Vertical Elastics Research Articles

Skeletal Class I with Open-Bite Malocclusion Treated with Anterior Vertical Elastics (AVE)

Enhancing aesthetics, occlusion and functions is a primary motivation for individuals with open-bite malocclusion seeking orthodontic treatment. Open-bite malocclusion, characterized by a lack of vertical overlap of the anterior teeth, can be effectively treated using anterior vertical elastics. It’s a common, non-surgical orthodontic approach to correct open-bite issues. In this case report, we present the treatment of a male patient with anterior open-bite malocclusion. Initially, the patient underwent a lingual frenectomy followed by an active and passive phase of swallowing rehabilitation by wearing a nocturnal lingual envelope (NLE). Subsequently, a fixed orthodontic appliance was bonded to achieve well-aligned arches, normalize the overjet and overbite with the use of anterior vertical elastics (AVE) and enhance both aesthetics and functions.

Orthodontic camouflage treatment of a hyperdivergent adolescent patient with anterior open bite and TMD: a case report

BackgroundIn orthodontics, anterior open bite is a common malocclusion that recurs frequently. Because the causes of anterior open bite are so varied, medical professionals must create customized treatment programs for each patient based on their unique etiology. Through the lowering of the posterior teeth, closure of the anterior teeth gap, and cooperation with intermaxillary traction, the treatment plan outlined in this case study sought to achieve a stable occlusion.Case presentationThis case report aims to describe an orthodontic camouflage treatment of a 15-year-old female patient with anterior open bite, arch width discrepancy and a history of temporomandibular joint disorder. The patient was treated with intermaxillary vertical elastics and the multiple edgewise arch wire (MEAW) approach. A satisfactory occlusion with a neutral molar relationship was attained after 29 months of orthodontic therapy. The condylography recording showed that this patient’s occlusion tended to be more stable both before and after our treatment. The purpose of this case study is to provide an overview of an orthodontic camouflage treatment for a female patient, who had a history of temporomandibular joint disease, anterior open bite, and arch width disparity.ConclusionsOur results demonstrated that more attention should be paid to levelling the occlusal plane, intrusion of the molars, decompression of temporomandibular joints and the etiology factors of malocclusion during the orthodontic period for those patients with anterior open bite.

Nonsurgical synergistic full-arch vertical intrusion treatment of bimaxillary protruded hyperdivergent skeletal Class II malocclusion using aligners.

A bone-borne full-arch vertical control strategy using miniscrews was deployed with aligners to treat a case of skeletal hyperdivergent Class II malocclusion with bimaxillary protrusion. Miniscrews were inserted in the posterior buccal and palatal regions and the anterior buccal region of the maxilla to distribute vertical intrusive force through the upper arch by anchoring vertical elastics from the miniscrews to the aligners. Synergetic lower anterior intrusion was completed using bilateral posterior miniscrews to counteract the extrusive force generated. Substantial full upper arch and lower anterior vertical intrusion was achieved. In conjunction with en masse anterior-posterior retraction, synergetic posterior and anterior vertical intrusion facilitated counterclockwise rotation of the mandible, creating significant esthetic improvement. Anterior vertical elastics also provided flaring of the anterior teeth, reducing the side effect of lingual tipping from en masse retraction, while successfully controlling overbite and incisor torque during space closure. The bone-borne full-arch vertical intrusion strategy can work well with aligners to address hyperdivergent skeletal Class II malocclusion with bimaxillary protrusion.

Orthodontic Treatment of an Ankylosed Maxillary Incisor Using a Combination of Surgical Luxation and Temporary Anchorage Device: A Case Report

When anterior tooth ankylosis happens before growth is completed, it leads to dentoalveolar vertical discrepancy which causes anterior openbite and aesthetic concerns. This case report presents a minimally aggressive approach for treatment of an ankylosed tooth in an adult patient using surgical luxation along with temporary anchorage device and vertical elastics. At the end of treatment, the anterior openbite was corrected with extrusion of the ankylosed incisor. The smile arc was significantly improved and the patient was satisfied with the results.

Non-Surgical Camouflage Treatment of a Skeletal Class III Patient with Anterior Open Bite and Asymmetry Using Orthodontic Miniscrews and Intermaxillary Elastics

This case report presents the non-surgical orthodontic camouflage treatment of an 18-year-old male patient with skeletal Class III asymmetry and severe anterior open bite. The anterior open bite was corrected by extrusion of the maxillary and mandibular anterior teeth and clockwise and counterclockwise rotation of the maxillary and mandibular occlusal plane, respectively, using intermaxillary Class III elastics between the maxillary posterior buccal miniscrews and mandibular canines and anterior vertical elastics between the maxillary and mandibular canines. Class III dental relationships and dental asymmetry were corrected via unilateral distalization of the mandibular dentition on the left side using a closed coil spring between the buccal shelf screw and hook. The patient’s smile esthetics and dental relationship were improved with a more favorable facial profile, and facial asymmetry was slightly alleviated after orthodontic camouflage treatment. The total treatment time was 15 months. A modified wraparound retainer with a scalloped labial bow, tongue crib, and tooth positioner was used simultaneously to prevent the potential relapse.

Camouflage Treatment of Skeletal Class III Malocclusion by Maxillary Total Arch Extrusion

In patients with skeletal Class III malocclusion and insufficient maxillary incisal display, maxillary total arch extrusion can be considered as one of the camouflage treatments to improve the smile and profile esthetics as well as the mandibular prognathism. This case report describes the use of MARPE (micro-implant assisted rapid palatal expansion) and maxillary total arch extrusion to treat a patient with skeletal Class III malocclusion who had transverse discrepancy and insufficient maxillary incisal display. The goal of the procedure was to improve the patient’s occlusion as well as facial esthetic. The maxillary removable anterior bite plate, mandibular posterior mini-implants, and vertical elastics were applied to attain the therapeutic goal. The improvement of the occlusal relationship and an esthetic smile were achieved through maxillary total arch extrusion and clockwise rotation of the mandible.

Intrusion of mandibular incisors using single mini-implant –A finite element study

A deep bite is a complex orthodontic problem that is a common feature of many malocclusions. Depending on the diagnosis, a deep overbite can be corrected. Mini implants can be used for the true intrusion of anterior teeth. FEA is a computer based numerical simulation technique used to calculate deflection, stress and displacement. To analyze stress distribution pattern and displacement of mandibular incisors when intrusive forces are applied using three dimensional finite element analysis. To compare intrusion of lower anterior teeth when ‘V’ pattern force and straight vertical pattern force are applied. A three dimensional finite element model was constructed to simulate mandibular teeth, periodontal ligament and alveolar bone. The displacement of individual tooth (central and lateral incisors) on three-dimensional planes and the von Mises stress distribution were compared. Intrusive forces when applied to four mandibular anterior teeth remarkable tipping of the labial segment was seen when straight vertical elastics were used as compared to the ‘V’ shaped elastics. Within the limits of this study, predictable intrusion with minimum labial tipping is seen using single implant using V pattern elastics.

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.

TREATMENT OF AN ANKYLOSED MAXILLARY CENTRAL INCISOR BY SINGLE-TOOTH OSSEOUS OSTEOTOMY

Ankylosis is the fusion between the mineralized root surface and the alveolar bone and led to development of infraocclusion. Osteocorticotomy is a surgical procedure in which the intact ankylosed tooth and adjacent bone are either repositioned in 1 step or moved orthodontically. This case report describes the treatment of a boy, aged 14.9 years, whose ankylosed maxillary right central incisor had been infraocclused due to the trauma. We performed a segmental osteotomy with in a single-stage surgery to allow for inferior repositioning of the tooth and bone. This technique permits optimal repositioning of the tooth and allow rapid movement of teeth with the block of bone. The traction of the single-tooth osteotomy block can be repositioned to the desired position immediately by vertical extrusion bends, vertical elastics, a coil spring, a nickel-titanium wire, or a simple distraction device.

Effect of piezocision on molar intrusion in open-bite treatment using a modified MEAW technique.

The aim of this retrospective study was to investigate whether a piezocision technique influences molar intrusion in open-bite cases. In all, 30patients with open-bite malocclusion were assigned to one of two groups: the piezocision groupcomprised 15patients who were treated using curved arches and anterior elastics with the simultaneous combination of piezocision which was performed interdentally in the upper posterior region, while the control group comprised 15patients who were treated with the same treatment mechanics without piezocision. In both groups, after leveling and aligning, upper 0.017 × 0.025 accentuated curve and lower 0.017 × 0.025 reversed curve of Spee NiTi archwires were placed. Anterior vertical elastics were applied between laterals and the canines on both sides. The effects of treatments were investigated on cone-beam computed tomography images acquired before use of elastics and after correction of open-bite. Open-bite closure was achieved in 2.85 ± 0.85 and 4.1 ± 1.58months in the piezocision and control groups, respectively, while total treatment lasted 1.4 ± 0.42 and 1.7 ± 0.43years, respectively. Extrusion of lower posterior teeth (p < 0.05) was observed together with extrusion of incisors and canines (p < 0.001) in the piezocision group, while only incisors and canines were extruded in the control group (p < 0.001). There were no significant differences between the groups (p > 0.05) except significant lower incisor extrusion (p < 0.05) and counter-clockwise rotation of the lower occlusal plane in the piezocision group (p < 0.001). The duration of open-bite correction was significantly shorter in the piezocision group. No molar intrusion was observed in either group. Open bite correction was achieved mainly by extrusion and retrusion of the incisors while maintaining upper molar positions.

Non-surgical and Non-extraction Orthodontic Treatment of an Excess Reverse Bite with Anterior Open Bite

This 13-year-old female had a severe Angle’s Class III malocclusion with an excessive negative overjet 7 mm, anterior open bite 2 mm, a prognathic chin and a concave lateral profile. But this patient and her parents refused orthognathic surgery. Finally, she was treated with a non-surgical and non-extraction approach. The treatment plan consisted of total distalization of mandibular dentition with bilateral temporary anchorage device (TAD) and maxillary incisor extrusion with vertical elastics. The active treatment period was 34 months. Normal overbite, overjet, and acceptable profile were achieved.

Without mini-plates, mini-implants and surgery: treatment of severe anterior open bite in an adult patient - a case report

Introduction: Currently, there is a tendency to treat open bite with mini-implants, miniplates, and orthognathic surgeries and build ups when these protocols are not always indicated and to be apply them unnecessarily and excessively. Objectives: This case report describes treatment of a severe anterior open bite in an adult patient with step bends and vertical elastics. Case report: The female patient was 29 years and 8 months old and reported that she had low self-esteem; therefore, she wanted to have her untreated open bite closed. By examination, a convex profile, vertical growth pattern, dental midline deviation, and tongue exposure could be seen upon smiling. The dental and skeletal sagittal relationship was Class II. The overjet was +5 mm and the anterior overbite was -5.5 mm. The severe skeletal open bite involved the first molars to the anterior teeth, and it was treated only with step bends and vertical elastics over 2 years. Results: Significant facial improvement, maxillary incisor exposure upon aesthetic smiling, and adequate overbite and overjet were observed. The upper and lower dental midlines fit to the sagittal line. A counterclockwise rotation of the mandible was observed. The severe skeletal open bite was treated. Conclusions: Severe skeletal open bite malocclusion treated with step bends and vertical elastics in adult patient demonstrated efficient, predictable and stable open bite correction.

Non-Surgical Orthodontic Treatment of Class III Adult with Posterior Crossbite, Anterior Open Bite and Asymmetric Occlusion, Using TADs and Auxiliary Wires: A Case Report

Class III malocclusion associated with posterior crossbite, anterior open bite pattern with asymmetric occlusion in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Skeletal Class III anteroposterior discrepancies in adult patients are generally managed either by surgical-orthodontic treatment or by orthodontic camouflage through dentoalveolar compensation. Although correction with surgery may be the most effective and stable way, many patients refuse surgical treatment plan because of the costs and traumas it may bring. This case report describes the successful use of TADs with expansion auxiliary wire to treat a 24-year-old man with skeletal class III malocclusion, posterior crossbite, anterior open-bite and asymmetric occlusion, mild upper and lower dental spacing and a chief manifestation of anterior crossbite. The patient refused surgery. A treatment plan was formulated consisting of using auxiliary expansion wire to expand the maxillary arch, 8 mm mini-screws between the roots of the mandibular canines and first premolars, preadjusted edgewise brackets to align the teeth, Class III and asymmetric elastics to correct the canines, premolars, and molars relationship and midline deviation, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct the anterior open-bite. In this case, without going through surgery, the posterior cross-bite was corrected, and ideal overjet and overbite relationships, midline coincidence and functional occlusion were all achieved. Satisfactory occlusal, functional, esthetic and stable results were obtained.

Corticotomy-assisted orthodontic camouflage in a class III adult patient with a severe transverse discrepancy

A 25-year-old man presented with a maxillary transverse discrepancy, posterior cross bite, anterior open bite, molar and canine class III. Treatment included a corticotomy in the upper lateral and posterior teeth, a palatal expansor and a sectional archwire to assist the expansion. The following treatment phase included bonding with Incognito System lingual appliance, interproximal reduction to solve the crowding and bite blocks to control the verticality. Two months after the bonding intermaxillary class III elastics were used to solve the sagittal discrepancy and eight months after the bonding vertical elastics were used in order to solve the anterior open bite until the end of the treatment. A Boston splint was applied for the upper arch, an essix splint was applied for the lower arch. The patient compliance was an essential aspect in the success of the orthodontic treatment.

“Convenience” orthodontics: Mechanics simplified!

The open bite malocclusion is one of the most difficult dentofacial deformities to treat. Extrusion of upper and lower incisors with extrusion arches and vertical elastics, a common orthodontic treatment modality for anterior open bites requires compliance or careful wire bending. Hence, an easier method that involves no wire bending or compliance and saves chair time is described in this article that would prove indispensable for the orthodontist.

Treatment of bilateral cleft lip and palate with maxillary collapse sequelae. Case report

Case report of an 11-year-old female patient with bilateral cleft lip and palate sequelae complete on the left side, incomplete on the right side with absence of upper lateral incisors and enamel hypoplasia on tooth #21.Treatment objectives were: to achieve functional occlusion, improve facial and dental esthetics, improve her quality of life by encouraging her self-esteem. An orthodontic treatment was performed with the use of 0.022 Roth brackets and with the extraction of lower first bicuspids as well as the remaining temporary teeth. Vertical elastics where used to settle the bite. At the age of 16 a removable denture was used to rehabilitate the area of the missing upper lateral incisors and to place a restoration on tooth #21. Surgery was performed to place a bone graft on teeth 12 and 22. Once growth has ceased dental implants will be placed. A lower fixed and an upper circumferential retainer was used. Key words: Cleft lip and palate, multidisciplinary attention, autogenous bone graft

Vertical control in the Class III compensatory treatment

Compensatory orthodontic treatment, or simply orthodontic camouflage, consists in an important alternative to orthognathic surgery in the resolution of skeletal discrepancies in adult patients. It is important to point that, to be successfully performed, diagnosis must be detailed, to evaluate, specifically, dental and facial features, as well as the limitations imposed by the magnitude of the discrepancy. The main complaint, patient's treatment expectation, periodontal limits, facial pattern and vertical control are some of the items to be explored in the determination of the viability of a compensatory treatment. Hyperdivergent patients who present with a Class III skeletal discrepancy, associated with a vertical facial pattern, with the presence or tendency to anterior open bite, deserve special attention. In these cases, an efficient strategy of vertical control must be planned and executed. The present article aims at illustrating the evolution of efficient alternatives of vertical control in hiperdivergent patients, from the use, in the recent past, of extraoral appliances on the lower dental arch (J-hook), until nowadays, with the advent of skeletal anchorage. But for patients with a more balanced facial pattern, the conventional mechanics with Class III intermaxillary elastics, associated to an accentuated curve of Spee in the upper arch and a reverse curve of Spee in the lower arch, and vertical elastics in the anterior region, continues to be an excellent alternative, if there is extreme collaboration in using the elastics.

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.

Utility Ties: Modified Kobayashi Ties

This article shows a simple and effective means to modify Kobayashi Ties. Ties made of 0.014 AJ Wilcock wire are stable and can be fabricated in multiple shapes. The final step of finishing, called settling, aims to bring all the teeth into proper occlusal inter digitation before the patient is placed in retention. Vertical elastics in triangular fashion, or light Class II or III elastics are enough to achieve the desired settling. Light or heavy elastics are needed even in the immediate postsurgical period to provide the required guidance of occlusion. The Kobayashi tie is commonly used for attaching elastics during the treatment. The technique, utilizing 0.010 stainless steel ligature wire to make Kobayashi ties, has already been suggested. 1,2

Efficacy of 2 finishing protocols in the quality of orthodontic treatment outcome

The objectives of this prospective clinical study were to evaluate the quality of treatment outcomes achieved with a complex orthodontic finishing protocol involving serpentine wires and a tooth positioner, and to compare it with the outcomes of a standard finishing protocol involving archwire bends used to detail the occlusion near the end of active treatment. The complex finishing protocol sample consisted of 34 consecutively treated patients; 1 week before debonding, their molar bands were removed, and serpentine wires were placed; this was followed by active wear of a tooth positioner for up to 1 month after debonding. The standard finishing protocol group consisted of 34 patients; their dental arches were detailed with archwire bends and vertical elastics. The objective grading system of the American Board of Orthodontics was used to quantify the quality of the finish at each time point. The Wilcoxon signed rank test was used to compare changes in the complex finishing protocol; the Mann-Whitney U test was used to compare changes between groups. The complex finishing protocol group experienced a clinically significant improvement in objective grading system scores after treatment with the positioner. Mild improvement in posterior space closure was noted after molar band removal, but no improvement in the occlusion was observed after placement of the serpentine wires. Patients managed with the complex finishing protocol also had a lower objective grading system score (14.7) at the end of active treatment than did patients undergoing the standard finishing protocol (23.0). Tooth positioners caused a clinically significant improvement in interocclusal contacts, interproximal contacts, and net objective grading system score; mild improvement in posterior band space was noted after molar band removal 1 week before debond.