Open bite

Summary Although the etiology of the open bite has been often investigated, its treatment is still a great challenge. The open bite can have skeletal or dento-alveolar origins, it can also be caused by habit or dysfunction. In this study, some examples are evaluated in order to find out which of these different factors has the greatest influence on the symptomatology of the open bite. The fundamental question is whether the open bite is caused by function or if there has been a functional adaptation. 250 cases of open bite treated by Dr. Veliskova and 175 own cases are presented in order to show typical variants as they are represented in the lateral remote x-ray picture. The principal criteria are the apparent differences between the direction of growth and the relations of anterior and posterior facial segments. If the treatment is chosen according to the etiologic findings (habitual, functional, or skeletal origin), a desirable result without recurrence can be reached by orthodontic, orthopedic or maxillo-surgical measures. Differential diagnosis is a decisive factor for a succesful treatment.

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Zusammenfassung Obwohl die Ätiologie des offenen Bisses schon in vielen Arbeiten untersucht wurde, ist seine Behandlung nach wie vor eine große Herausforderung. Ein offener Biß kann sowohl skelettaler oder dentoalveolärer Herkunft sein als auch durch Habits bzw. Fehlfunktion verursacht werden. Deshalb soll an einigen Beispielen herausgearbeitet werden, welcher der verschiedenen Faktoren wohl überwiegend am Krankheitsbild des offenen Bisses beteiligt ist. Grundsätzlich ist die Frage zu stellen, ob die Funktion den offenen Biß verursacht hat, oder ob eine funktionelle Adaptation stattgefunden hat. Anhand von 250 Fällen mit offenem Biß von Dr.Veliskova und anhand von 175 eigenen Fällen sollen typische Varianten, wie sie sich im seitlichen Fernröntgenbild darstellen, aufgezeigt werden. Dabei sind die offensichtlichen Unterschiede zwischen der Wachstumsrichtung und den Beziehungen zwischen den vorderen und hinteren Gesichtsabschnitten die Hauptkriterien. Wenn sich die Therapie nach der Ätiologie (habituell, funktionell oder skelettal) richten soll, so kann mit orthodontischen, orthopädischen oder kieferchirurgischen Maßnahmen ein wünschenswertes Ergebnis ohne Rezidiv erreicht werden. Ausschlaggebend ist die Differentialdiagnostik für eine erfolgreiche Behandlung.

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Résumée Bien que l'étiologie de la béance vraie ait été étudiée dans de nombreux travaux, son traitement demeure très difficile de nos jours, comme auparavant. La béance peut être squelettique ou dento-alvéolaire ou liée à des dysfonctions. C'est pourquoi il faut dégager parmi différents facteurs, celui qui est prépondérant dans la pathologie de la béance. Il faut principalement poser la question si c'est la fonction qui est la cause de la béance ou si elle n'en représente qu'une adaptation fonctionnelle. A l'aide de la téléradiographie de profil, on présente les variations typiques de 250 cas de béance du Dr.Veliskova et de 175 cas de l'auteur. Les critères de base demeurent les différences évidentes entre la direction de croissance et le relations entre la hauteur antérieure et postérieure de la face. Lorsque la thérapeutique est bien adaptée à l'étiologie (squelettique, fonctionnelle ou habitude néfaste), alors on peut atteindre un résultat désirable sans récidive avec des mesures d'orthodontie, d'orthopédie dento-faciale ou de chirurgie maxillaire. La primauté du succès thérapeutique réside dans le diagnostic différentiel.

     

Open bite and interdental sigmatism

The authors revealed very often open bite in preschool children with interdental sigmatism and vice versa. They investigated the effect of interdental sigmatism on the persistence of open bite. According to the authors findings open bite persists in 3-5 year-old children with open bite and interdental sigmatism after a 10-to-22 month follow-up significantly more often than in children of similar age with open bite but without interdental sigmatism. Interdental sigmatism is associated with already existing open bite. It is possible that at the time of their development open bite and interdental sigmatism have no causal relationship and the two defects associate accidentally. Only during subsequent development open bite persists more frequently in those children who suffer at the same time from interdental sigmatism, while in children without interdental sigmatism the open bite improves more often.     

Open bite treatment using clear aligners

A 35-year-old female patient with dentoalveolar open bite of 4 mm, molar Class I malocclusion, centered midlines, moderate crowding, and labial inclination of the lower incisor was treated with clear aligners to reduce protrusion and close the anterior open bite. The result showed that clear aligners were an effective method with which to correct this malocclusion. The treatment was complete after 18 months. The patient was satisfied with her new appearance and function.     

Open bite correction by intrusion of posterior teeth with miniscrews

The application of orthodontic miniscrews has simplified the treatment of an anterior open bite by making it more efficient and esthetic. A 19-year-old woman with an anterior open bite was treated by an intrusion of the maxillary posterior teeth using miniscrews. The posterior teeth were splinted on the palatal side with rapid maxillary expansion (RME), and an intrusive force was then applied to the miniscrews on the buccal side. The 3.5 mm anterior open bite was corrected after 5 months of intrusion. As a result, a harmonious facial profile was achieved by a closing mandibular rotation.     

摇椅弓配合种植钉非减数矫治前牙开(牙合)

目的 研究摇椅弓配合种植钉技术矫治前牙开(牙合)的效果,探讨该技术矫治开(牙合)的机制和临床要点.方法 选择18例青少年前牙开(牙合)患者,应用摇椅弓配合后牙区种植钉及前牙段垂直牵引进行矫治,分析矫治前、后的X线头颅侧位片变化.结果 矫治后上下磨牙直立并略压低,上、下颌切牙伸长且上切牙内收,(牙合)平面平整,前牙覆(牙合)覆盖正常,上下唇略内收.结论 摇椅弓配合种植钉技术能有效矫治青少年牙性前牙开(牙合),该技术矫治机理与MEAW技术相似,对轻度拥挤病例可以推磨牙向后并内收前牙.     

Open bite: orthodontic prosthetic surgical treatment. Presentation of a case

A patient with anterior open bite is studied. Treatment and technique selected for the surgical correction of his deformity is described. It is stated that on account to the socialist character of our medical assistance, this treatment is within reach of any patient requiring it. Finally, emphasis is made on the fact that control after surgery is as important as a right selection and performance of the technique used for the prevention of relapses.     

Open bite with deformity of the upper dental arch: A case report

Repeated surgical and orthodontic correction of open bite associated with a substantial narrowing of the upper dental arch has been reported. Follow-up examination 4 years after the operation confirmed the success of the treatment.     

Open bite: stability after bimaxillary surgery--2-year treatment outcomes in 58 patients

Stability after bimaxillary surgery to correct open bite malocclusion and mandibular retrognathism was evaluated on lateral cephalograms before surgery, 8 weeks post-operatively, and after 2 years. The 58 consecutive patients were treated to a normal occlusion and good facial aesthetics. Treatment included the orthodontic alignment of teeth by maxillary and mandibular fixed appliances, Le Fort I osteotomy, and bilateral sagittal split ramus osteotomy. Twenty-six patients also had a genioplasty. Intra-osseous wires or bicortical screws were used for fixation. Twenty-three patients had maxillo-mandibular fixation (MMF) for 8 weeks or more, six for 4-7 weeks, 14 for 1-3 weeks, and 15 had no fixation. At follow-up 2 years later, the maxilla remained unchanged and the mandible had rotated on average 1.4 degrees posteriorly. Seventeen patients had an open bite. Among them, eight patients had undergone segmental osteotomies. The relapse was mainly due to incisor proclination. The most stabile overbite was found in the group with no MMF after surgery.     

Open bite, dental alveolar protrusion, class I malocclusion: A successful treatment result.

This case report describes the treatment of a dentoalveolar protrusion, Class I malocclusion with an anterior open bite. The 21-year-old woman presented with a significant anteroposterior and vertical skeletal discrepancy. Her face was convex with procumbent lips. Intraorally, she had an anterior open bite of 4 mm, mild crowding, and an overjet of 4.5 mm. First premolar extractions in conjunction with tongue therapy and high pull headgear were used to reduce protrusion and close anterior open bite. Modification of a tongue thrust habit allowed conventional orthodontic treatment to correct this significant malocclusion and provide stability over the last 4 years.     

(牙合)垫与交互牵引联用矫治正锁(牙合)的临床应用体会

正锁(牙合)是上颌后牙被锁结在下颌后牙的颊侧,(牙合)面无咬合接触[1].个别后牙正锁(牙合)及单侧多数后牙的正锁(牙合)在临床上较为多见.锁(牙合)对咀嚼功能、颌面发育及颞下颌关节的健康影响都很大,因此临床上应充分重视、及早矫治锁(牙合)关系.     

Electropalatographic and cephalometric assessment of tongue function in open bite and non-open bite subjects

Anterior open bite (AOB) and tongue thrust swallowing are frequently associated, but the relationship between the two remains unclear. Electropalatography (EPG), which is used in speech pathology to measure dynamic tongue function for diagnostic, therapeutic, and research purposes, is a suitable technique for the investigation of this relationship. The present clinical study examined the dentofacial pattern and tongue function in AOB and non-open bite children. EPG recordings of speech and swallowing, and lateral head radiographs were obtained from eight 10-year-old boys with tongue thrust swallowing behaviour and AOB, and from eight age-matched non-open bite controls. Analysis of data from the two groups indicated that although differences were small, the open bite children displayed trends for longer face morphology and greater upper incisor proclination, less consistent production of closures during speech, a more posterior pattern of EPG contact, and relatively sparse EPG contact during swallowing. The discovery of differing patterns of contact for the /d[symbol: see text]/ and /t[symbol: see text]/ phonemes indicates that these should be included when speech is used to test for the presence of fronted tongue behaviour.