Skeletal Anterior Open Bite Research Articles

Miniplates with A New Design As Skeletal Anchorage for Intrusion of Posterior Maxillary Segment During Correction of Skeletal Anterior Open Bite (A Cohort Clinical Study)

Objective: This study aimed to evaluate the effect of newly designed miniplates that used as skeletal anchorage for maxillary molars’ intrusion during correction of skeletal anterior open bite (SAOB).Subjects and Methods: A sample of 22 patients with an age range from 14 to 22 years, suffering from skeletal anterior open bite (SAOB) with increased posterior maxillary vertical height. A new designed custom-made miniplates used after adaptation on 3D model of maxilla for every patient. They were used as buccal skeletal anchorage for maxillary molars’ intrusion. The measurements, including maxillary dento-alveolar heights (mm), buccal crestal alveolar bone heights (mm), bucco-palatal angulations (B-P⁰) of right and left maxillary first permanent molars, 3 months after intrusion commencement.Results: The dento-alveolar height as well as the buccal crestal alveolar height decreased significantly (p ≤ 0.001 and p ≤ 0.05, respectively) after intrusion. Similarly, the B-P angulations increased significantly (p ≤ 0.01) after intrusion.Conclusion: New custom-made preadapted miniplates’ designs were effective for posterior maxillary molar intrusion in cases of SAOB. Both the posterior maxillary dento-alveolar and buccal crestal alveolar bone heights diminished significantly.

COMBINED ORTHODONTICS AND SURGICAL APPROACH TO CLASS III MALOCCLUSION WITH ANTERIOR OPEN BITE IN ADULTS

Skeletal anterior open bite with Class III malocclusion in adults is one of the most difficult malocclusions to treat. Surgical intervening is a must, along with orthodontics in such complex cases. The most effective treatment option in adult patients with Class III malocclusion and the skeletal anterior open bite is surgical repositioning of the maxilla or both jaws. The present case report describes the treatment protocol for Class III malocclusion with an anterior open bite in adult, a novel orthodontic- surgical approach. A 24-year old male patient with a Class III malocclusion, anterior open bite (skeletal), poor facial aesthetics, mandibular and chin protrusion. The objective was to achieve ideal overjet and overbite, to achieve class 1 incisor, canine and molar relation. To correct anterior open bite and achieve Class I skeletal jaw bases and to achieve esthetically pleasing profile and functionally stable occlusion. Therefore, by correction of the dental and skeletal jaw relationship, we hoped to improve the patient’s self- esteem, confidence and improved oral health quality of life.

Nonsurgical treatment and stability of an adult with a severe anterior open-bite malocclusion.

OBJECTIVES:A skeletal anterior open-bite is a challenging malocclusion for the orthodontist due to the difficulty and instability of correction. Treatment options for the adult patient include extractions, anterior extrusion with intermaxillary elastics, posterior intrusion using skeletal anchorage, occlusal adjustment, and orthognathic surgery. Patient compliance plays a key role in posttreatment stability. The present case report demonstrates the orthodontic treatment of an adult patient who presented with a complex open-bite malocclusion.MATERIALS AND METHODS:Treatment involved the placement of four miniscrews to assist intrusion of maxillary molars by applying posterior vertical maxillary elastics and extrusion of the anterior segments using anterior vertical interarch elastics.RESULTS:Ideal intercuspation was successfully achieved and good stability was maintained during 3 years following treatment.CONCLUSION:The intrusion of the maxillary molars with miniscrews is an interesting option in selected cases of skeletal anterior open bite. The retention protocol should be specific in these cases.

Long-term stability of soft tissue changes in anterior open bite adults treated with zygomatic miniplate-anchored maxillary posterior intrusion.

To evaluate soft tissue changes and their long-term stability in skeletal anterior open bite adults treated by maxillary posterior teeth intrusion using zygomatic miniplates and premolar extractions. Lateral cephalograms of 26 patients were taken at pretreatment (T1), posttreatment (T2), 1 year posttreatment (T3), and 4 years posttreatment (T4). At the end of treatment, the soft tissue facial height and profile convexity were reduced. The lips increased in length and thickness, with backward movement of the upper lip and forward movement of the lower lip. The total relapse rate ranged from 20.2% to 31.1%. At 4 years posttreatment, 68.9% to 79.8% of the soft tissue treatment effects were stable. The changes in the first year posttreatment accounted for approximately 70% of the total relapse. Soft tissue changes following maxillary posterior teeth intrusion with zygomatic miniplates and premolar extractions appear to be stable 4 years after treatment.

Corticotomy for Correction of Skeletal Anterior Open Bite Using Miniplates as Skeletal Anchorage (A Clinical and Cone Beam Comparative Study)

Objective: This study was designed to evaluate the effect of corticotomy and miniplates’ usage as skeletal anchorage for maxillary molars’ intrusion during correction of skeletal anterior open bite (SAOB). Patients, materials and methods:A sample of 22 patients with an age range from 14 to 22 years, suffering from skeletal anterior open bite with increased posterior maxillary vertical height. The participants were randomly divided into two groups according to the corticotomy approach. Group I: both buccal and palatal corticotomies were performed. Group II: only buccal corticotomy was performed. Buccal miniplates and palatal mini-screws were used as skeletal anchorage for maxillary molars’ intrusion assisted by corticotomy. The measurements, including maxillary dento-alveolar heights (mm), bucal crestal alveolarbone heights (mm), bucco-palatal angulations (B-P˚) and mesio-distal angulations (M-D˚) of right and left maxillary first permanent molars, 4.5 months after intrusion commencement. Results: The dento-alveolar height as well as the buccal crestal alveolar height decreased significantly after intrusion in both groups (p≤0.001 and p≤0.05, respectively), but without significant differences between them. Similarly, the M-D and B-P angulations increased significantly after intrusion in both groups (p≤0.01 and p≤0.001, respectively), with no significant differences between both groups. Conclusions: The current corticotomy approaches and temporary anchorage devices (TADs) were similarly effective for maxillary molar intrusion in cases of (SAOB), but complete correction of SAOB was not achieved. Both the posterior maxillarydento-alveolar and buccal crestal alveolar bone heights diminished similarly in both corticotomy methods. Neither mesio-distal nor bucco-palatal angulations of maxillary first permanent molar crown revealed major changes in matching both approaches of intrusion.

Principles of Orthognathic Surgical Correction of Skeletal Anterior Open Bite

This article describes the principles of orthognathic surgical correction of skeletal anterior open bite (AOB), including a description of the aetiological factors involved in the development of predominantly skeletal AOBs, description of the presenting diagnostic features, the principles of treatment planning, orthodontic preparation, and postoperative requirements.

Correction of an skeletal anterior open bite with mini-screws and a modified bite block

ABSTRACT Skeletal anterior open bite may be treated with mini-screws since they provide an absolute anchorage to correct it through maxillary molar intrusion. With an adequate control a bite block was used in this case to help correct the malocclusion. Case report A 15 year-old male dolichofacial patient with an Angle class II division 1 malocclusion, a -4.5 mm anterior open bite and incompetent lips is hereby presented. Etiology: reduced anterior upper facial height. The treatment goal was to obtain a normal anterior overbite decreasing the posterior maxillary dentoalveolar height. Orthognathic surgery was indicated but the patient refused it. So the treatment consisted in two mini-screws implanted on the palatal side and a modified fixed bite block, activated with elastomeric chains. Results A molar intrusion of 2 mm was achieved; the anterior overbite changed to +2 mm, a mandibular counterclockwise rotation took place and the facial profile was improved. Conclusions The anterior open bite was corrected with a good control during molar intrusion and without buccal tipping.

Full-mouth rehabilitation of skeletal anterior open bite with severely decayed dentition: A case report

Full-mouth rehabilitation of skeletal anterior open bite with severely decayed dentition: A case report

Retaining corrected skeletal open bites. How can we increase the stability of our results?

Retaining corrected skeletal anterior open bites is challenging. If it is possible to identify the aetiological factors causing an open bite, an appropriate choice of treatment and retention may reduce relapse. Extruding anterior teeth to close anterior open bites is known to be unstable, so treatment is typically aimed at controlling the vertical position of maxillary molars, in addition to removing causative factors, such as breaking habits and improving tongue posture. Relapse rates are high, with relapse estimated at about 20-30%, with slightly more stability for a surgical approach. Various approaches with retainers are described that aim to restrict the eruption of posterior teeth, and improve the position of the tongue. These retainers often require excellent patient compliance and there is a lack of high quality evidence to support their use. Further research is required to confirm the effectiveness of these approaches.

Are temporary anchorage devices truly effective in the treatment of skeletal open bites?

Objective:The aims of this study were to evaluate the effects of temporary anchorage devices (TADs) in the treatment of skeletal open bites and to compare the results with untreated controls.Materials and Methods:A total of forty patients with skeletal anterior open bites were assigned to two groups of twenty each. The mean chronological age for the treatment group (14 female, 6 male) was 16.68 ± 2.80 years old, compared with 16.63 ± 2.83 years old for the control group (11 female, 9 male). Titanium miniplates fixed bilaterally to the infrazygomatic crest area were used as TADs and intrusive forces were applied to the posterior teeth with Ni-Ti coil springs. The treatment and normal growth changes were evaluated using 24 measurements (2 angular, 22 linear).Results:Statistically significant differences were found between the groups in Bx, By, Sn/GoGn, Ax-Bx, U6x, U6y, overjet, overbite, SN/OccP, N-Me, Ans-Me, S-Go/N-Me, interpremolar width, and intermolar width (P < 0.05). In the treatment group, statistically significant upper molar intrusion (mean ± standard deviation [SD], 3.59 ± 1.34; 95% confidence interval [CI], 2.96–4.22), posterior rotation of the occlusal plane (mean ± SD, 3.42 ± 2.17; 95% CI, 2.39–4.43), anterior rotation of the mandible (mean ± SD, 2.25 ± 1.91; 95% CI, 1.36–3.14), and resultant overbite improvement (mean ± SD, 4.82 ± 1.53; 95% CI, 4.10–5.53) were found (P < 0.05).Conclusions:Mild to moderate skeletal anterior open bites could easily be treated with TADs without orthognathic surgery. With the rigid anchorage of miniplates, true molar intrusion of up to 4 mm was achieved. With molar intrusion, anterior rotation of the mandible and a significant reduction in anterior face height were determined.

Changes of some functional speech disorders after surgical correction of skeletal anterior open bite

Skeletal anterior open bite (AOB) or apertognathism is characterized by the absence of contact of the anterior teeth and affects articulation parameters, chewing, biting and voice quality. The treatment of AOB consists of orthognatic surgical procedures. The aim of this study was to evaluate the effects of treatment on voice quality, articulation and nasality in speech with respect to skeletal changes. The study was prospective; 15 patients with AOB were evaluated before and after surgery. Lateral cephalometric x-ray parameters (facial angle, interincisal distance, Wits appraisal) were measured to determine skeletal changes. Before surgery, nine patients still had articulation disorders despite speech therapy during childhood. The voice quality parameters were determined by acoustic analysis of the vowel sound /a/ (fundamental frequency-F0, jitter, shimmer). Spectral analysis of vowels /a/, /e/, /i/, /o/, /u/ was carried out by determining the mean frequency of the first (F1) and second (F2) formants. Nasality in speech was expressed as the ratio between the nasal and the oral sound energies during speech samples. After surgery, normalizations of facial skeletal parameters were observed in all patients, but no statistically significant changes in articulation and voice quality parameters occurred despite subjective observations of easier articulation. Any deterioration in velopharyngeal insufficiency was absent in all of the patients. In conclusion, the surgical treatment of skeletal AOB does not lead to deterioration in voice, resonance and articulation qualities. Despite surgical correction of the unfavourable skeletal situation of the speech apparatus, the pre-existing articulation disorder cannot improve without professional intervention.

Diagnostic model of anterior open bite--a new way to predict skeletal type: a cross-sectional study.

The aim of this study was to determine a differential diagnostic model for anterior open bite (AOB) in children in order to predict evolution with growth in cases of skeletal or dysfunctional dysplasia. The sample was composed of 128 subjects divided into 2 groups according to overbite values: a control group with normal occlusion and 2.5 ± 1mm overbite, and an AOB group with a negative overbite. Measurements of hyoid bone position, gonial angle, SN/Go-Gn, FMA, height of alveolar processes, upper lip height, height of the anterior nasal spine to stomion superior, upper incisor and menton, antegonial notch, symphysis anatomy, condyle anatomy, convexity, facial axis, lower oropharyngeal area and curve of Spee were obtained for all subjects, based on lateral cephalometric radiographs and lateral photos. All data were analyzed, and multivariate logistic regression was applied. The area under the receiver operating characteristic (ROC) curve was calculated for the models obtained by logistic regression, in order to evaluate them. Statistical analysis was performed in IBM(®) SPSS(®) Statistics version 21.0. The results demonstrated that the AOB model was capable of predicting skeletal anterior open bite with an accuracy of 93%. The seven variables selected were: lower face height (LFH), height of mandibular alveolar process, antegonial notch, symphysis direction, symphysis thickness, gonial angle and facial axis. Measurements of facial morphology made it possible to construct a model able to differentiate, with a small margin of error, between the two distinct forms of AOB: skeletal and dysfunctional.

Factors related to stability following the surgical correction of skeletal open bite

Abstract Objectives: If a skeletal anterior open bite malocclusion is treated by orthognathic surgery directed only at the mandible, the lower jaw is repositioned upward in a counter-clockwise rotation. However, this procedure has a high risk of relapse. In the present study, the key factors associated with post-surgical stability of corrected skeletal anterior open bite malocclusions were investigated. Material and methods: Eighteen orthognathic patients were subjected to cephalometric analysis to assess the dental and skeletal changes following mandibular surgery for the correction of an anterior open bite. The patients were divided into two groups, determined by an increase or decrease in nasion-menton (N-Me) distance as a consequence of surgery. Changes in overbite, the displacements of molars and positional changes in Menton were evaluated immediately before and after surgery and after a minimum of one year post-operatively. Results: The group with a decreased N-Me distance exhibited a significantly greater backward positioning of the mandible. The group with an increased N-Me distance experienced significantly greater dentoalveolar extrusion of the lower molars. Conclusions: A sufficient mandibular backward repositioning is an effective technique in the prevention of open bite relapse. In addition, it is important not to induce molar extrusion during post-surgical orthodontic treatment to preserve stability of the surgical open bite correction.

Orthodontic treatment of anterior open bite: a review article—is surgery always necessary?

Anterior open bite cases are very difficult to treat satisfactorily because of their multifactorial aetiology and their very high relapse rate. Dependent on the origin of the anterior open bite malocclusion and the patient's age, there are several treatment possibilities ranging from deterrent appliances, high-pull headgear, fixed appliances with and without extractions to orthognathic surgery, and skeletal anchorage with miniplates or miniscrews. The gold standard treatment of skeletal anterior open bite cases is the combined approach of orthodontic treatment with fixed appliances and orthognathic surgery. In recent years, temporary anchorage devices (TAD) have been developed to correct anterior open bites orthodontically. With the introduction of TAD as an effective treatment modality, orthognathic surgery may be avoidable in selected anterior open bite cases. This is a relatively new technique and to date there remains a lack of evidence of long-term stability of anterior open bite closure with TAD.

Factors related to the incidence of anterior disc displacement without reduction and bony changes of the temporomandibular joint in patients with anterior open bite

We aimed to investigate factors related to the prevalence of anterior disc displacement without reduction (ADDwoR) and bony changes of the condylar head (bony changes) in the temporomandibular joints (TMJs) of patients with anterior open bite. Subjects are comprised of 36 preoperative patients (72 joints) with skeletal anterior open bite without facial asymmetry who had undergone orthognathic surgery at the Hokkaido University Hospital; magnetic resonance imaging of the TMJ and cephalometric analysis were performed before treatment. Logistic regression analysis was performed to clarify relationships among age, overbite, overjet, ANB angle, sella to nasion (SN) to mandibular plane angle (SN-MP angle), SN to ramus plane angle (GZN angle), gonial angle, and incidence of ADDwoR or bony changes in patients with anterior open bite. Fifteen patients had bilateral ADDwoR, and five patients had unilateral ADDwoR; 17 patients had bilateral bony changes, and five patients had unilateral bony changes. SN-MP angle was greater in 20 patients with ADDwoR than that in 16 patients without ADDwoR (p < 0.05). GZN angle was greater in the 20 patients showing bony changes than that in the 16 patients without bony changes (p < 0.05). In terms of dentofacial morphology, SN-MP angle appears to be associated with the incidence of ADDwoR, and GZN angle appears to be associated with bony changes in the TMJ.

Residents' journal review

Residents' journal review

Nonsurgical orthodontic treatment for an adult with skeletal open bite, class III malocclusion and posterior crossbite: A case report

Class III malocclusion associated with skeletal anterior open bite pattern in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Conventionally, several treatment alternatives are available such as tooth extraction, molar intrusion, and absolute anchorage system or orthognathic surgical correction. Although correction with surgery may be the most effective and stable way, many patients refused surgical treatment plan because of the costs and traumas it may bring. We reported a nonsurgical orthopedic treatment of 22-year-old male with severe skeletal anterior open bite, dental Class III malocclusion, posterior crossbite and a high mandibular plane angle. The patient refused surgery and extraction. So we formulated a treatment plan consisting of using rapid palatal expansion appliance to expand the maxilla, standard edgewise brackets to align the teeth, Class III elastics to correct the canines, premolars, and molars relationship, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct open bite. In this case, without suffering of surgery, the posterior crossbite was ideally corrected, and ideal overjet and overbite relationships and functional occlusion were all achieved. The patient obtained satisfactory occlusal as well as functional and stable results.

Combined Orthodontic and Orthognathic Surgical Treatment for the Correction of Skeletal Anterior Open-Bite Malocclusion: A Systematic Review on Vertical Stability

To evaluate vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. A literature search was performed to locate studies pertaining to vertical stability after combined orthodontic surgical treatment of skeletal anterior open-bite malocclusion. Data from the identified studies were extracted and assessed for quality. Short-term and long-term changes in the following variables were evaluated: overbite; mandibular plane, palatal plane, and intermaxillary angles; and anterior facial height. Nine studies, all retrospective, were appropriate for inclusion after review. The postoperative follow-up period ranged from 1 to 18 years. A wide variation was present for post-treatment changes and relapse. Dentally, overbite changes showed a wide variation, with more long-term relapse observed in patients after Le Fort I osteotomy. Skeletally, the mandibular plane and intermaxillary angles showed greater long-term relapse after bimaxillary surgery than after Le Fort I osteotomy. The same trend was seen for the post-treatment increase in anterior facial height. In contrast, the palatal plane seemed to remain rather stable. Vertical relapse is a characteristic in a certain number of patients after combined orthodontic surgical treatments regardless of surgery type. This can be observed dentally by an opening of the bite and skeletally by an increase in the mandibular plane and intermaxillary angles during long-term follow-up. Long-term skeletal relapse seems to be more common after bimaxillary surgery.

Eight-year stability of a severe skeletal anterior open bite with a hyperdivergent growth pattern treated with an edgewise appliance and chin cup therapy

An adolescent boy with an Angle Class II Division 1 malocclusion had a hyperdivergent growth pattern with an excessive lower facial height and an anterior open bite. Combined orthodontic and surgical treatment should be considered for patients with a skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, a 0.022 × 0.028-in nontorqued, nonangulated fixed appliance with a chincup as adjunct therapy is an alternative that can have excellent results. The final outcome of this treatment were great improvements in function, esthetics, and posttreatment stability after 8 years.

Anterior Open Bite Closure: A Case Report

Anterior open bite is often caused by a downward rotation of the mandible and/or by excessive eruption of the posterior teeth. In such cases, it is difficult to establish absolute anchorage for molar intrusion by traditional orthodontic mechanics. This article reports the successful treatment of a severe skeletal anterior open bite case using titanium screw anchorage. A female patient of 31 years of age had open bite of 7 mm with increased facial height. The mini screws were implanted on both maxilla and the mandible, and an intrusion force was provided with elastic chains for 13 months. After active treatment of 19 months, her upper and lower first molars were intruded by about 3 mm each, and good occlusion was achieved. Her retrognathic chin and convex profiles were improved by an upward rotation of the mandible. Our result suggests that titanium screws are useful for intrusion of molars in anterior open bite cases.