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Title a Case Report of Bilateral Brodie Bite in Early Mixed Dentition Using A Case Report of Bilateral Brodie Bite in Early Title Mixed Dentition Using Bonded Constriction Quad- helix Appliance. Nojima, K; Takaku, S; Murase, C; Nishi, Y; Sueishi Author(s) K. Journal Bulletin of Tokyo Dental College, 52(1): 39-46 URL http://hdl.handle.net/10130/2330 Right Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College, Available from http://ir.tdc.ac.jp/ Bull Tokyo Dent Coll (2011) 52(1): 39–46 39 Case Report A Case Report of Bilateral Brodie Bite in Early Mixed Dentition Using Bonded Constriction Quad-helix Appliance Kunihiko Nojima, Sakiko Takaku*, Chiaki Murase, Yasushi Nishii and Kenji Sueishi Department of Orthodontics, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan * Division of Orthodontics, Department of Oral Health Clinical Science, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan Received 26 July, 2010/Accepted for publication 6 October, 2010 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. Key words: Brodie bite—Early treatment—Angle Class II malocclusion— Bonded constriction quad-helix appliance—Bi-helix appliance Introduction arch was telescoped within the maxillary den- tal arch, known as the Brodie syndrome13). In 1943, Brodie first described a type of This type of occlusion, also called “scissors occlusion in which the mandibular dental crossbite” or “buccal crossbite”, refers to molar 39 40 Nojima K et al. Fig. 1 Pre-treatment facial photographs at age 9y2m Fig. 2 Pre-treatment intraoral photographs at age 9y2m crossbite resulting from incorrect horizontal the prevalence of this syndrome is 1–2%, positioning of the maxillary and mandibular making it a comparatively rare form of mal- dental arches, in which all the mandibular occlusion5). As it does not affect aesthetics, molar buccal cusps are telescoped within the both patients and their parents or guardians lingual side of the maxillary molars, so that may be unaware of the malocclusion. There- there is no intercuspation of the maxillary fore, fewer patients present with Brodie bite as and mandibular molars. In mixed dentition, a primary complaint compared with patients A Case Report of Bilateral Brodie Bite 41 Table 1 Model analysis Maxillary arch Mandibular arch Measurements S.D. Pre. treat Post. treatעS.D. Pre. treat Post. treat MeanעMean Coronal arch 30.0 28.2 1.21ע31.08 41.5 41.2 1.43עAnterior width 39.10 44.6 35.9 1.72ע44.65 53.2 57.2 1.86עPosterior width 50.98 11.0 9.1 1.28ע9.65 14.8 15.6 1.18עAnterior length 14.00 32.0 32.1 1.69ע28.63 37.4 37.5 2.08עPosterior length 32.18 Basal arch 34.2 33.7 1.41ע34.77 42.9 45.9 3.01עAnterior width 45.10 61.6 55.6 2.24ע62.01 68.1 71.0 2.39עPosterior width 65.72 8.5 8.8 1.42ע4.30 11.5 12.0 2.06עAnterior length 7.90 32.0 32.8 1.42ע23.13 33.0 33.5 2.25עPosterior length 25.35 (mm) exhibiting other types of malocclusion. For this reason, there have been few case reports of the treatment of Brodie bite in primary or mixed dentition. Nevertheless, this occlusal abnormality is unlikely simply to resolve spontaneously. It not only adversely affects chewing function3) and muscle function10) but also impairs the normal growth and development of the mandible Fig. 3 Pre-treatment panoramic radiograph at age 9y2m if left untreated, with the possibility of jaw deformities such as facial asymmetry and mandibular retrognathism. Therefore, early correction of this occlusion is essential. oral examination revealed a dental age of IIIA ,mm overjet 8ם 5mm overbite andם We obtained good therapeutic results in a with patient with bilateral Brodie bite within a spacing in the maxillary anterior teeth, bilat- short time period by fitting a bonded con- eral Brodie bite, and Class II molar relation striction quad-helix appliance to reduce the (Fig. 2). Model analysis showed an exces- width of the maxillary arch and raise the bite, sive coronal arch width of 57.2 mm (Mean mm) and basal arch width of 1.86עas well as a bi-helix appliance to expand the 50.98 -mm) in the max 2.39עmandibular arch. 71.0 mm (Mean 65.72 illary molar region, with narrow mandibular dental arch width at the molars of 35.9 mm mm) and alveolar base 1.72עCase (Mean 44.65 (mm 2.24עwidth of 55.6 mm (Mean 62.01 A boy, aged 9 years and 2 months, first came (Table 1). A panoramic radiograph revealed to our hospital after occlusal abnormality that the entire permanent dentition was in the molar region had been identified at a present (Fig. 3). Cephalometric analysis indi- local dental clinic. He was healthy with no cated slight skeletal mandibular retrogna- contributing medical history. The patient’s thism with SNA 79.0°, SNB 75.0°, and ANB family history did not reveal any relevant 4.0°, and labial inclination of the maxillary information. The facial features were symmet- and mandibular anterior teeth with U1 to FH ric from the frontal view, and the profile was 126.0°, L1 to FH 54°, and interincisal angle convex from the lateral view (Fig. 1). Intra- 108° (Fig. 4). From these findings, bilateral 42 Nojima K et al. S.D. Pre. treat Post. treatעMeasurements Mean 86 84 3.3עFacial angle (deg.) 86.1 3 8 3.0עConvexity (deg.) 6.4 1.5מ 6מ 2.5ע5.2מ (.A-B plane (deg 34 35 5.9עMandibular plane (deg.) 24.8 63 64 3.1עY-axis (deg.) 64.0 10 12 4.2עOcclusal plane (deg.) 8.4 110 108 5.6עInterincisal angle (deg.) 131.6 24 24 5.3עL-1 to Occlusal (deg.) 21.3 90.5 91 4.9עL-1 to Mandibular (deg.) 97.1 13 18.5 2.5עU-1 to A-P plane (mm) 7.8 10 10 2.4עFH to SN plane (deg.) 5.4 77.5 79 2.6עSNA (deg.) 83.4 76 75 2.5עSNB (deg.) 80.0 1.5 4 1.7עSNA-SNB diff. (deg.) 3.4 127 126 5.6עU-1 to FH plane (deg.) 110.8 55.5 54 5.8עL-1 to FH plane (deg.) 61.6 138 134 8.1עGonial angle (deg.) 117.5 75 80 4.5עRamus angle (deg.) 88.5 Fig. 4 Tracing and measurements on pre-treatment cephalometric radiograph Fig. 5 Intraoral occlusal view of constriction quad-helix appliance bonded on occlusal surface in maxillary arch (left) and bi-helix appliance in mandibular arch (right) Fig. 6 Post-treatment facial photographs at age 11y8m Brodie bite with slight mandibular retrogna- achieve a Class I molar relation, as well as thism was diagnosed. appropriate overbite and overjet until erup- Treatment objectives were to reduce the tion of the permanent dentition was complete. arch width of the maxillary dentition and The treatment plan consisted of reducing the expand the mandibular arch in order to width of the maxillary arch by covering the establish and stabilize molar occlusion and to occlusal surfaces of the maxillary first primary A Case Report of Bilateral Brodie Bite 43 Fig. 7 Post-treatment intraoral photographs at age 11y8m molar, second primary molar, and first perma- nent molar on both sides with resin to raise the bite and support and activate a bonded constriction quad-helix appliance, which was joined by a 0.040-inch quad-helix wire in 5-mm sections on either side and attached with a light-cured adhesive (Fig. 5). In addi- tion, a bi-helix appliance was fitted to the mandibular first molars to expand the man- dibular arch. After 5 months, the Brodie bite showed improvement. Cervical headgear was Fig. 8 Post-treatment panoramic radiograph at age 11y8m then fitted in order to correct the Class II molar relation, and the patient was observed regularly until eruption of the permanent dentition was complete. A Class I molar rela- pattern, anterior growth of the maxilla had tion was achieved after 2 years and 6 months, been controlled, while the mandible had although spacing remained in the maxillary grown markedly in the anteroinferior direc- and mandibular dentition (Figs.
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