Embracing a New Era
A dental malocclusion that is characterized by an anterior open bite is one of the most difficult conditions to treat because it results from the interaction of multiple etiologic factors. There are numerous treatment techniques reported for the orthodontic treatment of anterior open bites but these techniques are only successful if the underlying problems that are causing the open bite are addressed and corrected. Applying intrusive orthodontic forces to posterior teeth is a treatment option to close anterior open bites. Equally touted is the extrusion or eruption of anterior teeth as a common method of bite closure if it is not contraindicated in the patient. It has been reported that extruded teeth are less stable than intruded teeth, especially considering the forces of the tongue, cheeks, and lips on the extruded teeth. Relapse of the orthodontic case will occur if the extrusion of maxillary anterior teeth does not produce stability.
There are several factors that could be related to the development of an open bite. Among these are; an unfavorable mandibular growth pattern, heredity, imbalances between jaw postures, digit-sucking habits, nasopharyngeal airway obstruction, tongue posture/activity and head position.
Various orthodontic mechanical treatment modalities have been proposed for the correction of anterior open bites. Some of the nonsurgical therapies used for treatment and the retention of anterior open bite cases include; properly placed straight wire brackets, tongue crib appliance, bonded lingual spurs on the anterior teeth, posterior bite blocks for molar intrusion with and without magnets, and functional appliances. In general, stability of the orthodontic correction is the most important criteria in choosing an acceptable method of treatment for patients with open bite malocclusion. Many previous studies have indicated that if the open bite correction is not stable; it is because the tongue continues to be postured incorrectly which causes the bite to reopen.
After the anterior open bite treatment is finished, a .0175 twisted wire can be bonded lingually canine-to-canine or lateral to lateral depending on the anterior occlusion, as a fixed retainer on the upper arch. This is the same retention that is recommended for the fixed retainer on the lower, cuspid to cuspid, bonding to each tooth. In addition, the patient should be educated to swallow normally in order to control the tongue thrust habit. An additional back up to bonding the anterior teeth following comprehensive treatment is to seat a Hawley retainer on the upper arch, with a “tongue hole” placed in the retainer as a reminder to the patient for proper tongue position.
A potential disadvantage of this type of appliance for retention is that it is highly dependent on patient compliance. The Hawley retainer should be worn at least 18-20 hours per day including sleeping time. Once the braces have been removed, we find long term retainer wear is not predictable so we would always recommend a fixed bonded lingual retainer wire in addition to the removable retainer.
At Gerety Orthodontic Seminars, our 40+ years of experience provides us the information and documentation to successfully deal with all types of malocclusion. Your success begins with the proper diagnosis and information gathering so that you will be able to discern the cause of the malocclusion. Our emphasis is on case selection and using the proper orthodontic treatment modality to fit the patient. We offer a complete package of comprehensive orthodontic continuing education structured for general dentists that are interested in integrating orthodontics into their general practice. Regardless of your orthodontic needs, in terms of education and learning everything you need to know to have a successful orthodontic branch in your general practice, we have the solution for you and your dental team. We offer the flexibility of both online and classroom education for the entire office.