Evaluation of the open-bite Bionator versus the removable posterior bite plane with a tongue crib in the early treatment of skeletal anterior open bite: A randomized controlled trial

Abstract

Several treatment approaches can be found in the literature about early treatment of open bite. However, no studies have addressed the use of a removable posterior bite plane with a tongue crib (RPBP/C), compared with functional appliances, for treating open-bite cases. The objectives of this trial was to compare the effectiveness of the open-bite Bionator (OBB) and the RPBP/C as an early intervention to correct skeletal open-bite cases in children, in terms of limiting excessive vertical growth of the craniofacial skeletal components and normalizing the developement of the anterior dentoalveolar region. Two-arm, parallel-group randomized controlled trial was conducted. Forty patients with a skeletal anterior open bite (age range: 7.5-10.5 years) were treated at the University of xxxx School of Dentistry in xxxx, xxxx. They were distributed randomly into 2 equal groups: the OBB group (20 patients; mean age: 8.8 ± 1.5 years) and the RPBP/C group (20 patients; mean age: 8.6 ± 1.1 years). Randomization was based on a computer-generated sequence of random numbers. Primary outcome measures were the skeletal and dentoalveolar variables, whereas the secondary outcome measures were the soft-tissue parameters assessed on standardized lateral cephalograms collected before and after 12 months of treatment. Mann-Whitney U tests were used to detect significant differences between the 2 groups. Both the OBB and the RPBP/C appliances induced favorable dental effects. A statistically significant difference was found between the 2 groups in the overbite (P=0.003). Open bite in the OBB group showed a mean closure of 4.91 mm (SD 0.4 mm), and a mean closure of 3.43 mm (SD 0.3 mm) was observed in the RPBP/C group. Dentoalveolar changes at the anterior region were evident, with statistically significant extrusion, and lingual tipping of the maxillary and mandibular incisors (P ≤ 0.05). The results showed no significant differences in the skeletal changes between the 2 groups. The OBB and the upper posterior bite plane with crib were both effective in the early treatment of the skeletal anterior open bite. However, closure of the anterior open bite was mainly due to the dentoalveolar changes at the anterior region of the dental arches.