Oral-Health-Related Quality of Life (OHRQoL) and Anterior Open Bite in Adult Patients: A Case-Control Study

Efficacy of Clear Aligner Therapy for the Treatment of Anterior Open Bite in Adults: A Systematic Review and Meta-Analysis

The objective of the present systematic review and meta-analysis was to assess the effectiveness of clear aligner therapy (CAT) for the treatment of anterior open bite (AOB) in adults. The focused question was "Is CAT effective for the management of AOB in adults?". Databases were searched without time and language barriers up to and including August 2024 based on pre-specified eligibility criteria. Risk of Bias (RoB) assessment was performed using the Risk-of-Bias-In-Non-randomised-Studies-of-Intervention (ROBINS-I) tool. Meta-analyses were conducted using a random effects model (REM) for change in AOB and cephalometric measurements with an evaluation of the mean difference (MD) and/or standardised mean difference (SMD). The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool was used to assess the quality of evidence. Publication bias was assessed using Funnel plots and Egger's regression test. There were 14 studies included in the qualitative assessment and 12 in the meta-analysis. The RoB was moderate in 13 studies and low in one. The meta-analysis showed significant AOB correction with CAT [(MD) = 2.76 mm, 95% confidence interval (CI): 2.23-3.28] due to maxillary and mandibular incisor extrusion (MD = 0.85 mm, CI: 0.43-1.26 and MD = 0.86 mm, CI: 0.29-1.44, respectively). There were no significant changes identified for maxillary and mandibular molar intrusion or changes in the mandibular plane angle (MPA). The level of confidence was high for AOB correction, incisor extrusion, and molar intrusion and low for MPA. CAT leads to a significant correction of AOB of approximately 2.76 mm, which can be mainly attributed to incisor extrusion.

Influence of anterior open bite on oral health-related quality of life. A systematic review

Background

Anterior open bite is a malocclusion caused by genetic and environmental causes that affect esthetics, occlusion, and speech, impacting the quality of life in children, adolescents, and adults. However, to date, no systematic review has analyzed the influence of anterior open bite (AOB) on oral health-related quality of life.

Material and Methods

This systematic review conducted a comprehensive search in the MEDLINE (via PubMed), EBSCO, SCOPUS, and LILACS databases until September 30, 2023. A total of 321 articles were identified across these databases. After applying the selection criteria, 13 articles were selected for full-text evaluation. Ultimately, only six studies, all cross-sectional, were included in the review. The Newcastle-Ottawa Scale was utilized to assess the risk of bias in these studies.

Results

Six studies have found that AOB affects quality of life. In adults, it has a greater impact on women, especially on psychological and social well-being. In children, negative effects are observed in symptoms, function, and psychological aspects, with poor outcomes. One study found no significant differences in quality of life in children with AOB.

Conclusions

The review indicates that AOB (anterior open bite) significantly impacts quality of life, particularly in psychological and functional areas such as speech, eating, and smiling. This information is essential for both orthodontists and patients. While most studies show moderate bias, further well-designed research is recommended. Key words:Open bite, oral health-related quality of life, review.

Orthodontic Treatment Need and Its Relation to Gender, Oral Hygiene, and Age Range in a Mexican Population

Introduction Malocclusion, a prevalent oral health concern, significantly impacts both functional abilities and psychosocial well-being. The Dental Aesthetic Index (DAI) is widely used to assess malocclusion severity and orthodontic treatment needs. This study aims to evaluate the prevalence of orthodontic treatment needs based on the DAI in a Mexican population, considering factors such as gender, oral hygiene, and age range. Materials and methods This retrospective observational study analyzed 639 patient records from the Orthodontics and Dentomaxillofacial Orthopedics postgraduate program at the Autonomous University of San Luis Potosí, San Luis Potosí, Mexico. The DAI was used to assess malocclusion severity, and patients were classified into four categories based on their scores. Data on gender, oral hygiene, and age were also collected and analyzed. Results The results showed no significant association between DAI levels and gender, oral hygiene, or age range. However, a significant association was found between missing teeth and higher DAI scores (OR = 8.9), maxillary irregularity (OR = 8.6), and open bite (OR = 4.9). The prevalence of severe malocclusion (DAI ≥ 36) was notably high, affecting over 50% of the study population. Discussion The findings align with previous studies that highlight the influence of structural irregularities such as open bite and maxillary irregularities on severe malocclusion. While no significant associations were found with gender, oral hygiene, or age, the high prevalence of severe malocclusion underscores the need for early orthodontic intervention in Mexican populations. Conclusion This study demonstrates a high prevalence of severe malocclusion in a Mexican population and highlights the importance of addressing structural dental irregularities to prevent long-term complications. These findings emphasize the need for accessible orthodontic care and early screening programs.

The impact of dentofacial characteristics and malocclusions on dissatisfaction with dentofacial appearance

OBJECTIVES

To assess how, and to what extent, dentofacial features and malocclusions affect the perceived dissatisfaction with the appearance of dentofacial region in different age groups.

MATERIALS AND METHODS

Dissatisfaction with dental appearance (DDA) and facial appearance (DFA) of 430 patients were assessed using self-reported 5-point Likert scores (1: very satisfied - 5:very dissatisfied). Number of decayed, filled, and missing teeth, oral hygiene status, crowding in the upper/lower arches, molar relationship, overjet, overbite, posterior-crossbite, upper/lower midline deviations, face type, profile, nasal tip and chin deviations were assessed by an experienced orthodontist. Ordinal logistic regression analysis was performed to determine how the examined variables affected DDA and DFA scores.

RESULTS

The median age of the 430 patients (271 female, 159 male) was 23.0 years. 60.9% of the patients had Angle Class I, 32.3% had Angle Class II, and 6.7% had Angle Class III molar relationship. According to the IOTN (DC), 37.4% of the patients had grade 4 and grade 5. Gender had no impact on DDA and DFA. Being young (teenagers OR = 4.78, CI:2.43-9.40, young adults (OR = 3.15, CI: 1.70-5.83), having poor oral hygiene (OR = 2.32, CI: 1.37-3.92), missing teeth (OR = 1.19, CI:1.10-1.29), convex profile (OR = 1.94, CI:1.03-3.67), diastema (OR = 3.18, CI:1.33-7.61), crowding in the upper arch (moderate: OR = 2.10, CI:1.30-3.68, severe: OR = 5.94, CI:3.15-11.19) affected the DDA scores negatively. Class III malocclusion (OR = 5.60, CI:1.85-16.91), decreased overbite (OR = 2.44, CI:1.21-4.89), and increase in DDA scores (OR = 1.88, CI: 1.50-2.35) all increased the DFA scores.

CONCLUSION

Certain dentofacial characteristics and age of the patients significantly affect self-reported dissatisfaction with dental and facial appearance levels, with varying degrees of severity.

CLINICAL RELEVANCE

Awareness of the impacts of malocclusions and dentofacial features that result in patient dissatisfaction among those who apply for dental treatment at the clinic enables a deeper understanding of the patient's priorities, expectations from orthodontic treatment, and satisfaction with the outcome.

Effects of Occlusal Contact on Maxillary Alveolar Bone Morphology in Patients with and without Anterior Open Bite: A Cross-Sectional Study

Background/Objectives: Anterior open bite (AOB) is characterized by the absence of occlusal contact between the maxillary and mandibular anterior teeth, while the posterior teeth are in contact when occluded. Here, we aimed to clarify the difference in maxillary alveolar bone morphology in adult patients with and without AOB. Methods: This cross-sectional study was conducted on 50 adults aged 18-39 years: 25 patients without AOB (control group; 13 males and 12 females; age: mean ± standard deviation [SD], 22.2 ± 4.5 years) and 25 patients with AOB (9 males and 16 females; age: 24.2 ± 6.4 years). Using cone-beam computed tomography images, the height of the maxillary alveolar bone crest in the anterior and posterior teeth and thickness of the alveolar cortical bone on the labial and palatal sides were measured and compared between the two groups. An independent t-test and Pearson's correlation analysis were used to examine statistical significance (p < 0.05). Results: The AOB group showed a significantly longer (p = 0.016) posterior alveolar crest and thinner cortical bone on the buccal (p < 0.001) and lingual (p = 0.009) sides of the anterior region and the buccal (p = 0.006) sides of the posterior region than the control group did. Moreover, a significant negative correlation (p = 0.046; r = -0.403) was observed between bite force and cortical bone thickness on the buccal side of the posterior region in the AOB group. Conclusions: It is suggested that the absence of occlusal contact in the anterior area influences the alveolar bone morphology of the maxilla.

Vertical Dentofacial Skeletal Divergency Is Not Linked with Oral Health-Related Quality of Life

The aim of this study is to assess how vertical skeletal malocclusion affects oral health-related quality of life (OHRQoL) among a sample of individuals comprising adolescents, young adults, and adults seeking orthodontic treatment. From January 2019 to March 2020, participants were consecutively enrolled. The assessment of OHRQoL involved measurement using the oral health impact profile (OHIP-14). Lateral cephalograms were performed to measure the vertical skeletal divergency with four cephalometric measurements. Descriptive and inferential statistical analyses were performed. The Mann-Whitney test was applied to compare OHRQoL scores according to the vertical dimension category. The mean age of the participants ranged between 30.3 ± 14.9 and 29.9 ± 14.4 and there was a majority of female participants, between 64.1% and 65.9%. There were no statistically significant differences observed between hyperdivergent and normodivergent groups in either the total score or any domain of the OHIP-14 questionnaire. Individuals with hyperdivergent facial morphology did not show a reduced OHRQoL compared with a normodivergent facial type.

RANK-RANKL-OPG expression after gingival mesenchymal stem cell hypoxia preconditioned application in an orthodontic tooth movement animal model

Background

The expression of receptor activator of Nuclear Factor Kappa Beta (RANK) and its ligand (RANKL), as well as osteoprotegrin (OPG), in the alveolar bone (AB), may improve bone remodeling during orthodontic tooth movement (OTM). It is hypothesized that hypoxia-preconditioned gingival mesenchymal stem cells (GMSC) may be more effective than normoxia-preconditioned GMSC in this regard. This study aims to investigate the expression of RANK, RANKL, and OPG in the compression and tension sides of AB after allogeneic administration of GMSC that were normoxia or hypoxia-preconditioned in rabbits (Oryctolagus cuniculus) undergoing OTM.

Methods

Twenty-four healthy young male rabbits were divided into two groups: T1, which underwent OTM and received normoxia-preconditioned GMSC, and T2, which underwent OTM and received hypoxia-preconditioned GMSC. A ligature wire was attached to the mandibular first molar and connected to a 50 g/mm2 closed coil spring, exerting force on the central incisor and left mandibular molar of the experimental animals. After 24 h of OTM, either normoxia- or hypoxia-preconditioned GMSC were injected into the gingiva of the samples in a single dose of 20 μl of phosphate-buffered saline (PBS). All samples were sacrificed on days 7, 14, and 28, and immunohistochemistry was performed to analyze the expression of RANK, RANKL, and OPG on the tension and compression sides.

Results

The expressions of RANK-RANKL-OPG in the alveolar bone of the compression and tension sides were significantly different during the 14-day period of OTM following allogeneic administration of GMSC that were normoxia or hypoxia-preconditioned (p < 0.05).

Conclusion

The expression of RANK-RANKL was significantly increased on the compression side of the alveolar bone during OTM after the administration of hypoxia-preconditioned allogeneic GMSC but not on the tension side. Conversely, RANKL-OPG expression was enhanced on the tension side but not on the compression side, as observed through immunohistochemical analysis in vivo.

Gastric emptying rate of a solid meal in patients with anterior open bite malocclusion: A preliminary study

Objectives:

The objective of the study was to investigate the relationship between anterior open bite (AOB) malocclusion and digestion by evaluating mastication and gastric emptying (GE) of a solid meal.

Material and Methods:

We recruited 26 female participants and divided them into two groups according to their occlusion status: The control group with normal occlusion (n = 11; age: 25.2 ± 2.8 years; and body mass index [BMI]: 21.1 ± 1.9 kg/m2) and the AOB group with AOB malocclusion (n = 15; age: 23.2 ± 5.5 years; BMI: 21.0 ± 1.6 kg/m2). GE, chewing, and occlusion were assessed simultaneously. A food questionnaire survey was also administered on the same day.

Results:

A significant positive correlation was noted between open bite and the occlusal analysis findings. Negative correlations were found between the food questionnaire score and both the open bite and occlusal analysis findings, which confirmed that AOB affects mastication. However, no significant difference in the GE rate parameters was observed between the two groups.

Conclusion:

Adaptive mechanisms may have a compensatory effect on the GE rate. However, the lack of tooth contact in the anterior occlusal region resulted in reduced masticatory ability. Orthodontic treatment should thus be considered, regardless of the presence of digestive problems, to improve mastication.