PERUVIAN WINGS UNIVERSITY

VICE-RECTORATE OF RESEARCH AND POST DEGREE

SECOND SPECIALTY IN STOMATOLOGY
ORTHODONTICS AND MAXILLARY
ORTHOPEDIC

Vinay K. Chugh, Vijay P. Sharma, Pradeep, Tandon, and Gyan P. Singh

Fountain
Department of Orthodontics and Dentofacial Orthopedics, MG Dental College and
Hospital,
Jaipur, Rajasthan, India. Department of Orthodontics and Dentofacial Orthopedics,
MG College of
Dentistry and Hospital, Jaipur, Rajasthan, India.

Members:
Franco Barriga Juan Carlos
Pacori Ramirez Eleazar
Rodriguez Chipana Orlando.
 Introduction
• Total buccal crossbites, Brodie bite, buccal
monocclusion, scissor crossbite, or telescoping bite
are rare, but when they occur, they can be
extremely difficult to correct, even with surgery
and orthodontics. In most patients with scissors
crossbites, the upper teeth erupt beyond their
lower antagonists, creating serious occlusal
difficulties.
• A tendency toward maxillary buccal crossbite is
found in Australian aborigines, who otherwise
have ideal dentitions and perfect occlusions.
• Barrett called these "X" occlusions. Although in
principle it may be a transverse discrepancy with
failure in the maxilla or mandible, or in both jaws,
becoming a problem because the unopposed teeth
overerupt in the arch, creating a situation of
lengthening of the posterior teeth that need to be
intruded by several millimeters and its lateral
repositioning.

ec
• The loss of a tooth can have significant effects
on the stability of both arches. With the loss of a
lower first molar, the second and third molars
migrate mesially, the mandibular second
premolars move distally, and the upper first
molar overerupts.
• The mesial inclination of the mandibular second
molars produces redundant edematous gingiva,
accumulating on the mesial surface, creating a
space inaccessible for hygiene.
• The mesial inclination causes the distal cusps of
the second molar to create an occlusal
prominence, creating occlusal deflective
excursive contacts that generate horizontal
forces on the molars of both jaws.
 Summary
• This article presents a young patient
with a scissors bite or bilateral partial
telescopic bite in the posterior region
and who had her lower right first molar
extracted. The patient was treated with
lower arch expansion, and the anterior
open bite was closed with the help of
masticatory muscle exercises and other
high-traction appliances. The second
and third molars were verticalized and
mesialized to close the extraction
spaces.
 Case report
A 17-year-old patient presented to the department of
orthodontics and dentofacial orthopedics, King George's
University of Dental Sciences, India. His main complaint was
the inability to chew with his posterior teeth.
The intraoral examination. She had a bilateral scissors bite in
the region
later. His right mandibular first molar had been extracted 4
years ago
before due to a poor endodontic prognosis, resulting in a tilt
and
Mesial migration of the second molar.
This malocclusion developed partially due to lingual inclination
of
the mandibular buccal segments and partially due to the loss
of the
first molar (fig 1 and 2).

Fig. 1
The maxillary right and left posterior teeth were
extruded, and the buccal surface of the first molar
was worn away, with the underlying dentin exposed.
She had a class I MRI and class II MRI due to mesial
migration of the mandibular right second molar. The
dental midline was deviated 1.5 mm to the right side.
Aside from the Brodie bite and the mesial tilt and
migration of the mandibular second molar, almost
everything else about his occlusion was within
acceptable limits.
 Cephalometry
Variable
Pretrea
Normal change
Posttreat s
He indicated that
tment ment
she was average,
SNA (°)
SNB (°)
82
79
82+- 3
79 +-3
82
79
0
0 with a class I skeletal
pattern. The soft
ANB (°) 3 3 +- 1 3 0
Wits projection (mm) -1 0 -2.5 -1.5

tissue profile is
Incisor angle superior to the plane 118 108 +- 5 118 0
maxilla (°)
Angle of the lower incisor to the plane 95 92 +- 5 97 2
mandibular (°)
Interincisal angle (°) 124 133 +- 10 123 -1
convex with good
Angle
maxillomandibular(°)
of the flat 24 27 +- 5 24 0 symmetry
Height to the upper edge of the
anterior
(mm) face
56 56 0
frontal and the
Height to the lower edge of the anterior 66
(mm)
66 0
facial proportions.
Facial height radius (%) 54 55 54 0
Lower incisor to the APo line (mm) 3 0-2 3.5 0.5
Lower lip to Ricketts E plane 3 -2 3 0
(mm)
Upper lip to line (mm) 0 -2- -3 0 0
 The panoramic x-ray
• He showed
dentition
permanent

complete,
except for the
extraction of the
lower right first
molar, and the
severe tilting and
mesialization of the
second molar in the extraction space.
 Treatment
• Treatment options were limited for this patient.
She declined to consider surgery, but, because
the problem was caused primarily by the
buccolingual tilt of the dentition rather than an
underlying skeletal problem, a nonsurgical
approach was feasible. By it as he
treatment plan
certain for the correction dental with
braces
Standard edgewise 0.022 x 0.028 in. The
mandibular arch would be expanded, the
maxillary arch compressed, and the mandibular
molars straightened. High tensile with a force of
500 g per side would be used throughout the
expansion period, cross elastics were used to help
minimize molar extrusion and promote intrusion.
Removal of the third molar (except the
mandibular right) would provide space for
alignment.
 TREATMENT PROGRESS
Bite lift.
Alignment and leveling.
Expansion of the mandibular arch.
Verticalization of the molars.
 Fig. 6

g. 7
Periapical radiographs
 Treatment Results
In general. The patient's treatment was excellent, and his
cooperation with extraoral appliances tightening exercises and oral
hygiene was good.
Occlusion ended in a bilateral molar and canine class I relationship.
The scissors bite and anterior open bite were corrected, and the
resulting profile was satisfactory.
Superimposition of pre-treatment and post-treatment cephalograms
demonstrated intrusion of the maxillary molars and slight extrusion
of the mandibular molars. The upper molar was invaded
approximately 2 mm. Superimposition also showed mesial
movement of the right mandibular molars and slight forward
inclination of the mandibular incisors. Overall, the superimposition
showed that facial height was the same as before treatment (Fig. 10)
• When correcting a telescopic bite, we will need to lift the
bite and this is done with removable occlusal plates and the
complete cooperation of the patient.
• Several treatments have been developed to correct scissors
bite. These procedures are aimed at improving the molar
position since some teeth may be in abnormal positions
(extruded or have a buccal or lingual inclination).
• Ex. With orthodontic surgery we can correct the vertical
inclination (it could be solved) But at the same time it
leads to the inevitable opening of the anterior bite caused
by the supraeruption of the posterior teeth as a result of
straightening. In turn, this open bite has been managed in
one step , but had to rely on a combination of high
traction with a harness and masticatory muscle exercises.
• In a prospective study of the principles of open bite treatment, it has been
shown that light masticatory exercises combined with a high-pull headgear
produced significant reductions in ANB and mandibular angles and
mandibular autorotation, reducing by 2.2°. the same modality in which the
patient was asked to gently clench his bite (GAC International Bohemia NY)
for 1 minute 5 times per day, each session includes 1 minute 5 seconds of
isometric clenching (80% of maximum) followed by 5 seconds of rest the
English Olfert recommends this treatment for growing patients, adult
patients can also be used, but with greater intensity and longer duration at
least 5 minutes every hour for at least 6 hours. Sugar-free gum is also advised
as much as possible. The patient showed excellent cooperation with the
high-pull harness and following the instructions of the exercises for the
masticatory muscles, so the bite was brought to the pretreatment level. That
is, open bite and closure was carried out only by the intrusion of the
posterior teeth; No mechanics were used for extrusion of the anterior teeth.
The left mandibular third molar was extracted. Space closure was
favored by straightening followed by prosthesis to achieve a better
prognosis and long-lasting functional results. The lower right second
and third molars were mesialized in a considerable amount of time.
The mesialization was performed with section mechanics using a T-
loop to generate the moments necessary for root movement. The
patient had excellent oral health during treatment, and the mesial
bone defect resolved. Bonded Labial retainers were used in the
buccal segments. And tightening exercises were indicated. The
objectives were achieved. Good molar and canine class I
relationships were established.
 GNG"ISSIONS
• The Tooth migrates after the extraction of the first permanent molar as
a result there is periodontal deformity and "collapse" of the occlusion.
Deviations from the normal alignment of teeth bring irregular changes
in gingival and bone architecture. and complicates oral hygiene
(complete plaque removal) leading to progressive disease in the form
of inflammation, attachment loss and caries. It becomes evident that
proximal and occlusal contacts are important in maintaining tooth
alignment and arch integrity. Treatment can improve chewing
function, aesthetics, occlusion and periodontal condition. Chewing
exercise is an important adjuvant treatment in the correction of
malocclusion and an open bite. Although surgery or mini screws
means that virtually any malocclusion can be corrected, understanding
and correct application of the fundamental principles of biomechanics
can still make a big difference. If the patient is reasonably motivated,
adult orthodontic therapy can provide comprehensive rehabilitation in
function and appearance with a satisfactory long-term prognosis.
fig. 10. Cephalometric overlay of 17 years
(black) and 18 years and 6 months (red)
 BIBLIOGRAPHY
• Harper DL. Case report of a Brodie bite. Am J Orthod
Dentofacial Orthop 1995; 108:201 – 6.
• Seward FS. Tooth attrition and temporomandibular
joint. Angla orthod 1976; 46:162-70.
• Okeson JP. Management of temporomandibular
disorders and occlusion. &th Ed. St. Louis; Mosby: 2008
• McLaughlin RP. Bennet JC Trevisi HJ. Systemized
orthodontic treatment mechanics. 1st Ed. St Louis:
Mosby 2001. p. 92 and 290.
thank
you