Treatment Of Anterior Open Bite Research Articles

Dentoskeletal effects produced by removable palatal crib, bonded spurs, and chincup therapy in growing children with anterior open bite.

To evaluate the dentoskeletal effects of different anterior open bite treatment modalities in children. This cephalometric study assessed changes resulting from different treatment approaches on 77 growing children with anterior open bite. A control group (n = 30) was used for comparison. Lateral cephalograms were available before treatment and after 12 months. The sample was divided into four groups: removable palatal crib associated with a chincup (G1), bonded spurs associated with a chincup (G2), chincup (G3), and nontreated control (G4). Statistical comparisons among the four groups were performed on T1 and the treatment changes using analysis of variance with Tukey's post hoc tests. No statistically significant changes in skeletal variables were found among the groups, except for lower anterior face height (LAFH) increase in G1. Overall, effects in all of the treated groups were exclusively dentoalveolar. A larger overbite (OB) increase was observed in G1 and G2 when compared with G3 and G4. The maxillary incisors in G1 showed increased palatal tipping, retrusion, and more vertical dentoalveolar development as well as increased lingual tipping among mandibular incisors. There was less vertical development of maxillary and mandibular molars in G3. A removable palatal crib provided an improvement in OB (97.5%), followed by the bonded spurs (84.5%). Conversely, the chincup-only group did not have positive OB effects.

Corticotomy assisted treatment of anterior open bite in an adult patient

Corticotomy assisted treatment of anterior open bite in an adult patient

Corticotomy assisted treatment of anterior open bite in an adult patient

This case report discusses orthodontic treatment combined with the corticotomy technique to accelerate tooth movement and shorten the treatment time in a 34-year-old female patient with an anterior open bite and flared and spaced upper and lower incisors. Fixed orthodontic appliances (MBT 0.018″ edgewise brackets) were bonded, and 4 months later, buccal and lingual corticotomy with alveolar augmentation procedure in the maxillary arch from canine to canine was performed. Orthodontic therapy proceeded with frequent activation of the appliances to retract the incisors every 2 weeks. The total treatment time was 10 months with an active period of 4 months and no adverse effects were observed at the end of active treatment. The addition of the decortication procedure to the conventional orthodontic therapy decreased the duration of treatment significantly. Successful closure of the anterior open bite with adequate overbite and interdigitation of the teeth was achieved.

Dişsel Ön Açık Kapanışın ''Bonded Spur'' Apareyi ile Tedavisi

Dişsel Ön Açık Kapanışın ''Bonded Spur'' Apareyi ile Tedavisi

Effects of palatal crib and bonded spurs in early treatment of anterior open bite: A prospective randomized clinical study.

To evaluate the overbite correction of fixed palatal crib (FPC) and bonded lingual spur (BLS) in the early treatment of anterior open bite (AOB) in mixed dentition (primary outcome) as well as its influence on dental and skeletal cephalometric measurements (secondary outcome). The selected patients had AOB and a mean age of 8.23 years. They were divided into the following three groups by casting lots: control (n = 13), palatal crib (n = 13), and spur (n = 13). Data from the lateral teleradiography was obtained at the beginning, at 6 months, and after 1 year. The cephalometric analysis was performed by Cef-X program, recording the values of SNA, SNB, ANB, SnG oGn, 1.PP, IMPA, nasolabial angle, overbite, and overjet. Intergroup and intragroup comparisons were obtained via one-way analysis of variance. The degree of AOB was similar at baseline (P > .05). At 6 months and then after 1 year all groups showed improvement in the overbite. However, only the crib and spur groups showed positive overbite. No cephalometric measurements changed significantly over the period analyzed. We conclude that the FPC and BLS are simple and effective for the treatment of anterior open bite, with the advantage given to the FPC.

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.

The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study.

Insufficient attention is given in the literature to the early treatment of anterior open bite (AOB) subjects receiving orofacial myofunctional therapy (OMT), which aims to harmonize the orofacial functions. This prospective pilot study investigates the effects of OMT on tongue behaviour in children with AOB and a visceral swallowing pattern. The study comprised of 22 children (11 boys, 11 girls; age range: 7.1-10.6 years). They were randomly assigned into OMT and non-OMT subjects. The randomization was stratified on the presence of a transversal crossbite. At baseline (T0), at the end of treatment (T1) and at 6 months after T1 (T2) maximum tongue elevation strength was measured with the IOPI system (IOPI MEDICAL LLC, Redmond, Washington, USA). Functional characteristics such as tongue posture at rest, swallowing pattern and articulation and the presence of an AOB were observed. OMT did significantly change tongue elevation strength, tongue posture at rest, and tongue position during swallowing of solid food. At T2 more OMT subjects had contact between the lower central incisors and their antagonists or palate (P = 0.036). More OMT subjects performed a physiological pattern of water swallowing than non-OMT children at T1 and T2, although the differences were not significant. Articulation of /s,l,n,d,t/ was not improved by OMT. No interaction between OMT and expansion was found for any of the parameters. OMT can positively influence tongue behaviour. However, further research is recommended to clarify the success of OMT as an adjunct to orthodontic treatment and to identify possible factors influencing the outcome.

Effectiveness of the open bite treatment in growing children and adolescents. A systematic review.

The extensive literature concerning the early treatment of anterior open bite (AOB) is still controversial and covers a wide variety of therapeutic approaches. The objective of this study was to provide a comprehensive review evaluating the effectiveness of the orthodontic correction of AOB in growing individuals. Search was conducted on PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, Scielo, and Lilacs databases. Trials registries were consulted for ongoing trials, and grey literature was also contemplated. Selection process was performed to include controlled trials enrolling growing subjects who underwent orthodontic treatment to correct AOB and/or hyperdivergent facial pattern. Data were grouped and analysed descriptively. Qualitative appraisal was performed according to the Cochrane risk of bias tool, for randomized clinical trials (RCTs), and MINORS tool for non-RCTs. The 22 studies included in this review mostly considered mixed dentition subjects, and there was a considerable variation regarding therapeutic approaches. Because of poor-quality and/or insufficient evidence, consistent results were not found. However, some useful clinical inferences and suggestions for future studies were provided for each therapeutic modality considered here. Additional efforts must still be directed to perform, whenever possible, RCTs; or to conduct prospective controlled trials with adequate sample sizes, consecutively assembled subjects, with the comparison of contemporary and equivalent groups.

Early treatment of anterior open bite: Comparison of the vertical and horizontal morphological changes induced by magnetic bite-blocks and adjusted rapid molar intruders.

ObjectiveThis prospective clinical study aims to determine the differences between two treatment modalities for anterior open bite in growing patients. The treatment modalities involved the use of magnetic bite-blocks (MBBs) or rapid molar intruders (RMIs) applied with posterior bite-blocks.MethodsFifteen consecutive patients with a mean age of 11.2 (standard deviation [SD] = 1.6) years and a mean open bite of -3.9 mm were treated with MBBs. Another 15 consecutive patients with a mean age of 10.9 (SD = 1.8) years and a mean open bite of -3.8 mm were treated with RMIs applied on bite-blocks. Cephalometric radiographs were obtained before (T1) and immediately after appliance removal (T2). The treatments lasted four months, during which the appliances were cemented to the teeth. The morphological changes were measured in each group and compared using logistic regression analysis.ResultsThe MBB group exhibited significantly greater decreases in SNA angle, ANB angle, overjet, and maxillary incisor angle (p < 0.05). The MBBs induced greater effects on the maxilla and maxillary dentition. The MBBs restrained maxillary forward growth and retracted the maxillary incisors more effectively than did the RMIs. Consequently, changes in the intermaxillary relationships and overjets were more distinct in the MBB group.ConclusionsThe anteroposterior differences between the appliances suggest that MBBs should be preferred for the treatment of patients with Class II open bites and maxillary incisor protrusions.

Orthodontic and orthopaedic treatment for anterior open bite in children.

Anterior open bite occurs when there is a lack of vertical overlap of the upper and lower incisors. The aetiology is multifactorial including: oral habits, unfavourable growth patterns, enlarged lymphatic tissue with mouth breathing. Several treatments have been proposed to correct this malocclusion, but interventions are not supported by strong scientific evidence. The aim of this systematic review was to evaluate orthodontic and orthopaedic treatments to correct anterior open bite in children. The following databases were searched: the Cochrane Oral Health Group's Trials Register (to 14 February 2014); the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2014, Issue 1); MEDLINE via OVID (1946 to 14 February 2014); EMBASE via OVID (1980 to 14 February 2014); LILACS via BIREME Virtual Health Library (1982 to 14 February 2014); BBO via BIREME Virtual Health Library (1980 to 14 February 2014); and SciELO (1997 to 14 February 2014). We searched for ongoing trials via ClinicalTrials.gov (to 14 February 2014). Chinese journals were handsearched and the bibliographies of papers were retrieved. All randomised or quasi-randomised controlled trials of orthodontic or orthopaedic treatments or both to correct anterior open bite in children. Two review authors independently assessed the eligibility of all reports identified. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated for dichotomous data. The continuous data were expressed as described by the author. Three randomised controlled trials were included comparing: effects of Frankel's function regulator-4 (FR-4) with lip-seal training versus no treatment; repelling-magnet splints versus bite-blocks; and palatal crib associated with high-pull chincup versus no treatment.The study comparing repelling-magnet splints versus bite-blocks could not be analysed because the authors interrupted the treatment earlier than planned due to side effects in four of ten patients.FR-4 associated with lip-seal training (RR = 0.02 (95% CI 0.00 to 0.38)) and removable palatal crib associated with high-pull chincup (RR = 0.23 (95% CI 0.11 to 0.48)) were able to correct anterior open bite.No study described: randomisation process, sample size calculation, there was not blinding in the cephalometric analysis and the two studies evaluated two interventions at the same time. These results should be therefore viewed with caution. There is weak evidence that the interventions FR-4 with lip-seal training and palatal crib associated with high-pull chincup are able to correct anterior open bite. Given that the trials included have potential bias, these results must be viewed with caution. Recommendations for clinical practice cannot be made based only on the results of these trials. More randomised controlled trials are needed to elucidate the interventions for treating anterior open bite.

Maxillary molar intrusion with zygomatic anchorage in open bite treatment: lateral and oblique cephalometric evaluation.

We aimed to use lateral and oblique radiographs to evaluate dental and skeletal changes arising from maxillary molar intrusion with zygomatic anchorage in open bite patients. We conducted a pilot study including nine patients (six females and three males; mean age, 18.7 ± 5.1years) with skeletal open bite treated with titanium miniplates for posterior dentoalveolar intrusion. Lateral and oblique (right and left, 45°) radiographs were obtained before (T1) and 6months after intrusion (T2). A paired t test was used for statistical evaluation. The maxillary posterior teeth were intruded 2.03 ± 0.87mm (p < 0.01) with 450×g of force, which resulted in counterclockwise rotation of the mandible (1.57°, p = 0.02) and clockwise rotation of the occlusal plane (4.27 ± 2.66°, p = 0.01). Anterior facial height decreased by a mean of 1.79 ± 1.51mm (p < 0.01). No significant change in the palatal plane or in anteroposterior molar movement was observed. The oblique radiograph at 45° was useful for the assessment of molar intrusion and anteroposterior displacement. The treatment of anterior open bite with skeletal anchorage provided intrusion of molars and counterclockwise rotation of the mandible, resulting in open bite closure.

Perawatan Ortodontik Gigitan Terbuka Anterior

Perawatan gigitan terbuka anterior telah lama dianggap sebagai tantangan bagi ortodontis. Prevalensi gigitan terbuka anterior antara 3,5% hingga 11% terdapat pada berbagai usia dan kelompok etnis, serta ada sekitar 17% pasien ortodonti memiliki gigitan terbuka. Stabilitas hasil perawatan gigitan terbuka anterior sangat sulit, karena adanya kombinasi diskrepansi anteroposterior dengan gigitan terbuka skeletal sehingga dibutuhkan tingkat keterampilan diagnosis dan klinis yang tinggi. Etiologi gigitan terbuka anterior sangat kompleks karena dapat melibatkan skeletal, dental, dan faktor-faktor habitual. Eliminasi faktor etiologi merupakan hal yang penting dalam perawatan gigitan terbuka anterior. Berbagai cara perawatan untuk koreksi gigitan terbuka anterior diantaranya bedah ortognatik dan perawatan ortodontik kamuflase, seperti high-pull headgear, chincup, bite blocks, alatfungsional, pencabutan gigi, multi-loop edgewise archwires dan mini implan. Stabilitas hasil perawatan adalah kriteria yang paling penting dalam menentukan cara perawatan gigitan terbuka anterior.Orthodontic Treatment of Anterior Open Bite. An anterior open bite therapy has long been considered a challenge to orthodontist. The prevalence of anterior openbite range from 3,5 % to 11% among various age and ethnic groups and it has been shown that approximately 17% of orthodontic patients have open bite. Stability of treatment result of anterior open bite with well-maintained results is difficult, because the combination of anteroposteriorly discrepancy with skeletal open bite requires the highest degree of diagnostic and clinical skill. The etiology is complex, potentially involving skeletal, dental and habitual factors. The importance of an anterior open bite therapy is to eliminate the cause of the open bite. Various treatment modalities for the correction of an anterior open bite have been proposed, orthognatic surgery and orthodontic camouflage treatment such as high-pull headgear, chin cup, bite blocks, functional appliances, extractions, multi-loop edgewise arch wires and mini implant. The stability is the most important criterion in deciding the treatment method for anterior open bite malocclusion.

Camouflage Treatment of a Severe Open Bite Case

Skeletal open bite is a complex and multifactorial anomaly. There are many reasons for the occurrence of open bite, including skeletal abnormal growth pattern; dental, respiratory, neurologic, and habitual factors; and tongue posture and function. Anterior open bite is one of the most difficult problems to treat in orthodontics. Various treatment modalities for the correction of an anterior open bite have been proposed such as extrusion of anterior teeth using intermaxillary elastics, multiloop edgewise archwire technique developed by Kim, inhibition of molar eruption using bite blocks and high-pull headgear during growth, and extraction therapy. The most effective treatment option in adult patients is the repositioning of both the maxilla and mandible through a surgical correction. Although satisfactory results can be achieved with orthognathic surgery, the complexity, risks and costs of surgery are disadvantages of the surgical treatment. With the advent of skeletal anchorage, a number of studies were released to introduce the treatment of anterior open bite by intrusion of maxillary posterior teeth. This report presents the treatment and long-term stability of an adult case of a severe anterior open bite treated by means of extraction of the 4 first molars.

Treatment of Anterior Open Bite with the Bimler Functional Appliance: Report of Three Cases

There is still controversy regarding the efficacy of functional appliances when treating malocclusion at an early age. Although a good outcome from treatment is important, the stability of the results over time becomes a major concern. This paper presents the results of three open bite cases treated with the Bimler type-A appliance in the mixed dentition. The open bite cases presented here demonstrate stability of the treatment results for more than 14 years without active retention after the active treatment period. A comparison between these cases and those performed with an elastic functional appliance, and the action of that appliance on tongue posture, are discussed. The cases presented in this paper support treating malocclusions at an early age with functional appliances. The features of the appliance chosen to treat an open bite early can be a key factor for the results and stability.

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.

Treatment of anterior open bite and multiple missing teeth with lingual fixed appliances, double jaw surgery, and dental implants

The treatment of adult patients with severe anterior open bite frequently requires orthognathic surgery, especially when the chin is retruded severely. If a patient has multiple missing posterior teeth, it is difficult to control the occlusal plane because it is challenging to obtain anchorage during orthodontic treatment. We report on a 25-year-old woman who had a skeletal Class II malocclusion, severe anterior open bite, vertical maxillary asymmetry, and severe dental caries on her molars. There was no posterior occlusal contact between the maxillary and mandibular molars since 5 of her molars had to be extracted because of severe caries. Lingual fixed appliances and double jaw surgery were performed to treat her skeletal and dental problems, and dental implants helped restore her masticatory function. Pretreatment, posttreatment, and retention photographs demonstrate effective, esthetically pleasing, and stable treatment results.

Combining traditional techniques to correct anterior open bite and posterior crossbite

The treatment of anterior open bite often requires the use of skeletal anchorage to prevent excessive eruption of the posterior teeth and consequent downward rotation of the mandible. However, this procedure might not always be accomplished. This article reports the successful treatment of an anterior open bite and a posterior crossbite in a young boy, combining traditional techniques and involving high-pull maxillary traction to help growth to correct the skeletal Class II malocclusion without skeletal anchorage. The vertical dentoalveolar contribution of maxillary growth was also favorable to close the bite, whereas cross-elastics corrected the axial inclination of the mandibular posterior teeth, eliminating the inverted posterior crossbite. The open bite was completely closed with edgewise appliances, which also achieved normal overjet, intercuspation, and incisor exposure on smiling. Traditional mechanics for the treatment of open bite and crossbite remain a useful alternative when patients do not accept skeletal anchorage.

Dentoalveolar comparative study between removable and fixed cribs, associated to chincup, in anterior open bite treatment

ObjectiveThe aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite.Material and MethodsEach group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test.ResultsVertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting. ConclusionsThe Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet.

Poster 41: Stability of Anterior Open Bite Correction in Class III Patients Using Bimaxillary Surgery Involving Intraoral Vertical Ramus Osteotomy

There is currently limited data on the use of intraoral vertical ramus osteotomy (IVRO) in the surgical treatment of anterior open bite and class three malocclusion. The purpose of this study is to investigate the stability of Le Fort I osteotomy with IVRO in the correction of anterior open bite with concomitant class III malocclusion. Chart reviews of patients who underwent surgical correction of anterior open bite with class three malocclusion were obtained from the years 2004-2009. Preoperative, postoperative, and 1 year postoperative lateral cephalograms were obtained. Anterior open bite was measured clinically from the edge of the maxillary central incisor to the edge of the mandibular central incisor along its axis. Angular measurements were used to evaluate jaw movement in the horizontal and vertical directions. Anterior-posterior movement of the jaws was determined by changes in the SNA and SNB angles. Vertical movements of the maxilla were calculated from changes in the Maxillary Occlusal Plane (MOP) and Palatal Plane (PP) angles to SN. Mandibular vertical movement was based on changes in the mandibular plane (MP) angle to SN. Dental compensation was determined by changes in MOP and MP angles. All cephalograms were traced and measured digitally with Dolphin© software. Statistical analysis was performed with the SAS procedure PROC MIXED (SAS/STAT software, SAS institute Inc., Cary, NC, USA). The accuracy of landmark identification, superimposition, and measurements were confirmed by retracing all cephalograms 7 days later by the same investigator. Sixty patient records were identified with 27 meeting the inclusion criteria. Six patients failed to have positive incisal overlap at 1 year postoperative (23%). Comparing preoperative data between the 2 groups, patients in the relapse group had a more significant open bite (OB −6.07 mm vs. −3.48 mm, p<0.05), overjet (−2.14 mm vs. −0.79 mm, p<0.05), maxillary posterior vertical excess (SN-PP: 0.75° vs. 3.74°, p<0.05), and a steeper mandibular plane angle (SN-MP: 41.98° vs. 36.35°, p<0.05). Surgically, the relapse group also had more maxillary clockwise movement compared to the non-relapse group (SN-PP +5.72° vs. +3.39°, p<0.05), but less mandibular counterclockwise movement (SN-MP −0.93° vs. −2.46°, p<0.05). When separating patients based on the severity of their preoperative open bite: no patients failed in the mild group (1–3 mm open bite; 0/9, 0%), 3 patients failed in the moderate group (3–6 mm open bite; 3/13, 23%), and 3 patients failed in the severe group (>6 mm open bite; 3/5, 60%). IVRO, when performed with maxillary Le Fort I osteotomy, has a success rate (78% positive incisal overlap at 1 year post operative) that is comparable to other surgical techniques when treating patients with anterior open bite and concomitant class III malocclusion. Patients likely to relapse have a severe preoperative open bite, a high preoperative mandibular plane angle, or inadequate mandibular counterclockwise movement during surgery. This study provides an evidence-based alternative to current techniques.

Skeletal class III and anterior open bite treatment with different retention protocols: a report of three cases

The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.