Noncompliant treatment of skeletal open bite

Three-dimensional dentoalveolar changes in open bite treatment in mixed dentition, spurs/posterior build-ups versus spurs alone: 1-year follow-up randomized clinical trial

This randomized clinical trial aimed to compare the three-dimensional dentoalveolar maxillary changes after anterior open bite treatment with bonded spurs and build-ups versus bonded spurs alone. Patients from 7 to 11 years of age with anterior open bite were randomly allocated into two groups. Bonded spurs and posterior build-ups were used in the experimental group and only bonded spurs were used in the comparison group. The randomization sequence was generated at www.randomization.com. Opaque, sealed and sequentially numbered envelopes were part of the allocation concealment. Digital dental models were acquired before (T1) and after 12 months of treatment (T2) and de-identified for analysis purposes. Three-dimensional changes of maxillary permanent incisors and first molars were evaluated by means of T1 and T2 dental model superimposition. Landmark-based registration on the posterior teeth and registration on the palate using regions of interest were performed. T or Mann–Whitney U tests were used for intergroup comparisons (P < 0.05). Mean difference (MD) and 95% confidence interval (CI) were calculated. Twenty-four children (17 girls and 7 boys) were included in the experimental group (mean age 8.22 ± 1.06 years) and 25 children (14 girls and 11 boys) were included in the comparison group (mean age 8.30 ± 0.99 years). After 12 months of treatment, inferior displacements of maxillary incisors were similar in the experimental (1.55–2.92 mm) and comparison (1.40–2.65 mm) groups. Inferior displacement of the maxillary molars was also similar in both groups (MD: − 0.13 mm; 95% CI − 0.38, 0.12). The experimental and comparison groups showed medial and lateral displacements of the permanent first molars, respectively (MD, − 0.31 mm; 95% CI − 0.51, − 0.11). Lingual inclination of the permanent first molars were observed in the experimental group and buccal inclination in the comparison group (MD, − 2.16°; 95% CI − 3.72, − 0.60). Similar three-dimensional displacements of maxillary central and lateral incisors, and inferior displacements of maxillary permanent first molars were observed in both groups. Bonded spurs associated with posterior build-ups demonstrated some medial displacement and lingual inclination of the maxillary permanent first molars while opposite changes were noticed in the comparison group.

Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.

Intrusion of the maxillary posterior teeth with a single buccal mini-implant positioned bilaterally in young adults with a tendency towards hyperdivergence: A clinical study

BACKGROUND

Skeletal anchorage systems have been used for intrusion of the posterior teeth with satisfactory results. To achieve this, mini-implants are placed at anatomically challenging sites such as the palate or require several mini-implants to produce the desired effect.

OBJECTIVE

To determine the magnitude of intrusion of the maxillary posterior teeth achieved on a continuous arch wire using a single buccal mini-implant placed bilaterally in young patients with a tendency towards hyperdivergence and to evaluate its influence on the skeletal, dental and soft-tissue structures.

METHODS

A total of 17 patients with proclination of the anterior teeth, tendency towards hyperdivergence and clockwise rotation of the mandible were selected. First premolars were extracted as part of treatment protocol. A 0.022-MBT bracket prescription was used. Mini-implants were placed bilaterally on the buccal aspect at the mucogingival junction or slightly gingival to it between the maxillary second premolar and first permanent molar. A total of 200 g of intrusive force was placed from a continuous 0.019 × 0.025 inch stainless-steel arch wire to the mini-implant by means of an elastomeric thread on both sides. Lateral cephalograms and study models were taken before the start of intrusion and six months later. Parametric and non-parametric tests were done to assess treatment results.

RESULTS

Significant intrusion was observed in the maxillary molar and premolar region with tendency towards intrusion in the anterior region. There was significant decrease in lower anterior facial height (LAFH) with anti-clockwise mandibular rotation, decrease in facial proportion index and total facial height. No changes were observed in the transverse plane.

CONCLUSION

Intrusion of the permanent maxillary molar can be achieved on a continuous arch wire with a single buccal mini-implant placed bilaterally with improvement in facial aesthetics, especially in the vertical plane. This method may be beneficial in patients with borderline vertical discrepancy treated with conventional friction mechanics during space closure after first premolar extractions.

Evaluation of anterior open bite correction in patients treated with maxillary posterior segment intrusion using zygomatic anchorage

INTRODUCTION

This study aimed to investigate dentofacial changes in patients treated with maxillary molar intrusion with zygomatic anchors.

METHODS

The study group was composed of 19 patients with anterior open bite who had intrusion of the posterior dentoalveolar segment using an acrylic appliance supported by bilateral zygomatic miniplates. The study was carried out on lateral cephalograms of the subjects taken before treatment and after intrusion.

RESULTS

Cephalometric changes obtained with maxillary molar intrusion were statistically significant. ANB, Wits, SN-GoGn, PP-MP, ANS-Me, NA-APo, SN-OP, U1-OP, U6-NF, overjet, and overbite values were also statistically significant.

CONCLUSIONS

Posterior dentoalveolar intrusion by zygomatic anchorage was an effective method for anterior open bite treatment. Although overbite and vertical skeletal measurements changed because of posterior dentoalveolar intrusion, the soft tissue was not significantly affected.

Nonsurgical correction of a Class III skeletal anterior open-bite malocclusion using multiple microscrew implants and digital profile prediction

A 20-year-old woman had a severe anterior skeletal open bite and a moderate skeletal Class III relationship with a prognathic mandible and a straight profile. She declined surgery. However, molar intrusion in a Class III patient with a straight profile can cause forward mandibular rotation and deterioration of the profile to a concave pattern. We used digital facial profile prediction software to determine whether the orthodontic compensation treatment would be acceptable to the patient. The final treatment plan consisted of extraction of the third molars, maxillary molar intrusion, and total distalization of the mandibular dentition with multiple microscrew implants. The patient cooperated with the use of Class III interarch elastics. The active treatment period was 20 months. Proper overbite and overjet, good occlusion, and an acceptable facial profile were achieved.

Nonsurgical treatment of skeletal anterior open bite in adult patients: Posterior build-ups

OBJECTIVE

To (1) evaluate the efficacy of build-ups in the correction of anterior open bite in adults, (2) evaluate their efficacy in producing molar intrusion, (3) analyze skeletal and dental changes, and (4) assess the long-term stability.

MATERIALS AND METHODS

The sample consisted of 93 lateral cephalograms from 31 patients with skeletal and dental anterior open bite. The patients had received orthodontic treatment consisting of bonded resin blocks on the maxillary molars combined with Tip-Edge Plus bracket appliances. Cephalometric measurements were performed on radiographs taken before treatment (T1), after treatment (T2), and after a retention period (T3), which were analyzed and compared.

RESULTS

Significant dental and skeletal changes were observed after treatment. Molar intrusion averaging 1 mm; 1.44 and 1.57 mm extrusion of mandibular and maxillary incisors, respectively; and a mean of 3.98 mm overbite increase were observed. The mandibular plane angle showed a mean closure of 1.19°, and there was a mean decrease in anterior facial height of 0.7 mm. A mild relapse tendency was observed, but long-term stability was acceptable.

CONCLUSIONS

Build-ups are an effective treatment alternative for anterior open bite in adults. Outcomes remain significantly stable during the retention period.

Early treatment of anterior open bite: Comparison of the vertical and horizontal morphological changes induced by magnetic bite-blocks and adjusted rapid molar intruders

OBJECTIVE

This prospective clinical study aims to determine the differences between two treatment modalities for anterior open bite in growing patients. The treatment modalities involved the use of magnetic bite-blocks (MBBs) or rapid molar intruders (RMIs) applied with posterior bite-blocks.

METHODS

Fifteen consecutive patients with a mean age of 11.2 (standard deviation [SD] = 1.6) years and a mean open bite of -3.9 mm were treated with MBBs. Another 15 consecutive patients with a mean age of 10.9 (SD = 1.8) years and a mean open bite of -3.8 mm were treated with RMIs applied on bite-blocks. Cephalometric radiographs were obtained before (T1) and immediately after appliance removal (T2). The treatments lasted four months, during which the appliances were cemented to the teeth. The morphological changes were measured in each group and compared using logistic regression analysis.

RESULTS

The MBB group exhibited significantly greater decreases in SNA angle, ANB angle, overjet, and maxillary incisor angle (p < 0.05). The MBBs induced greater effects on the maxilla and maxillary dentition. The MBBs restrained maxillary forward growth and retracted the maxillary incisors more effectively than did the RMIs. Consequently, changes in the intermaxillary relationships and overjets were more distinct in the MBB group.

CONCLUSIONS

The anteroposterior differences between the appliances suggest that MBBs should be preferred for the treatment of patients with Class II open bites and maxillary incisor protrusions.

Multiloop edgewise archwire in the treatment of a patient with an anterior open bite and a long face

An adolescent girl with an Angle Class III malocclusion, excessive lower facial height, and anterior open bite sought nonsurgical treatment. She was treated with a multiloop edgewise archwire (MEAW). In association with a chincup, MEAW mechanics allowed the successful correction of the anterior open bite and the molar relationship, without major alterations of the patient's profile. Combined orthodontic and surgical treatment should be considered for patients with skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, MEAW treatment is an alternative that can have excellent results.

Skeletal Open Bite Correction with Rapid Molar Intruder Appliance in Growing Individuals

Objective: To determine the dentofacial effects of a fixed functional appliance, the rapid molar intruder (RMI).

Materials and Methods: One control group (n = 10) and two study groups (n = 10 each) were formed. The first experimental group consisted of growing children in the mixed dentition period who received RMI therapy alone. The second experimental group consisted of growing children in the early permanent dentition period who received both RMI and fixed appliance (edgewise) therapy together. Mean changes for the measurements for each group were evaluated by the Wilcoxon signed rank test. Comparisons of the mean changes between the groups were made by the Kruskal-Wallis test.

Results: Open bite correction was achieved by counterclockwise rotation of the mandible as a consequence of redirecting growth in both treatment groups. The ANB angle decreased significantly (P &lt; .05). Significant decreases were also noted for vertical skeletal characteristics in both treatment groups (P &lt; .05). Molar intrusion was statistically significant for both maxillary and mandibular first molars (P &lt; .05) in both treatment groups.

Conclusions: The RMI appliance provided effective bite closure and favorable dentofacial changes for nonsurgical open bite treatment in growing patients. It was concluded that this method could be regarded as a safe and noncompliance alternative for early intervention of skeletal open bite correction.