A Case Report of Bilateral Brodie Bite in Early Mixed Dentition Using Bonded Constriction Quad-helix Appliance

Abstract

Brodie bite is a comparatively rare type of malocclusion found in primary and mixed dentition. It not only adversely affects chewing and muscle functions, but also impairs normal growth and development of the mandible. This report describes the therapeutic results of a patient with bilateral Brodie bite in early mixed dentition after using a bonded constriction quad-helix appliance. The patient, a boy aged 9 years and 2 months, first visited our hospital after occlusal abnormality in the molar region was detected at a local dental clinic. Case analysis resulted in a diagnosis of bilateral Brodie bite with slight mandibular retrognathism. Treatment objectives were to reduce the arch width of the maxillary dentition and expand the mandibular arch in order to establish and stabilize molar occlusion and to achieve a Class I molar relation and appropriate overbite and overjet. Treatment comprised covering the occlusal surface of the maxillary molars with resin and attaching a bonded constriction quad-helix appliance joined with a 0.040-inch quad-helix wire. A bi-helix appliance was also fixed to the mandibular dentition. Brodie bite visibly improved after 5 months. Cervical headgear was then fitted and the patient observed until eruption of the permanent dentition was complete. Class I molar relation was achieved after 2 years and 6 months, although spacing remained in the maxillary and mandibular dentitions. Treatment of bilateral Brodie bite in mixed dentition by means of a bonded constriction quad-helix appliance attached to the maxillary dentition enabled effective bite opening and reduction in the width of maxillary arch independent of the patient's cooperation, providing good therapeutic outcome in a short time period.

Bilateral Scissor Bite Treated by Rapid Mandibular Expansion Following Corticotomy

“…The methods reported include the combined use of a mandibular expansion appliance for the mandibular dental arch with contraction of the maxillary dental arch using cross-elastics 10) ; reduction of the maxillary arch and expansion of the mandibular arch using cross-elastics 2) ; reduction of the maxillary arch by using a bonded constriction quad-helix appliance together with expansion of the mandibular arch using a bi-helix appliance 8) ; surgical constriction of the maxilla to correct excess width 11) ; mandibular expansion by posterior subapical mandibular surgery and the use of a lingual arch appliance 12) ; and mandibular widening by distraction osteogenesis 5) . The basic treatment mechanisms thus comprise contraction of the width of the maxillary arch and expansion of the width of the mandibular arch.…”

“…If left untreated, scissor bite not only adversely affects chewing function, but also impairs the normal growth and development of the mandible. Although cross-bite alone is unlikely to lead to the development of oral disease, dysfunction can arise from the resulting impairment of mastication 8) . Scissor bite is a comparatively rare form of malocclusion, occurring in less than 0.01% of such cases 1) .…”

“…This is because it involves buccal tipping of the maxillary molars with over-extrusion and lingual tipping of the mandibular molars with extreme vertical overlap, making it impossible to attach orthodontic appliances to the buccal surface of the mandibular teeth and palatal surface of the maxillary teeth. Various methods have been reported in the treatment of scissor bite 2,5,6,8,10,11) . Here, we report the successful treatment of bilateral scissor bite in the posterior region in an adult patient.…”

“…A number of methods are available for expanding the mandibular arch, and these include the use of cross-elastics 2,10) a bi-helix 8) , a lingual arch 12) , and surgery 5,12) . The use of cross-elastics necessitates strong patient cooperation.…”

Treatment of Brodie syndrome

“…This device is found in several forms in the literature 22,46 . nojima et al 31 used a Quad Helix modified with resinous splints to correct bilateral Brodie occlusion in a 9-year-old patient. Contraction activation is bilaterally performed at anterior helices using the amount necessary to correct the malocclusion.…”