Case Report

Clear Aligners and Miniscrews in a Scissor Bite Adult Treatment

Table 3

Relevant results of the selected articles.

Author and year of publicationTitleSampleEtiologyTreatmentConclusion

Presented case“Scissor bite: systematic review and clinical case treated with aligners and mini-implants”♀ 24 years old
SB—total right side (14, 15, 16, 17/44, 45, 46, 47)
Other associated problems: convex profile and facial asymmetry; deep bite with pronounced cant in the lower occlusal plane on the SB side
SB—dental+skeletal (mandible); severe compression of the mandibular arch; right molar and canine class II; left molar and canine class III; skeletal class II, hypodivergentMaxilla: Invisalign aligner series (22 h/day)+buccal button of 17 and palatal MS between 16 and 17
Mandible: Invisalign aligner series (22 h/day)+lingual button 44, 45, 46, and 47 and MS in retromolar trigone and between 44 and 45
Total treatment time: 1 year 8 months
Retainers: Vivera®
Control: 2 years, no relapse
Integration of aligners and MS can be effective to orthodontically treat severe SB with occlusal plane control in adult patients
Despite the maintenance of the class II relationship on the right side, there is a stable occlusion and improvement of the vertical dimension

Tamamura et al. [4]“Use of palatal miniscrew anchorage and lingual multi-bracket appliances to enhance efficiency of molar scissor-bite correction”♀ 17 years and 4 months
SB—right side (17/47)
Other associated problems: straight profile without facial asymmetry; crowding of the upper and lower front teeth
SB—dental; bilateral molar class I; bilateral canine class I; skeletal class IMaxilla: 2 MS in the palatal region of the 17 (1 buccal, 1 palatal)+elastic chain by occlusal 17+lingual multibracket appliance
Mandible: buccal brackets appliance
Total treatment time: 26 months
SB correction: 3 months
Retainer: wraparound for maxilla and lingual adhesive retainer for mandible
Combination of palatal MS and lingual multibracket appliances increases the efficiency of SB correction in molars

Chugh et al.
[12]
“Brodie bite with an extracted mandibular first molar in a young adult: a case report”♀ 17 years old
SB—bilateral posterior
Other associated problems: absence of 46; convex profile without facial asymmetry
SB—dental; left molar class I; right molar class II; bilateral canine class I; skeletal class IMaxilla: maxillary bite plate on anterior teeth (3 months)
Mandible: stainless steel jockey arch with crossed elastics
Total treatment time: 18 months
SB correction: 5 and a half months
Retainer: maxilla: Hawley with labial arch; mandible: lingual retainers bonded canine-to-canine
Conventional orthodontic treatment is a minimally invasive option that can, depending on the patient, provide a complete rehabilitation with a satisfactory prognosis

Jung [7]“Treatment of severe scissor bite in a middle-aged adult patient with orthodontic mini-implants”♂ 49 years old
SB—left side (24, 25, 26, 27/34, 35, 36, 37, 38)
Other associated problems: straight profile, slight facial asymmetry, and deviation of the mandible on the right side
SB—skeletal (mandible); right and left canine class II; indeterminate bilateral molar class; skeletal class IIMaxilla: ceramic brackets buccally on teeth 24, 25, 26, and 27. MS on the palatal and buccal alveolar bone. Metallic buttons on the palatal face of the 24, 25, 26, and 27 with elastic chain
Mandible: ceramic brackets lingually on teeth 34, 35, 36, and 37
1 MS between teeth 35 and 36
Total treatment time: 2 years
SB correction: 18 months
Retainer: mandible—Hawley retainer; maxilla—circumferential retainer
Control: 14 months, lower molars with slight lingual tipping and distal face of 27 with greater pocket depth (lost retention)
The final records showed that orthodontic MS were very effective in correcting SB

Suda et al. [13]“Orthognathic treatment for a patient with facial asymmetry associated with unilateral scissors-bite and a collapsed mandible arch”♀ 21 years old
SB—right side (14, 15, 16, 17/44, 45, 46, 47)
Other associated problems: facial asymmetry and unilateral collapsed mandibular arch (right)
SB—skeletal (mandible); bilateral class I; skeletal class IIMaxilla: bite plate
Mandible: posterior subapical mandibular surgery and lingual arch
Total treatment time: 4 years and 8 months
SB correction: 7 months
Retainer: Hawley circumferential retainers in the maxilla and mandible
Control: 1 year, no relapse
Efficacy of posterior subapical mandibular surgery in the successful correction of scissor bite and collapsed mandibular arch

Nascimento [14]“Treatment of bilateral Brodie bite in a periodontally compromised patient using distraction osteogenesis”♂ 37 years old
SB—bilateral posterior
Other associated problems: concave profile without asymmetry
SB—skeletal (mandible); class II division 2; skeletal class IIMaxilla: fixed appliance
Mandible: distraction osteogenesis in the mandibular symphysis region+mandibular distraction device with palatal screw (13 days of activation and 90 days of stabilization)+mandibular advancement surgery
Retainer: circumferential in the maxilla and lingual canine-to-canine retainer in the mandible
Distraction osteogenesis of the mandibular symphysis has proven to be very important in the treatment of bilateral SB, making it possible to correct functional, periodontal, and esthetic problems

Kim et al. [15]“Surgery versus nonsurgery option for scissors bite treatment”Case 1: ♂ 36 Y
SB—left side (24, 25, 26, 27, 28/34, 35, 36, 37, 38)
Case 1: SB—dental; mild skeletal class IIICase 1:
Maxilla: fixed appliance with 2 MS; metallic buttons on palatal surface of posterior teeth for elastic chain
Mandible: fixed appliance with 1 MS in the buccal alveolar bone between teeth 35 and 36
Case 1: MS can be used to successfully correct SB.
Case 2: ♂ 28 Y
SB—posterior bilateral
Other associated problems: facial asymmetry
Case 2: SB—skeletal severe (maxilla); bilateral class III; skeletal class ICase 2:
Maxilla: Le Fort I maxillary osteotomy
Mandible: SSRO and mentoplasty
SB correction: 24 months
Case 2: the combination of Le Fort I segmental osteotomy and SSRO was an effective treatment to improve facial asymmetry as well as transversal discrepancy

Sakamoto et al. [5]“Bilateral scissor bite treated by rapid mandibular expansion following corticotomy”♂ 17 Y
SB—bilateral posterior
Other associated problems: convex profile and prognathism of the maxilla
SB—skeletal (mandible); right molar class I; left class I; skeletal class IIMaxilla: quad-helix (expansion of 16 and 26)
Mandible: corticotomy and rapid lateral mandibular expansion appliance (36, 33, 43, 46)
Total treatment time: 4 years and 7 months
SB correction: 7 months
Retainers: circumferential in the maxilla and mandible
Control: 2 years and 7 months, no relapses
Lateral mandibular expansion after corticotomy is effective in young adult patients with a narrow mandibular arch

Morelon et al. [8]“Traitement d'un syndrome de Brodie unilatéral par contraction chirurgicale des maxillaires”♂ 22 Y
SB—left side (24, 25, 26, 27, 28/34, 35, 36, 37, 38)
Other associated problems: maxillary prognathism
SB—skeletal (maxilla); right molar class I; right canine class I; skeletal class IIMaxilla: segmented Le Fort I osteotomy fixed appliance 15 days after osteotomy
SB correction: 6 months
Retainer: 4 osteosynthesis plates in “L” and “J” shape
Le Fort I osteotomy is an acceptable and quick solution for the treatment of SB

Lee et al. [16]“Severe unilateral scissors-bite with a constricted mandibular arch: bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf”♀ 33 Y
SB—right side (14, 15, 16, 17/44, 45, 46, 47)
Other associated problems: convex profile; mandibular arch constriction and facial asymmetry
SB—skeletal (mandible); left molar class I; left canine class I; skeletal class IIMaxilla: fixed appliance with 2 occlusal bite tubes cemented on teeth 26 and 27 and extra-alveolar MS on the infrazygomatic ridge (retract the maxillary arch)
Mandible: fixed appliance with lingual brackets on teeth 46 and 47+extra-alveolar buccal MS between 46 and 47
Total treatment time: 27 months
SB correction: 4 months
Retainer: invisible overlay retainers for both arches
Control: 38 months, no relapse
Extra-alveolar MS are a minimally invasive method for SB correction with maxillary protrusion

Baik et al. [6]“Correcting severe scissor bite in an adult”♀ 28Y
SB—right side (14, 15, 16, 17/44, 45, 46, 47)
Other associated problems: convex profile and facial asymmetry
SB—dental+skeletal (mandible); left molar and canine class I; undetermined right molar and canine class; skeletal class II, hyperdivergentMaxilla: fixed appliance with 2 interradicular MS, 1 buccal and, 1 palatal between the 16 and 17+removable bite plate
Mandible: modified lingual arch
Total treatment time: 3 years
SB correction: 7 months
Retainer: wraparound removable appliance
Control: 6 years, no relapse
Integration of MS and lingual arch may be effective for treating severe SB in adult patients

Nakamura et al. [17]“Nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite and excessive overjet”♀ 26 Y
SB—bilateral posterior
Other associated problems: convex profile; excessive overjet
SB—skeletal (narrow mandible, wide maxilla); class II division 1; skeletal class I, hypodivergentMaxilla: lingual arch with an anterior bite block, 2 MS (1 between 24 and 25 and 1 between 26 and 27, both in palatal)+posterior edgewise appliance with elastics
Mandible: 2 MS (1 between 34 and 35 and 1 between 36 and 37, both buccally)+edgewise appliance with elastics+lingual arch
Total treatment time: 56 months
SB correction: 12 months
Retainer: removable and fixed in both arches
Control: 13 months, no relapses
Fixed MS and bite blocks were effective and efficient in facilitating the correction of bilateral SB

Habash [18]“Scissor bite and crowding correction with clear aligners: case report”♀ 21 Y
SB—right side (14/44)
Other associated problems: deep bite
SB—dental; bilateral molar and canine class I; skeletal class IMaxilla: Invisalign aligner series (22 h/day)
Mandible: Invisalign aligner series (22 h/day)
Total treatment time: 14 months
Retainer: fixed and removable (not specified)
Control: 1 year, no relapse
The use of aligners is an effective way of solving orthodontic problems such as SB and crowding in a time frame comparable to conventional fixed orthodontics. In addition, this system is associated with excellent oral hygiene and esthetics

SB: scissor bite; MS: miniscrew; TPA: transpalatal arch; DB: distobuccal.