Nonsurgical treatment of a skeletal vertical discrepancy with a significant open bite

Abstract

A case report of a patient who exhibited with a skeletal Class II, dental Class I malocclusion with maxillary right first molar to maxillary left first molar open bite. A hyperdivergent cranial base/mandibular plane angle is presented. Maxillary-mandibular arch form and arch width discrepancies, a low labial frenum, multiple diastemas, and mandibular dental protrusion were present. A history of thumb sucking was evident. Active tongue thrusting and inadequate tongue posture at the time of treatment were documented. The patient was treated without extraction with an 0.022-inch edgewise appliance. A modified tongue crib with a palatal button was used until stable bite closure was achieved. Ideal overbite and overjet relationships were established. A Class I molar and canine occlusion was obtained. The transverse discrepancy was solved, and excellent dentofacial esthetics were achieved. Posttreatment records for 38 months document the stability of the treatment result. [This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements of the certification process conducted by the Board.] (Am J Orthod Dentofac Orthop 1997;112:124-31.)