Journal of medical research and practice

Navdha Chaudhary

2162-6391 (Print)
2162-6375 (Online)
http://dx.doi.org/10.20936/jmrp/1503

Available at www.jmrp.info

Case report/research article

Bilateral First premolar Scissor bite

Correction Using Cross arch Elastics: A
Case Report
Navdha Chaudhary1,*, Babita Ahlawat, Ashok Kumar
Author affiliations
*1

Senior Resident, Eklavaya Dental College, Kotputli, District Jaipur, Rajasthan, India
Senior Resident, Department of Dentistry, SHKM GMC, Nalhar, Mewat, Haryana, India
3
Associate Professor, Department of ENT, SHKM GMC, Nalhar, Mewat, Haryana, India
2

Address reprint requests to

Dr. Babita Ahlawat
Flat no. 302; B-1 Block; Residential Campus; SHKM GMC, Nalhar, Mewat122107 Haryana, India or at
drbabita.ahlawat@gmail.com

Abstract: Scissors-bite is a malocclusion characterized by buccal inclination or buccoversion of the maxillary

posterior tooth and/or linguoclination or linguoversion of the mandibular posterior tooth. This type of
malocclusion causes reduced contact of the occlusal surfaces and can cause excessive vertical overlapping of the
posterior teeth. When the mouth is closed the molars miss each other and overlap with no contact. The chewing
function is affected in patients having scissor bite since the involved teeth make no contact with each other.
Patients may also experience a clicking or pain in the jaw joints since the jaw is usually forced to function in a
deviated position during the chewing process. In patients with mixed dentition, scissor bite results in extrusion of
the involved tooth which often leads toocclusal interference and a mandibular functional shift with growth.
Malocclusion can influence masticatory function. Early diagnosis of scissor bite is thus essential to correct the
inclination of the compromised teeth and thus prevent a lateral shift of the mandible before adaptive remodeling
of the TMJ can cause asymmetrical mandibular growth.
Key words scissors-bite; cross arch elastics
INTRODUCTION
A scissor bite, also known as Buccal non-occlusion, is defined as buccal displacement of a maxillary
posterior tooth, with or without contact between the lingual surface of the maxillary lingual cusp and the
buccal surface of the mandibular antagonists buccal cusp1-5. A complete buccal crossbite, known as a
Brodie bite, is caused by a combination of excessive maxillary width and a narrow mandibular alveolar
process, although the width of the mandibular base is usually normal3. The prevalence of scissorbite
malocclusion is 1.1% in children and 0.42.7% in adults6.
Differential diagnosis and treatment of posterior crossbites in children must determine whether the
discrepancy is a localized problem in tooth eruption (dental crossbite), a gross basal disharmony between
the maxilla and mandible (skeletal crossbite), or a transverse discrepancy in upper to lower arch width
that produces a lateral shift of the mandible on closure (functional crossbite) 7.
Dental posterior crossbites involve atypical eruption and alignment with localized displacement of
individual teeth into cross-bite configurations. When the mouth is closed teeth miss each other and
overlap with no contact.
Scissor-bite, labial eruption of the upper molar8, lingual tipping of the lower molar3 or any
combination of these conditions can cause occlusal interference by restricting lateral jaw movement.
These changes may explain why the smooth and efficient grinding-type masticatory jaw movement may
be difficult for patients with scissorbite.

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Navdha Chaudhary

Journal of medical research and practice

CASE REPORT
DIAGNOSIS
A 13 year old boy presented a chief complaint of irregularly placed teeth. His mother reported that he
had no oral habits and was in excellent physical and dental health. The maxillary dental midline coincided
with the facial midline. An intraoral examination revealed bilateral single tooth scissor bites with respect
to 14, 44 and 24, 34 with a class I molar relation (figs. 1 & 2). The upper arch was extremely wide, with
pronounced buccal tipping of first premolars on both the sides, while the lower arch was extremely
constricted, with equally pronounced bilateral lingual tipping of first premolars. Functional analysis
revealed a true bilateral buccal non occlusion due to dental positioning, and the skeletal asymmetry was
confirmed by an anteroposterior radiograph taken with the teeth apart and a panoramic radiograph.

Figure 1. Intraoral preoperative view showing scissors bite with

respect to 14 and 44.

Figure 2. Intraoral preoperative view showing scissors with

respect to 24 and 34.

TREATMENT PLAN
The treatment plan was to correct the scissor bite through tooth movement alone. Lingual buttons
were bonded on the buccal surfaces of 14, 24 and lingual surfaces of 34, 44. Cross arch elastics were
placed from buccal surface of 14 to lingual surface of 44 and similarly on the contralateral side (figs. 3 &
4). To allow full correction of the scissor bite, composite was added to the occlusal and buccal surfaces of
the lower first molars. Patient was given instructions for changing elastics once a day and in case of any
tear.

TREATMENT PROGRESS
Patient had a very good compliance and a noticeable movement was achieved in 3 weeks. Correction
occurred within 8 weeks and complete cuspal interdigitation was established (figs. 5 & 6). The retention
appliance was not required because mechanical interlocking by interdigitation of cusps held the teeth in
their respective new relationship.

Figure 3. Intraoral view showing cross elastics.

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Figure 4. Intraoral view showing cross elastics.

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Navdha Chaudhary

Journal of medical research and practice

Figure 5. Correction of scissors bite with respect to 14, 44.

Figure 6. Correction of scissors bite with respect to 24, 44.

DISCUSSION
Scissor bite is characterized by labial eruption of the maxillary posterior teeth. Either the maxillary
tooth does not occlude with its mandibular antagonist tooth orcontact is made between the lingual
surface of the maxillary lingual cusp andthe buccal surface of the mandibular buccal cusp. Scissor bite is
caused by an arch-length discrepancy in the posterior region. The scissor bite has no significant influence
on the facial profile and is not known to reduce airway. The chewing function is bad since the involved
posterior teeth make no contact with each other.
Patients may experience a clicking or pain in the jaw joints since the jaw is usually forced to function in a
deviated position during the chewing process.
Tooth wear is unlikely since teeth usually do not come
in contact with each other. Most often posterior crossbite and scissor bite are seen with respect to
isolated molars or premolars and are usually corrected in conjunction with comprehensive edgewise
orthodontics. Within an interceptive context, isolated posterior tooth crossbite can be corrected using
cross-arch elastics.
The maxillary first molars tend to erupt buccally, whereas the mandibular first molars tend to erupt
lingually. This tendency for a contradictory direction of eruption may produce a posterior crossbite
(scissors bite)9,10. The primary problems in correcting a scissor bite involving a molar are (1) buccal
tipping with over extrusion of the maxillary molar, (2) lingual tipping with over extrusion of the
mandibular molar, (3) a molar position that is resistant to correction, and (4) a lack of space for
appliances on the palatal side of the maxillary molar and buccal side of the mandibular molar8.
In patients with mixed dentition, scissor bite causingextrusion of the involved tooth can result in occlusal
interference and a mandibular functional shift with growth. Therefore, early treatment is
needed.Malocclusion can influence masticatory function11-15. In individuals with normal occlusion, the
chewing pattern involves lateral deviation of the mandibular incisor towards the bolus, which is followed
by medial deviation during closing16,17. However, in patients with unilateral posterior crossbite, a higher
prevalence of a reverse chewing pattern12 and lower maximum bite force, as compared to that of patients
with normal occlusion, has been reported12,13, and the lateral and medial poles of the condyle on the
crossbite side move more medially and less laterally during mastication14. Early diagnosis of scissor bite
is thus essential to correct the inclination of the compromised teeth and thus prevent a lateral shift of the
mandible before adaptive remodeling of the TMJ can cause asymmetrical mandibular growth.

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Article citation:
Chaudhary N, Ahlawat B, Kumar A. Bilateral first premolar scissor bite correction using cross arch elastics: A
case report. J Med Res Prac. 2015;04(01):12-15. Available at htp://www.jmrp.info/index.php/jmrp
Disclaimer:- Any views expressed in this paper are those of the authors and do not reflect the official policy or
position of the Department of Defense.
Source of support: None

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