MANAGEMENT OF BILATERAL SCISSOR BITE IN AN ADULT PATIENT USING A COMBINATION OF PALATAL IMPLANT AND RETROMANDIBULAR MINIPLATES - A CASE REPORT

ABSTRACT A 28-year-old female reported with a complaint of muscle pain and difficulty in chewing. She presented with bilateral scissor bite in the mandibular second and third molar region. Other than scissor bite, her occlusion was within acceptable limits. Initially, a removable splint was given along with muscle relaxants to relieve muscle tenderness. Subsequently, orthodontic treatment was initiated using skeletal anchorage and minimal orthodontics by placing fixed orthodontic attachments only in the posterior teeth. A modified transpalatal arch with soldered hooks was placed in the maxillary second molars, and a midpalatal mini-implant was placed to aid in their intrusion and constriction. Distal, intrusive, and buccal forces were applied through the soldered buccal tube on the miniplate for distal and uprighting movement of the mandibular molars. After establishing occlusal contacts in the second molar region, full arch bracket bonding was done. As a result of uprighting of the mandibular molars, open bite was noticed in the anterior region. A soft splint was fabricated, and clenching exercises were advised to assist in the closure of open bite. The total treatment time was 13 months, and good intercuspation was established in the posterior teeth and normal overjet and overbite. Lingual retainer was bonded on the mandibular anterior teeth.Additionally, buccal bonded retainers were bonded on the mandibular second premolar, first molar, and second molar, bilaterally. The posterior occlusion showed good stability during the one-year follow-up period. The customized version of the retromandibular miniplate and palatal mini-implant allowed reasonable control of biomechanical forces and showed effectiveness in scissor bite treatment. Clenching exercises served as a helpful adjunct in the closure of open bite.