Improved stability of open bite deformities: taking control of the transverse width using digital technology and robotic archwire bending

Abstract

Many factors need to be considered when selecting the treatment protocol for the surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including any dysfunction of the temporomandibular joint or tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of a skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist who also designs the patient’s digital occlusion. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment until debonding, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.