MANAGEMENT OF OPEN BITE

INDIAN
ACADEMY

DENTAL

Leader in continuing dental education
www.indiandentalacademy.com

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CONTENTS
•
•
•
•
•

What is an open bite ?
Evolution of open bite
Classification of open bite.
Various treatment modalitie...
Biomechanics of treatment
modalities.
1. Biomechanics of open bite correction before growth completion
biomechanics of – a...
WHAT IS AN OPEN BITE ?

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OPEN BITE
The Glossary of Orthodontic Terms
defines open bite as a developmental or
acquired malocclusion whereby no verti...
Evolution of open bite

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• Open bite develops as result of the interaction of many
etiologic factors.
•

In young children, digit habits and pacifi...
In the adolescent and the adult, it is difficult to
assign singular causation. The influence of the
tongue,lip, and airway...
SKELETAL FACTORS IN THE DEVELOPMENT OF AN
OPEN BITE TYPE:
1. The combination of
 excessive development
of the upper mid-f...
2. The posterior half of the
palate is tipped
downward, carrying the
molars further
downward. This gives
rise to a large
p...
3. Because of the short ramus and the lower
palate, the pharyngeal space is constricted. In
order to breathe, these person...
4. When enlarged tonsils are
present, the tongue is further
confined anteriorly. As the
narrow palatal vault reduces
the n...
CLASSIFICATION
1. Dento Alveolar Open Bite.
2. Skeletal Open Bite.

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Dento Alveolar Open Bite


The extent of the
dentoalveolar open bite
depends on the extent
of the eruption of the
teeth.
...
3.

In vertical growth
patterns the
dentoalveolar
symptoms include a
protrusion in the upper
anterior teeth with
lingual i...
4. In horizontal growth
patterns, tongue posture
and thrust may cause
proclination of both
upper and lower incisors.

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5. A lateral open bite may be considered
dentoalveolar in combination with infra-occlusion
of molar teeth.

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Skeletal Open-Bite

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Skeletal Open Bite.
1. Skeletal Class I Open Bite
2. Skeletal Class II Open Bite
3. Skeletal Class III Open Bite

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Positional Deviations
Acc to Sassouni…

1. The four bony
planes of the face
are steep to each
other, bringing the
center 0...
2. The anterior arc,
therefore follows the
convexity of the
profile.

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3. The posterior vertical
chain of muscles is
arcuate, and the
masseter muscle is
posterior to the buccal
teeth, thus crea...
4. The cranial base angle and the gonial angle
are obtuse.

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Dimensional Deviations
1. The total posterior facial
height (S-Go) tends to
be half the size of the
anterior total facial
...
2. The Lower Anterior
Facial Height exceeds
the Upper Anterior
Facial Height.

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3

The facial breadths
tend to be narrow,
giving a long, ovoid
appearance in the
frontal view.

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5.The ramus is short
with an antegonial
notch at its lower
border.
6. The mandibular
symphysis is narrow
antero posteriorl...
• There is a lack of chin mental protuberance
development.
• According to the Sheldonian somatotyping, the
open-bite type ...
SKELETAL CLASS II OPEN BITE
1.

2.

In this type, in some instances,
the rotation of the mandible may
be purely positional...
SKELETAL CLASS III OPEN BITE
1. This combination
consists primarily of an
open-bite with a palatal
deficiency or a large
m...
Among the facial deformities, these have
probably the worst prognosis in terms of
dentofacial orthopedics.
If correction o...
On the other hand, the reduction of the
mandibular protrusion is attempted by rotating
the mandible downward and backward,...
VARIOUS TREATMENT
MODALITIES
OF
OPEN BITE

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1.

2.

3.

H

abit therapy:

A

ppliance therapy:

S

urgical management:

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BIOMECHANICS OF HABIT
BREAKING APPLIANCE

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TREATMENT IN THE DECIDUOUS DENTITION

1. Control of abnormal habits and elimination of
dysfunction should be given top pri...
Screening Appliance
1. Screening appliances intercept and eliminate
all abnormal perioral muscle function in
acquired malo...
Mixed Dentition-treatment

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Tongue Crib
1. A removal or fixed appliance can inhibit tongue
thrust.
2. The crib used with a removable appliance for an
...
NORMAL OCCLUSION

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ANTERIOR TONGUE THRUST

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TONGUE CRIB

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5. The acrylic also can be
interposed between the
teeth, covering the
occlusal surfaces of the
upper molars, to prevent
er...
The bite-block here can be 3 to 4 mm, which is
usually beyond the postural vertical dimension
in open-bite patients.
In su...
BIOMECHANICS OF FUNCTIONAL
APPLIANCE IN OPEN BITE
CORRECTION

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Activator
1. The bite is opened 4 to 5 mm to develop a
sufficient elastic depressing force and load the
molar that are in ...
To “close the V” between
upper and lower dental
arches by depressing
the posterior maxillary
segments with the
activator i...
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Bionator
1. Used to inhibit abnormal posture and function of
the tongue.
2. The construction bite is as low as possible, b...
4. The palatal bar has the
same configuration as
the standard bionator,
with the goal of moving
the tongue into a more
pos...
5. The labial bow differs
from the standard
appliance, that the wire
runs approximately
between the incisal
edges of the u...
6. The labial part of the bow is placed at the height
of correct lip closure thus stimulating, the lips to
achieve a compe...
FRANKLE IV
The working principle of
the FR in establishing the
mandibular forward
rotation with the
posterior edges of the...
1. Normally, anterior open bite problems show
protracted tongue posture with incompetence of
lips. The tongue tooth contac...
TWIN BLOCK
• Maintain occlusal contact
to intrude the posterior
teeth

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PITFALLS
• Do not allow the second
molars to over erupt
• Extend occlusal cover or
occlusal rests distally to
second molar...
• Do not trim the upper
block in open bite cases.
• This will allow the lower
molars to erupt and again
popping the bite o...
BIOMECHANICS OF HEAD GEAR

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Centers of resistance in
midfacial complex.
1. Alveolar process.
2. Maxilla.

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Direction of force passes
behind both alveolar
and skeletal centers of
resistance, producing
clockwise rotation of
maxilla...
Direction of force passes
between alveolar and
skeletal centers of
resistance, producing
clockwise rotation of
maxilla and...
Direction of force passes
above both alveolar and
skeletal centers of
resistance, producing
counterclockwise rotation
of m...
Lloyd E Pearson
Describes seven different procedures for
treatment of open bite with backward rotating
mandible

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OCCIPITAL HEADGEAR WITH CHIN
CUP

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1. In the mixed dentition open-bite patient we could
intrude the upper first permanent molars and then
remove the remainin...
4. The lower molars will often tend to extrude in
this type of situation. Unless mechanics are
designed to control their e...
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Extraction of first premolars and use a vertical pull-chin cup

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1. Extraction of first premolars and use a vertical
pull-chin cup with (16 ounces of forces)
2. This can close the mandibu...
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possible mechanisms of action at work
a) maxillary sutures are pressure sensitive and
some intrusion of the maxilla could ...
Mandibular bite- block therapy

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1. Mandibular bite- block therapy, augmented with
vertical pull-chin cup therapy, can produce a
favorable holding of the v...
MANDIBULAR BITE BLOCK THERAPY WITH VERTICAL PULL CHIN CUP
THERAPY

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MANDIBULAR BITE BLOCK THERAPY WITH VERTICAL PULL CHIN CUP
THERAPY

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AFTER CORRECTION

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Magnetic bite blocks.

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1. Magnetic bite blocks.
2. Although we get rapid results, two difficulties
arise with bite blocks
a. Extreme mouth openin...
MAGNETIC BITE BLOCKS

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MAGNETIC BITE BLOCKS

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MAGNETIC BITE BLOCKS

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vertical reduction genioplasty.

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1. One advantage, is that it does not involve the
temporomandibular joints,
2. It can be done after non-surgical treatment...
The Extrusion Arch

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1. The extrusion arch is a term coined to describe
the reverse action of already existing and well
established intrusion a...
Mode Of Action
AT THE MOLAR:1. A second order couple is generated at the molar with
crown tipping mesially and root tippin...
MODE OF ACTION AT MOLAR

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MODE OF ACTION AT MOLAR

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PROXIMAL VEIW

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• AT THE INCISORS:• Extrusion can involve single teeth or group of teeth.
• When a group of teeth are to be extruded ,a
se...
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Low transpalatal arch
1.

It is considered that the
transpalatal bar
interferes with the
normal vertical descent
of the up...
2. It is believed that, tongue
pressure against the
transpalatal arch during
swallowing, especially
when the transpalatal
...
Low Mandibular Lip Bumper
1. Cetlin and Hoeve advocated the use of a lip
bumper for the development of the lower dental
ar...
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3. But there is no further explanation or evidence
that a lower lip bumper can be used to prevent
eruption of the mandibul...
Wedge Principle Coupled With The
Extraction Of Teeth
Two major approaches of applying the wedge
principle by extraction of...
Garlington and Logan found that enucleation of
mandibular second premolars is beneficial,




To control the vertical d...
 Pearson stated that after the extraction of
premolar teeth, there is some mesial drift of the
posterior teeth (out of th...
High Angle Begg Cases
1. In high angle begg cases we avoid class II
elastics to avoid open bite and accentuation of
presen...
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Bracket Position
1. The placement point for incisor brackets may
vary in cases of infraocclusion.
2. In cases of open bite...
Triangle Elastics
1. Triangle elastics aid in the improvement of
class I cuspid intercuspation and increasing the
overbite...
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Anterior Vertical Elastics
 Class II orientation.

 Class III orientation

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Avoid Intermaxillary Elastics
1. Intermaxillary elastics from the posterior teeth
have a vertical force vector which extru...
How To Use Class II Or Class III Elastics

1. If class II or III elastics are required, they
should be attached posteriorl...
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ACTIVE VERTICAL CORRECTOR
1. AVC is a simple
removable or fixed
orthodontic appliance
that intrudes the
posterior teeth of...
Active vertical corrector

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3. By effective intrusion of posterior teeth, the mandible is
allowed to rotate in upward and forward directions.
4. The u...
Method of Action :1. Force system -- generated by repelling
magnets,
2. AVC is considered superior to a static bite block
...
Multiloop Edgewise Arch Wire
1. Multiloop Edgewise Arch Wire was developed
by Kim to achieve these goals :A, Correcting th...
1. The MEAW contains horizontal and vertical
loops fabricated from a 16 x 22 ss wire in an L shape fashion
2. The vertical...
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4. Typical tip back bends of 3-5degrees are given
on each tooth.
5. Elastics are placed between the loops that lie
mesial ...
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 KIMS technique was later modified by AYHAN
ENACAR et.al, using 16 x 22 reverse curve
NiTi arch wires with heavy intermax...
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Skeletal Anchorage System
1. Skeletal anchorage system was developed for
tooth movements.
2. SAS consists of titanium mini...
4. Elastic threads are used as a source of
orthodontic force to reduce excessive molar
height.
5. The lower molars were in...
 SAS is an effective adjunctive biomechanical
procedure for correction of skeletal open-bite
malocclusion with out unfavo...
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Conclusion

Surgical management:

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• One method of surgical correction is to extract
second and/or third molars if they are the only
source of centric contac...
• Surgical procedures to improve the patency of
the airway must be undertaken with caution.
Documenting the amount and loc...
• This is especially important because it is recognized that
a reduction in tonsilar and adenoid tissue occurs near
adoles...
• Maxillary impaction allows forward and upward
rotation of the mandible, therefore decreasing
the lower face height and e...
conclusion
The treatment of open bite remains a challenge
to the clinician, and careful diagnosis and timely
intervention ...
REFERENCES
1. Subtelny, J. D.: Open-bite: Diagnosis and
treatment, Am.J.orthod. 42; 337, 1964.
2. Hellman, M.: Open bite, ...
DOUBTS

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Thank you
For more details please visit
www.indiandentalacademy.com

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Biomechanics of open bite correction /certified fixed orthodontic courses by Indian dental academy

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Biomechanics of open bite correction /certified fixed orthodontic courses by Indian dental academy

  1. 1. MANAGEMENT OF OPEN BITE INDIAN ACADEMY DENTAL Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS • • • • • What is an open bite ? Evolution of open bite Classification of open bite. Various treatment modalities. Biomechanics of treatment modalities. 1. Biomechanics of open bite correction before growth completion 2. Biomechanics of open bite correction after growth completion Conclusion. www.indiandentalacademy.com
  3. 3. Biomechanics of treatment modalities. 1. Biomechanics of open bite correction before growth completion biomechanics of – a) habit breaking appliance b) functional appliances - activator - bionator - FR-4 - twin block c) orthopedic appliance 2. Biomechanics of open bite correction after growth completion biomechanics of - a) fixed appliance mechanotherapy for open bitecorrection b) surgical management for open bite correction www.indiandentalacademy.com
  4. 4. WHAT IS AN OPEN BITE ? www.indiandentalacademy.com
  5. 5. OPEN BITE The Glossary of Orthodontic Terms defines open bite as a developmental or acquired malocclusion whereby no vertical overlap exists between maxillary and mandibular anterior or posterior teeth. www.indiandentalacademy.com
  6. 6. Evolution of open bite www.indiandentalacademy.com
  7. 7. • Open bite develops as result of the interaction of many etiologic factors. • In young children, digit habits and pacifiers are the most common etiologic agents. • In the mixed dentition years other than the normal transitional open bite, some openbites are probably attributable to lingering habits, where others are clearly skeletal in nature. www.indiandentalacademy.com
  8. 8. In the adolescent and the adult, it is difficult to assign singular causation. The influence of the tongue,lip, and airway on the development of malocclusion remains to be substantiated. Variations in growth intensity, the function of the soft tissues and the jaw musculature, and the individual dentoalveolar development influence the evolution of open bite problems. www.indiandentalacademy.com
  9. 9. SKELETAL FACTORS IN THE DEVELOPMENT OF AN OPEN BITE TYPE: 1. The combination of  excessive development of the upper mid-face heights (cranial base to molars)  a lack of development of posterior facial heights (S-Go) results in the downward and backward rotation of the mandible. www.indiandentalacademy.com
  10. 10. 2. The posterior half of the palate is tipped downward, carrying the molars further downward. This gives rise to a large palatomandibular plane angle. www.indiandentalacademy.com
  11. 11. 3. Because of the short ramus and the lower palate, the pharyngeal space is constricted. In order to breathe, these persons keep their tongues forward. Further enhanced by the dental open-bite, there is a tongue-thrusting tendencies. www.indiandentalacademy.com
  12. 12. 4. When enlarged tonsils are present, the tongue is further confined anteriorly. As the narrow palatal vault reduces the necessary space, there is a tendency towards tongue protrusion. This, in turn, may be a factor in the creation of bi-dental protrusion www.indiandentalacademy.com
  13. 13. CLASSIFICATION 1. Dento Alveolar Open Bite. 2. Skeletal Open Bite. www.indiandentalacademy.com
  14. 14. Dento Alveolar Open Bite  The extent of the dentoalveolar open bite depends on the extent of the eruption of the teeth. Eg: Supraocclusion of the molars and infraocclusion of the incisors can be primary etiologic factors. www.indiandentalacademy.com
  15. 15. 3. In vertical growth patterns the dentoalveolar symptoms include a protrusion in the upper anterior teeth with lingual inclination of the lower incisors. www.indiandentalacademy.com
  16. 16. 4. In horizontal growth patterns, tongue posture and thrust may cause proclination of both upper and lower incisors. www.indiandentalacademy.com
  17. 17. 5. A lateral open bite may be considered dentoalveolar in combination with infra-occlusion of molar teeth. www.indiandentalacademy.com
  18. 18. Skeletal Open-Bite www.indiandentalacademy.com
  19. 19. Skeletal Open Bite. 1. Skeletal Class I Open Bite 2. Skeletal Class II Open Bite 3. Skeletal Class III Open Bite www.indiandentalacademy.com
  20. 20. Positional Deviations Acc to Sassouni… 1. The four bony planes of the face are steep to each other, bringing the center 0 close to the profile. diagram www.indiandentalacademy.com
  21. 21. 2. The anterior arc, therefore follows the convexity of the profile. www.indiandentalacademy.com
  22. 22. 3. The posterior vertical chain of muscles is arcuate, and the masseter muscle is posterior to the buccal teeth, thus creating a mesial component of forces responsible for the dental protrusion. www.indiandentalacademy.com
  23. 23. 4. The cranial base angle and the gonial angle are obtuse. www.indiandentalacademy.com
  24. 24. Dimensional Deviations 1. The total posterior facial height (S-Go) tends to be half the size of the anterior total facial height (N-Me). www.indiandentalacademy.com
  25. 25. 2. The Lower Anterior Facial Height exceeds the Upper Anterior Facial Height. www.indiandentalacademy.com
  26. 26. 3 The facial breadths tend to be narrow, giving a long, ovoid appearance in the frontal view. www.indiandentalacademy.com
  27. 27. 5.The ramus is short with an antegonial notch at its lower border. 6. The mandibular symphysis is narrow antero posteriorly and long vertically. www.indiandentalacademy.com
  28. 28. • There is a lack of chin mental protuberance development. • According to the Sheldonian somatotyping, the open-bite type rates high in ecto-morphs. • The palatal vault is high and narrow. www.indiandentalacademy.com
  29. 29. SKELETAL CLASS II OPEN BITE 1. 2. In this type, in some instances, the rotation of the mandible may be purely positional. Often this is due to a downward and backward rotation of the mandible. This rotation is associated with excessive extrusion of the molars. If these interferences were removed, the mandible could be permitted to rotate in a closing direction, improving the Class II and the open-bite patterns simultaneously. www.indiandentalacademy.com
  30. 30. SKELETAL CLASS III OPEN BITE 1. This combination consists primarily of an open-bite with a palatal deficiency or a large mandible. www.indiandentalacademy.com
  31. 31. Among the facial deformities, these have probably the worst prognosis in terms of dentofacial orthopedics. If correction of this open-bite is attempted by rotating the mandible in a closing direction, the protrusion of the chin is increased. www.indiandentalacademy.com
  32. 32. On the other hand, the reduction of the mandibular protrusion is attempted by rotating the mandible downward and backward, the open-bite is increased. www.indiandentalacademy.com
  33. 33. VARIOUS TREATMENT MODALITIES OF OPEN BITE www.indiandentalacademy.com
  34. 34. 1. 2. 3. H abit therapy: A ppliance therapy: S urgical management: www.indiandentalacademy.com
  35. 35. BIOMECHANICS OF HABIT BREAKING APPLIANCE www.indiandentalacademy.com
  36. 36. TREATMENT IN THE DECIDUOUS DENTITION 1. Control of abnormal habits and elimination of dysfunction should be given top priority in the deciduous dentition. 2. The anterior open bite improves as soon as the habit is stopped. 3. Treatment with screening appliances is indicated in such open- bite cases. www.indiandentalacademy.com
  37. 37. Screening Appliance 1. Screening appliances intercept and eliminate all abnormal perioral muscle function in acquired malocclusions resulting from abnormal habits, mouth breathing, and nasal blockage. 2. Open bite created by finger sucking and retained visceral deglutition-pattern, tongue function can be helped with vestibular screens. www.indiandentalacademy.com
  38. 38. Mixed Dentition-treatment www.indiandentalacademy.com
  39. 39. Tongue Crib 1. A removal or fixed appliance can inhibit tongue thrust. 2. The crib used with a removable appliance for an anterior open bite consists of a palatal plate with a horseshoe-shaped wire crib. 3. The crib is placed in the area of local tongue dysfunction and resultant malocclusion. www.indiandentalacademy.com
  40. 40. NORMAL OCCLUSION www.indiandentalacademy.com
  41. 41. ANTERIOR TONGUE THRUST www.indiandentalacademy.com
  42. 42. TONGUE CRIB www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. 5. The acrylic also can be interposed between the teeth, covering the occlusal surfaces of the upper molars, to prevent eruption of these teeth and enhance anchorage of the plate, which is especially beneficial in open-bite problems. www.indiandentalacademy.com
  45. 45. The bite-block here can be 3 to 4 mm, which is usually beyond the postural vertical dimension in open-bite patients. In such cases a stretch reflex is elicited from the closing muscles that enhances the depressing action on the buccal segments and helps close the anterior open bite. www.indiandentalacademy.com
  46. 46. BIOMECHANICS OF FUNCTIONAL APPLIANCE IN OPEN BITE CORRECTION www.indiandentalacademy.com
  47. 47. Activator 1. The bite is opened 4 to 5 mm to develop a sufficient elastic depressing force and load the molar that are in premature contact. 2. Properly constructed activators that follow this principle can influence the vertical growth pattern in these cases. www.indiandentalacademy.com
  48. 48. To “close the V” between upper and lower dental arches by depressing the posterior maxillary segments with the activator in a manner analogous to that of orthognathic surgery www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50. Bionator 1. Used to inhibit abnormal posture and function of the tongue. 2. The construction bite is as low as possible, but a slight opening allows the interposition of posterior acrylic bite blocks for the posterior teeth, to prevent their extrusion. 3. To inhibit tongue movements, the acrylic portion of the lower lingual part extends into the upper incisor region as a lingual shield. Closing the anterior space without touching the upper www.indiandentalacademy.com teeth.
  51. 51. 4. The palatal bar has the same configuration as the standard bionator, with the goal of moving the tongue into a more posterior or caudal position. www.indiandentalacademy.com
  52. 52. 5. The labial bow differs from the standard appliance, that the wire runs approximately between the incisal edges of the upper and lower incisors. www.indiandentalacademy.com
  53. 53. 6. The labial part of the bow is placed at the height of correct lip closure thus stimulating, the lips to achieve a competent seal and relationship. The vertical strain on the lips tends to encourage the extrusive movement of the incisors, after eliminating the adverse tongue pressures. www.indiandentalacademy.com
  54. 54. FRANKLE IV The working principle of the FR in establishing the mandibular forward rotation with the posterior edges of the buccal shields as a rotational center. Anteriorly, the mandible is raised by the force of the anterior vertical muscle chain being strengthened by lip seal exercises. www.indiandentalacademy.com
  55. 55. 1. Normally, anterior open bite problems show protracted tongue posture with incompetence of lips. The tongue tooth contact replaces the lip seal during deglutition to create negative atmospheric pressure. 2. FR IV along with lip exercises cause lip contact, reducing tongue protrusion and cause the tongue to move back into its normally raised position in proximity with palate, during deglutition. www.indiandentalacademy.com
  56. 56. TWIN BLOCK • Maintain occlusal contact to intrude the posterior teeth www.indiandentalacademy.com
  57. 57. PITFALLS • Do not allow the second molars to over erupt • Extend occlusal cover or occlusal rests distally to second molars. www.indiandentalacademy.com
  58. 58. • Do not trim the upper block in open bite cases. • This will allow the lower molars to erupt and again popping the bite open. www.indiandentalacademy.com
  59. 59. BIOMECHANICS OF HEAD GEAR www.indiandentalacademy.com
  60. 60. Centers of resistance in midfacial complex. 1. Alveolar process. 2. Maxilla. www.indiandentalacademy.com
  61. 61. Direction of force passes behind both alveolar and skeletal centers of resistance, producing clockwise rotation of maxilla and maxillary dentition. www.indiandentalacademy.com
  62. 62. Direction of force passes between alveolar and skeletal centers of resistance, producing clockwise rotation of maxilla and counterclockwise rotation of maxillary dentition. www.indiandentalacademy.com
  63. 63. Direction of force passes above both alveolar and skeletal centers of resistance, producing counterclockwise rotation of maxilla and maxillary dentition. www.indiandentalacademy.com
  64. 64. Lloyd E Pearson Describes seven different procedures for treatment of open bite with backward rotating mandible www.indiandentalacademy.com
  65. 65. OCCIPITAL HEADGEAR WITH CHIN CUP www.indiandentalacademy.com
  66. 66. 1. In the mixed dentition open-bite patient we could intrude the upper first permanent molars and then remove the remaining deciduous teeth, permitting open-bite closure. 2. occipital headgear with a transpalatal arch to control the inclination of the molars as they are intruded. 3. After the molars have been intruded perhaps 3 mm the deciduous teeth are removed, the mandible is hinged closed, and the anterior open-bite is closed. www.indiandentalacademy.com
  67. 67. 4. The lower molars will often tend to extrude in this type of situation. Unless mechanics are designed to control their eruption. 5. An addition of a vertical pull-chin cup to the occipital headgear and transpalatal arch would intrude the upper molars, while preventing the eruption of the lower molars. 6. As the open bite closes the mandible hinges upward, reducing the height of the lower face. www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
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  70. 70. Extraction of first premolars and use a vertical pull-chin cup www.indiandentalacademy.com
  71. 71. 1. Extraction of first premolars and use a vertical pull-chin cup with (16 ounces of forces) 2. This can close the mandibular plane angle, reduce the lower facial height and close anterior open bites. 3. Approximately 40 of closure of the mandibular plane angle was found in his study. www.indiandentalacademy.com
  72. 72. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. possible mechanisms of action at work a) maxillary sutures are pressure sensitive and some intrusion of the maxilla could occur. b) The posterior teeth tend to move forward mesially. c) A retardation of eruption of the posterior teeth. www.indiandentalacademy.com
  75. 75. Mandibular bite- block therapy www.indiandentalacademy.com
  76. 76. 1. Mandibular bite- block therapy, augmented with vertical pull-chin cup therapy, can produce a favorable holding of the vertical height throughout the growth period, intrusion of posterior teeth, The hinging of the mandibular plane in a counterclockwise direction and closure of anterior open bites. www.indiandentalacademy.com
  77. 77. MANDIBULAR BITE BLOCK THERAPY WITH VERTICAL PULL CHIN CUP THERAPY www.indiandentalacademy.com
  78. 78. MANDIBULAR BITE BLOCK THERAPY WITH VERTICAL PULL CHIN CUP THERAPY www.indiandentalacademy.com
  79. 79. AFTER CORRECTION www.indiandentalacademy.com
  80. 80. Magnetic bite blocks. www.indiandentalacademy.com
  81. 81. 1. Magnetic bite blocks. 2. Although we get rapid results, two difficulties arise with bite blocks a. Extreme mouth opening which is difficult to tolerate the appliance by the patient. b. lateral movement of the mandible, that can cause some temporomandibualr joint strain. www.indiandentalacademy.com
  82. 82. MAGNETIC BITE BLOCKS www.indiandentalacademy.com
  83. 83. MAGNETIC BITE BLOCKS www.indiandentalacademy.com
  84. 84. MAGNETIC BITE BLOCKS www.indiandentalacademy.com
  85. 85. vertical reduction genioplasty. www.indiandentalacademy.com
  86. 86. 1. One advantage, is that it does not involve the temporomandibular joints, 2. It can be done after non-surgical treatment as an adjunct to bring the chin up and forward, to improve facial balance, and to achieve competency www.indiandentalacademy.com
  87. 87. The Extrusion Arch www.indiandentalacademy.com
  88. 88. 1. The extrusion arch is a term coined to describe the reverse action of already existing and well established intrusion arch. 2. Wire used is  16 x 22 SS or 17 X25 TMA with 900 offset bend at the molars. www.indiandentalacademy.com
  89. 89. Mode Of Action AT THE MOLAR:1. A second order couple is generated at the molar with crown tipping mesially and root tipping distally. 2. The equilibrium is achieved because the anterior end of the wire extrudes the incisors and posterior end intrudes the molars. 3. Relatively very minimal buccal flaring of the molar is seen. www.indiandentalacademy.com
  90. 90. MODE OF ACTION AT MOLAR www.indiandentalacademy.com
  91. 91. MODE OF ACTION AT MOLAR www.indiandentalacademy.com
  92. 92. PROXIMAL VEIW www.indiandentalacademy.com
  93. 93. • AT THE INCISORS:• Extrusion can involve single teeth or group of teeth. • When a group of teeth are to be extruded ,a segment of heavy arch wire may be used in the brackets of the anterior teeth, and the teeth are extruded as if they were one big tooth. • Whether the extrusion arch is tied segmentally or to continuous arch wire or placed directly into the brackets the effect is the same www.indiandentalacademy.com
  94. 94. www.indiandentalacademy.com
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  98. 98. Low transpalatal arch 1. It is considered that the transpalatal bar interferes with the normal vertical descent of the upper molars, and therefore retards maxillary vertical alveolar development. www.indiandentalacademy.com
  99. 99. 2. It is believed that, tongue pressure against the transpalatal arch during swallowing, especially when the transpalatal arch is placed low in the palate, will inhibit maxillary alveolar vertical growth. www.indiandentalacademy.com
  100. 100. Low Mandibular Lip Bumper 1. Cetlin and Hoeve advocated the use of a lip bumper for the development of the lower dental arch. 2. They suggested that if the lip bumper were adjusted low, the cheek and lip mucosa would rest above the appliance, and this will inhibit vertical mandibular molar dentoalveolar development. www.indiandentalacademy.com
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  103. 103. 3. But there is no further explanation or evidence that a lower lip bumper can be used to prevent eruption of the mandibular molar teeth. www.indiandentalacademy.com
  104. 104. Wedge Principle Coupled With The Extraction Of Teeth Two major approaches of applying the wedge principle by extraction of teeth to control the vertical dimensions. 1.Loss of posterior anchorage so that the anchor teeth move mesially and are located farther anteriorly in the arch in an area of greater vertical dimension. 2. Extraction of first or second molars in both arches to decrease the posterior dentoalveolar height. www.indiandentalacademy.com
  105. 105. Garlington and Logan found that enucleation of mandibular second premolars is beneficial,    To control the vertical dimension. Increased in forward rotation of the mandible. Significant decrease in lower anterior face height.  The criteria selection :a. b. c. d. Minimal lower arch discrepancy (6 to 10mm). A mandibular plane angle greater than 380. A hyperdivergent skeletal pattern. Increased lower anterior facial height. www.indiandentalacademy.com
  106. 106.  Pearson stated that after the extraction of premolar teeth, there is some mesial drift of the posterior teeth (out of the wedge) and this permits the mandible to hinge closed. www.indiandentalacademy.com
  107. 107. High Angle Begg Cases 1. In high angle begg cases we avoid class II elastics to avoid open bite and accentuation of present class II . 2. We give mild class I elastics in such cases. www.indiandentalacademy.com
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  110. 110. Bracket Position 1. The placement point for incisor brackets may vary in cases of infraocclusion. 2. In cases of open bite, placing anterior brackets I mm more towards the gingival side. www.indiandentalacademy.com
  111. 111. Triangle Elastics 1. Triangle elastics aid in the improvement of class I cuspid intercuspation and increasing the overbite relationship anteriorly by closing open bites in the range of 0.5 to 1.5 mm. 2. They extend from the upper cuspid to the lower cuspid and first bicuspid teeth. www.indiandentalacademy.com
  112. 112. www.indiandentalacademy.com
  113. 113. Anterior Vertical Elastics  Class II orientation.  Class III orientation www.indiandentalacademy.com
  114. 114. Avoid Intermaxillary Elastics 1. Intermaxillary elastics from the posterior teeth have a vertical force vector which extrudes these teeth and can further open the posterior vertical dimension. 2. Class II elastics from 6 - 6 should not be utilized until these teeth are well anchored in buccal cortical bone . www.indiandentalacademy.com
  115. 115. How To Use Class II Or Class III Elastics 1. If class II or III elastics are required, they should be attached posteriorly to premolars rather than molars. 2. These ‘short elastics minimize the extrusive effect on the back of the arch www.indiandentalacademy.com
  116. 116. www.indiandentalacademy.com
  117. 117. ACTIVE VERTICAL CORRECTOR 1. AVC is a simple removable or fixed orthodontic appliance that intrudes the posterior teeth of both the maxilla and mandible by reciprocal forces. www.indiandentalacademy.com
  118. 118. Active vertical corrector www.indiandentalacademy.com
  119. 119. www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. www.indiandentalacademy.com
  122. 122. 3. By effective intrusion of posterior teeth, the mandible is allowed to rotate in upward and forward directions. 4. The uniqueness of this appliance is that, it corrects anterior open bite problems by actually reducing anterior facial height. 5. Problems formerly thought to require orthognathic surgery, can now be treated successfully with AVC. www.indiandentalacademy.com
  123. 123. Method of Action :1. Force system -- generated by repelling magnets, 2. AVC is considered superior to a static bite block appliance energized only by the intermittent force from the muscles of mastication. 3. The constant force system of the AVC results in greater rapidity of tooth movement. www.indiandentalacademy.com
  124. 124. Multiloop Edgewise Arch Wire 1. Multiloop Edgewise Arch Wire was developed by Kim to achieve these goals :A, Correcting the inclination of the occlusal planes. B, Aligning the maxillary incisors relative to the lip line. C, Uprighting the axial inclinations of the posterior teeth. www.indiandentalacademy.com
  125. 125. 1. The MEAW contains horizontal and vertical loops fabricated from a 16 x 22 ss wire in an L shape fashion 2. The vertical loops act as a break between the teeth, lowers the load deflection rate and provides horizontal control. 3. The horizontal loops further reduces the load deflection rate and provides vertical control. www.indiandentalacademy.com
  126. 126. www.indiandentalacademy.com
  127. 127. www.indiandentalacademy.com
  128. 128. 4. Typical tip back bends of 3-5degrees are given on each tooth. 5. Elastics are placed between the loops that lie mesial to opposing cuspids. 6. Recommended elastic size is 3/16 inch heavy, with a force approximately 50 gms when the jaw is closed. www.indiandentalacademy.com
  129. 129. www.indiandentalacademy.com
  130. 130.  KIMS technique was later modified by AYHAN ENACAR et.al, using 16 x 22 reverse curve NiTi arch wires with heavy intermaxillary elastics applied in the canine region www.indiandentalacademy.com
  131. 131. www.indiandentalacademy.com
  132. 132. www.indiandentalacademy.com
  133. 133. Skeletal Anchorage System 1. Skeletal anchorage system was developed for tooth movements. 2. SAS consists of titanium miniplates, that are temporarily implanted in the maxilla or the mandible as an immobile anchorage. 3. These miniplates are fixed at the buccal cortical bone around the apical regions of the lower first and second molars on both the sides. www.indiandentalacademy.com
  134. 134. 4. Elastic threads are used as a source of orthodontic force to reduce excessive molar height. 5. The lower molars were intruded about 3 to 5 mm, and open-bite was significantly improved with little if any extrusion of the lower incisors, with counter clockwise rotation of the occlusal plane . www.indiandentalacademy.com
  135. 135.  SAS is an effective adjunctive biomechanical procedure for correction of skeletal open-bite malocclusion with out unfavorable side-effect. www.indiandentalacademy.com
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  138. 138. Conclusion Surgical management: www.indiandentalacademy.com
  139. 139. • One method of surgical correction is to extract second and/or third molars if they are the only source of centric contacts. • Glossectomies have been used to correct open bite problems associated with abnormal tongue habits. Their effectiveness in closing anterior or posterior open bite problems has not been substantiated. www.indiandentalacademy.com
  140. 140. • Surgical procedures to improve the patency of the airway must be undertaken with caution. Documenting the amount and location of the obstruction is a prerequisite. • In many cases, a more conservative medical approach may serve the same purpose when the obstruction is related to allergies www.indiandentalacademy.com
  141. 141. • This is especially important because it is recognized that a reduction in tonsilar and adenoid tissue occurs near adolescence, and other children appear to "outgrow" certain allergies. • Severe skeletal open bites in patients who are not growing are often treated by combined orthodonticsurgical approach. • Superior repositioning of the maxilla, via total or segmental maxillary osteotomies, is indicated in skeletal open bite patients with excess vertical maxillary growth. www.indiandentalacademy.com
  142. 142. • Maxillary impaction allows forward and upward rotation of the mandible, therefore decreasing the lower face height and eliminating anterior open bite. • This upward and forward autorotation often makes mandibular reduction or reduction genioplasty necessary as well. • Superior repositioning of the maxilla is one of the most stable orthognathic surgical procedures. www.indiandentalacademy.com
  143. 143. conclusion The treatment of open bite remains a challenge to the clinician, and careful diagnosis and timely intervention will improve the success of treating this malocclusion. www.indiandentalacademy.com
  144. 144. REFERENCES 1. Subtelny, J. D.: Open-bite: Diagnosis and treatment, Am.J.orthod. 42; 337, 1964. 2. Hellman, M.: Open bite, Am J. orthodont. 17: 421, 1931. 3. Robert J Issacson, Closing anterior open bite :the extrusion arch. Seminars in orthodontics. 7.34 – 41 .2001 4. Vertical Control with a Headgear- Activator CombinationCLAUDE CHABRE, DCD, DSO JCO 1990 OCT 618 - 624 www.indiandentalacademy.com
  145. 145. DOUBTS www.indiandentalacademy.com
  146. 146. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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