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PubMed2004

Relationship between maxillofacial morphology and deglutitive tongue movement in patients with anterior open bite.

We reported previously that patients with anterior open bite had tongue tip protrusion, slower movement of the rear part of the dorsal tongue, and earlier closure of the nasopharynx during deglutition. In the present study, the relationship between this characteristic tongue movement and maxillofacial morphology in patients with anterior open bite was investigated. The subjects were 10 female patients with anterior open bites and 10 women with normal overbites as controls. Maxillofacial morphology was measured by cephalometric radiography, and tongue movement during deglutition was analyzed by cineradiography. The relationship between each value obtained by cephalometric radiography and cineradiography was evaluated by simple correlation analysis. In the patients with anterior open bite, there were significant correlations between mandibular plane angle, ramus height of the mandible, or anteroposterior dimension of the maxilla and movement of the front part of the dorsal tongue during deglutition. Furthermore, there were also significant correlations in these patients between mandibular plane angle, gonial angle, or ramus height of the mandible and the change in the contact between tongue and palate during deglutition. The controls did not have the correlations like these. Our study suggests that characteristic tongue movements during deglutition in patients with anterior open bites are closely related to their morphological features.

Adolescent↗
PubMedDate not supplied

[Etiological aspects of anterior open bite and its implications to the oral functions].

BACKGROUND: Open bite is a complex anomaly that has a difficult treatment. Frequently, unsatisfactory results and relapse of orthodontic treatment are observed. AIM: To associate orofacial malfunction and deleterious oral habits to anterior open bite. To congregate evidences for the better understanding of the etiology and of the development of anterior open bite and its potential association to myofunctional disorders. METHOD: An exploratory study, to obtain relative risk measurements associating clinical characteristics, sucking habits and myofunctional alterations in 130 scholars. This study was developed in two stages: the first was based on a questionnaire about the child's oral habits which was answered by the parents, and the second involved odontologic and speech-language evaluations. RESULTS: In this sample, the most prevalent occlusion disorder was anterior open bite, which was associated to vertical facial growth (relative risk (RR) 3.12; confidence internal (CI) 1.20-9.90) and to Angle's Class II malocclusion (p-value = 0.01). An association was also observed for anterior open bite and lingual interference (RR 2.44; CI 1.13-5.27). The same was not observed for speech disorders (RR 0.80; CI 0.20-2.30). CONCLUSION: A correlation exists between the etiology of anterior open bite, deleterious oral habits, and a few orofacial malfunctions. An association between the history of deleterious habits and the occurrence of lingual interposition during swallowing, as well as with speech disorders was identified. These findings emphasize the necessary interaction between orthodontists and speech-language pathologist during the treatment of patients. The rehabilitation role of speech-language therapy stands out, through the oral myofunctional therapy, emphasizing the positioning of the tongue during swallowing, speech and when in habitual position.

Bottle Feeding↗
PubMed1985

Components of adult Class II open-bite malocclusion.

In an effort to identify the frequency and distribution of the dental and skeletal components of adult Class II malocclusion with and without open-bite, 124 adults, half of whom had an anterior open-bite, were evaluated. Significant differences (P less than 0.05) between the open-bite and non-open-bite groups were found for the following measurements: the posterior maxilla exhibited vertical excess in the open-bite group; the maxillary occlusal plane was less steep in the open-bite group; the mandibular occlusal plane was more steep in the open-bite group; the gonial angle was higher in the open-bite group; the mandibular plane angle was higher in the open-bite group; the mandibular ramus was positioned in a more downward and backward (clockwise) location in the open-bite group; the total and lower anterior facial height were increased in the open-bite group; and the mandible was less protrusive in the open-bite group. No significant intergroup differences were noted in the cranial base, the anteroposterior position of the maxilla or of the upper and lower incisors, the palatal plane, posterior facial height, mandibular ramus height, or mandibular body length. The results of this analysis indicate that the average Class II open-bite malocclusion is characterized by aberrations in both the maxilla and the mandible. Therapy, therefore, may frequently require surgical intervention in both jaws to successfully correct this deformity.

Adolescent↗
PubMed2005

Classification of anterior open bite using individualized cephalometry.

OBJECTIVE: The objective of this study was to describe the cephalometric characteristics of the open bite, and to classify the open bite according to individualized norms. MATERIAL AND METHOD: The lateral cephalograms of 134 patients with an anterior open bite (min -0.5 mm) were analyzed. Patients were classified according to the inclination of the jaws, applying the principles of individualized cephalometry. The harmony box described by Hasund was used to define individualized norms for the inclination of the upper and lower jaws in each patient. The open bite was classified into four sub-types: (1) dental, (2) skeletal with enlarged ML-NSL angle, (3) skeletal with reduced ML-NSL angle, and (4) skeletal with deviations in upper and lower jaws. A skeletal open bite was found in 89 patients (66.4%). A dental open bite was found in 45 patients (33.6%). RESULTS: A number of significant differences were found between these four groups using single-factor variance analysis and the Bonferroni a posteriori test, (p < or = 0.05, p < or = 0.01, p < or = 0.001). The most prominent variables were index value of anterior facial hight, total facial height ratio, gonial angle, and Y-axis. No significant differences were found for overbite, however. CONCLUSION: It was possible to use individualized norms to classify the open bite into four sub-types. The demarcation between the four groups was supported statistically. The extent of the anterior open bite does not allow any conclusions as to the craniofacial pattern.

Adolescent↗
PubMed2002

Changes in alveolar morphology during open bite treatment and prediction of treatment result.

It has been postulated that dentoalveolar height is enlarged by a compensation mechanism in long face subjects. In this study, dentoalveolar composition was studied in 83 open bite patients. It was found that increases in overbite during treatment coincided with vertical lengthening of the symphysis, which exceeded increments in lower face height. This vertical growth coincided mainly with an increase in the area of the symphysis. Furthermore, a retrusion of the maxillary incisors enhanced bite deepening. Stability of the overbite during the retention period was studied in a subset of 22 patients. It was found that retrusion of the maxillary incisors during treatment led to a more stable overbite during the retention period. Vertical lengthening of the symphysis relative to the increase in lower face height seemed to enhance bite opening during retention. Prediction of the overbite may be reliable, if a re-evaluation of the patients takes place during active treatment. The angle NTGoGn had a substantial predictive value (multiple R = 0.46) for post-treatment overbite. It is concluded that in open bite patients, a dentoalveolar compensation mechanism results in a stable overbite at the end of treatment by enlarging symphysial height through a moderate increase in symphysial volume. In addition, retrusion of the maxillary incisors contributes to overbite reduction. However, an excessive increase in vertical height of the symphysis relative to lower face height may relapse after active treatment. For prediction of the post-treatment overbite, the angle NTGoGn may be used, although a re-evaluation during treatment is recommended.

Adolescent↗
PubMed2004

Treatment of open bite with microscrew implant anchorage.

Open bite treatment with microscrew implant anchorage is discussed in relation to vertical control of the posterior dentoalvelar dimension. Maxillary microscrew implants provided anchorage for intruding the posterior teeth and retracting the anterior teeth; mandibular microscrew implants were used to apply intrusion force distal to the mandibular first molars to prevent mesial tipping of the posterior teeth during space closure. Closing the mandibular plane after intruding the maxillary posterior teeth and bodily mesial movement of the mandibular posterior teeth contributed to facial profile improvement. The efficacy and potency of microscrew implants in open bite treatment are discussed.

Adult↗
PubMed1991

Advanced periodontal disease and development of anterior open bite. A case report.

Severe anterior open bite in adults is often both functionally and esthetically unacceptable. The treatment usually consists of a combined orthodontic and surgical correction. The stability of open bite treatment results is often poor. The case presented is of marked anterior open bite in a previously normal bite patient with advanced periodontal disease. An etiology for the development of this condition is suggested and a successful treatment described.

Aged↗
PubMedDate not supplied

Open bite: a review of etiology and management.

Diagnosis and treatment of open bite malocclusion challenges pediatric dentists who attempt to intercept this malocclusion at an early age. This article updates clinicians on the causes and cures of anterior open bite based on clinical data. Patients with open bite malocclusion can be diagnosed clinically and cephalometrically, however, diagnosis should be viewed in the context of the skeletal and dental structure. Accurate classification of this malocclusion requires experience and training. Simple open bite during the exchange of primary to permanent dentition usually resolves without treatment. Complex open bites that extend farther into the premolar and molar regions, and those that do not resolve by the end of the mixed dentition years may require orthodontic and/or surgical intervention. Vertical malocclusion develops as a result of the interaction of many different etiologic factors including thumb and finger sucking, lip and tongue habits, airway obstruction, and true skeletal growth abnormalities. Treatment for open bite ranges from observation or simple habit control to complex surgical procedures. Successful identification of the etiology improves the chances of treatment success. Vertical growth is the last dimension to be completed, therefore treatment may appear to be successful at one point and fail later. Some treatment may be prolonged, if begun early. Long-term clinical outcomes are needed to determine treatment effectiveness and clinicians should consider the cost-effectiveness of these early initiated and protracted plans.

Behavior Therapy↗
PubMed2004

Severe anterior open-bite case treated using titanium screw anchorage.

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 33 years eight months of age had open bite of -7.0 mm and increased facial height. The titanium screws were implanted in both the 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 about 3.0 mm each, and good occlusion was achieved. Her retrognathic chin and convex profiles were improved by an upward rotation of the mandible. Our results suggest that titanium screws are useful for intrusion of molars in anterior open-bite cases.

Adult↗
PubMed2005

Differential diagnosis of skeletal open bite based on sagittal components of the face.

AIMS: This study examined the morphology of skeletal open bite with respect to the sagittal components of the face. METHODS: The material consisted of cephalometric and hand-wrist films of 49 girls and 22 boys with skeletal open bite. The samples were grouped into Class I, II, and III facial types on the basis of ANB angle. In addition to conventional dentofacial variables, nasopharyngeal airway area was also measured on lateral headfilms. All measurements were examined by analysis of variance and Duncan test. Subsequently the factors leading to open bite were evaluated using multiple-regression analysis. RESULTS: Dentofacial morphology differed in the sagittal components of skeletal open bite, and the differences were most obvious between the Class II and Class III open bite groups. Posterior maxillary dentoalveolar height and mandibular incisor inclination were important factors in the development of open bite in the skeletal Class I and Class II open bite groups, while in the skeletal Class III open bite group, the nasopharyngeal airway and the gonial angle were involved. CONCLUSION: Sagittal components of skeletal open bite should be considered in the differential diagnosis and treatment planning of such cases.

Adolescent↗
PubMed1989

[The use of spring-loaded posterior bite-block in the treatment of open-bite].

The treatment objectives of open-bite cases which occurs as a result of the excess vertical growth of nasomaxillary complex, increase in the upper and lower posterior vertical dentoalveolar development, downward and backward growth of the mandible are restraining of the growth capacity of these regions and leading the growth of the mandible on the horizontal plane. One of the treatment alternatives of these cases is the spring-loaded posterior bite block; a functional orthopedic appliance. In this case report which the effects of spring-loaded posterior bite block therapy on craniofacial and dentoalveolar structures have been shown; three cases having chronological ages of 9 years 8 months; 10 years 4 months and 10 years 1 month were presented and the treatment results were discussed. The common effects of spring-loaded posterior bite-block therapy observed in three cases are; the restraint of the vertical growth of the maxilla and of both lower-upper posterior dentoalveolar structures, change in the growth pattern of the mandible from vertical towards horizontal plane.

Child↗
PubMed2006

Dynamic MRI evaluation of tongue posture and deglutitive movements in a surgically corrected open bite.

Tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.

Adult↗
PubMed1998

The nature of arch width difference and palatal depth of the anterior open bite.

Measurements were made of study casts of patients with anterior open bite to compare the width of maxillary and mandibular arches and the depth of the palate. This study was designed to (1) explore the nature of the arch width difference for patients with anterior open bite, whether dental or skeletal in nature, and (2) clarify the general impression of "high" palatal vaults for anterior open bite cases, to make sure if there are "absolutely high" or "relatively high" palatal vaults. Measurements in male and female patients with open bite malocclusions were analyzed and compared with those in male and female patients with normal occlusions. Similar trends were found for both sexes. Skeletally narrowed maxillary posterior width and dentally widened mandibular posterior widths were found. Palatal depth was in the normal range in the patients with anterior open bite. Orthopedic widening of the maxillae and inclining of the mandibular posterior teeth lingually are recommended when orthodontic treatment is to be rendered to patients with anterior open bite.

Adolescent↗
PubMed1994

Case report: nonsurgical treatment of an adult with severe anterior open bite.

A malocclusion characterized by open bite and vertical maxillary excess can be one of the most difficult problems to correct through orthodontic treatment because of the difficulty in permanently changing the morphological disharmony and/or functional disorder associated with open bite. However, in some patients with less severe skeletal impairment it may be possible to orthodontically correct the occlusal disharmony so that the new relationship of the dental arches becomes compatible with normal function of the oral environment. Stability may be enhanced if mechanics are used which do not extrude posterior teeth.

Activator Appliances↗
PubMed1984

Components of adult Class III open-bite malocclusion.

In an effort to identify the frequency and differences in the dental and skeletal components of a large sample of adults with Class III malocclusion, with and without open bite, 176 subjects, one half of whom had an anterior open bite, were evaluated. These subjects were chosen by looking at the lateral cephalometric radiographs that were taken of 302 adults (128 men and 174 women) who exhibited at least an end-to-end Class III molar and canine relationship. The dental overbite was calculated for all subjects, and those with a negative overbite were placed in the open-bite (OB) group. Those with a positive overbite were placed in the non-open-bite (non-OB) group. The dental overbite was the only criterion used to define the open-bite and non-open-bite groups. The open-bite subjects were paired with a non-open-bite subject by sex, presence of presurgical orthodontic treatment, and anterior cranial base length. Eighty-eight subjects in each group (43 men and 45 women) were obtained. Various measures of craniofacial structure were calculated and analyzed by comparing the OB and non-OB groups with the paired t test. The areas that showed significant differences (p less than 0.05) between the OB and non-OB groups were as follows: the posterior maxilla exhibited vertical excess in the OB group; the maxillary occlusal plane was less steep in the OB group; the mandibular occlusal plane was more steep in the OB group; the gonial angle was higher in the OB group; the mandibular plane angle was higher in the OB group; the mandibular ramus was positioned in a more downward and backward location in the OB group; the total anterior facial height and lower facial height were increased in the OB group; the vertical height of the anterior maxilla was increased in the OB group; and the mandible was less protrusive in the OB group. No significant intergroup differences were noted in the cranial base, the anteroposterior position of the maxilla or the upper and lower incisors, the palatal plane, posterior facial height, mandibular ramus height, or mandibular body height. The results of this analysis indicate that the average Class III open-bite malocclusion is characterized by aberrations in both the maxilla and the mandible. Surgical therapy may, therefore, require intervention in both jaws to correct this deformity successfully.

Adolescent↗
PubMed1999

Cephalometric evaluation of the anterior open bite treatment.

The present study was aimed at evaluating the treatment changes of anterior open bite malocclusion cases treated by means of the Multiloop Edgewise Arch Wire technique, which is considered one of the more effective treatment modalities for anterior open bite malocclusions. The open bite sample was composed of 16 young adults, 4 males and 12 females. The normal occlusion sample, as a controlled sample was composed of 58 young adults who had pleasing facial profiles and normal occlusions with no experience of orthodontic or prosthodontic treatment. The normal sample was subdivided by the cephalometric vertical facial relationships. Forty adults with cephalometric vertical facial relationships within the normal range of Korean standards were classified as Normal Occlusion Group 1. Eighteen adults with an increased vertical facial relationship but with normal occlusion, were classified as Normal Occlusion Group 2. Thirty-nine reference points were digitized on each film, and the computerized cephalometric analysis was obtained with 8 skeletal, 10 dentoalveolar, 17 teeth angulations, and 4 occlusal plane measurements. Treatment changes were determined by the paired t test, and the structural differences between the four groups were tabulated by the Student's t test. The treatment changes were observed mainly in the dentoalveolar region in the upper and the lower occlusal planes, accompanied by the uprighting of the posterior teeth to the occlusal plane through the distal tipping movement of the entire dentition. After the treatment, there was a tendency for the structural feature of the open bite group to approximate those of the normal occlusion group 2. This ascertains that the treatment changes of open bite malocclusion produced by means of the multiloop edgewise arch wire technique are similar to those found in the natural dentoalveolar compensatory mechanism.

Adolescent↗
PubMed2005

An adult case of skeletal open bite with a large lower anterior facial height.

Control of the height of posterior dentoalveolar regions is of great importance for the correction of skeletal open bite. Traditionally, second premolar extraction facilitates the closure of open bite by inducing a counterclockwise mandibular rotation without molar intrusion. This article reports treatment for a 24-year six-month-old female patient with an open bite and large anterior facial height. She complained of occlusal disturbances and difficulty of lip closure because of the open bite. Overjet and overbite were +3.0 mm and -3.0 mm, respectively. To correct open bite and crowding, the bilateral extraction of the maxillary and mandibular second premolars plus multibracket appliances for mesial movement of the molars was selected as the treatment plan. After a two-year treatment, an acceptable occlusion was achieved, the lower anterior facial height was decreased, and the lips showed less tension in a lip closure. An acceptable occlusion was maintained without recurrence of the open bite during a three-year retention period, indicating a long-term stability of the occlusion. The results of this treatment indicated that the correction of open bite with no or less molar intrusion or incisor extrusion is of great importance for achieving stable occlusion and avoiding the relapse of open bite.

Adult↗
PubMed1990

[Importance of posterior tooth-to-denture base discrepancy in the development of skeletal open-bite malocclusion].

This paper describes the relationship between the development of skeletal open-bite malocclusion and the tooth-to-denture base discrepancy. The cases which have a severe skeletal open-bite malocclusion are presented to evaluate the causing factor of the anterior open-bite. The anterior open-bite was associated with inferiorly positioned maxillary molars caused by the squeezing out effect of the tooth-to-denture base discrepancy, especially those in posterior part of dentition (posterior discrepancy), which provided a less steep maxillary occlusal plane in the denture frame. It was suggested that the posterior discrepancy induced a descending movement of the posterior teeth followed by a change of the occlusal plane and this effect of the posterior discrepancy was important factor in developing anterior open-bite malocclusion.

Cephalometry↗