A CASE REPORT
Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci ) April 2022, Volume 7, Number 1: 57-60
Department of Orthodontics,
Faculty of Dentistry, University of
Indonesia, Jakarta, Indonesia
Correspondence to: Citra L. Yuwono.
Department of Orthodontics, Faculty
of Dentistry, University of Indonesia,
Jakarta, Indonesia
widayati22@yahoo.com
Received 28 March 2021
Revised 7 July 2021
Accepted 28 November 2021
Available online 1 April 2022
 © 2022 JDMFS. Published by Faculty of Dentistry, Hasanuddin University. All rights reserved.
Second molar scissor bite correction in class ii
malocclusion using miniscrew and cross-elastic
(second molar scissor bite correction)
Citra L. Yuwono,* Retno Widayati
Abstract
Objective: Scissor bite is one of the atypical findings that could be
found in daily practice, especially in Class II malocclusion. The aim was
to report second molar scissor bite correction using miniscrew and
cross-elastic.
Methods: A 20 years-old, female, had second molar scissor bite with
Class II malocclusion. Extrusion and buccoversion of the upper left
second molar were noted with lingual tipping of bilateral lower second
molar. Deep bite and mild crowding were found with missing upper
first premolar and lower anterior tooth gemination. A miniscrew was
placed to intrude the extruded second molar, while additional cross-
elastic was used to correct both upper and lower teeth position.
Keywords: Cross-elastic, Miniscrew, Orthodontic treatment, Scissor bite
DOI: 10.15562/jdmfs.v7i1.1186
Introduction
Scissor bite, also known as lingual crossbite, is a
form of malocclusion where the buccal cusp of
lower teeth occludes with the palatal cusp of upper
teeth, which can occur due to buccal tilting of upper
teeth or lingual tilting of lower teeth.1,2 Transverse
discrepancy between dentoalveolar arches has
been considered as the main etiology, either
excessive growth of maxilla or lack of mandible
growth.3,4 Scissor bite is commonly seen in Class II
malocclusion, especially Class II division 2.2 It often
involves second molars, as lack of mandible growth
causing it to erupt lingually.4
Scissor bite correction involves palatal tipping
and intrusion of the upper tooth, along with
uprighting of the lower tooth.2 Additional anchor-
age such as transpalatal arch (TPA), temporary
anchorage device such as miniscrew, and cross-
elastic might be needed to avoid unwanted tooth
movement. TPA was reported successfully intrude
maxillary molar, however, oral discomfort might
occur in some cases.5 Another popular approach
known for its simplicity and ease procedure with its
small size is miniscrew. In scissor bite correction,
miniscrews can be placed either at the buccal or
palatal.6-8 Elastomeric chain can be used from
buccal tube to the buccal miniscrew, along with
P-ISSN.2503-0817, E-ISSN.2503-0825
CrossMark
Results: Combination of miniscrew and cross-elastic successfully
correct second molar scissor bite in seven months through intrusion
and palatal tipping of upper molar and uprighting of the lower molar.
With a total treatment of twenty-three months, a good intercuspation
was achieved with Class I canine, Class II molar relationship, and
normal overjet and overbite
Conclusion: The use of miniscrew with cross-elastic successfully
correct second molar scissors bite in Class II malocclusion.
elastomeric chain from palatal button to the palatal
miniscrew.7 Or by running an elastomeric chain
from buccal tube, across the occlusal surface, to
palatal miniscrew.6,8 Miniscrew can also be used
for uprighting and intrusion of the lower tooth by
running an elastomeric chain from lingual button
to buccal miniscrew.7
Scissor bite correction can also be achieved
through the reciprocal effect of cross-elastic.
However, it demands compliance and good
anchorage to minimize complications, such as
tooth extrusion, premature contact, and mandible
clockwise rotation.6,8,9 In this case report described
second molar scissor bite correction by miniscrew
and cross-elastic.
Case Report
A 20 years-old female patient presented with a
chief complaint of irregular teeth. The patient
had fixed orthodontic treatment with upper
first premolar extraction years ago by general
practitioner involving only maxillary arch. She
had a brachyfacial type with slightly convex facial
profile, and normal nasolabial angle Figure 1.
Maxillary dental midline was coincident with facial
midline, while mandibular dental midline showed
3mm deviation to the right due to gemination of
57
A CASE REPORT
lower right canine and lateral incisor Figure 1.
Intraorally, Class I canine and Class II molar
relationship was observed on both sides. A Class
II incisor was found with 5mm overjet and 5.5mm
overite. Mild crowding was observed with lingual
tilting of both lower second molar, while the left
upper second molar showed buccal tilting and
extrusion, leading to scissor bite Figure 2. A..
At the end of the treatment, class I canine and
class II molar relationships were maintained, while 2
mm overjet and overbite were achieved Figure 2. B..
Panoramic radiograph showed the presence of
upper and lower third molar on both sides. Figure
3A – Figure 3D lateral cephalometric analysis
showed a Class II skeletal jaw relationship with
retrognathic mandible and hypodivergent pattern
Table 1. The patient has been diagnosed with
angle class II malocclusion with Class II skeletal
relationship with mild crowding, deep bite, and
second molar scissor bite.
Figure 1. Pretreatment facial photographs.
Figure 2. A. Pretreatment intraoral photographs
 Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci) April 2022 7(1): 57-60 | doi: 10.15562/jdmfs.v7i1.1186
The treatment objectives included aligning,
correcting scissor bite, and establishing proper
overjet and overbite. Treatment initiated with
upper left third molar extraction to gain space for
intrusion, followed by miniscrew (1.2x8mm, Jeil
Medical Corp.) placement in the inter-radicular
palatal area between upper left first and second
molar. Pre-adjusted Edgewise bracket with MBT
prescription slot 0.022” was bonded to all teeth,
while molar bands were bonded to upper and lower
left second molar. Anterior bite riser was used by
placing resin composite in the palatal surface of
upper central incisors to give occlusal clearance and
avoid premature contact that might occur between
the upper molar and buccal tube of the lower
molar. Aligning and leveling began with NiTi 0.014
without involving the upper left second molar.
Interproximal stripping was done to gain space
for aligning in lower arch. Elastomeric chain was
used by running it from buccal tube of the upper
left second molar, across the occlusal surface, to
the palatal miniscrew Figure 4A. Additional cross-
elastic 1/4” 3,5oz was used from the buccal tube of
the upper left second molar to the lingual cleat of
the lower left second molar.
After seven months, intrusion and correction
of the upper molar were achieved using a palatal
miniscrew which remained stable and removed at
the end of active treatment. Following alignment,
correction of anterior teeth inclination was done
by placing labial root torque on SS 0.019x0.025
in both upper and lower teeth. During finishing,
gingivectomy was done in upper and lower left
second molar as gingival hyperplasia occurred
during intrusion and uprighting. After twenty-
three months of active treatment, upper and lower
wrap-around removable retention were placed
with an additional anterior bite plate in the upper
retainer.
Good intercuspation was provided through scissor
bite correction. When pretreatment and post-
treatment, lateral cephalometric were observed
Table 1 and Figure 4B, no significant was seen in
maxilla and mandible skeletal changes in relation
to cranial base nor changes in vertical skeletal
changes. Dentally, uprighting of upper incisors was
seen followed by an increased inclination of lower
incisors. It could be observed that the lower incisors
were proclined with bodily movement leading to
overbite and overjet correction Figure 5.
Discussion
In this case report, the scissor bite occurred due to
extrusion and buccoversion of the upper second

Figure 2. B. Post-treatment intraoral photographs.
Figure 3. A. Pretreatment lateral cephalometric, B. Pretreatment panoramic, C.
Post-treatment lateral cephalometric, D. Post-treatment panoramic
Figure 4. A. Intrusion and palatal tipping of upper left second molar, B.
Superimposed tracings of pretreatment and post-treatment lateral cephalometric
(blue line: pretreatment, red line: post-treatment).
Figure 4. A. Intrusion and palatal tipping of upper left second molar,
B. Superimposed tracings of pretreatment and post-treatment lateral
cephalometric (blue line: pretreatment, red line: post-treatment).
 59
A CASE REPORT
molar and lingual tipping of the lower second
molar. Since the upper second molar position was
extruded and buccoversion, intrusion, and palatal
tipping were planned. A stable anchorage was
needed to deliver intrusion and palatal tipping,
which was achieved by placing miniscrew. The
miniscrew was placed in the palatal area between
the upper left first and second molar. With the
elastomeric chain running from the palatal
miniscrew across the occlusal surface of the second
molar to the buccal aspect of the tooth, it resulted
in intrusion and palatal tipping of the tooth. The
effect of this movement was following the expected
tooth movement.
As the lower second molar tipped lingually,
buccal uprighting was needed. Cross-elastic usage
in scissor bite helps uprighting the lower molar by
placing it between the lingual aspect of lower molar
to the buccal aspect of upper molar. It produces
equal and opposite forces, thus able to correct upper
and lower teeth. However, it may lead to premature
contact due to its extrusive forces, hence usually
not recommended in over-erupted tooth.10 In this
case report, miniscrew was placed in the maxilla
to deliver intrusion, thus extrusion of the upper
molar was avoided. After seven months, second
molar scissor bite was successfully corrected using
miniscrew and cross-elastic.in buccal
Following scissor bite correction, gingival
hyperplasia occurred around the upper and lower
left second molar. During orthodontic treatment,
this gingival enlargement usually occurs due to
plaque accumulation, chemical irritation, and
compression from orthodontic force.11 Poor oral
hygiene and molar band usage could increase risk of
plaque accumulation, thus increasing risk of gingival
hyperplasia formation. Moreover, a considerable
orthodontic force had been applied to correct their
positions, which favored gingival enlargement.
Treatment of gingival hyperplasia was performed
by periodontists, starting with oral prophylaxis and
oral health education as initial treatment, followed
by surgical approach.12 Gingivectomy was done
to improve gingival contour and esthetic and to
prevent further gingival breakdown.12
At the end of treatment, 2mm overjet and
overbite were achieved from uprighting of upper
anterior teeth and proclination of lower ante-
rior teeth. Anterior protraction of lower anterior
teeth was expected. A 1-2mm protraction of lower
incisors consider being stable.13 In this case, upper
and lower wrap-around removable retention were
placed with an additional anterior bite plate in the
upper retainer.
A CASE REPORT

4. Park JH, Kim TW. Correction of bilateral second molar

scissor-bite during retention phase. Int J Ortod 2011;22:
39-43.
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transpalatal arch for molar intrusion. J Int Oral Health
2014;6: 88-89.
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8. Ishihara Y, Kuroda S, Sugawara Y, et al. Long-term stability
of implant anchored orthodontics in an adult patient with
Figure 5. Post-treatment facial photographs. a Class II division 2 malocclusion and a unilateral molar
scissor-bite. Am J Ortod Dentofacial Orthop 2014;145:
Table 1. Pretreatment and post-treatment lateral cephalometric analysis S100-113.
9. Chang MJ, Wei MW, Chang C, et al. Full-cusp class II
Norm Pretreatment Post-treatment malocclusion with bilateral buccal crossbite(scissor-bite)
SNA 82±2o 82o 82o in an adult. Int J Ortho Implantol 2015;37: 60-79.
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SNB 80±2 o
77 o
77o technique for correction of unilateral scissor bite. J Clin
Diagn Res 2016;10: ZH01-ZH02.
ANB 2±2o 5o 5o
11. Gorbunkova A, Pagni G, Brizhak A, et al. Impact of
The Wits 0±1.77 2mm 2mm orthodontic treatment on periodontal tissues: a narrative
review of multidisciplinary literature. Int J Dent 2016:
Facial Angle 87±3o 84o 84o 4723589.
Angle of Convexity 0±10 o
10 o
10o 12. Tuli AS, Bhatnagar N. Gingival hyperplasia a sequela of
orthodontic therapy - A case report. Acta Scientific Dent
Go Angle 123±7o 103o 103o Sci 2018;2: 84-84.
13. Johnston CD, Littlewood SJ. Retention in orthodontics. Bri
SN-MP 32±3o 25o 25o Dent J 2015;218: 119-122.
MMPA 27±4o 21o 20o
Interincisal Angle 135±10o 126o 123o
UI-SN 104±6o 105o 100o
This work is licensed under a Creative Commons Attribution
UI-MxP 109±6 o
113 o
108o
LI-MP 90±4o 99o 109o
E line-lower lip 1mm 0mm -1mm
E line-upper lip 0mm 3mm 4mm

Conclusion
The use of miniscrew in buccal and palatal upper
second molar with cross-elastic successfully correct
second molar scissors bite in Class II malocclusion.

Acknowledgment
None.

Conflict of Interest
The authors hereby declared no conflict of interest.

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of orthodontic techniques used for treating patients with
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 Journal of Dentomaxillofacial Science (J Dentomaxillofac Sci) April 2022 7(1): 57-60 | doi: 10.15562/jdmfs.v7i1.1186