Correction Of Open Bite Research Articles

Volumetric Changes of Frontal Sinus after Correction of Anterior Open Bite

Volumetric Changes of Frontal Sinus after Correction of Anterior Open Bite

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.

Taming the vertical growth of mandible in a growing patient with skeletal open bite: A case report

Skeletal open bite poses a significant challenge due to its association with downward and backward mandibular rotation and vertical maxillary overgrowth. Early intervention is critical, especially in patients with a hyperdivergent skeletal phenotype, as facial growth patterns are established early in development. This case report details the treatment of a 9-year-old male with a severe anterior open bite of 6 mm, vertical growth pattern, and class I skeletal relationship. Initial treatment included high-pull headgear with an intraoral transpalatal arch and tongue cribs to control the molar eruption and tongue posture. Over nine months, this approach reduced the open bite by restricting maxillary molar movement and promoting mandibular autorotation. In the second phase of treatment, temporary anchorage devices (TADs) were placed in the parasagittal region along with a transpalatal arch to achieve active molar intrusion and improve incisor exposure. The combination of orthopedic appliances and TADs successfully eliminated the open bite and corrected overjet, while improving incisor alignment, facial profile, and smile esthetics. Cephalometric analysis revealed a reduction in the mandibular plane angle, lower anterior facial height, and improved incisor extrusion. This case highlights the efficacy of early skeletal open bite correction using non-surgical methods, with TADs providing effective molar intrusion and stable long-term results. The integration of headgear and skeletal anchorage offers an effective treatment modality for young patients with severe open bites, potentially eliminating the need for more invasive surgical procedures in the future.

Are zygomatic implants an alternative to orthognathic surgery in the treatment of a vertical discrepancy ? A case series to describe an open bite treatment protocol

IntroductionThis report aims to present case series to describe a treatment protocol for correction of severe open bite in non-growing patients MethodologyPatients diagnosed with skeletal open bite malocclusion (overbite range: -3 to -6 mm) were treated using a bonded appliance and skeletal anchorage. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants (MPI). Intrusion was continued until positive overbite occurred. Treatment progressed with conventional fixed orthodontic treatment for alignment and settling. MPIs were retained until the end of treatment for retention of intrusion ResultsClinically effective open bite correction was achieved by intrusion of maxillary buccal segment and mandibular counterclockwise autorotation ConclusionThis protocol includes zygomatic anchorage and an appliance that aims triple intrusion effect through combination of orthodontic and physiological forces. Achieving significant maxillary intrusion, controlling mandibular eruption and maximizing mandibular counterclockwise autorotation are the main outcomes of this protocol.

Dentoalveolar effects of open-bite correction with the dual action vertical intra-arch technique: A finite element analysis.

To evaluate tooth displacement and periodontal stress generated by the dual action vertical intra-arch technique (DAVIT) for open-bite correction using three-dimensional finite element analysis. A three-dimensional model of the maxilla was created by modeling the cortical bone, cancellous bone, periodontal ligament, and teeth from the second molar to the central incisor of a hemiarch. All orthodontic devices were designed using specific software to reproduce their morpho-dimensional characteristics, and their physical properties were determined using Young's modulus and Poisson's coefficient of each material. A linear static simulation was performed to analyze the tooth displacements (mm) and maximum stresses (Mpa) induced in the periodontal ligament by the posterior intrusion and anterior extrusion forces generated by the DAVIT. The first and second molars showed the greatest intrusion, whereas the canines and lateral incisors showed the greatest extrusion displacement. A neutral zone of displacement corresponding to the fulcrum of occlusal plane rotation was observed in the premolar region. Buccal tipping of the molars and lingual tipping of the anterior teeth occurred with intrusion and extrusion, respectively. Posterior intrusion generated compressive stress at the apex of the buccal roots and furcation of the molars, while anterior extrusion generated tensile stress at the apex and apical third of the palatal root surface of the incisors and canines. DAVIT mechanics produced a set of beneficial effects for open-bite correction, including molar intrusion, extrusion and palatal tipping of the anterior teeth, and occlusal plane rotation with posterior teeth uprighting.

Stability of skeletal open bite correction in adult patients by molar intrusion: A meta analysis

To review and compile literature to check the post retention stability of skeletal open bite correction by molar intrusion. Articles were searched in Electronic database of English literature i.e. PubMed, Cochrane Library, Embase and google scholar. Titles and abstracts of potential articles with inclusion criteria were examined and included based on consensus agreement. Abstracts of articles having characteristics that were uncertain were examined, with full article retrieval if necessary. The reference list of the retrieved articles were also searched. On comparing the mean post treatment and post retention of overbite derived from their respected forest plot graphs, there was 32 percent relapse in the overbite correction. This study states that skeletal open bite patients treated with molar intrusion have 68 % stability, whereas the intruded molar have a 95% stability.

Does planned molar intrusion with aligners assist with closure of anterior open bite?

This study aimed to determine whether prescribed molar intrusion, with or without virtual occlusal bite-blocks (BB), resulted in actual molar intrusion and assisted with anterior open bite (AOB) correction in adult patients treated with Invisalign clear aligners (Align Technology, Santa Clara, Calif). A retrospective study was conducted with 36 adult patients with AOB. Subjects were divided into 2 treatment groups: planned molar intrusion (PMI) and no-PMI (No-PMI). PMI was obtained from the tooth movement tables in the ClinCheck software. Patients with PMI were further categorized by the presence or absence of virtual posterior BB (PMI-BB and PMI-No BB, respectively). Treatment success was determined on the basis of positive vertical incisor overlap in posttreatment cephalograms. Treatment changes were assessed using pretreatment and posttreatment cephalometric radiographs (Welch 2-sample t test, 95% confidence interval, P= 0.05). Finally, treatment stability was assessed at least 1-year posttreatment using the Photographic Open Bite Severity Index (POSI). There were 15 patients with No-PMI and 21 without PMI (total n= 36). The mean overbite change was 2.5 ± 1.0 mm for No-PMI and 3.2 ± 1.8 mm for patients with PMI (P= 0.12). All patients had positive vertical incisor overlap in posttreatment cephalograms, indicating 100% treatment success. Open bites were corrected primarily by incisor retroclination and extrusion in both treatment groups. The average measured molar intrusion for the PMI group was 0.71 mm greater than the change for the No-PMI group, but the difference was not statistically significant after controlling for potentially confounding variables (P= 0.074). A total of 14 patients from the original sample were assessed for stability using the POSI analysis. Of those, 12 (85.7%) had a POSI score of0. Regardless of whether the molar intrusion was planned or not, the modality of AOB correction with Invisalign clear aligners was primarily incisor extrusion and retroclination. Overall, aligners are an effective appliance for the treatment of adult AOB. Based on our limited sample, treatment stability was similar to that reported for fixed appliances.

Anterior open bite correction in adults through MEAW technique: A case report

Anterior open bite correction in adults through MEAW technique: A case report

Management of a severe skeletal open bite case using temporary anchorage devices and multiloop edgewise arch wire technique

Key Clinical MessageThe primary cause of complex AOB malocclusion is typically a combination of dental, skeletal, functional, and habitual factors. Open bite correction is a challenging treatment due to its complexity and the requirement for long‐term stability, therefore, multidisciplinary treatment is often the best option for achieving stable esthetic outcomes.

Three-Dimensional Evaluation of Treatment Effects and Post-Treatment Stability of Maxillary Molar Intrusion Using Temporary Anchorage Devices in Open Bite Malocclusion.

Background: We investigated treatment outcomes and post-treatment stability in 10 patients with an anterior open bite and nonsurgical orthodontics. Methods: The patients underwent maxillary molar intrusion using temporary anchorage devices (TADs) to deepen the overbite due to mandibular autorotation. Lateral cephalograms and dental cast models were obtained before treatment (T0), immediately after it (T1), and >1 year after it (T2). Skeletal and dental cephalometric changes and three-dimensional movements of the maxillary dentitions were evaluated. Results: At T0, cephalometric analysis indicated that patients had skeletal class I with tendencies for a class II jaw relationship and a skeletal open bite. During active treatment (T0 to T1), the maxillary first molar intruded by 1.6 mm, the mandibular first molar extruded by 0.3 mm, the Frankfort-mandibular plane angle decreased by 1.1°, and the overbite increased by 4.1 mm. Statistically significant changes were observed in the amount of vertical movement of the maxillary first molar, Frankfort-mandibular plane angle, and overbite. Three-dimensional (3D) dental cast analysis revealed that the maxillary first and second molars intruded, whereas the anterior teeth extruded, with the second premolar as an infection point. In addition, the maxillary molar was tipped distally by 2.9° and rotated distally by 0.91°. Statistically significant changes were observed in the amount of vertical movement of the central incisor, lateral incisor, canine and first molar, and molar angulation. From T1 to T2, no significant changes in cephalometric measurements or the 3D position of the maxillary dentition were observed. The maxillary and mandibular dentitions did not significantly change during post-treatment follow-up. Conclusions: Maxillary molar intrusion using mini-screws is an effective treatment for open bite correction, with the achieved occlusion demonstrating 3D stability at least 1 year after treatment.

Effectiveness of Invisalign Treatment on Open Bite Correction.

Open bite is a common orthodontic malocclusion that can have functional and aesthetic implications. Traditional orthodontic treatments have been used to correct open bites, but the effectiveness of Invisalign, a clear aligner therapy, in open bite correction remains a topic of interest. A retrospective analysis was conducted on a cohort of 50 patients with open bites who underwent Invisalign treatment. Pre-treatment and post-treatment records, including cephalometric radiographs, dental models, and clinical photographs, were assessed. The open bite was defined as a negative overbite greater than 2 mm. Treatment duration, number of aligners used, and patient compliance were also recorded. Statistical analysis, including paired t-tests and subjective patient feedback, was employed to evaluate the treatment outcomes. The mean pre-treatment open bite was -3.5 mm (SD = 1.2), and the mean treatment duration was 18 months (SD = 2.5). On average, patients received 24 sets of aligners (SD = 4.1) during the treatment. Post-treatment evaluation showed that the mean overbite improved to + 1.5 mm (SD = 0.8), indicating successful open bite correction. The paired t-test revealed a statistically significant difference between pre-treatment and post-treatment open bite measurements (P < 0.001). Patient satisfaction was high, with 90% of participants reporting improved aesthetics and comfort. Invisalign treatment demonstrates effectiveness in correcting open bites, with statistically significant improvements in overbite measurements.

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.

Highlights of orthognathic surgery in class II patients: a systematic review

Introduction: Orthognathic surgery is indicated to modify the position of the maxillomandibular structure, which may cause changes in the sagittal position of the mandibular condyle in individuals with retrognathism and mandibular prognathism. In the context of orthognathic surgery, anterior open bite (AOB) is an easily recognized malocclusion and presents only aesthetic and functional problems. Objective: Foi desenvolver uma revisão sistemática para apresentar as principais considerações da cirurgia ortognática em pacientes classe II. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 88 articles were found, 40 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.5%&gt;50%. The etiology of anterior open bite is multifactorial and may be caused by environmental and hereditary factors. Class II patients may have significantly greater amounts of lateral and inferior translation than class III patients. Two-jaw surgery for open bite correction led to different directions and amounts of condylar rotational displacement in patients with skeletal class II malocclusion. Treatment can be carried out through preventive, interceptive, corrective, or even surgical treatments. The differentiated bonding of brackets to the anterior teeth is also a very useful resource for the treatment of anterior open bite.

Anterior open bite correction via molar intrusion: Diagnosis, advantages, and complications

Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal anchorage devices, prompts counterclockwise rotation of the mandible. This rotation not only corrects anterior open bite but also contributes to a decrease in anterior facial height, improvements in lip incompetency, and forward movement of the chin. For successful outcomes, temporary skeletal anchorage devices, installed on both the buccal and palatal sides, must deliver equivalent intrusion force to the maxillary teeth. Treatment planning should consider factors such as skeletal discrepancies, vertical excess, incisor exposure, and configuration of the occlusal plane. Clinicians are advised to closely monitor periodontal changes and consider overcorrection to ensure lasting stability and maintenance of incisal overlap post-treatment.

Orthodontic correction of acquired open bite with TMJ degeneration: A retrospective study of outcomes and stability

Newly developed temporary anchorage devices (TADs) serve a strong orthodontic anchorage to intrude molars for correction of anterior open bite (AOB). We measured cephalometric changes in skeletal open bite patients which developed subsequently to temporomandibular joint disorders with bilateral point contacts at terminal molars. We retrospectively recruited 32 patients who had been treated their TMD before orthodontic correction (overbite: -3.14±1.86mm). Partial orthodontic appliances were used to intrude posterior teeth using TADs until positive OB obtained (T1). Full fixed appliances were then used to achieve proper overjet and overbite (T2). We collected lateral cephalograms before (T0), during (T1) and after (T2) treatment, and at follow-ups (T3). Using ANOVA, we analyzed the differences among these time points to determine treatment changes and stability of orthodontic results. In this group predominantly comprising young adult women, orthodontic treatment with TADs significantly reduced upper posterior dental heights (T2-T0:-1.84±0.66mm) and facilitated the retraction and uprighting upper incisors (T2-T0: -9.92±1.72°), to achieve appropriate OJ (T2-T0: -3.21±0.49mm) and OB (T2-T0: 4.10±0.28mm) with p<0.05. Except upper posterior dental height, most of cephalometric changes including OJ, OB, and upper incisal axis remained significant at follow-ups with retention time of 3.7±2.6 years. Only three out of 30 patients experienced small amount of open bite at T3. Orthodontic correction of OJ remained relatively stable among 90% of patients with TMJ degeneration by intrusion via TADs. This modern but conservative orthodontic approach can improve occlusal functions in skeletal open bites.

A Novel Approach for Anterior Open bite Correction

A Novel Approach for Anterior Open bite Correction

Comparison of Class II open bite correction by temporomandibular joint prostheses or bimaxillary orthognathic surgery

IntroductionThe aim of this study was to evaluate the outcome of skeletal Class II and anterior open bite patients who received simultaneous Le fort I osteotomies with temporomandibular joint (TMJ) prostheses or bimaxillary orthognathic surgery. Materials and MethodsPatients with condylar resorption (CR) were treated by TMJ prostheses and orthognathic surgery and divided into two groups. Cephalometric radiographs were obtained before and after operation to find out the surgical alteration by comparing measures at different time points. Results23 patients were included. Mean overbite of the patients was increased by 3.39 mm in TMJ prostheses group and 3.24 mm in orthognathic group. Occlusal plane angle was averagely rotated -6.06° and 1.31°; mandibular plane counterclockwise rotated 12.23° and 5.81°, respectively. The increase of ramus height in TMJ prostheses group were significantly greater than orthognathic surgery group (8.02 ± 1.96 mm vs. -0.09 ± 1.29 mm). The overall treatment effect was stable in both groups during the 1-year follow up. DiscussionTwo surgical plans seem to be reliable treatments of anterior open bite and mandibular retrognathism caused by temporomandibular disease. TMJ prostheses with simultaneous Le fort I osteotomies close open bite by lengthening the height of ramus and rotating maxillo-mandibular complex counterclockwise, while bimaxillary orthognathic surgery by rotating maxilla clockwise and mandible counterclockwise without rebuilding ramus.

Predictability of anterior open bite treatment with Invisalign

Anterior open bite correction with Invisalign has been claimed to have relatively good predictability because of the proposed function of clear aligners to function as occlusal bite-blocks, limiting extrusion of the posterior teeth or possibly even intruding posterior teeth. This proposal, however, remains relatively unsubstantiated. The objective of this study was to investigate and determine the accuracy of Invisalign treatment in correcting anterior open bite by comparing the predicted outcome from ClinCheck to the achieved outcome for the initial aligner sequence. A retrospective study used pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 76 adult patients from private specialist orthodontic practices. Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners. Geomagic Control X software was used to measure overbite and overjet in the pretreatment, posttreatment, and predicted outcomes stereolithography files for each patient. Approximately 66.2% of the programmed open bite closure was expressed compared with the prescribed ClinCheck outcome. The use of posterior occlusal bite-blocks and prescribed movement of teeth via anterior extrusion, posterior intrusion, or a combination of the 2 made no difference to the efficacy of open bite closure. Two-week aligner changes resulted in 0.49 mm more bite closure on average. The prescribed bite closure in ClinCheck software overestimates the bite closure that is clinically achieved.

Dual-action vertical intraarch technique: A multifocal technique for open bite correction

The dual action vertical intra-arch technique (DAVIT) is an innovative non-compliant multifocal mechanics for open bite correction. It is based on simultaneous posterior intrusion and anterior extrusion, which can occur at similar or different rates according to the patient's needs. This report presents the clinical handling of this innovative mechanics. The occlusal and cephalometric effects of the DAVIT device are shown by the treatment of an open bite Class III malocclusion. Six months after DAVIT placement, the open bite was corrected by increasing the overbite 5.1 mm. Dentoalveolar changes associated with open bite correction with DAVIT included maxillary molar intrusion, maxillary incisor extrusion and palatal tipping, uprighting of maxillary posterior teeth, and maxillary occlusal plane rotation. Maxillary incisor exposure and smile esthetics improved significantly. DAVIT efficiency seems to be associated with its non-compliant multifocal mechanical action, which can be adjusted according to the patient's occlusal and esthetic needs.

The efficacy of anterior open bite closure when using Invisalign's optimized extrusion versus conventional attachments.

Clear aligners are reported to control anterior open bites. Despite this, anterior extrusion remains difficult with aligners. Optimized extrusion attachments on incisors may facilitate anterior extrusion to correct open bite with Invisalign. The aim of this retrospective study was to compare the efficacy of anterior open bite correction with Invisalign when using optimized extrusion versus conventional attachments. This was a retrospective cohort study. The pre- and post-treatment intraoral scans of patients with anterior open bite treated with Invisalign aligners were assessed. Patients were divided into two groups: group A, patients with horizontal conventional attachments and group B, patients with optimized extrusion attachments on incisors. The pre and post-treatment overbite and the planned overbite change were measured and compared between the groups. Descriptive statistics were computed and statistical significance was set at P < 0.05. A total of 86 patients were included. Both groups showed significant increases in overbite, but there was no difference in the open bite correction efficacy in patients with conventional versus optimized attachments. Shorter treatment times for open bite closure were reported for patients with optimized attachments. Anterior open bite can be corrected regardless of the attachment type. Optimized attachments are no more effective than using conventional attachments in incisor extrusion to correct open bite. Patients with anterior open bite with optimized attachments observed shorter treatment times for overbite correction. When correcting anterior open bite with Invisalign, the attachment type does not improve the success rate. Optimized extrusion attachments on incisors may shorten the treatment time compared to conventional attachments.