# Scissorbite, Deepbite and AP Corrections

<https://shub.invisalign.com/cc-cloud/latest/index.html?locale=en_US&user=user&ccModIntegrity=false&configUrl=%2Fconfig%2Fscsl_cc_cloud&ccId=433236>

Her occlusion looks good on the left side, but on the right side. There is a crossbite on the 17/47 ( which i think is ok to leave as is), but Im not sure about the 13/43 position. Does this look like an appropriate initial plan or is there anything I should consider to improve the final positions the R side ?


# Schalk Answer

##  Scissorbite: 

[https://www.loom.com/share/8912664d562e4635b3b6b1c30e63241d?sid=a301defb-be0d-4358-bb3d-e6a1ad292c73](https://www.loom.com/share/8912664d562e4635b3b6b1c30e63241d?sid=a301defb-be0d-4358-bb3d-e6a1ad292c73)



1. **Identifying the Issue**
   * Scissor bite present, causing edge-to-edge biting on lower buccal to upper palatal.
   * Significant wear due to misalignment.
2. **Correction Method**
   * Crown movement is all that’s needed, so much easier than if the roots had to move. 
   * Use 3D controls to adjust crown position
3. **Possible Treatment Approaches**
   * Placement of attachments to ensure tracking of teeth.
   * Consideration of elastics and buttons for more significant scissor bites.
   * Plan for overcorrection to account for potential movement discrepancies.
4. **Final Adjustments**
   * Possibility of abnormal occlusion due to wear, may require occlusal equilibration.



##  Deepbite Correction and Sequential Distalization: 

[https://www.loom.com/share/d2ae3b6b400b4d1186aaa1c36e9f40b8?sid=66dd8bb9-b542-4046-82fe-1bc796abbda8](https://www.loom.com/share/d2ae3b6b400b4d1186aaa1c36e9f40b8?sid=66dd8bb9-b542-4046-82fe-1bc796abbda8)


### Deepbite Correction

In this case, the deepbite correction focuses on addressing the significant curve of Spee, primarily resulting from the extrusion of anterior teeth. The overcorrection or overtreatment of the intrusion, particularly of the canines, is crucial, as it ensures the desired outcome even though the actual results may not entirely match the planned movements. The aim is to have a small step-up in the canine position, preventing an excessive intrusion that might lead to lack of tracking. Adjusting the intrusion of the canines to be slightly less while still maintaining the desired overtreatment is key to achieving proper alignment and avoiding an unsightly buccal positioning.

Additionally, ensuring symmetry in the final alignment is important, especially when comparing the first premolars in different quadrants. The grid tool can assist in visualizing and adjusting the position of the teeth to maintain symmetry. The overall goal is to prevent one premolar from sitting higher than the other, which could lead to an imbalanced final occlusion. These meticulous adjustments help achieve a better tracking of the aligners and contribute to a more aesthetically pleasing and functional deepbite correction.

### Class II Correction

For correcting the Class II occlusion on the patient's right side, the recommended approach involves using sequential distalization in combination with Class II elastics. This method effectively interlocks the canines into a Class I occlusion by moving the teeth backward in a controlled manner. Sequential distalization requires careful planning, where each tooth only begins its distal movement once a significant portion of the previous tooth's movement is complete. This stepwise approach ensures that the movement is gradual and precise, reducing the risk of undesired extrusion or improper alignment.

The use of elastics is essential in this process, as they aid in achieving the desired posterior movement and maintaining proper intercuspation. The elastics should be worn 24 hours a day, and their attachment points need to be carefully planned, with button cutouts positioned towards the distal of the lower first molar. The effectiveness of the distalization process is reliant on using a slit in the aligner or an additional button cutout, depending on the specific needs of the case. Proper patient compliance with elastic wear is critical to the success of this Class II correction strategy.


Instructions to Technician:   
  
*Sequential Distalization Protocol*


1. *Please correct the occlusion with sequential distalization*
2. *Do not allow the second tooth to start distalizing until 50% of the first tooth's movements are complete. Then the third tooth should not start distalizing until the first tooth is finished its movement.*
3. *Continue the pattern of only allowing two teeth to distalize at a time.*
4. *Treat the upper canine as an individual tooth, but the lateral and central incisors can move together as a single unit.*
5. *Do not allow any of the molars to extrude. If leveling of the arch is required, only allow intrusion of posterior teeth to ensure a flat occlusion. A bite jump may then be shown in the vertical dimension. Do not give any AP corrections with a bite jump.*