Anterior Open Research Articles

Efficacy of Clear Aligner Therapy for the Treatment of Anterior Open Bite in Adults: A Systematic Review and Meta-Analysis.

The objective of the present systematic review and meta-analysis was to assess the effectiveness of clear aligner therapy (CAT) for the treatment of anterior open bite (AOB) in adults. The focused question was "Is CAT effective for the management of AOB in adults?". Databases were searched without time and language barriers up to and including August 2024 based on pre-specified eligibility criteria. Risk of Bias (RoB) assessment was performed using the Risk-of-Bias-In-Non-randomised-Studies-of-Intervention (ROBINS-I) tool. Meta-analyses were conducted using a random effects model (REM) for change in AOB and cephalometric measurements with an evaluation of the mean difference (MD) and/or standardised mean difference (SMD). The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool was used to assess the quality of evidence. Publication bias was assessed using Funnel plots and Egger's regression test. There were 14 studies included in the qualitative assessment and 12 in the meta-analysis. The RoB was moderate in 13 studies and low in one. The meta-analysis showed significant AOB correction with CAT [(MD) = 2.76 mm, 95% confidence interval (CI): 2.23-3.28] due to maxillary and mandibular incisor extrusion (MD = 0.85 mm, CI: 0.43-1.26 and MD = 0.86 mm, CI: 0.29-1.44, respectively). There were no significant changes identified for maxillary and mandibular molar intrusion or changes in the mandibular plane angle (MPA). The level of confidence was high for AOB correction, incisor extrusion, and molar intrusion and low for MPA. CAT leads to a significant correction of AOB of approximately 2.76 mm, which can be mainly attributed to incisor extrusion.

Transtuberositary, Anterior Open Wedge High Tibial Osteotomy (TT-AOW-HTO) to Correct a Negative Slope

ZusammenfassungEin knöchernes Genu recurvatum tritt klinisch durch eine Überstreckbarkeit des Kniegelenks in Erscheinung. Neben den Problemen durch die Hyperextension kann es hierdurch langfristig außerdem zu einer Insuffizienz des hinteren Kreuzbandes (HKB) kommen. Kausale Therapie dieser Tibiakopfextensionsdeformität stellt eine Slope-erhöhende Tibiakopfosteotomie dar. Hierbei gibt es bisher nur wenige Publikationen zu klinischen Ergebnissen, insbesondere zur reinen Slope-Korrektur ohne Veränderung der Frontalachse. Im Folgenden wird die Technik der transtuberositären ventral öffnenden Tibiakopf-Flexions-Osteotomie (Transtuberositary Anterior Opening Wedge High Tibial Osteotomy, TT-AOW HTO) zur Erhöhung des tibialen Slope gezeigt (mit Ablösen und „Bioplating“ der Tuberositas tibiae). Nach vorgeschalteter Arthroskopie erfolgt nach der Osteotomie von ventral die Interposition eines autologen Beckenkammspans und die Osteosynthese mit 2 winkelstabilen Platten von medial und anteromedial.

Orthodontic Management of a Growing Patient With a Skeletal Class III Malocclusion and an Anterior Open Bite: A Case Report

Orthodontic Management of a Growing Patient With a Skeletal Class III Malocclusion and an Anterior Open Bite: A Case Report

Volumetric Changes of Frontal Sinus after Correction of Anterior Open Bite

Volumetric Changes of Frontal Sinus after Correction of Anterior Open Bite

Surgical and Camouflage Orthodontic Treatment of Anterior Open Bite: Comparison of Profile Attractiveness.

To evaluate the profile's attractiveness between the different protocols for treating the anterior open bite. The sample comprised 39 patients with anterior open bite treated with or without extractions, divided into two groups: The surgical group (G1) comprised 21 subjects (10 males, 11 females) with a mean initial age of 21.86 years (SD = 5.09), treated with fixed orthodontic appliance followed by orthognathic surgery, for a total mean period of 2.53 years (SD = 0.61). The mean overbite was -5.01 mm (SD = 2.50); The camouflaged group (G2) comprised 18 subjects (9 males, 9 females), with a mean initial age of 20.47 years (SD = 4.19), treated only with fixed orthodontic appliance, for a total mean period of 2.56 years (SD = 0.94). The mean overbite was -4.28 mm (SD = 1.15). Lateral photographs from pretreatment and posttreatment were used. These photographs were evaluated by 46 laypeople and 67 dentists, who rated the attractiveness of each profile from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with independent t-tests. Both groups presented improvement in the profile attractiveness with treatment (p < 0.001). Before treatment, the profile of the surgical group was significantly less attractive than the profile of the camouflaged group (p < 0.001). The surgical presented a more attractive profile at the final stage than the camouflaged group (p < 0.001). The surgical group showed a greater improvement in profile attractiveness with treatment than the camouflaged group (p < 0.001). In the final stage, the surgical presented a more attractive and greater improvement in profile attractiveness than the camouflaged group. The laypeople and dentists judged similarly the initial profile attractiveness.

Use of hyperboloid as an adjunct in functional jaw orthopedics – case report

Anterior open bite can be defined as a malocclusion with a negative vertical discrepancy between the incisal edges of the upper and lower anterior teeth, which do not have occlusal contacts with the antagonists and sometimes extends to the canines and, less frequently, to the premolars is one of the malocclusions with the greatest aesthetic and/or functional impairment. Anterior open bite can have several etiologies: finger sucking and/or pacifier, oral breathing, onychophagia, lip interposition, atypical swallowing, tongue interposition when uttering phonemes and anterior posture of the tongue at rest. Orofacial myofunctional disorders are present in cases of anterior open bite, generally associated with etiologies and adapt to this altered morphological condition. Regarding the anterior opening amplitude, the anterior open bite is classified as: minimum up to 1 mm, moderate between 1 and 5 mm and severe +5 mm [1]. Open bite can be classified into: maxillary, mandibular and hybrid open bite [2]. Myofunctional therapy is considered a treatment method that can increase muscle strength, cause changes in functional patterns and thus prevent deviations in craniofacial development, as it promotes new posture of structures at rest and during the performance of the functions of the stomatognathic system [3]. The hyperboloid is an instrument for increasing muscle tone and when used in chewing, it is efficient in inducing growth and remodeling. The hyperboloid fills a gap in the modern diet, with the consistency of hard, raw and dry foods [4]. Exercises with a size M hyperboloid with wire were prescribed as an initial approach. After 2 months of treatment, there was an improvement in the interincisor distance. The exercise was maintained for another 5 months. He stopped attending appointments for 2 years and 2 months. Upon his return, the results of the functional examination of swallowing, chewing, protrusion and laterality were observed, and we opted for the installation of the SN3. the hyperboloid, in this case, showed its efficiency in balancing the stomatognathic system.

Evaluation of Stability and Stress Distribution on Plate and Bone for Correction of Anterior Open Bite with Le Fort I Osteotomy: New Plate Design

Aim: Many different fixation methods have been proposed in the literature for the treatment of open bite. Beginning with the use of plates and screws, rigid fixation methods have become commonplace, however, open bite is a disorder prone to relapse despite rigid fixation. In our study, we aimed to eliminate the need for guided split usage during surgery and to increase postoperative stabilization in open bite patients with a new personalized plate design. Material and Method: For this purpose, a three-dimensional (3D) head model was created in the virtual environment. After the Le Fort I osteotomy on the model, the inferior segment of the maxilla was placed 1 cm forward and positioned to leave a space between the inferior and superior part of the maxilla. Different fixation methods were applied to fix the bone segments. In the first group, four plates with a thickness of 0.8 mm were fixed. In the other groups, we used three different thicknesses (0.4 mm, 0.6 mm, 0.8 mm) of the continuous plate we designed. The amount of movement and tension that occurred on the bone segments, plates, and screws were evaluated. Results: The maximum movement in the study was observed with the standard 4-plate fixation method, and the minimum movement was observed with the custom plate system with 11-screw type with a thickness of 0.8 mm. As a result, it has been found that the custom-made continuous plates provide a more rigid fixation than the standard plates. Conclusion: It may be possible to reduce the likelihood of a relapse problem by designing a plate with the appropriate thickness and form to spread the stress on the bone over a wider area.

Use of Clear Aligners with a Surgery-First Approach for Treatment of the Anterior Open Bite: A Systematic Review and Comparison with Conventional Fixed Appliances

Use of Clear Aligners with a Surgery-First Approach for Treatment of the Anterior Open Bite: A Systematic Review and Comparison with Conventional Fixed Appliances

Non-Surgical Treatment of a Skeletal Class II Patient with Anterior Open Bite and Distal Impaction of the Mandibular Second Molars

Non-Surgical Treatment of a Skeletal Class II Patient with Anterior Open Bite and Distal Impaction of the Mandibular Second Molars

Improved Superelastic Wire (ISW) Treatment for Skeletal Class III Malocclusion with Anterior Open Bite and Missing Upper Left Incisor

Improved Superelastic Wire (ISW) Treatment for Skeletal Class III Malocclusion with Anterior Open Bite and Missing Upper Left Incisor

Skeletal Anterior Open Bite Attenuates the Chewing-Related Increase in Brain Blood Flow.

The masticatory function of patients with skeletal anterior open bite (OPEN) is reported to be impaired compared with that of patients with normal occlusion (NORM). In this study, we compared brain blood flow (BBF) in patients with OPEN and NORM and investigated the factors related to BBF during mastication in patients with OPEN. The study included 17 individuals with NORM and 33 patients with OPEN. The following data were collected: number of occlusal contacts, jaw movement variables during mastication, and BBF measured with functional near-infrared spectroscopy during chewing. The number of occlusal contacts, maximum closing and opening speeds, closing angle, and vertical amplitude were smaller in the OPEN than in the NORM group. Interestingly, BBF increased less in the OPEN group. Correlation analysis revealed that several parameters, including number of occlusal contacts and closing angle, were correlated with changes in BBF during mastication. These results suggest that not only occlusion but also jaw movement variables and factors related to masticatory muscles contribute to the chewing-related increase in BBF. In conclusion, BBF increases less during mastication in patients with OPEN than in those with NORM. In addition, the higher increase in BBF is correlated with jaw movement. Together, we discovered that OPEN exhibits significant adverse effects not only on masticatory function but also on brain function.

Effects of Occlusal Contact on Maxillary Alveolar Bone Morphology in Patients with and without Anterior Open Bite: A Cross-Sectional Study.

Background/Objectives: Anterior open bite (AOB) is characterized by the absence of occlusal contact between the maxillary and mandibular anterior teeth, while the posterior teeth are in contact when occluded. Here, we aimed to clarify the difference in maxillary alveolar bone morphology in adult patients with and without AOB. Methods: This cross-sectional study was conducted on 50 adults aged 18-39 years: 25 patients without AOB (control group; 13 males and 12 females; age: mean ± standard deviation [SD], 22.2 ± 4.5 years) and 25 patients with AOB (9 males and 16 females; age: 24.2 ± 6.4 years). Using cone-beam computed tomography images, the height of the maxillary alveolar bone crest in the anterior and posterior teeth and thickness of the alveolar cortical bone on the labial and palatal sides were measured and compared between the two groups. An independent t-test and Pearson's correlation analysis were used to examine statistical significance (p < 0.05). Results: The AOB group showed a significantly longer (p = 0.016) posterior alveolar crest and thinner cortical bone on the buccal (p < 0.001) and lingual (p = 0.009) sides of the anterior region and the buccal (p = 0.006) sides of the posterior region than the control group did. Moreover, a significant negative correlation (p = 0.046; r = -0.403) was observed between bite force and cortical bone thickness on the buccal side of the posterior region in the AOB group. Conclusions: It is suggested that the absence of occlusal contact in the anterior area influences the alveolar bone morphology of the maxilla.

The Effectiveness of Aligners in the Treatment of Anterior Open Bite in Adult Patients: A Systematic Review and Critical Appraisal

An anterior open bite is a dental malocclusion, the diagnosis of which is fundamental for its treatment. With the evolution of artificial intelligence, it is possible to treat it through the Invisalign G4 protocol, depending on the degree of severity. The aim of this study was to perform a systematic review, based on the PICO strategy, to evaluate the effectiveness of aligners and accessory devices in adult patients with anterior open bites. The search was carried out in the following databases for publications over the last ten years: PubMed, Web of Science, Cochrane Library, and LILACS. The inclusion criteria were clinical studies evaluating adults with anterior open bites (overbites &lt; 0 mm) and orthodontic studies with aligners. The exclusion criteria were studies of cases with dentofacial deformities, previous orthodontic treatment, history of surgery/trauma, or systemic diseases that affect craniofacial growth, as well as animal studies, reviews, and clinical cases. The selection was carried out separately by two researchers. In the four databases, 108 articles were obtained. By reviewing the titles and abstracts and applying the exclusion criteria, 91 articles were eliminated. The seven resulting articles were submitted to the inclusion criteria, two of which were excluded due to their lack of patients presenting an open bite and the absence of aligner treatment. According to the PRISMA method, five studies were selected. The collected data showed an increase in overbites with the use of aligners. The bias assessment was performed with the ROBINS-I tool, indicating a moderate risk of bias. The included studies demonstrated the effectiveness of aligners in the treatment of adults with mild or moderate open bites; however, due to the lack of scientific evidence, it is necessary to carry out randomized studies with the same standardized variables.

개방교합과 안면 비대칭을 보이는 골격성 II급 부정교합 환자의 비수술적 치료

개방교합과 안면 비대칭을 보이는 골격성 II급 부정교합 환자의 비수술적 치료

Traumatic Posterior Hip Dislocation in a Child: When is an Anterior Open Reduction Indicated? A Case Report

Traumatic hip dislocations in children are uncommon, occurring in about 5% of all dislocations in children. Neglected hip dislocations are rarer and pose a serious threat to the normal development of the hip with complications of avascular necrosis and unstable gait. Open reduction is usually required, but the most appropriate surgical approach has not been clearly defined. We reported a child with a traumatic posterior hip dislocation who was successfully treated through an anterior approach after a previously failed posterior open reduction. An anterior open reduction of the hip following a previous failed posterior open reduction is a safe procedure and avoids the likelihood of an iatrogenic injury to the sciatic nerve. Pre-operative imaging with a CT scan or MRI is required in neglected cases to visualise intra-articular bone fragments, which can prevent a concentric reduction.

The Value of Axial Imaging to Check Reduction after Anterior Approach Open Reduction for Developmental Dysplasia of the Hip

Background: There are still many controversies regarding the diagnosis and management of developmental dysplasia of the hip (DDH). Axial imaging is routinely used after closed or open reduction to confirm reduction has occurred. In this study, we aimed to determine the rate of early re-dislocation or failure of reduction after anterior approach open reduction (AOR), to establish whether there is a true need for routinely performing post-operative axial imaging.&#x0D; Methods: We retrospectively reviewed radiographs, operation notes and post-operative CT scan images of our AOR cases from September 2018 to June 2020. The CT scan images were reviewed to check the post-operative reduction and congruency. The ‘posterior neckline’ and the ‘modified Shenton line’ were used to assess reduction. The related literature was also reviewed.&#x0D; Results: Thirty patients were included. The post-operative CT scans confirmed that all cases had reduced congruent hips. The CT scans did not change future treatment plans for any patient in this cohort and did not predict late re-dislocation.&#x0D; Conclusions: The rate of early re-dislocation or failure of reduction after AOR was negligible. Traditional routine axial imaging after this operation is therefore unjustified and has no value in predicting possible late re-dislocations. It also comes at the cost of extra radiation to the child and expense for the health system. We recommend stopping the routine use of post-operative axial imaging and using it selectively for specific indications, including teratologic and neuromuscular hips, bilateral DDH, and after revision surgery, in addition to closed reductions and medial approach open reduction.

Evaluation of Dimensional Changes in Maxillary and Frontal Sinus in Adult Patients With Anterior Open Bite and Normal Overbite: A Retrospective Cone Beam Computed Tomography (CBCT) Study.

An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually involve either intrusion of posterior teeth or extrusion of anterior or a combination of both. The anatomical relationship between the apex of the maxillary molar roots to the inferior wall of the maxillary sinus floor is crucial in planning posterior intrusion. The paranasal sinuses influence the growth of the facial structures that eventually get altered in various malocclusions. Studies have proven that theheight of the sinusgets modified in anterior open bite owing to pneumatization. This study aims to evaluate the distance from the root apex of maxillary first molars (mesiobuccal, distobuccal, and palatal roots) to the maxillary sinus floor to evaluate the significance of the vertical pneumatization of the sinus on planning for true intrusion in anterior open bite and to assess the correlation between frontal and maxillary sinuses in an anterior open bite. This retrospective study evaluated 30 pre-treatment cone beam computed tomographies (CBCTs) of patients out of which 15 were with anterior open bite and 15 with ideal overbite. Linear measurements were carried out using care stream software in CBCTs. There was a significant correlation between the distance of the palatal root and the distobuccal root of the maxillary first molar to the maxillary sinus floor bilaterally in the anterior open bite (p<0.04). A significant moderate positive correlation of the maxillary and frontal sinus height in anterior open bite (p<0.006). A significant moderate negative correlation between the distance from the palatal root to the maxillary sinus floor and maxillary sinus height in anterior open bite (p<0.001). Vertical pneumatisation of the maxillary sinus has caused a significant negative correlation between the apex of the palatal root of the maxillary first molar tooth and the maxillary sinus floor in the anterior open bite. The palatal root being the closest to the sinus floor, and the distobuccal root being second nearest. There is a significant correlation between the height of the sinuses in the anterior open bite.

Orthodontic Correction of an Anterior Open Bite with Periodontally Compromised Upper Incisors Using Miniscrews

This case report describes the camouflage treatment of a patient with an anterior open bite, bimaxillary skeletal protrusion with a mild class II skeletal pattern, reduced periodontium with generalized slight bone loss, localized severe bone loss at the maxillary upper incisors, and a tongue thrust habit. Orthodontic treatment included modifying the resting posture of the tongue and sectionally intruding maxillary posterior teeth while controlling the extrusion of mandibular posterior teeth using temporary anchorage devices (TADs), followed by sectional mechanics at the maxillary arch and continuous arch mechanics at the mandibular arch, along with interpromximal reduction at the mandibular teeth and inter-arch elastics from the mandibular teeth to the maxillary TADs to minimize orthodontic force magnitude and duration specifically applied to periodontally compromised maxillary incisors. The patient’s chief complaint was addressed, and treatment objectives were achieved, with good esthetic and occlusal outcomes. Stability was shown over a 56-month follow-up period.

Efficiency of Aligners in Correcting Anterior Open Bite: A Systematic Literature Review

Background: The utilization of orthodontic aligners for treating various malocclusions has significantly increased in recent years. However, there is uncertainty regarding the evidence supporting their effectiveness in correcting anterior open bite. Objective: The purpose of this study was to systematically review the literature and evaluate the clinical effectiveness of clear aligners in correcting anterior open bite based on the available evidence. Materials and methods: A total of three databases (Pubmed, Sciences Direct and Google Scholar) were searched until March 2023, in addition to a manual search in the following journals: the American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, and the European Journal of Orthodontics. Prospective and retrospective studies assessing the ability of aligners in achieving incisal extrusion and molar intrusion movements published during the last 10 years in English were eligible to be selected. Study selection and data extraction were undertaken independently by two reviewers. Risk-of-bias (RoB) assessment was evaluated using the study quality assesment tool of NHLBI, NIH. The reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Nineteen relevant articles were included in the analysis, comprising four prospective non-randomized and fifteen retrospective non-randomized studies. Among these, four studies compared the efficacy of aligners versus fixed appliances in correcting anterior open bite, while fourteen papers evaluated the overall effectiveness of aligners in treating this malocclusion. The risk of bias was categorized as high in one study, moderate in eight studies, and low in ten studies. Extrusion was found to be easily achievable with aligners, with the actual quantity of extrusion often surpassing predictions in the majority of studies. The mean reported extrusion amounted to 1.8mm. Additionally, the mean reported intrusion was 0.75mm. Conclusion: It is evident that aligners are an effective option for the treatment of anterior open bite, this effectiveness is achieved by combining the extrusion and palatal tipping of the anterior segments with the intrusion of the lateral segments, resulting in a counterclockwise rotation of the mandible. Moreover, aligner treatment may be a valid alternative to conventional orthodontic therapy, but it does not appear to provide better control over the vertical dimension compared to fixed orthodontic appliances in adult patients.

Anterior Open Bite Malocclusion: From Clinical Treatment Strategies towards the Dissection of the Genetic Bases of the Disease Using Human and Collaborative Cross Mice Cohorts.

Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to difficulties with speech, chewing, and biting. Its etiology is multifactorial, involving a combination of genetic, environmental, and developmental factors. Genetic studies have identified specific genes and signaling pathways involved in jaw growth, tooth eruption, and dental occlusion that may contribute to open bite development. Understanding the genetic and epigenetic factors contributing to skeletal open bite is crucial for developing effective prevention and treatment strategies. A thorough manual search was undertaken along with searches on PubMed, Scopus, Science Direct, and Web of Science for relevant studies published before June 2022. RCTs (clinical trials) and subsequent observational studies comprised the included studies. Orthodontic treatment is the primary approach for managing open bites, often involving braces, clear aligners, or other orthodontic appliances. In addition to orthodontic interventions, adjuvant therapies such as speech therapy and/or physiotherapy may be necessary. In some cases, surgical interventions may be necessary to correct underlying skeletal issues. Advancements in technology, such as 3D printing and computer-assisted design and manufacturing, have improved treatment precision and efficiency. Genetic research using animal models, such as the Collaborative Cross mouse population, offers insights into the genetic components of open bite and potential therapeutic targets. Identifying the underlying genetic factors and understanding their mechanisms can lead to the development of more precise treatments and preventive strategies for open bite. Here, we propose to perform human research using mouse models to generate debatable results. We anticipate that a genome-wide association study (GWAS) search for significant genes and their modifiers, an epigenetics-wide association study (EWAS), RNA-seq analysis, the integration of GWAS and expression-quantitative trait loci (eQTL), and micro-, small-, and long noncoding RNA analysis in tissues associated with open bite in humans and mice will uncover novel genes and genetic factors influencing this phenotype.