Adenoid Facies: A special facial type has become associated with individuals who have a long history of mouth breathing. It is characterized by -Open mouth posture.A nose that appears to be flattened.Nostrils that are small and poorly developed.A short upper lip.A voluminous + pouting lower lip.A vacant facial expression as a result of hanging posture of the lower
Interference with normal eruption of incisors due to an interposed thumb or fingers.Excessive eruption of posterior teeth.
Gaining confidence of the patient:Should be gentle, caring, calm, concerned + friendly.Education to the patient :Adult approach:a. Explain consequences.b. Explain result of treatment.c. Use casts + photographs.Often enough to terminate habit.More effective in older children.Reminder Therapy:Meant for the children who want to quit the habit but need help:Securing an adhesive bandage with waterproof tape on the finger that is sucked.Anterior portion of quad helix appliance.4. Reward Therapy:Small tangible reward daily for not engaging in the habit.Large rewards for complete cessation of habit.5. Restriction Therapy:Indicated for these children who want to quit the habit but when all above approaches have failed.An elastic bandage to prevent the arm from being flexed should be used.Should be prescribed for night only for 6-8 weeks.The child should be explained that this is not a punishment.6. Appliance Therapy:Includes:Vestibular screen.Tongue crib-Removable.Fixed. Fixed is preferred because of patient compliance.
Malocclusion in vertical plane.
A deviation in the vertical relationship of the
maxillary and mandibular dental
arches characterized by a definite lack of
contact between opposing segments of
teeth.” (Daniel Subtelny, 1964).
“Localized absence of occlusion while the
remaining teeth are in occlusion” (Moyer’s).
According to location:
According to cause:
Dental or simple OB.
Skeletal or complex OB.
“Absence of contact between the maxillary
and mandibular incisors at centric relation (Worms 1971).”
Absence of vertical overlap of incisors.
“Lack of contact between the posterior teeth
when the teeth are in centric occlusion.”
Dental (Simple) OB:
When the basal skeleton is normal and
the open bite is confined to the teeth and alveolar processes.
Results from skeletal dysplasia, so severe that
the alveolar processes cannot cope to maintain occlusal stops.
Secondary to class III malocclussion.
change in mode of respiration
,lowers the mandible and the
supra-eruption of posterior
downward and backward
rotation of mandible
increased facial (ant) height.
Factors that cause mouth
breathing Enlarged adenoids or tonsils.
Allergic rhinitis, nasal
Normal upto 4-5 years
- Inadequate development of the
anterior alveolar process.
- Incomplete eruption of the incisor
Accommodation of thumb
Lowered positioning of mandible
Alteration in vertical equilibrium
Excessive eruption of posterior teeth
defined as placement of the
tongue tip forward between
the incisors during
Failure of eruption
Excessive tipping of the
Elongation of lingual cusp
as a consequence of orthodontic
Distalization of 6 l 6
Elongation of mesial cusps
OpenBite (Great concern in
Jaw rotation during
The palatal plane
with an increased in
Only if associated with long face syndrome.
I. HIGH PULL HEADGEAR TO THE MOLARS:
Maintains the vertical position of the maxilla.
Inhibits eruption of the maxillary posterior teeth..
14 hours, putting the headgear right after dinner
and wearing it until next morning.
350 – 450 gm / side (12 – 16 ounces).
It does not control the eruption of other teeth.
II. HIGH PULL HEADGEAR TO A MAXILLARY SPLINT:
acrylic splint to which a face bow and HP headgear is attached.
appears to have substantial maxillary skeletal and dental effect with
good vertical control.
Unfortunately, this appliance allows mandibular posterior teeth to erupt
freely, and if this occurs, there may be neither redirection of growth for
favorable upward and forward mandibular rotation.
III. FUNCTIONAL APPLIANCES WITH BITE BLOCKS :
The retraction force of headgear is replaced by the
somewhat lesser “headgear effect” of the functional
appliance with posterior bite block
To inhibit eruption of posterior teeth and vertical
descent of the maxilla.
When the mandibular is held in this position by the
appliance, the stretch of soft tissues (including but not
limited to the muscles) exerts a vertical intrusive force in
the posterior teeth.
In children with AOB the anterior teeth are allowed
to erupt, which reduces the OB.
As this allows the mandible to position
forward, horizontal growth of mandible can be
IV. HP HEADGEAR TO A FUNCTIONAL APPLIANCE
WITH BITE BLOCKS:
Most effective approach in OB classII.
Increases the control of maxillary growth.
Allows the force to be delivered to the whole maxilla
Improves retention appliance.
Produces force direction near the estimated center of
resistance of the maxilla.
The headgear tube – is incorporated in premolar
Force = 250 – 500 /side
High pull headgear to a maxillary
High pull headgear to maxillary
Functional appliance with bite blocks
High pull headgear to a functional
appliance with bite blocks
Surgical Orthodontics is a term that refers to
surgical procedures carried out as an adjunct
to or in conjunction with orthodontic
Orthognathic surgery is a surgical procedure
carried out along with orthodontic therapy to
correct dento-facial deformities or severe
orofacial disproportion involving the
maxilla, the mandible or both in combination.
I. MAXILLARY SURGERY:
LeeForte I down fracture of maxilla, or.
Segmental maxillary osteotomy, and
II. MANDIBULAR SURGERY:
1. BSSO (BILATERAL SAGITTAL SPLIT OSTEOTOMY)
2. INVERTED ‘L’ OSTEOTOMY OF RAMUS WITH RIF:
III. SUPERIOR REPOSITIONING OF THE CHIN BY A
MANDIBULAR LOWER BORDER OSTEOTOMY
(AOB NOT RELATED TO LONG FACE):
There are 2 major possibilities:
1-Deficient eruption of maxillary incisor:
*LeForte 1 osteotomy with or without
anterior and posterior components.
*Maxillary anterior segmental osteotomy.
2-AOB due to deficient eruption of mandibular
incisors +excessive eruption of posterior
*anterior subapical osteotomy
*total submandibular sub-apical osteotomy
Worms F.W, Meskin L.H, Isaacson R.J., Open bite. AJO
Klein: The Thumb sucking habit: Meaningful or Empty.
Clinical Biomechanics, Seminar Orthodontics; March
2001, Vol 7. No.1.
Carano A., Machita W. A rapid molar intruder for `Noncompliances treatment’ . JCO 2002 March; 8: 137-142.
Iscan M.N. Akkaya Sevil and Koralp E. The effects of the
spring - loaded posterior bite-block on the maxillo-facial
morphology. Eur J Orthod 1992; 14:54-60.