocks of the
posterior teeth of the upper jaw are not in contact with the longitudinal fissures of the lower poste-
rior teeth, but with their lingual tubercles and, when the anomaly is pronounced, they can remain
without contact.
Lingvo-occlusion, formed by narrowing the lower dentition, is characterized by the fact that
the palatal tubercles of the upper posterior teeth are projected when they are closed in the cheek
side from the longitudinal fissures of the lower teeth of the same name and come into contact with
the cheek tubercles of the premolar and molars of the mandible.
Vestibular occlusion is formed as a result of an increase in the size of the upper and lower
dentitions in the transverse direction. The vestibular occlusion can also be one- and two-sided.
When vestibular occlusion, formed by increasing the transverse size of the lower dentition, there is
a significant overlap of the upper posterior teeth of the lower. Late diagnosis of cross-bite increas-
es the duration of treatment of pathology, as well as the social adaptation of the child
[3].
Materials and methods.
As a result of orthodontic examinations, the prevalence of dental-
anomalies was studied, namely the frequency of occurrence of cross-bite among patients aged 12
to 14 years. A total of 150 people were examined, who sought specialist advice, out of a total of 20
adolescents, a cross bite of various forms and severity was revealed.
Orthodontic diagnosis is preceded by a complete clinical, functional and instrumental exami-
nation. During the examination, patients were conducted clinical, radiological and functional diag-
nostic methods.
Clinical examination methods. Complaints were collected, anamnesis was collected, a gen-
eral examination, an examination of the face and oral cavity, and palpation of the temporomandib-
ular joint when lowering and raising the lower jaw.
Additional examination methods. To measure the size of the teeth, the width of the dentition
and the apical bases (according to the methods of Pon, Linder-Hart, NG Snagina), the study of the
head TRG in a direct projection.
Biometric methods for studying models of the jaws make it possible to determine the topog-
raphy and severity of morphological abnormalities in anomalies of the development of the jaws
and dentitions, help to make the correct diagnosis and substantiate the optimal treatment plan for
the patient. Measurements of models of the jaws are based on the existence of regularities in the
relationship between the sizes of teeth on the one hand and the sizes of dentitions, apical bases on
the other
[4].
Functional tests were also applied. Clinical functional tests give an idea of the direction of
displacement of the lower jaw and its causes, impaired dentition closure, changes in TRG, the size
of the interocclusal space in the region of the posterior teeth, differences in the voltage of the mas-
ticatory muscles on the left and right, and the asymmetry of the facial skeleton. Our patients were
carried out functional test by Ilina-Markosyan
[5]:
1. When examining a patient, the position of the lower jaw was assessed at rest and during a
conversation, which made it possible to identify facial bite anomalies.
2. Patients were asked to close the rows of teeth without opening their lips. With anomalies
caused by the displacement of the mandible, the facial signs of the violation became more pro-
nounced, respectively offsets. Sagittal abnormalities were recorded by changing the profile of the
face, horizontal - by changes in its face.
3. Patients were asked to open their mouth wide. With cross-bite with displacement of the
lower jaw, due to pathology of the temporomandibular joint or its size, the asymmetry of the face
increased. In cases where there was a ―habitual‖ displacement of the jaw, the asymmetry was elim-
inated. The displacement of the midline between the incisors in the upper jaw was evaluated in
relation to the mid-sagittal plane of the face, and in the lower jaw in relation to the center of the
upper dental arch.
Results and discussion.
As a result of the examination, 20 cases of cross bite of various
forms were identified, of which 8 were boys and 12 girls. It was established vestibular occlusion in
Оригинальная статья
Доктор ахборотномаси № 2—2019
53
4 patients, lingual occlusion in 13 patients and palate occlusion in 3 patients.
Age
12 years
13 years
14 years
Boys
4
2
2
Girls
5
3
4
Table 1.
Distribution of adolescents by gender and age.
A survey of some patients revealed complaints of pain in the temporomandibular joint
(TMJ), due to a decrease in the number of occlusal contacts, the chewing function, chewing of the
cheek mucosa, abnormal speech articulation (dyslalia) were disturbed, and patients also noted the
appearance of crunch and pain when opening the mouth.
During the clinical examination, asymmetry of the face was revealed, therefore, a violation
of the face aesthetics, while the patient's chin is shifted to the side, the upper lip on the same side
sinks, the opposite side of the lower part of the face is flattened. On examination of the oral cavity,
the dilation of the 4 and narrowing of the dentition in 16 patients, displacement of the mandible,
impaired contact of the posterior teeth, intersection of the dentition when the jaws were closed,
misalignment of the labia of the lower and upper lips and the midline of the dentition relative to
the midline of the face decreased lower third of the face, pronounced chin fold. When viewed in 2
patients, a blockage of the mandible was noted - a dysfunction of the TMJ develops; further high
risk of deforming arthrosis of the TMJ. As a result of the uneven distribution of chewing pressure
in almost 100% of patients, development of lesions of periodontal tissues — periodontitis of mild
and moderate severity — is observed.
After the collection of complaints and clinical examination were conducted biometric stud-
ies. To determine the width of the dental arches, the Pond method was used, which established the
relationship between the sum of the width of the crowns of the upper four incisors and the width of
the dentitions in the area of premolars and molars. The teeth are marked with dots: on the upper
4th middle of the inter-tubercular fissure, on the upper 6th anterior depression of the interbugular
fissure, on the lower 4th most distant point of the slope of the buccal tuber, on the lower 6th apex
of the posterior or middle buccal hill. Then, the obtained data were compared with the average in-
dividual norm (according to Linden - Hart) taking into account the shape of the face, determining
the degree of narrowing of the dentition, symmetrical or asymmetric narrowing.
Biometrics - Pon's method (narrowing in the area of premolars in the upper jaw by 7.2 + 1.5
mm, at the lower one - 8.3 + 1.1 mm; narrowing in the area of the molars, respectively, by 9.9 +
1.2 mm and 9, 2 + 0.81 mm), Bolton (discrepancy between the size of the incisors and canines of
the upper jaw with the sizes of the corresponding teeth on the lower jaw), Tonn (index 1.26), N.G.
Snagina (narrowing of the apical base of the lower jaw 2 degrees in 9, 1 degree in 11), offset of the
midline of the lower dentition, its mismatch with the middle line of the upper dentition by 3 + 1.2
mm, sagittal slit - 3 + 2.2 mm , the overlap of the lower incisors with the upper more than 2/3 of
the height.
To substantiate the diagnosis, teleroentgenography (TRG) of the head was performed in a
direct projection. The TRG was decoded using the R.M. Ricketts method. The following indicators
were revealed: the distance between the upper and lower molars from the right and the left (1.3 +
0.9 mm), the lower intermolar width (50.0 mm), the lower interfangular width (24.3 + 0.2 mm),
the position of the middle line (1.0 + 0.3 mm). The interposition of the lower first pattern and the J
-Ag line (15.3 + 0.5 mm), the middle lines of the dentition and jaws (0.4 + 0.15 mm) and the posi-
tion of the occlusal plane (0.8 + 0.21 mm).
Consultations of specialists from related specialties were recommended for the planning of a
comprehensive individual treatment - a therapist, the need is the presence of carious teeth; the sur-
geon, the need for a history of pain in the temporomandibular joint; orthopedist, necessity - identi-
fication of secondary edentulous in 2 patients; periodontist, the need - almost 100% of patients
J. I. Durdiev, S. R. Abasniya
Доктор ахборотномаси № 2—2019
54
noted the development of damage to periodontal tissues - gingivitis, periodontitis mild and moder-
ate severity.
Conclusions:
1. In the process of diagnosing patients, it was found that in most cases the cause of the de-
velopment of transversal anomalies was a violation of the sequence of eruption of lateral
(premolars, molars) teeth. The prevalence rate among adolescents aged 12-14 years is higher.
2. When making a reliable diagnosis of anomaly, its form and severity, planning appropriate
treatment, teleroentgenography takes an important place.
3. Joint diagnostic examination and treatment planning with doctors of other specialities, dy-
namic monitoring of the patient’s condition allow approaching the patient’s treatment more indi-
vidually and comprehensively.
4. It is advisable to identify and eliminate diseases and anomalies of the teeth in children:
this contributes to the correct formation of dental arches, preventing the formation of cross bite,
asymmetry of the facial skeleton, periodontal pathology and temporomandibular joint.
References:
1. Anokhina, A.V. A system for the early detection and rehabilitation of children with dental-anomalies: Abstract.
dis. ... Dr. med Sciences / A.V. Anokhina. Kazan, 2008. 36 p.
2. S.N. Gontarev, Yu. A. Chernyshova, I. E. Fedorova, I. S. Gontareva. Cross bite in orthodontic practice // Scien-
tific vedomosti. Medicine Series. Pharmacy. 2013. № 11 (154). Issue2 2/1-Belgorod. p.26-28.
3. Propedeutic orthodontics: study guide / Yu.L. Obraztsov, S.N. Larionov. Ch. 5 2007 p. 160.
4. General orthodontics: proc. Method. manual / I.V. Tokarevich, L.V. Kipkaeva, N.V. Korkhova, A.G. Korenev.
Minsk: BSMU, 2010. p.18-19.
5. Vavilova, T.P. Prevention of dental diseases in the treatment of modern fixed orthodontic appliances / T.P.
Vavilova, M.V. Korzhukova. M., 1997. 36 p.
Оригинальная статья
