Skeletal Open Bite Research Articles

Aesthetic and functional rehabilitation in a patient with anterior skeletal open bite using lithium dissilicate glass-reinforced ceramic: a case report

The aim of this clinical report is to present the replacement of unsatisfactory metal-ceramic crowns of elements 12, 11, 21 and 22, by lithium disilicate glass-reinforced ceramic crowns in a patient with skeletal anterior open bite. A patient sought care at the Dental Hospital at the School of Dentistry of UFU, complaining of odor between the metal-ceramic crowns of the antero-superior teeth. After clinical and radiographic examination, invasion of the biological space was noticed, surgery was indicated in order to restore the biological space. After healing, the pre-existing cast metal posts were masked using an opaque composite resin and the teeth were reprepared for full all-ceramic crowns. Impressions were taken in two steps, using PVS associated to retraction cords. The ceramic copings were obtained in lithium disilicate ceramic, and the veneering was performed by stratification. After testing the ceramics crowns in relation to, fit, function and aesthetic results, cementation was completed using modified absolute isolation, followed by prophylaxis of preparations with pumice and saline, surface treatment of the ceramic restorations and luting using self-adhesive resin cement. Finally, an occlusal splint was produced to control the effects of bruxism and orofacial pain symptoms. The anterior open skeletal bite was a challenging factor for the rehabilitation of this patient; however, one must consider the entire process that the patient would undergo if choosing for orthognathic surgery, and the patient should be aware of the case limitations. In addition, the use of lithium disilicate glass-reinforced ceramics proved the versatility of this material for anterior aesthetic restorations.

Molar intrusion vs maxillary surgical impaction in skeletal open bite patients: Systematic review

Objective: Skeletal openbite’s control, is an effective challenge in orthodontics. In adults, treatment of severe skeletal open bite consists mainly of surgically repositioning the maxilla or the mandible. Recently, molar intrusion by using skeletal anchorage has been developed as a new strategy for open-bite treatment. The aim of this research is to compare the effectiveness of 2 approaches: Molar intrusion Vs surgical impaction in skeletal open bite’s control through a systematic review. Material and Methods: A search of the literature was performed in the following data bases: PubMed, Science Direct, Cochrane library. The search was limited to publications written in english and french from 2010 to 2021 Results: Out of 83 references initially identified, 12 corresponded to our inclusion criteria. These studies have looked at molar intrusion using skeletal anchorage or surgical impaction of the maxillary with or without mandibular osteotomy in the treatment of skeletal open bite. These studies have reported an increased incisal coverage, decreased lower facial height, counterclockwise rotation of the mandible, and a satisfactory stability of results. Conclusion: The intrusion of molars using implant anchorage seems to be the most rational therapeutic procedure for skeletal open bite patients offering satisfactory skeletal and dento-alveolar results.

Assessment of relapse of skeletal open bite treatment in adult patients treated with molar intrusion using temporary anchorage devices and orthognathic surgery - a systematic review

Objective: The purpose of this study is to systematically assess the available evidence for relapse of skeletalopen bite treatment using temporary anchorage devices and orthognathic surgery. Materials and Methods: Fiveelectronic databases such as MEDLINE, COCHRANE, SCIELO, GOOGLE SCHOLAR, EMBASE were systematicallysearched up to June 2020. Methodological quality studies were graded by means of the Effective Public HealthPractice Project (EPHPP) Quality Assessment Tool. Results: In total, 1005 studies were identified for screening,and 6 studies were eligible. The quality assessment tool showed moderate quality for all the studies. Theimmediate post treatment correction of open bite was better in the surgical studies than in the studies treatedwith TADs. Conclusion: Stability of treatment results of anterior openbite was comparable in cases treated inboth the treatment modalities. Relapse of anterior open bite was associated with cases in which the posttreatmentoverbite was minimal. Overbite seems to be more stable when only the maxilla has been operated on than withbi-maxillary surgeries. Counterclockwise rotation of the mandible with subsequent reduction of anterior facialheight was better in surgical correction than through TADs. KEYWORDSSkeletal open bite; Temporary anchorage devices; LeFort 1 impaction; Bi-maxillary surgery.

Non-Surgical Approach to Correct Skeletal Open-Bite Malocclusion in an Adult Patient Using Third Molar Intrusion Mechanics: A Clinical Case Report

AbstractParadigm is shifting in the orthodontic world with the introduction of mini screw type of temporary anchorage devices (TADs). This clinical report shows treatment and 3-year retention results of nonsurgical and extraction treatment in a 34-year-old female patient treated with maxillary molar intrusion mechanics and habit control. After 24 months of active orthodontic treatment, splendid outcomes were achieved. She presented with a chief complaint of problems in biting from her front teeth. She has a Class II skeletal and dental relationship with increased vertical proportions. Control of vertical dimension and producing autorotation of mandible were the key reasons to reduce facial convexity and improvement in profile. Treatment effects of 5 degrees of autorotation of mandible and 4 mm of maxillary molar intrusion were produced to correct pre-treatment anterior open bite of 5 mm. Based on available clinical evidence, we suggest that TADs with composite buttons on molars can be used as a valuable tool to intrude molars including wisdom teeth, and help correct the skeletal open-bite with good control without buccal tipping.

Invisalign System as a Treatment of a Skeletal Open Bite: A Case Report With a 5-Year Follow-up

Background: Orthodontic treatments of skeletal open bite are among the most challenging and at high relapse. Available therapies vary from behaviour-modifying appliances in growing patients to surgical approach in adults. Recently, clear aligners, such as Invisalign®, have also been proposed as a treatment modality, to be used alone or in combination with temporary anchorage devices. Case report: A 19-year-old female presented with 3-mm anterior open bite, peg-shaped upper lateral incisors, incorrect tongue posture at rest and during function. Due to aesthetic request, an orthodontic camouflage with Invisalign® was carried out for 17½ months, along with myofunctional therapy and composite veneers on upper lateral incisors. During the first months of retention, intermaxillary vertical elastics were maintained at night-time as positive feedback to the tongue. A 5-year follow-up confirmed stability of the results. Conclusions: A system of clear aligners in combination with myofunctional therapy was effective in the treatment of a skeletal open bite malocclusion, with stability at 5 years. The closure of the anterior open bite was obtained through a combination of lower molar intrusion, incisor extrusion and counterclockwise rotation of the mandible. In selected cases of optimal compliance, Invisalign® may constitute a feasible treatment option in management of open bite in non-growing patients.

The Effect of Tooth Extraction on Skeletal Open Bite Correctionin Adults: A Systematic Review

The Effect of Tooth Extraction on Skeletal Open Bite Correctionin Adults: A Systematic Review

Condylar degeneration in anterior open bite patients: A cone beam computed tomography study

The purpose of this study was to investigate the prevalence of condylar degeneration in patients with anterior open bites (AOB). Cone beam computed tomography (CBCT) scans of 194 patients with AOB (108 with skeletal open bites and 86 with dental open bites) and 100 patients serving as controls were included in this retrospective study. Two oral and maxillofacial radiologists categorized each of the 588 condyles as normal, degenerative-active, or degenerative-repair. The χ2 analysis with Bonferroni adjustment was used to evaluate the relationship of condylar status (normal vs degenerative) to anterior open bites. Of the 103 degenerative condyles, there were 59 in the group with skeletal open bites, 14 in the group with dental open bites, and 30 in the control group. Condylar degeneration occurred twice as frequently in patients with skeletal open bites as it did in the control group (P < .0001). Conversely, a greater frequency of normal condyles was found in the group of patients with dental open bites (P = .0002). The group with skeletal open bites also showed a significantly higher frequency of bilateral degenerative condyles (P = .0001). The frequency of condylar degeneration did not differ significantly between female and male individuals. Degenerative condylar change was significantly more likely in patients with skeletal open bites and less likely in patients with dental open bites.

Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes.

To compare the root resorption resulting from miniscrew-supported maxillary posterior dentoalveolar intrusion using two different force magnitudes. Adult patients with skeletal open bite, indicated for maxillary posterior dentoalveolar intrusion, were recruited and randomly assigned to the comparison or intervention groups. The comparison group involved applying 200 g of intrusive force per segment, which measured 20 g per root, while this force was 400 g per segment in the intervention group, measuring 40 g per root. Twenty participants were included in the final analysis after 2 patients dropped out, 1 in each group, to end up with 10 subjects (200 roots) per group. There was statistically significant root resorption of 0.84 ± 0.96 mm and 0.93 ± 1.00 mm in the comparison and the intervention groups, respectively. However, there was no statistically significant difference between the groups. Root resorption inevitably took place in association with orthodontic intrusion. However, increasing the magnitude of the intrusive force did not increase the amount of root resorption, either statistically or clinically.

Openbite in hyperdivergent adult: Le Fort I impaction versus maxillary molar intrusion using bone anchorage. A literature review.

The objective of this study is to compare, based on literature review, the short and long-term efficiency of the correction of anterior openbite in hyperdivergent adults by orthodontics combined with maxillary molar intrusion using temporary anchorage devices (group A), versus maxillary surgical impaction (group B). The articles were retreived from five databases (last update in May 2020). Data selection and extraction are done independently by two reviewers, then validated and gathered after consensus to limit bias. Twelve low to medium evidence level studies meet the inclusion criteria, including two dedicated to jaw impaction surgery. All the studies analyzed short-term dentoskeletal changes, six assessed long-term stability up to 3.5 years for group B and to 4 years for group A. Both groups showed a decrease in anterior facial height and closure of the anterior openbite by mandibular autorotation. The results were stable over the long term for both groups. The orthodontic solution of molar intrusion associated with skeletal anchorage is an alternative to the surgical solution of mild skeletal openbite in adults. Randomized controlled clinical trials with control groups are essential to reach reliable conclusions.

Management of anterior open-bite in the deciduous, mixed and permanent dentition stage: a descriptive review.

Anterior open bite is one of the most complex malocclusions to manage. The interaction of skeletal, dental, and soft tissue effects can contribute to develop an anterior open bite. The skeletal open bite requires a more complex approach of treatment to reach function, aesthetics, and stability. The approaches vary depending on the causative factors and the age of patients. Treatment approaches for open bite patients differ when dealing with adults and growing patients. The aim of this descriptive review was to summarize the main existing treatment strategies for anterior open bite, from the noninvasive behavioural shaping to the orthodontic intrusion with skeletal anchorage.

Intrusion of posterior teeth using miniplates: intrusive mechanics is not the same as intrusion force.

ABSTRACTObjective: Biologically explain some of the bone mechanisms involved in the intrusion, or intrusive effect, of teeth submitted to skeletal open bite correction using four miniplates. Methods: The results of dental intrusion were measured and compared in 3D reconstructions of cone beam computed tomography scans taken before and after treatment of 20 patients with skeletal open bite, aged between 18 and 59 years. Results: The results allow deducing that the compression and traction forces biologically promoted deformation or deflection of the osteocyte network that controls bone design, and these effects involved the external and internal surfaces of the bone, with the formation of new layers, including the cervical portion of the alveolar bone crest. This helps understanding how dental intrusion occurs in intrusive mechanics, whose forces are of inclination rather than intrusion. The root resorptions caused by the use of miniplates were insignificant, due to the more homogeneous distribution of forces in the several teeth simultaneously involved. Conclusion: Imaging studies in CT scans tend to capture in details the subperiosteal and endosteal phenomena of dental intrusion - before and after the application of intrusive mechanics -, in the form of a set of modifications called dental intrusion or intrusive effect .

Skeletal open bite Class III compensatory treatment with biofunctional therapy

Introduction: Class III skeletal malocclusion in adult patients presents mainly two treatment options: the surgical-orthodontic approach or compensatory treatment. Case Report: In the present report, it was described the case of a 23-year-old male patient who presented skeletal Class III malocclusion associated with anterior open bite. The patient refused surgical-orthodontic treatment. Thus, the compensatory orthodontic treatment was performed with the biofunctional technique, consisting of preadjusted brackets with accentuated palatal torque on the maxillary incisors and accentuated buccal torque on mandibular incisors. This prescription aims to minimize the effects of Class III intermaxillary elastics, promoting more bodily movement than tipping of the anterior segments and improve bone remodeling. The anterior open bite was treated with lingual spurs, differentiated bonding of the accessories and early intermaxillary elastics. After 23 months of treatment, a functional occlusion was observed with bilateral Class I canine and molar relationships, overbite correction, and satisfactory smile esthetics. Conclusion: The great outcomes indicate that compensatory orthodontic treatment is possible in skeletal discrepancies, with the correct diagnosis and considering patient compliance. The biofunctional technique provided a favorable dental positioning for Class III correction.

Assessment of the duration of the pubertal growth spurt in patients with skeletal open bite

PurposesThe objectives were to assess the skeletal age of patients with skeletal open bite and to estimate and compare the mean chronological age related to CS3 and CS4 (cervical stage, CS) and the duration of the pubertal growth spurt (PGS).MethodsOrthodontic records of 145 patients were analyzed in this retrospective cross-sectional study. The study group comprised 104 patients with skeletal open bite (angle between cranial base plane line [NS] and mandible base plane line [ML] > 39° according to Steiner), whereas the control group comprised 41 patients with normal anteroposterior and vertical measurements. Skeletal age was assessed using the 6‑stage CVM (cervical vertebral maturation) method according to Baccetti. Quantitative variables were characterized by means of the arithmetic mean and standard deviation. The PGS duration was calculated as the difference between the means of the chronological ages related to CS3 and CS4.ResultsIn the study group, the arithmetic means related to CS3 and CS4 were 11.12 and 13.54 years, respectively; the duration of the PGS was 2.42 years. In the control group, the arithmetic means related to CS3 and CS4 were 10.71 and 11.82 years, respectively; the duration of the PGS was 1.11 years.ConclusionsIn patients with skeletal open bite, the duration of PGS is longer but it occurs at a similar chronological age compared to patients with normal anteroposterior and vertical measurements. The PGS in males begins later than in females. Knowledge on the longer growth spurt in patients with skeletal open bite compared to patients with normal anteroposterior and vertical relationships can be useful in the selection of an appropriate therapeutic method and also provides information about the possibility of a longer and thus more effective orthopedic approach directed at positive change in the vertical growth pattern during intense bone remodeling.

Surgery First and Atypical Extraction for a Skeletal Class III with Severe Anterior Open Bite and Severe Crowding— Three-year Stability

This case report features a successful combined surgical-orthodontic treatment of a patient with skeletal Class III malocclusion with severe anterior open bite and severe mandibular crowding. Clinical examination revealed concave profile with long-face deformity caused by retrognathic maxilla and excessive vertical growth of mandible, maxillary crowding despite absence of maxillary first premolars, mandibular incisor retroclination, deep curve of Spee, and blocked-out mandibular canines. The treatment involved surgery-first approach with extraction of lower right first premolar and atypical extraction of lower left canine due to its poor periodontal support. Harmonized facial profile, pleasing smile, good occlusal interdigitation as well as skeletal stability were evident 3 years after active orthodontic treatment.

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

Evaluation of the facial soft tissue changes in skeletal anterior open bite patients treated with rapid molar intruder appliance using cone beam computed tomography

Aim: The aim of this study was to evaluate the facial soft tissue changes in skeletal anterior open bite patients treated with rapid molar intruder appliance using cone beam computed tomography (CBCT). Materials and Methods: This retrospective study included 2 groups. The first treatment group included randomly selected CBCT scans of 20 skeletal open bite patients (8 males and 12 females, mean age 11.6±1.1 years) who were treated with the rapid molar intruder appliance (RMI) for molar intrusion. The CBCT scans were taken before treatment (T1) and after open bite correction (T2). The facial soft tissue changes in the treatment group were compared with a closely matched second untreated control group with normal anterior overbite (9 males and 11 females, mean age 11.9± 1.2 years). Results: The first group showed significantly greater decreases in the angle of facial convexity and the H angle than the second group. The first group showed significantly greater increases in the lower lip protrusion and the soft tissue chin prominence than the second group. The upper lip protrusion and the soft tissue facial height were decreased in the first group and increased in the second one. The difference was statistically significant. The nasolabial angle was increased in the first group and decreased in the second one. The difference was statistically significant. Conclusions: Molar intrusion using the rapid molar intruder appliance (RMI) could result in significant improvement in the facial soft tissue profile in skeletal anterior open bite patients.

Relations between anterior disc displacement and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle.

In this study we investigated the relation between anterior disc displacement (ADD) and maxillomandibular morphology in skeletal anterior open bite with changes to the mandibular condyle. Thirty female patients (60 joints) with both conditions were evaluated. Magnetic resonance imaging of the temporomandibular joint (TMJ) was used to diagnose both ADD and changes to the mandibular condyle (erosion, osteophyte, and deformity). The relations among ADD, changes to the mandibular condyle, and maxillomandibular morphology were examined statistically. Changes to the mandibular condyle had a higher score than sym anterior open bite, the deviated side in asymmetric anterior open bite, and the non-deviated side. The score for disc displacement on the non-deviated side was lower than both the sym side and the deviated side. Unilateral changes to the mandibular condyle and unilateral disc displacement were not apparent in sym anterior open bite, but a unilateral non-displaced disc was seen only on the asymmetric side. Mandibular condylar changes were significantly more common on the deviated, than on the non-deviated, side. The SNB angle was significantly smaller, and the ANB, GZN, and SN-mandibular plane angles were significantly larger in sym anterior open bite. Overjet, ANB angle, GZN angle, and SN-MP angle were significantly larger, and the SNB angle was significantly smaller, in the presence of ADD without reduction and mandibular condylar deformity. We conclude that the prevalence of ADD without reduction and changes to the mandibular condyle were related to mandibular asymmetry and mandibular morphology in anterior open bite. This retrospective study suggests that ADD without reduction and mandibular condylar bone changes may be related to the progression of skeletal class II open bite and mandibular asymmetry in cases of skeletal open bite.

Force magnitude as a variable in maxillary buccal segment intrusion in adult patients with skeletal open bite.

To compare the effects of two different force magnitudes on maxillary posterior segment intrusion using mini-screws. The null hypothesis was that there would be no difference between the two force magnitudes. Adult patients with skeletal open bite and a dental open bite ranging from 3 to 8 mm were recruited for this trial. The comparator group had 200 g of intrusive force applied for posterior segment intrusion, whereas 400 g of force was applied in the intervention group. Primary outcomes were the amount of posterior teeth intrusion and anterior open bite closure. Twenty-two subjects were randomized to include 11 participants in each group. One participant dropped out in each group, leaving us with 10 subjects to be analyzed per group. There was statistically significant posterior teeth intrusion of 2.42 ± 2.06 and 2.26 ± 1.87 mm for the comparator and intervention groups, respectively, with no difference between them. Statistically significant open bite closure was achieved in both groups, measuring 2.24 ± 1.18 and 3.15 ± 1.06 mm in the comparator and intervention groups, respectively, with no difference between them. Both the 200 g and 400 g intrusive forces yielded similar outcomes in terms of posterior teeth intrusion and anterior open bite closure.

Skeletal open bite cranial base characteristics in young Latin-American individuals with class I, II and III malocclusions: An observational study

This study aimed to compare cranial base linear and angular measurements between individuals with skeletal open bite and different sagittal skeletal relationships. This observational and cross-sectional study included 101 lateral radiographs of young Latin-American individuals with skeletal open bite that met the inclusion criteria and were collected from a private radiological centre. Three groups were formed. Groups 1, 2 and 3 included individuals with skeletal open bite (negative overbite and FMA>30°) and Class I (n=31), II (n=35) and III (n=35) sagittal skeletal relationship, respectively. The anterior and posterior cranial bases (SN and SBa), and cranial base angles (BaSN and ArSN) were measured. Groups were compared with one-way analysis of variance and post-hoc Scheffé tests. The influence of predictor variables on the cranial base were evaluated with linear regressions (α=0.05). The cranial base angles were significantly smaller (approximately 3° to 5°) in the skeletal open bite Class III group (BaSN=127.97°±5.86°, ArSN=120.19°±6.12°) when compared with the other groups. BaSN angle, Class I versus Class III (p<0.001) and Class II versus Class III (p<0.001). ArSN angle, Class I versus Class III (p=0.005) and Class II versus Class III (p=0.026). Multiple linear regressions showed that sex had a significant influence on both cranial base dimensions with men showing larger values than women. Skeletal open bite Class III individuals show a smaller cranial base angle than Skeletal open bite Class I or II individuals.

Assessment of dentofacial widths in adults with anterior open bite.

Anterior open bite is a complex condition involving a combination of various dental and skeletal components in three dimensions. The data on the differences and changes in the transverse relation in individuals with anterior open bite are limited. To assess the dental arch widths in individuals with anterior open bite using study casts and facial widths using frontal cephalogram and to compare these widths with that of individuals without anterior open bite. Eighty adults [40 with and 40 without anterior open bite, mean (standard deviation) age = 20.68 years] were selected. The study group was divided into skeletal (n = 19) and dental (n = 21) open bite groups according to Jarabak's ratio. Posteroanterior cephalograms and study casts were analyzed. The mean width of zygomatic arch (112.18 mm) and condylar region (100.55 mm) in the control group was significantly higher (P < 0.05). The mean gonial width in the skeletal open bite group (81.143 mm) was significantly (P < 0.05) lesser than the dental open bite group (84.842). The maxillary intercanine width for the skeletal open bite group (36.48 mm) was significantly (P < 0.01) higher than that of the dental open bite group (34.26 mm). A transverse deficiency was seen in in the zygomatic and condylar regions in adults with anterior open bite. Individuals with a skeletal open bite showed a narrow gonial and wider maxillary intercanine width compared with individuals with dental open bite.