Article ID: WMC005190 ISSN 2046-1690

Comparison of Orthodontic Techniques used for

treating patients with severe form of scissor bite: a
systematic review
Peer review status:
No

Corresponding Author:
Dr. Emanuele Fantasia,
Attender, Oral and Maxillo Facial Sciences Department, La Sapienza, Orthognatodonthics Unit, Via dei Ramni 24
sc. B int. 2, 00185 - Italy

Submitting Author:
Dr. Emanuele Fantasia,
Attender, Oral and Maxillo Facial Sciences Department, La Sapienza, Orthognatodonthics Unit, Via dei Ramni 24
sc. B int. 2, 00185 - Italy

Other Authors:
Dr. Martina Maria D'Emidio,
Attender, Oral and Maxillo Facial Sciences Department, La Sapienza, Orthognatodonthics Unit - Italy
Dr. Gabriella Padalino,
Attender, Oral and Maxillo Facial Sciences Department, La Sapienza, Orthognatodonthics Unit - Italy
Dr. Giuseppe Rodi,
Attender, Oral and Maxillo Facial Sciences Department, La Sapienza, Orthognatodonthics Unit - Italy

Article ID: WMC005190

Article Type: Systematic Review
Submitted on:07-Oct-2016, 09:45:09 AM GMT Published on: 10-Oct-2016, 05:42:16 AM GMT
Article URL: http://www.webmedcentral.com/article_view/5190
Subject Categories:ORTHODONTICS
Keywords:Scissor bite, buccal bite, Brodie syndrome, Brodie bite, Class II malocclusion
How to cite the article:Fantasia E, D'Emidio M, Padalino G, Rodi G. Comparison of Orthodontic Techniques
used for treating patients with severe form of scissor bite: a systematic review. WebmedCentral
ORTHODONTICS 2016;7(10):WMC005190
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.

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Comparison of Orthodontic Techniques used for

treating patients with severe form of scissor bite: a
systematic review
Author(s): Fantasia E, D'Emidio M, Padalino G, Rodi G

Abstract When the problems of this malocclusion are

predominantly skeletal, they will be corrected by
functional or mechanical orthopedic appliances,
requiring much patient compliance2-4, as they could
Background: Severe forms of scissor bite or Brodie
require a surgical-orthodontic treatment. If this doesn’t
syndrome is rare orthodontic malocclusion that occurs
occur the treatment time will increase and the risk of a
with a frequency of 0.01% in general population.
failure of the orthodontic therapy too3.
Several methods have been described to obtain a
correction from a dental, skeletal and soft tissutal The Class II malocclusion, in particular the first
points of view. In literature it was described: jaws division type, with a proclination of the upper central
osteotomies, surgery first approach, as the use of incisors, can sometimes relate with a scissor bite. It
orthopedic-functional devices and extractions with the can be partial or total, unilateral or bilateral as in the
fixed multibrackets orthodontics combined with Brodie bite 5 , also called buccal nonocclusion or
miniscrews for the skeletal anchorage. The aim of telescopic bite. It’s a rare form of malocclusion with a
work is to compare all the treatment to evaluate their prevalence of 0.01% in the general population6, but
applicability, efficacy, effectiveness and relapsing risk when it occurs it can be extremely difficult to correct,
in combination with the compliance of patients. even with surgery7 and orthodontic treatment. Total
scissor bite eliminates the lateral and the protrusive
Results: The ortho-surgical correction remains the
excursions as it determines significant alterations in
golden standard in severe dentofacial deformities
the eruptive sequence of permanent teeth in the form
because of its more applicability, lower risks of failure
that maxillary teeth erupt past their maxillary
and rapidity, as it doesn’t need patient compliance.
antagonists. This particular bite was defined by Barrett8
However not all the patients accept to undergo surgery,
an “X occlusion”. This malocclusion seems to originate
so pure orthodontic approach is need. So the
from a discrepancy between the transverse diameters
combination of fixed orthodontics with skeletal
of maxilla and mandible. However, the orthodontic
anchorage has proven the best effective and stable to
problems spread also in the other spatial planes as the
5 years from therapy. In young patient with mild form
unopposed teeth in each arch sopraerupt. In this way
of malocclusion when it was intercepted early, a
the posterior teeth need to be intruded and
functional therapy should be attempted.
repositioned laterally.
Conclusion: Each form of clinical case requires a
In general, the total scissor bite recognizes a
proper evaluation considering the age of patient, the
dento-alveolar discrepancy, because the mandibular
features of pathology as the presence of other
alveolar process is narrow whereas the maxilla is
complications. So there isn’t a standard approach, but
normally developed. Many clinicians reported severe
sure the orthognathic surgery as in recent times the
articular problems to TMJ (temporo-mandibular joint).
combination of fixed orthodontics with skeletal
These could be due to the alterations of mouth
anchorage could provide adequate skeletal and
functions and in particular of the mastication9. The
dento-alveolar changes useful to reduce the
great vertical overlap of the two arches represent the
malocclusion.
handicap of positioning the orthodontic brackets on the
Introduction surfaces of mandibular teeth.
Till now, no studies have been performed to analyse
all the orthodontic problems related to the treatment of
In orthodontics the most frequent type of malocclusion severe forms of scissor bite. So the aim of this work is
is the Class II. It can be classified into three forms: the to lead a systematic review of literature to select all the
skeletal type, the dento-alveolar type, and the pure articles focused on the therapy of severe scissor bite
dental type. These alterations require dental or and to collect all data about the treatment time,
skeletal effects depending on the kind of treatment.1 efficacy as the risk of relapsing to the malocclusion.

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Materials and Methods than normal patients, ranging between +3 and +16
mm, as the overbite is also increased from +4 to +11
mm. All the cases have Angle class II malocclusion for
the molar and canine occlusion, but a small group
There are few articles on international literature about
shows a subdivision with a I class relationship on one
this topic so all the possible synonyms for this
side, generally the left side.
malocclusion have been searched. The systematic
review of literature has been performed on the The literature reported a wide variability in the
principal medical databases: PubMed (Medline), Lilacs cephalometric landmarks: the SNA angle ranges from
and Scopus. The keywords used were: Class II 78.5 to 85 degrees, while SNB angle shows a greater
malocclusion, Brodie syndrome, Brodie bite, scissor variability with a range from 69.5 to 80 degrees, ANB
bite, buccal bite and telescopic bite to identify all angle has values comprised between 5.0 to 10.6
articles reporting on the treatment of Class II degree. Some patients at the Tweed analysis show to
malocclusion with scissor bite until September 2016. be iperdivergent with a FMA angle higher than 29.5
No restrictions of time and languages have been fixed. degrees (ranges from 29.5 to 35 degrees), while a
The results have been filtered and valued following our small group has serious form of deepbite. All the
eligibility criteria and then organized following the patients show a considerable proclination of the upper
PRISMA method10. central incisors, with the angle between these teeth
and Frankfurt plane comprises between 118 and 134
The search identified 15,329 abstracts, which were
degrees.
reviewed manually and each article of interest was
marked for further review. The full text of the marked Etiology
studies was retrieved and studies that satisfied our This malocclusion can result from either excessive
eligibility criteria were included in this review. The width of the maxilla, deficient width of the mandible or
eligibility criteria were: availability of abstracts; a combination of both with variable expression. So
accurate description of clinical case with clinical finds; except for rare form related to bad habits as
inclusion of treatment plan; evaluation of treatment swallowing, finger sucking or pacifier sucking, that
results with radiographic records, at least radiographic have been early intercepted in children, all the other
pantograms and lateral cephalometric radiograms; cases don’t show a relation with functional alterations.
accurate description of follow up of at least five years. So the skeletal relationship of malocclusion is probably
At the end of the selection, we identified nineteen related to hereditary influences. This consideration is
articles. proven by the observation that many patients reported
other forms of scissor bite or Class II malocclusion in I
Results division, that can present variable expressivity.
Treatment objective
All the data reported in literature have been collected Analysing only the orthodontic problems of the severe
in Microsoft Excel 2013 and have been classified scissor bite combined with a Class II malocclusion the
according to the steps of the orthodontic clinical treatment plan must take in account: the establishing
protocol. of normal skeletal relationship, narrowing the maxilla,
advancing the mandible, and reducing the maxillary
Diagnosis
vertical excess; correct the dental relationships and
Patients reported in literature with severe forms of improve occlusal function, improving overbite and
scissor bite have a great variability in age at the overjet, archiving class I relationships bilaterally, at
moment of the diagnosis and of the planning of the least at the canine occlusion, aligning dental midline;
treatment. So this could be interpreted as a significant and finally the treatment must improve facial
grade of variability in all the phases of treatment, but in aesthetics, reducing the gingival display when smiling,
particular of diagnosis, therapy and maintenance. reducing the mandibular asymmetry which sometimes
All the patients reported in literature with severe forms relate with a severe scissor bite and improving the
of scissor bite can show a great dento-alveolar prominence of chin.
discrepancy or skeletal class II malocclusion with an Treatment alternatives
important mandibular hypoplasia. Generally, they have
Considering the great variability of the patient as the
a convex profile, lip incompetence and sometimes
age of diagnosis, the presence of articular problems,
they show a gummy smile. At the intraoral
but also the different grade of scissor bite that can be
examinations all patients revealed an overjet greater
partial or total, several therapeutic approaches have

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been proposed during the years. Two groups of the sagittal skeletal anchorage. This simplifies the
treatments can be considered: the surgical-orthodontic orthodontic treatment procedure as it minimizes the
approach and the pure orthodontic method. need for patient compliance.19 The anchorage control
The orthognathic surgery was the first kind of in fixed orthodontics is considered one of the most
treatment to be used in the past, because of the important factors capable to influence the outcomes in
prevalent idea was that only the simple form of scissor particular for hyperdivergent adult. 20 The use of
bite could be efficacy treated with only orthodontics 11. miniscrews for correcting class II malocclusion has
Many cases reported in literature were treated with a proved effective in retracting upper incisors and
Le Fort I osteotomy of the maxilla that was retracted improving the convex facial profile and gummy smile.
and rotated, while the mandible were performed with There was an increase in crownroot ratio for central
bilateral sagittal osteotomies. This approach is incisors, referred to the possibility of apical root
undoubtedly faster than orthodontic one and it let resorption during intrusion and long-distance retraction.
possible to solve all forms of Brodie bite, but not all the The application of 5-years follow-up demonstrated a
patients would accept it with its sequelae. So, during stable, well-aligned dentition with ideal intercuspation
the time different orthodontic approaches have been and harmonious facial.
proposed as alternatives to the surgery. If the patient According to literature, mild malocclusions in young
is young and he has not yet reached the peak of patients could be treated with a pure orthodontic
pubertal growth, the orthopedic devices can be applied method, through the application of
to stimulate the growing of mandible, advancing its orthopedic-functional devices. In particular, Yogosawa21
spatial position. The other orthodontic possibilities are: describes the efficacy of biteplane to advance the
the use of fixed multibrackets appliances, eventually in mandible, correct the TMJ position and rotate the
combination with surgery as genioplasty to correct the occlusal plane in clock-wise direction. The mandible
retrusive chin; the extractions of four premolars to grew down and forward in relation to the cranial base
solve the Angle class II malocclusion (pure or and there was a good control of the vertical dimension.
subdivision) using intraoral elastics and, finally the The real limits of using orthopedic devices are the
combination of fixed orthodontics with miniscrews to necessity of early interception of the malocclusion that
retract the maxilla and to advance the mandible. The has to be mild and not severe, as the compliance of
last method was proposed in Korean works12 only in patient because of the wide lasting of treatment (12-18
recent times and it has demonstrated a great efficacy months).
comparable to the ortho-surgical treatment in adult CONCLUSIONS
patients.
Different approaches have been proposed to solve
DISCUSSION severe scissor bite combined with class II
Each clinical case is unique and different from the malocclusion. The surgery remains the fastest and the
others, so establishing the treatment planning it’s most effective treatment because of its applicability
really important to consider the initial condition of the also in severe malocclusions, but it’s also the most
patient and evaluate the severity of malocclusion. challenging for the patient that has to support a
Generally, if the patient is adult and/or the convalescence period. So a valid alternative is the
malocclusion is severe the gold standard is the fixed orthodontics combined with skeletal anchorage,
surgical-orthodontic correction, that in recent times that makes possible the modification of dental arches
may provide a surgery first approach13. If cases relate in all the three dimensions with important effects on
to a narrow lower dental arch, the surgical expansion the position and dimensions of the alveolar bone.
of this arch will be the preferred option.14,15 However,
other surgical procedures have been developed to References
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