Indian Journal of Contemporary Dentistry, July-December 2020, Vol.8, No.2 11 Modified Use of Quad Helix to Correct Scissor Bite in Growing Child: A Case Report Sanjeev Vaid1, Aditi Malhotra2, Dimple Chainta3, Kehar Singh Negi4, Atul Singh5 1Assistant Professor, Dept of Dentistry, Room no. 106, Dr Y.S. Parmar, Govt. medical college, Nahan, 2Ex-Resident, Department of Orthodontics & Dentofacial Orthopedics, HPGDC, Shimla, 3Assistant Professor, 4Professor & Head, Department of Orthodontics & Dentofacial Orthopedics, HPGDC, Shimla, 5Senior Resident, Dept of Dentistry, Room no. 106, Dr Y.S. Parmar, Govt. medical college, Nahan Abstract Molar scissor-bite is a common finding in orthodontics and many times, it can be found as a sole malocclusion in a patient. Alignment of such buccally erupted molars is a challenging task. This article describes a modified use of conventional quad helix appliance to correct scissor bite in a growing child. Keywords: Scissor bite, malocclusion, quad helix, early treatment. Introduction techniques.[1,5] Scissors bite, also known as buccal crossbite is Cross elastics have a disadvantage of extrusion of the buccal occlusion of the maxillary teeth with the molars and also require patient compliance. Many palatal mandibular teeth and can be classified as complete cantilever arches are designed which are activated with or incomplete, unilateral or bilateral.[1] In the young e-chains. These are difficult to manage clinically and patient scissor bite may not be urgent, but it can hide a require frequent activations due to e-chain’s faster force problem with the temporomandibular joint (TMJ) that decay. Pulling the upper molar palatally with elastic can become manifested with growth.[2] This abnormality traction from a single palatal implant causes the crown may not resolve by itself and if left untreated would of the tooth to tilt lingually, burying its lingual cusps affect chewing and muscle function and may impair into the mucosa, posing problems in banding the molar normal growth and development of the mandible. So later on for uprighting.[6] This case report describes deformities like facial asymmetry and mandibular easy method of treating bilateral molar scissor-bite. By retrognathism are likely possible in these patients. Early modifying the conventional Quad helix appliance and treatment with emphasis on arch development can be achieving treatment results in a time frame of 2 months. beneficial in managing scissor bite cases.[3,4] The appliance works on reciprocal anchorage not taking Many devices and orthodontic techniques have been support from any other tooth in the arch. proposed for the correction of this defect at an early stage. The use of cross elastics, or 2 dimensional lingual Case Report attachments, adjusting torquing in sequential archwires An 11-year-old girl in mixed dentition presented till the desired correction is achieved and recently the for routine dental check up when accidental diagnosis use of micro-implants are among a few commonly used of scissor bite with respect to both upperr 1st molar was made. The patient was at the beginning of the second stage of mixed dentition and showed a Class Corresponding author: I occlusion(mesial step) on both sides. The upper Dr. Aditi Malhotra, incisors were in ugly duckling stage and lower anteriors Ex-Resident, Department of Orthodontics &Dentofacial showed mild croding with coincident midlines. Both Orthopedics, HPGDC, Shimla, the maxillary first molars showed abnormal buccal [email protected] 12 Indian Journal of Contemporary Dentistry, July-December 2020, Vol.8, No.2 inclination, with a developing scissor bite. Oral hygiene was acceptable and the patient had neither referred pain, nor functional limitations.(Fig 1) Treatment plan An interceptive treatment was planned with modified use of conventional quad helix appliance. Both the upper first permanent molars were banded and quad helix appliance was fabricated and cemented in position with reverse activation.(Fig 2) Regular follow up was done and after second activation scissor bite was corrected.(Fig 3) The results were achieved in two months period. The appliance was subsequently removed and after the complete eruption of all permanent teeth corrective fixed orthodontic treatment was started for correction of crowded arches. Fig. 2: quad helix before and after reverse activation Indian Journal of Contemporary Dentistry, July-December 2020, Vol.8, No.2 13 Conflicts of Interest :Nil Sources of Funding: Nil Consent: written consent was taken from patient’s parents Ethical Clearance: Not applicable References 1. Shukla I, Tikku T, Sachan K, Srivastava K. A Novel Method of Treatment of Unilateral Scissor Bite. www.journalofdentofacialsciences.com, 2015; 4: 21-23. Figure 3: Post scissor bite correction 2. Pinho T. Early treatment of scissor bite. J Clin Discussion Orthod 2011 Sep;45(9):498- 506. Scissor bite is a condition in which one tooth or teeth 3. Ogihara K, Nakahara R, Koyanagi S, Suda M. Treatment of a Brodie bite by lower lateral are abnormally positioned buccally or lingually with expansion: a case report and fourth year follow-up. reference to the opposing tooth or teeth.Correction of J Clin Pediatr Dent. 1998;23:17–21. scissor bite is an essential part of orthodontic treatment as 4. Sodagar A, Razavi ESE, Farhadifard H. Treatment it leads to the establishment of proper molar interdigitation of a Bilateral Scissors-Bite in an Adolescent With essential for good functional and occlusion efficiency. Fixed Appliances. Iran J Orthod. 2015;1:1-5 [7] Although the scissor bite itself might not cause pathosis, compromised mastication could eventually 5. V. Favero, L. Sbricoli, L. Favero. Scissor bite in a young patient treated with an orthodontic- lead to temporomandibular dysfunction. Early treatment orthopedic device. A case report. Eur J Paed Dent. has been advocated because spontaneous correction 2013;14:153-155 is unusual and if not treated at early age permanent 6. Kapadia RM. A simple and effective appliance asymmetry may result, for which surgical treatment for correction of bilateral molar scissor bite: “The modality may remain the only treatment of choice.[8] M-shaped palatal arch”. Int J Orthod Rehabil. Several procedures have been suggested for correction of 2017;8:125-7. a scissor bite. An intermaxillary cross elastic is effective 7. Singh A, Mathur AM, Sharma SK, Pandit A. for the treatment of scissor bite. However, it often causes Simplified Approach to Scissor Bite Correction: discomfort, gingival irritation, and poor oral hygiene for A Case Report. Int J Oral Health Med Res. the patient. In addition, such treatment often gives rise to 2017;4(3):65-66. molar extrusion which results in a reduction in overbite 8. Thilander B, Bjerklin K. Posterior crossbite and/or occlusal interference.[9] This case report presented and temporomandibular disorders (TMDs): interceptive treatment of developing scissor bite which Need for orthodontic treatment? Eur J Orthod. was diagnosed accidently. Early intervention in this case 2012;34:667-73. prevented complicated malocclusion development and 9. Kalia A, Sharif K. Modified quad helix for now only simple alignment of arches is required to finish correcting scissor bite. J Asian Pac Orthod Soc. the case. This early treatment approach gave predictable 2011;2:22-23. results with less patient dependence and discomfort. Conclusion Early intervention of scissor bite is essential to correct the inclination of the affected teeth and alveolar arch and thus prevents the development of permanent transverse malocclusion. .