orthodontics

Treatment of Brodie Syndrome

Anisha ValliLeave a comment

1. Definition

  • Rare transverse malocclusion where maxillary teeth overlap mandibular teeth completely.
  • Contact between palatal surfaces of maxillary teeth and buccal surfaces of mandibular teeth — no intercuspation.

2. Classification

TypeDescriptionCommon Association
BilateralBoth sides affectedSkeletal Class II, deep bite
UnilateralOne side affectedLaterognathia, facial asymmetry
Localized (single tooth)Often 2nd molarEruption anomaly or iatrogenic

3. Etiology

  • Skeletal: Maxillary exognathia / Mandibular endognathia
  • Functional: High tongue posture → maxillary expansion
  • Dental: Eruption or retained deciduous teeth
  • Iatrogenic: Uncontrolled maxillary expansion
  • Genetic: Familial cases reported

4. Clinical Features

  • Intraoral: Wide, flat maxillary arch; narrow mandibular arch; lateral open bite or supraclusion.
  • Extraoral: Minimal facial change (unless unilateral → asymmetry).
  • TMJ: May show clicking, deviation, or discomfort.

5. Diagnostic Tools

  • Clinical & model analysis
  • Frontal ceph / CBCT → evaluate skeletal base, alveolar inclinations, symmetry
  • Tongue posture & function evaluation

6. Treatment Objectives

  • Coordinate arches transversely
  • Achieve functional intercuspation
  • Prevent TMJ strain and asymmetry
  • Restore normal growth pattern (in children)

7. Treatment by Age & Severity

A. Early / Growing Patients

Orthopedic phase

  • Maxillary contraction & Mandibular expansion
    • Split Schwartz plate (symmetrical/asymmetrical)
    • Quad Helix (reversed activation)
    • Hyrax disjunctor (reverse screw)
    • Mandibular expansion plate / Arnold expander / Crozat

Aim: Reduce transverse discrepancy before skeletal lock develops.

B. Adolescents / Adults

Orthodontic phase

  • Manage lateral supraclusion → occlusal blocks / resin wedges.
  • Use lingual + buccal appliances for control.
  • Apply torque control:
    • Maxillary palatal root torque
    • Mandibular buccal root torque
  • Intermaxillary “criss-cross” elastics (only with vertical control).
  • Miniscrew anchorage → apply palatoversion (maxilla) & vestibuloversion (mandible) without extrusion.

C. Localized Scissor Bite (e.g., 2nd molar)

  • Transpalatal arch with elastic chain (Kucher-Weiland technique)
  • Dragon Helix or Miniscrew + elastic module
  • Extraction of causal molar (if indicated, replace with 3rd molar)

D. Severe / Skeletal Cases

Surgical options

ProcedureIndicationKey Feature
Lefort I with contractionMaxillary exognathia5–6 mm contraction possible
Segmental osteotomy (Schuchardt)Unilateral Brodie + supraclusionRisk of devascularization
Symphyseal distraction osteogenesisMandibular endognathiaStable, minimally invasive
Posterior subapical osteotomyUnilateral deformityCorrects localized collapse

8. Prognosis

  • Untreated: Functional imbalance, mandibular growth inhibition, TMJ asymmetry.
  • Early-treated: Stable with normal mandibular development.
  • Adult cases: May require combined ortho-surgical management.

9. Key Clinical Tips

✅ Identify alveolar vs skeletal origin early.
✅ Avoid unnecessary maxillary expansion.
✅ Use miniscrew anchorage to minimize extrusion.
✅ Manage vertical dimension before transverse correction.
✅ Maintain occlusal guidance and retention with passive lingual arch post-correction.

Reference:
Sebbag M., Cavaré A. Treatment of Brodie Syndrome. J Dentofacial Anom Orthod 2017; 20:109. DOI: 10.1051/odfen/2018118

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