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A temporomandibular joint case with an anterior open bite and a high mandibular plane angle was treated by erupting the posterior teeth after creating a posterior open bite using a Garcia Distraction Appliance and a Garcia Pivot Splint.
The purpose of this study was to determine the characteristics and longitudinal changes of the arch morphology and occulusion of the deciduous open bite cases. The materials used in this study were the serial plaster casts of 40 Japanese children with deciduous open bite, and they were measured with the three dimentional system. The following results were obtained: 1. The form of dental arch with open bite in the early primary dentition changed remarkably in the maxilla but little in the mandible. In children with open bite, the maxillary intercanine distance was narrower, the maxillary arch length was longer, the palatal height of the front area was higher, but the back one was lower, and the upper central primary incisors were located more forward and upward higher than in children without open bite. 2. In the late primary dentition, the dental arch shape in the spontaneous closure group showed little difference from the control group. However the deciduous upper central incisors of the spontaneous closure group were very remarkably inclined to the palatal side, and the vertical over-jet was larger than that in the control group. The larger the horizontal over-jets were in the early deciduous dentition, the larger the vertical over-jet changed in the late deciduous dentition. 3. In the spontaneous closure group, the point of the dental arch showed a regular changing aspect, in which place marked variation was recognized in the early deciduous dentition as compared with the control group. Because of spontaneous closure, the dental arch shape approached the one of control group rapidly. 4. The result of multivariate analysis indicate that not only discontinuance of thumb-sucking but also many variables of the dental arch shape and occlusal condition may induce spontaneous closure of the open bite within the deciduous dentition term.
A new technique is described for outpatient treatment of anterior open bite. The compression osteogenesis method with a two-stage corticotomy was used in the posterior maxilla to treat a woman with severe anterior open bite. Three-week post-surgical compression using anchor plates and elastics repositioned the posterior maxillary bone/teeth segments by 7 mm to the ideal superior position. The patient had a stable skeletal position of the maxilla at 14-month follow-up with satisfactory results and no complications after orthodontic treatment. This technique appears to be an efficient option for treating patients with anterior open bite.
INTRODUCTION: The aim of this study was to evaluate tongue movements in subjects with anterior dental open bites during deglutition by using real-time balanced turbo field echo cine-magnetic resonance imaging. METHODS: The study included 28 subjects. Two groups were formed according to the presence of anterior open bite (at least 2 mm). The open-bite group (OBG) consisted of 18 patients (14 girls, 4 boys) with a mean age of 14.5 +/- 2.7 years. The control group (CG) consisted of 10 patients (5 girls, 5 boys) with a mean age of 14.5 +/- 2.6 years. We evaluated deglutition during 3 stages: oral (stage 1), pharyngeal (stage 2), and esophageal stage (3). RESULTS: Results indicated that (1) in the OBG, from stage 2 to stage 3, the anterior portion of the tongue dorsum was elevated [corrected] whereas its midportion was lowered [corrected]; (2) in the CG, its posterior portion was lowered [corrected] from stage 2 to stage 3; (3) in the CG, the tongue tip was positioned more posteriorly [corrected] at stage 2 than at stage 1; (4) in the OBG, the tongue tip moved more anteriorly in all stages of deglutition than in the CG. CONCLUSIONS: Compensatory tongue functions occur in patients with anterior dental open bites. Dynamic MRI is a promising tool for evaluating swallowing patterns in these patients.
PURPOSE: The purpose of this longitudinal study was to assess the relationship between nonnutritive sucking habits and anterior open bite in 305 4- to 5-year-old children attending state schools in the city of Recife, Brazil. METHODS: The data were collected by interviewing the children's mothers or guardians and through clinical examinations carried out by 1 calibrated examiner (K = 1). Bivariate analyses (Pearson chi-square, McNemar, and Stuart-Maxwell tests) were used for the statistical analysis. RESULTS: The prevalence of sucking habits was low, and the sample showed reductions after 1 year of follow-up. The prevalence of anterior open bite decreased from 33% to 29% after 1 year. A significant association was found between anterior open bite and sucking habits. Open bite self-correction was associated with the abandoning of deleterious habits. CONCLUSIONS: The low prevalence of nonnutritive sucking habits and its reduction during the period studied seem to reflect a natural tendency in preschool children. Even presenting a slight reduction, the high prevalence of anterior open bite draws attention to the importance of longitudinal studies to support scientific evidences for early clinical intervention.
The tongue surface movement of young patients with or without open bite was evaluated by ultrasound images taken on the posterior part of the tongue on the frontal plane to determine whether there is any relationship between the tongue movement and open bite malocclusion in the early mixed dentition period. The standardized reproducible ultrasound images were obtained using ultrasound diagnostic equipment that was fabricated in a cephalostat unit having a probe stabilizer. At the central portion of the tongue, no significant differences were detected in the duration or the momentum of tongue surface movement on a frontal plane was detected between the patients with and without open bite during swallowing. The farther the region was from the central portion, however, the longer the duration and the bigger the momentum of the tongue surface movement was found in the open bite group. Based on this evidence, it is suggested that an open-bite child swallows by using a tongue thrust motion that forms using a large depressed area in the tongue, whereas a normal child without tongue thrust forms a rather narrow groove in the central portion of the tongue when swallowing.
This study examined the effects of the vertically activated bite block, a new appliance designed for maxillary molar intrusion in open bite malocclusion, on the dentofacial structures in 1 adolescent patient and 1 adult patient. The vertically activated bite block consists of 2 parts, the main block and an auxiliary segment. The auxilliary segment is separated bilaterally from the main block in the posterior region and connected bilaterally to the main block in the palatal region by open jackscrews. Closing the jackscrews moves the auxiliary segment toward the palate, thereby inducing molar intrusion. The present study achieved a reduction in open bite, using the VABB through: (1) active intrusion of the maxillary molars; (2) control of posterior vertical alveolar development and/or compensatory eruption of the mandibular molars; (3) stimulation of anterior vertical alveolar development by restriction of the tongue; and (4) anterior repositioning of mandible. Achieving these dentoalveolar and skeletal changes are required treatment objectives in cases of skeletal open bite. As a result of attaining these objectives, the open bite was eliminated in 1 early growth and 1 late growth patient by 14 mm and 6 mm, respectively.
In this study, the clinical significance of three floating norm systems, the Bergen Box (BB), the Segner-Hasund Harmonybox 1 and 2 (SHH1 and SHH2), as well as the influence of treatment modalities for predicting results of an open bite treatment were investigated. In the BB and SHH1, patients with a steep mandibular plane angle or a skeletal open bite configuration (O1mand, O1mandmax, O1max, or N1mand) were considered 'high risk', while in the SHH2, only the configurations O1mand and O1mandmax were considered high risk. All other configurations were designated 'low risk'. It was postulated that in high risk patients, the overbite was likely to relapse into an open bite after retention. Cephalograms of 83 open bite patients taken before treatment (T1) and at the end of retention (T2) were studied. Patients designated as low risk generally had a normal overbite at T2 after treatment, regardless of which box was used. The risk configurations of the SHH1 and SHH2 at T1 were significant predictors of the overbite at T2, the first being slightly better compared with the SHH2. The main clinical values of the SHH1 and SHH2 are strongly supported by the relatively good success rate in distinguishing a low-risk configuration. Reliable prediction of the treatment results of high-risk patients with risk configurations according to the SHH is improved by evaluating treatment modalities. The posterior bite splint seemed to have a bite opening effect, while a bite closing effect was associated with the use of a removable retention appliance.
There is no single management strategy for dealing with open bites, which vary greatly in presentation and severity. The general dental practitioner is recommended to assess treatment need on whether the open bite is a problem to the patient: if it is not, then no remedial treatment may be required. To aid the practitioner in the often difficult decision-making process, in this paper the possible causes of open bite malocclusion are reviewed, together with the methods currently available for treatment of this condition and the uncertainties inherent in the prognosis. The need for treatment is also discussed, to assist the general dental practitioner in deciding as to whether referral is necessary.
The combined simultaneous anterior and posterior maxillary ostectomy has proved to be a useful method of treating skeletal open-bite. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower-face height, contour-deficient chin, and Class II malocclusion. Primary contraindications are the Class III skeletal open-bite and lip competence. We have used the procedure as routine treatment for many open-bites over the past 5 years since we first described it. Clinically, the results have been most gratifying, with marked improvement in facial appearance and stability of the open-bite correction. A preliminary study of stability following this procedure indicated good stability with regard to the vertical repositioning of the maxillary segments. A recently completed study by us on thirty-two patients treated with this procedure and followed for an average of 1.5 years showed excellent stability. This is by no means the only method by which open-bite may be successfully treated, but it is one more method to add to our armamentarium. The surgical procedure must be carefully planned and executed to attain the best possible results. Furthermore, the orthodontic procedures, particularly those involving vertical forces, must be provided at the proper time so that the surgical results are not compromised. Nevertheless, with proper planning, attention to detail, and meticulous execution, the results are rewarding.
This case report describes the treatment of a severe anterior open bite, Class II malocclusion with a history of dummy sucking. The 9-year-old girl presented with a significant anteroposterior and vertical discrepancy. Her face was convex with procumbent lips. She had an anterior open bite of 9 mm, an overjet of 8 mm, and a transverse maxillary deficiency. In consultation with the parents and patient, a nonsurgical therapy was elected, with the goals of reducing protrusion and closing the anterior open bite.
Until recently, surgical correction of the jaws has been widely regarded as the most effective treatment of open bites in the permanent dentition. In the following case report an open bite was treated non-surgical by intrusion of the molars with a magnet appliance. The forces of repelling magnets, fixed opposite in the upper and lower jaw were used to intrude the first and second molars. This intrusion allowed an autorotation of the mandible upward and forward to close the open bite. By reduction of the open bite of about 3 mm a surgical intervention could be avoided.
Anterior open bite (AOB) may be expected to close spontaneously in approximately 50% of Caucasian patients. Computer-derived discriminant analysis of a single cephalometric radiograph has been shown to predict closure or non-closure in 88% of patients at the pre-puberal stage, in 74% at the puberal stage, and in 94% at the post-puberal stage. In this study, the predictive capacity of the computer analysis was tested against predictions made by groups of clinicians in Belfast and Toronto. The computer analysis was carried out on the first cephalometric radiographs of a new sample of 34 open bite cases collected serially and recorded over a minimum of 2 years. Thus, the spontaneous outcome was known to the authors. The first radiographs were shown to 20 clinicians in Belfast and 22 in Toronto who were asked to predict the spontaneous outcome. The computerised discriminant analysis made correct predictions in 85% and the clinicians in 64% of the sample. There were no significant differences between the predictions of clinicians in Belfast and Toronto, but computer prediction was more accurate than all grades of clinician. The predictions of qualified orthodontists were generally more accurate than prequalified orthodontists which were more accurate than those of undergraduate dental students but the differences did not rise to the level of statistical significance. For patients at the puberal stage the predictive capacity of qualified orthodontists was less than orthodontists in training. Computer prediction of the spontaneous outcome in open bite improves clinical diagnosis.
A Paediatric dentist may be the first person consulted for professional advice concerning children with speech problems. A positive significant relationship has been hypothesized by some authors between tongue-thrust swallowing and articulation disorders in children. This study was undertaken to find out whether any articulation disorders are associated with the habit of tongue-thrust swallowing, or is it the type of anterior bite that plays an important role in the normal or abnormal speech production in tongue-thrust swallowers. Forty subjects with tongue-thrust swallowing in the age group of 7-16 years were examined. Of these 20 had normal anterior bite while rest had anterior open bite. A word articulation test was used and word level articulation testing was done for initial, medial and final positions. The sounds tested were: Linguoalveolars, Labiodentals, Linguodentals, Linguopalatals, Bilabials and Linguovelars. The results of the study have indicated that the presence of articulation disorders is strongly associated with the anterior open bite present in tongue-thrust swallowers but a simple, direct relationship between the presence of defective consonant sounds and tongue-thrust swallowing has not been found.
Early diagnosis of patients exhibiting open bites that are complicated by skeletal Class II and vertical growth problems can facilitate subsequent treatment. Eight patients with Class II skeletal open bite were treated with the high-pull activator appliance and compared to reasonably matched controls to determine the effects of the appliance. The high-pull activator was found to reduce forward growth of the maxilla and increase mandibular alveolar height, transforming the Class II molar relationship into a Class I molar relationship. The overjet and open bite were decreased, and, in addition, the appliance reduced the amount of forward and downward movement of the maxillary molars, providing vertical control of the maxilla during Class II orthopedic correction. These results demonstrated that open bite complicated by a Class II vertical growth pattern can be treated during the mixed dentition with favorable results by a combination of a removable functional appliance and high-pull headgear.
The records of 40 nongrowing open bite patients treated with orthodontics and maxillary surgery were divided into two groups and evaluated. The extrusion group (n = 19) included those patients who had presurgical maxillary incisor extrusion of at least 1.5 mm. In the nonextrusion group (n = 21), the maxillary incisors were maintained or intruded prior to surgery. Statistical analysis showed no relationship between presurgical extrusion of the maxillary incisors and the stability of open bite correction; the maxillary incisors were generally stable long term in both groups. Overbite decreased a mean of -0.97 mm in the extrusion group and -0.67 mm in the nonextrusion group during the mean 5-year 10-month follow-up period after appliance removal. Twenty-five percent (10 of 40, 5 from each group) of the sample had no incisal overlap long term. These findings suggest that a moderate amount of presurgical incisor extrusion or lack of extrusion are stable long term and have little influence on posttreatment stability of open bites. The decrease in overbite observed after treatment may result from the influence of various dental, skeletal, and soft tissue factors rather than from any single factor.
INTRODUCTION: The aim of this prospective clinical study was to cephalometrically investigate the dentoalveolar and skeletal changes produced by a removable appliance with palatal crib associated with high-pull chincup therapy in children with Angle Class I anterior open-bite malocclusions. METHODS: Thirty children with initial mean age of 8.61 years and mean anterior open bite of 4.01 mm were treated with removable appliances with palatal crib associated with chincup therapy for 12 months. A control group of 30 subjects with initial mean age of 8.33 years and mean anterior open bite of 3.95 mm with the same malocclusion was followed for 12 months for comparison. RESULTS: The removable appliance with palatal crib combined with vertical chincup did not yield significant changes in maxillary and mandibular skeletal components, maxillomandibular relationship, or vertical facial pattern. Overall, effects in the treated group were exclusively dentoalveolar. Open bite in the treatment group showed a mean closure of 5.01 mm (SD +/- 1.73). CONCLUSIONS: The association of high-pull chincup therapy with a removable appliance and palatal crib provided no positive skeletal influence on the vertical facial pattern of patients treated for open bite in the mixed dentition.
Lateral cephalometric radiographs of 39 patients who were treated with an open bite bionator, also known as a "bionator to close the bite," were obtained from six private orthodontic practices. Comparisons of pretreatment cephalometric values with published standards indicate that clinicians do not generally use this appliance for patients who have marked excessive anterior vertical dimension. Rather, the cases appear to be Class II with mild anterior open bites or with some indication of open bite tendency, such as a steep mandibular plane angle. Changes in cephalometric values during treatment with the appliance were compared with normal growth standards. Patients exhibited a reduction in facial convexity and overjet, reduced eruption of maxillary molars, and less of an increase in facial height than expected. The appliance appears to be effective for Class II correction in patients who require control or improvement of moderately excessive vertical dimension.