Skeletal and dental open bite treatment using clear aligners and orthodontic miniscrew-anchored fixed appliances in permanent dentition: A systematic review

Abstract

BackgroundThe objective was to systematically review studies assessing the efficacy of clear aligner therapy (CAT) and miniscrew-anchored fixed appliances (MAFAs) in the correction of skeletal and dental open bite in the permanent dentition. MethodsA literature search was conducted across different databases, including PubMed, Cochrane Library, Science Direct, Web of Science, Medline, Scopus and Google Scholar, up to April 2024. Studies were chosen based on prespecified inclusion criteria. The dentoskeletal changes based on lateral cephalometry were evaluated from the included papers. Study selection, data extraction, and risk of bias (RoB) assessment were performed in duplicate. Risk of bias assessment was done using ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) and Cochrane RoB 2 tools. GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessed certainty of evidence. ResultsOut of the 22 studies that were selected, 13 papers covered MAFAs, while 9 articles focused on CATs. Since the included papers consist of prospective and retrospective observational studies, as well as two randomized controlled trials, the scientific evidence is at a low level. CATs primarily induced posterior teeth intrusion and anterior teeth extrusion, contributing to the reduction of the posterior vertical dimension and improved occlusal contacts. Conversely, MAFAs facilitated significant molars intrusion, and controlled anterior teeth extrusion, effectively addressing both dental and skeletal discrepancies. ConclusionsThis review supports the use of MAFAs and CATs for treating skeletal and dental open bite, highlighting their effectiveness and implications for orthodontic practice. The limitations of this study should be considered when interpreting the results.