Open bite (3)

CLOSING
ENCOUNTERS
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INTRODUCTION
Anterior open bite is one of the most
difficult orthodontic problems to
correct.
The etiology of anterior open bite
may be both complex and difficult to
establish and yet is critical in
developing treatment regimen that
will produce stability and
satisfactory cosmetic results

SIMPLE OPEN BITE
Tongue thrust causing
anterior deformation is called
simple open bite.
Moyers(1964)

COMPLEX OPEN BITE
Combined tongue thrust
causing both an anterior and
posterior open bite is called complex
open bite. It is more difficult to treat.
Moyers(1964)

 EPIGENETIC AND
 ENVIRONMENTAL FACTORS
ARE BOTH OF CONCERN IN THE
ETIOLOGY OF OPEN BITE.
ETIOLOGY

EPIGENETIC FACTORS
• Includes
1. Posture,morphology and size of
the tongue.
2. Skeletal growth pattern of maxilla
& mandible.
3. Vertical relationship of the jaw
base.

ENVIRONMENTAL FACTORS
• Abnormal function and improper
respiration are the most significant.
• Disturbed or occluded nasal
respiration can cause a change in the
function of both tongue and mandible
which can lead to open bite.

TREATMENT
• Treatment depends on localization
and etiology of malocclusion.
• Treatment plan varies for dentoalveolar
and skeletal open bite.

DENTO ALVEOLAR OPEN BITE
1. Habit control
2. Elimination of abnormal
perioral musculature function

SKELETAL OPEN BITE
• Redirection of growth is possible
during the active growth period.
• Management in adults is by surgery/
orthodontic treatment.

TREATMENT IN THE MIXED
DENTITION
• Control of abnormal habits.
• Elimination of dysfunction.
• Deforming muscle activity -treatment
with screening appliance or activator.
• Skeletal open bite-extra oral
orthopaedic appliances such as chin
caps can be used

Selection of appropriate treatment
depends on the type of open
bite.Three types of open bites may
be differentiated:
• Dento alveolar
• Skeletal
• Combined
(Contd.)

DENTO ALVEOLAR OPEN BITE
• It occurs as a consequence of various
dysfunctions.
• Early mixed dentition
Screening therapy is indicated.
• Late mixed dentition
Multi attachment fixed appliance
is indicated.

SKELETAL OPEN BITE
Treatment depends on at least 2
factors:
• Severity of malocclusion.
• Possibility of dentoalveolar
compensation
Treatment options include:
• Growth modification
• Orthodontic camouflage

COMBINED OPEN BITE
Because of the dual nature of etiology a
combined treatment approach is
recommended.
Treatment follows 2 possible combinations.
• Elimination of abnormal perioral muscle
function.
• Improvement of skeletal relationship.

TREATMENT IN THE
PERMANENT DENTITION
Multiattachment fixed
mechanotherapy is the method of
choice with guided extraction
procedures to correct dento alveolar
problems and compensate for any
skeletal problems that exist.

(Contd.)
• Functional appliances are helpful in
the retention phase of therapy.
• In adults surgical intervention with
pre/post surgical orthodontics
needs to be considered.

CASE I :23/F
C/O-
Forwardly placed teeth
DIAGNOSIS-
Patient has tongue thrust and anterior
open bite
TREATMENT PLAN-
Tongue spike given.
Begg mechanotherapy with all 5’s
extraction.

PRE TREATMENT

CURRENT STATUS

CASE II: 22/F.
C/O- Spacing in the anterior
region
DIAGNOSIS-Patient has anterior
open bite due to simple tongue
thrust and thumb sucking habit
with posterior crossbite on the
right side.
TREATMENT PLAN-
Niti palatal expander.
All 5’s extraction with PAE
Mechanotherapy followed by
Advancement Genioplasty.

CASE III:22/F
C/O-Protruded upper teeth.
ON EXAMINATION-Patient has a
tongue thrust habit.
DIAGNOSIS-Dento alveolar class
1 malocclusion on a class 2
skeletal base with anterior open
bite.
TREATMENT PLAN-Fixed Tongue
Crib with PAE mechanotherapy &
all 4’s extraction.

CASE IV: 18/M:
C/O-Inability to chew.
DIAGNOSIS-Dento alveolar Class 2
subdivision on a Class 2 skeletal
base with an anterior open bite and
right side posterior cross bite.
TREATMENT PLAN
SURGERY-Le Fort 1 with mid
palatal osteotomy and expansion
assisted with hyrax and vertical
impaction of the maxilla
ORTHODONTICS: All 4”s with PAE
mechanotherapy

PRE SURGICAL
POST SURGICAL

POST SURGICAL

PRE TREATMENT
POST TREATMENT

Open bite (3)

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