|Year : 2023 | Volume
| Issue : 1 | Page : 2
The prevalence of Brodie bite in untreated orthodontic patients in Nigeria
Idia N Ize-Iyamu, Joseph N Otaren
Department of Preventive Dentistry, University of Benin Teaching Hospital, University of Benin, Benin City, Nigeria
|Date of Submission||19-Apr-2022|
|Date of Decision||22-May-2022|
|Date of Acceptance||28-Jun-2022|
|Date of Web Publication||18-Mar-2023|
Idia N Ize-Iyamu
Department of Preventive Dentistry, University of Benin, Benin City
Source of Support: None, Conflict of Interest: None
OBJECTIVE: The Brodie bite (BRB) is a rare posterior crossbite affecting the transverse occlusal relationship with the palatal cusps of the upper molars, biting into the vestibule and outside the buccal cusps of the lower molar teeth. The BRB is a highly challenging orthodontic problem and is an extreme form of scissors bite. Patients with this problem present with facial deformity and inability to chew on the affected side. The problem is usually not identified until it becomes severe. This study aimed to identify the prevalence of BRB among untreated orthodontic patients in two geo-political zones in Nigeria.
METHODS: A total of 1,041 untreated orthodontic patients who presented to two different orthodontic centres located in two geo-political zones (South/South-Benin City and North Central-Abuja, Nigeria) over a 3-year period were evaluated for the presence of BRB. The transverse dimension of the occlusion was examined for the presence of a crossbite or scissors bite. The molar teeth were used as the reference point for occlusion with Angle's classification of malocclusion. Four groups were identified, namely, teeth in occlusion (TIO) (Angle's Classes I, II or III malocclusion served as the control group), scissors or lingual crossbite (LCB), buccal crossbite (BCB) and BRB. A posterior crossbite was confirmed when the upper molar teeth were biting outside the buccal groove of the lower molar teeth either lingually or buccally. A BRB was identified when the palatal cusps of the upper molars were biting into the buccal vestibule of the lower jaw, with the deviation of the face to that side. Statistical analyses were performed using SPSS version 21; frequencies were determined for the variables, and cross-tabulations between the variables were established. P values < 0.05 were considered significant.
RESULTS: The overall prevalence of BRB in this study was 0.6% (six patients). The values in the South/South (Benin City) were 997 untreated orthodontic patients, with a prevalence of 0.5% (five patients). The North Central (Abuja) zone had a total of 44 untreated orthodontic patients, with a prevalence of 2.3% (one patient). Unilateral BRB was seen in five patients (80%), and bilateral BRB was seen in one patient (20%). The condition was more prevalent among women (four patients, 80%) and on the right side (three patients, 60%). Angle's relationship in Classes I, II and III (TIO or control group) was seen in 911 patients (87.5%). The LCB and BCB groups comprised 39 (3.8%) and 85 patients (8.1%), respectively. Posterior crossbite was seen in 130 patients (12.5%).
CONCLUSION: The prevalence of BRB in this study was found to be 0.6%, with the condition being more prevalent in women and on the right side.
Keywords: Brodie bite, Nigeria, orthodontics
|How to cite this article:|
Ize-Iyamu IN, Otaren JN. The prevalence of Brodie bite in untreated orthodontic patients in Nigeria. J Orthodont Sci 2023;12:2
| Introduction|| |
Brodie bite (BRB) is a malocclusion that affects the transverse occlusal relationship and manifests as a complete displacement of the maxillary arch in relation to the mandibular arch. The condition is also identified as an 'exaggerated scissors bite or a telescopic bite' that results from a transverse deficiency affecting several teeth.,,
This malocclusion is clinically defined by a complete lateral or transverse positioning of the maxillary arch in relation to the mandibular arch. The mandibular arch is totally imbricated inside the maxillary arch., The transverse deficiency can be skeletal or dental in origin, and when skeletal, the maxillary base may be excessive and displaced in the transverse direction. When the deficiency affects the mandible, it leads to a longitudinal transverse constriction of the alveolar bone, which grows excessively. This growth may manifest as either a unilateral (asymmetrical) or a bilateral (symmetrical) crossbite wherein a single tooth or several teeth are abnormally positioned buccally or lingually with reference to the opposing tooth or teeth.,, The clinical manifestations are severe and are associated with transverse, sagittal and vertical skeletal and dental problems.
The aetiology of BRB may be multifactorial and includes genetic syndromes, the shape and position of the tongue, transverse deficiencies of the maxilla or mandible, growth inhibition of the mandible and lingual mobility disorders. William–Beuren syndrome or Robin syndrome is a rare genetic disorder characterized by pre- and post-natal growth retardation, which results in distinctive facial and dental features of which the BRB is the most distinctive one. Studies, have demonstrated that genetic disorders that present with a sagittal shift accompanied by a retruded mandible may also result in a symmetrical or asymmetrical BRB.
The shape and position of the tongue may play a role in increasing the maxillary base, thereby resulting in a transverse displacement. The force and high tongue posture may cause total displacement, thus leading to occlusal disharmony as a result of excess volume that alters the arch form., This disharmony may result in the maxilla closing buccally and completely enveloping the mandibular arch. This high tongue posture may induce mandibular deficiency at the alveolar level, with the arch displaced lingually because of the absence of the tongue in the correct lingual position.,, However, according to Bassigny, the high position of the tongue induces transverse mandibular deficiency at the alveolar level and, therefore, results in defective transverse mandibular development rather than a transverse maxillary excess. A muscular aetiology and lingual habits have been suggested in some studies.,,, These factors may cause a transverse maxillary excess or deficiency. Some authors have proposed a combination of volume abnormality, change in posture and/or lingual mobility disorder.,,
Maxillary or mandibular deficiencies may be noted in severe skeletal Class II malocclusions wherein the retruded position of the mandible allows the maxillary arch to confine the mandibular arch completely, thus resulting in a BRB. An occlusal lock is thus formed, which inhibits the mandibular growth and aggravates the Class II relationship. The BRB and posterior crossbite lead to absence of contact between the anterior maxillary and mandibular arches because of occlusal disharmony that arises from the fact that the teeth are not in occlusion. Stimulation of the alveolar bone is thus prevented, which results in a delay or derangement of teeth eruption. The teeth may be lingually tilted in the mandible and supra-erupted in the maxilla. Clinical evaluation demonstrates a complete lack of visibility of the lower arch, which is hidden within the maxillary arch. Supra-eruption of the maxillary teeth may, at times, occlude on the buccal vestibule. This condition is referred to as Brodie syndrome.
The BRB has been described as a severe form of scissors bite, which is a type of posterior crossbite and a transverse discrepancy between the maxillary and mandibular arches. The aetiology of the buccal crossbite (BCB) is complex, and the lowered tongue posture has been implicated as one of the causative factors. In children, non-nutritive sucking habits, upper airway constriction and mouth breathing are factors associated with the formation of a posterior crossbite. However, while partial contact may exist between the maxillary and mandibular arches in the BCB, there is a total absence of contact in the BRB. Numerous studies have been conducted on posterior crossbite, and BCBs and LCBs have been identified in several countries.,,,, Multiple studies are available on posterior crossbite in our environment; however, none have determined the prevalence of a BRB.,,,,, Although many previous studies have provided data on the prevalence of posterior crossbites, only one study has identified the presence of scissors bite in the population studied.
This study, therefore, aimed to determine the prevalence of BRB in untreated orthodontic patients in Benin City, Nigeria.
| Methodology|| |
This prospective cross-sectional study was conducted among untreated orthodontic patients in two geo-political zones in Nigeria, namely, South-South and North-West. Patients with malocclusion, those aged ≥10 years and those with permanent teeth from the incisors to the second molars on all four quadrants were included. Patients <10 years of age, those with missing permanent teeth from the incisors to the second molars on any of the four quadrants, those in the mixed-dentition stage and those with a posterior crossbite caused by occlusal interferences were excluded. Moreover, patients with a previous history of orthognathic surgery or congenital malformations were excluded. This research was approved by the Research Committee of the University of Benin Teaching Hospital, protocol number ADME/E 22/A/VOL.VII/14831649.
The clinical examination that determined the presence of a crossbite was performed in the clinic by using a mirror to analyse the molar relationship of the upper and lower first permanent molars with the teeth in centric occlusion, as described by EH Angle.
Class I – The mesiobuccal cusp of the maxillary first molar bites on the buccal groove of the mandibular first molar. Malocclusion or mis-alignment of the teeth, normal overbite and overjet and maxillary and mandibular crowding or spacing may be present.
Class II – The mesiobuccal cusp of the maxillary first molar occludes distal to the buccal groove of the mandibular first molar.
Class III – The mesiobuccal cusp of the maxillary first molar occludes mesial to the buccal groove of the mandibular first molar.
Crossbite was defined as an inadequate transverse relationship between the maxillary and mandibular teeth.
It is said to be present when the posterior teeth occlude in an abnormal buccolingual relationship with the opposing teeth. Posterior crossbite can result from malpositioning of a tooth or teeth and/or the skeleton.
It is said to be present when the buccal cusps of the lower teeth occlude buccal to the buccal cusps of the upper teeth and exhibit a vertical overlap.
Scissor bite (LCB)
It is said to be present when the buccal cusps of the lower teeth occlude lingual to the lingual cusps of the upper teeth. There is buccal positioning of the upper posterior teeth and lingual positioning of the lower posterior teeth, with no contact of the occlusal surfaces.
It is a severe form of scissors bite, with the upper molars' palatal cusps lying outside the lower molars' vestibular cusps.
Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 21, Chicago, IL, USA. The variables were tabulated, and frequencies and percentages were determined. Cross-tabulations between the variables were done. P < 0.05 was considered significant.
| Results|| |
A total of 1,041 participants were included in this study. The sex distribution was 364 (35%) men and 677 (65%) women.
Figure 1] shows the data distribution, with a total number of 997 patients (95.8%) in Benin City and 44 patients (4.2%) in Abuja, Nigeria. Majority of the patients (873, 87.3%) exhibited a normal transverse occlusal relationship. BCB and LCB were seen in 81 (8.1%) and 38 (3.8%) patients, respectively. BRB was seen in five patients (0.5%) in Benin and in one patient (2.3%) in Abuja.
The comparative distribution of posterior crossbite and normal occlusion is shown in [Table 1].
|Table 1: Comparative distribution of posterior crossbite with normal occlusion|
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Normal occlusion was seen in 911 patients (87.5%), whereas LCB or scissors bite was seen in 39 patients (3.8%). BRB was seen only in six patients (0.6%). Posterior crossbite was seen in 130 patients (12.5%).
The four identified groups are compared in [Figure 2]. Teeth in occlusion was seen in 911 patients (87.5%), LCB or scissors bite seen in 39 patients (3.8%), BCB was seen in 85 patients (8.1%), BRB seen in six patients (0.6%).
|Figure 2: Comparative evaluation of normal occlusion and posterior crossbite|
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[Figure 3] shows the distribution of molar relationship in normal occlusion and crossbite. Class I molar relationship was the most prevalent in normal occlusion (668 patients, 73.3%) and unilateral crossbite (82 patients, 68.3%). It was also the highest in bilateral crossbite (80%). Class III was the lowest in unilateral crossbite (five patients, 4.2%) and normal occlusion (33 patients, 3.6%).
|Figure 3: Distribution of molar relationship in normal occlusion and crossbite|
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The distribution of untreated orthodontic patients over a 3-year period from 2018 to 2020 is demonstrated in [Figure 4]. The highest number was seen in 2019, with 370 patients (35.5%) from both geo-political zones. The least number was seen in 2020, with 329 patients (31.6%).
|Figure 4: Distribution of untreated orthodontic patients over a 3-year period|
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[Figure 5] shows the sex distribution in the two geo-political zones over the 3-year period. The values in the South/South (Benin City) were 997 untreated orthodontic patients, with a prevalence of 0.5% (five patients). On the contrary, North Central (Abuja) saw a total number of 44 untreated orthodontic patients, with a prevalence of 2.3% (one patient). [Figure 6] is for illustration of LCB. [Figure 7] is illustrative of BRB.
|Figure 5: Distribution of sex and Brodie bite in the two geo-political zones|
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| Discussion|| |
In this study, the overall prevalence of BRB in the two cities located in two different geo-political zones was 0.6%. In other studies too, BRB has been shown to be a rare and severe form of posterior crossbite that occurs in 1.0%–1.5% of the population., While the values from our study differ from those reported in other studies, the prevalence rates demonstrate the uncommon nature of this form of posterior crossbite., Other studies have determined the prevalence of this condition to be 1%–2% among children in the mixed-dentition stage., Although our study was performed in patients with permanent dentition, the values were much lower than those from other studies involving patients with mixed dentition., The results from other studies involving patients with permanent dentition were also much higher than the prevalence rates observed in the present study. These findings differ from the results of this study as a much lower prevalence was identified., While the studies by Grewe and Hagan are older studies, more recent ones have focused on the prevalence rates of posterior crossbite without identifying the BRB.,, In this study, the rarity of the BRB was inferred from the low values over the 3-year period, which were 0.5% in Benin City and 2.3% in Abuja, Nigeria. This disparity could be attributed to the larger sample size of the untreated orthodontic patients in one of the geo-political zones.
The prevalence of scissors bite in this study was 3.8%. This value is high when compared with another Nigerian study, which reported a prevalence of 0.5%, but low when compared with the study by daCosta et al., which recorded a higher prevalence of 5.9%. A study was conducted to identify scissors bite in both the primary and permanent teeth and the transition of this trait via both dentitions. This study by Lombardo et al. demonstrated that the prevalence of scissors bite increased from 0.4% in the primary teeth to 0.5% in the permanent dentition. This value differs from the results obtained from the present study and could be due to the fact that interventions are performed earlier in developed countries, which alleviate the severity of scissors bite in the permanent dentition.
Posterior crossbite was seen in 12.5% of the patients in this study, which is much higher than the value of 3.7% reported in the study by Adekoya et al. In a Rwandan study, the prevalence of posterior unilateral crossbite was identified to be 26%. In the present study, unilateral crossbites belonging to Angle's Classes I, II and III were identified to be 68.3%, 27.5% and 4.2%, respectively. The study by daCosta and Utomi showed that unilateral crossbite was more frequent than bilateral crossbite, which agreed with the results from the present study. Moreover, in their study too, the prevalence of Class I crossbite (77.2%) was higher, which agrees with our findings. However, the results from this study on Classes II and III differed from the values observed in the study by daCosta and Utomi, which demonstrated a prevalence of 9.0% in Class II and 12.7% in Class III. This difference is probably because their study evaluated and correlated both anterior and posterior crossbites with the molar relationship. While another study by Goyal identified crossbite alone, our study differentiated the three skeletal classes, which could explain the wide variations in the prevalence values. Bilateral crossbite was also identified in our study, with skeletal Class I demonstrating the highest prevalence of 80%. Most studies have identified only the presence of a posterior crossbite. Drummond reported a prevalence of 10.4% in a South African population, whereas in an Indian population, a prevalence of 5.5% was reported by Nainani and Relan. These studies,,, however, had recorded posterior crossbites and not BRBs, which are more uncommon. The prevalence of posterior crossbite observed in this study was 12.5%, which is higher than the values obtained from a South African study but much lower than the prevalence of 26% from a Rwandan study. Our study also recorded a much higher prevalence of posterior crossbite than that from an Indian study. Other Nigerian studies have identified the prevalence of posterior crossbite as 4.5% by Ajayi, 5.0% by daCosta et al. and 19.6% by daCosta and Utomi. The variations in these studies are a result of patient selection. Those studies with higher prevalence rates, for example, the one by daCosta and Utomi, were clinic-based studies on untreated orthodontic patients who presented as a result of a malocclusion. The present study was conducted in orthodontic clinics and involved patients presenting with malocclusion; hence, the high prevalence of 12.5%.
More women (80%) than men were identified with the BRB in this study. A study by daCosta and Utomi also demonstrated that more women present with posterior crossbites than men. Their study, however, did not identify the BRB. Most studies, that identified the BRB varied from this study in the sex distribution and showed a male predisposition. Furthermore, this study determined that unilateral BRB of the right side was more involved in the prevalence of the BRB.
In conclusion, the prevalence of BRB in this study was 0.6%, and the condition was found to be more prevalent in women and on the right side. Class I molar relationship (Angle's) was the most prevalent in normal occlusion, unilateral crossbite and bilateral crossbite, whereas Class III molar relationship was the lowest in unilateral crossbite and normal occlusion.
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Conflicts of interest
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