165-open bite -oussama sandid- olivier sandid (1).pdf

163-Open bite- Malocclusion
M. ABOULNASER- Orthodontist, BUA, USA.
O. SANDID- Orthodontist, France.
2009

Plan
Introduction
1-Definition
2-Etiologic Factors a-Hereditary, Unfavorable growth patterns
b-Digit-sucking habits.
c-Increased tongue size
d-Tongue thrusting
e-Orofacial muscle activity, orofacial functional matrices
f-Nasopharyngeal Airway Obstruction associated Mouth Breathing
g-Imbalances between jaw posture, and eruptive forces and head position
h-Iatrogenic factors, extruding molars during treatment
i-Trauma or pathology to one or both condyles
3-Open bite Classification 3a-Dentoalveolar open bite
3b-Skeletal Open Bite
4 –Diagnosis -Dental Openbite
-Skeletal Open Bite
cephalometric Evaluation of Patients with Anterior Open-bite
5-Treatment 5a-Dental Openbite Treatment with tongue crib or tongue spurs
5b-Dental Openbite Treatment with Quadhelix -tongue Crib
5c-Dental Openbite - Treatment with elastics
5d-Early tooth extraction in the treatment of anterior openbite in hyperdivergent patients
5e-Open bite treated by intruding posterior teeth-miniscrews
5f-Correction of Minor Open Bite -Incisor Extrusion)
5g-Class III mechanics employed for vertical control- J-hooks
5h-Open bite, treated with extraction of permanent teeth
5i-Open-bite non-extraction treatment
5j-Open bite, treated with Molar extraction, premolar extraction
5k-Orthodontics-surgical combination therapy for class III skeletal open bite
5l-Treatment of Anterior Open Bite with the Invisalign System
5p-Orfacial Myology/Tongue Thrust Therapy
6-Conclusions

Introduction
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Anterior open bite is generally defined as a condition where the upper incisor crowns
fail to overlap the lower incisor crowns when the mandible is brought into full occlusion,
Hence an openbite could range from a mild case of ‘edge to- edge’ incisor relationship to
a severe skeletal open bite with only the molars in contact.
Simple open bites are usually confined to the teeth and
alveolar process where as complex openbites are based primarily on vertical skeletal
dysplasias
.

1-Definition
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Skeletal Open Bite: As a result of increased downward and backward
inclination of the mandible, the mandibular angle is increased .
Dentoalveolar open bite: Origin as a result underdevelopment anteriorly of
the maxillary and mandibular alveolar process
Skeletal Open Bite
Dentoalveolar open bite

2-Etiologic Factors
a-Hereditary, Unfavorable growth patterns
d-Tongue thrusting
e-Orofacial muscle activity, orofacial functional matrices
f-Nasopharyngeal Airway Obstruction associated Mouth
Breathing
g-Imbalances between jaw posture, and eruptive forces and
head position

2-Etiologic Factors
• Many potential etiologic factors are implicated as causes of open
bite including, Genetic, Environmental
• a- Hereditary, Unfavorable growth patterns, Increased tongue size,
Abnormal skeletal growth pattern of the maxilla and mandible
• b-Digit-sucking habits.
• c-Tongue thrusting and orofacial muscle activity.
• D-Nasopharyngeal Airway Obstruction associated Mouth
Breathing
• d-Orofacial functional matrices, mouth breathing etc
• e-Imbalances between jaw posture, and eruptive forces and head
position.

2a-Open bite -Etiologic Factors
a1-Abnormal skeletal growth pattern of the maxilla and mandible
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http://www.scielo.br/pdf/dpjo/v16n3/en_a16v16n3.pdf

2a-Open bite -Etiologic Factors
a- Hereditary, Hyperdivergent Skeletal Pattern
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The patient may often has a long
and narrow face.
-Divergent cephalometric planes
-Steep anterior cranial base
-Downward and forward rotation
of the mandible.
-Vertical maxillary increase
-Increased lower anterior facial
height
-Decreased upper anterior facial
height
-Increased anterior and decreased
posterior facial height
-A steep mandibular plane angle
-Small mandibular body and ramus
-The patient may have short upper
lip with excessive maxillary incisor
exposure

2b-Open bite -Etiologic Factors
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2b-Open bite -Etiologic Factors
AOB in primary teeth caused by pacifier sucking and B) spontaneous correction after removal of
habit. C) AOB in mixed dentition caused by thumb sucking. it is noteworthy how AOB morphology
differs according to causative agent. Pacifier is soft and deformable, creating more elongated and
narrow open bite, whereas finger is stiffer and larger, creating wider, rounded open bite with
protruded maxillary incisors and deficient eruption in mandibular incisors. D) When thumb sucking
habit is so intense the back of the finger may become callous.

2c-Open bite -Etiologic Factors
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2d-Open bite -Etiologic Factors
d-Tongue thrusting
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2d-Open bite -Etiologic Factors
d-Tongue thrusting
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AOB caused by poor posture of the tongue at rest and lip interposition (A). Cephalometric
radiograph contrast allows the tongue to be viewed in its resting position, supported by the
mandibular incisors, preventing their proper eruption, and the interposition of the lower lip
between the incisors, preventing the proper eruption of the maxillary incisors is also visible
(B).
Alderico Artese*, Stephanie Drummond**,Dental Press J Orthod 139 2011 May-June;16(3):136-61

2e-Open bite -Etiologic Factors
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d1-Abnormal Swallowing / Tongue thrust habit
Protrusion of the tongue against or between the anterior dentition and excessive
circum-oral activity
During deglutition
Innate behavior
Universal infant oral behavior for children under the age 6 years

2f-Open bite -Etiologic Factors
e- Orofacial muscle activity, orofacial functional matrices
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Schematic illustrating balance between forces of lips and
tongue (arrows), allowing contact of maxillary incisor and therefore
achieving normal overbite.

2g-Open bite -Etiologic Factors
f-Nasopharyngeal Airway Obstruction associated Mouth Breathing
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http://ejo.oxfordjournals.org/content/29/5/426

2j-Open bite -Etiologic Factors
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2h-Open bite -Etiologic Factors
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3-Open bite Classification
3a-Dentoalveolar open bite

3-Open bite Classification
Anterior open bite Posterior open bite
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Dentoalveolar open bite Skeletal Open Bite

3a-Dentoalveolar open bite
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Márcio Rodrigues de ALMEIDA, Renato Rodrigues de ALMEIDA, Ana Claúdia de Castro Ferreira CONTI,J Appl Oral Sci . 2006;14(6):470-5

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4 –Diagnosis
-Dental Openbite
-Skeletal Open Bite
-Cephalometric Evaluation of Patients with Anterior
Open-bite

4-Diagnosis: Dental Openbite
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www.aso.org.au
Patients generally exhibit normal facial features with only intra-oral abnormalities related to
the aetiology, eg. Thumb sucking, tongue function/posture. The openbite is generally
confined to the incisor region and maybe asymmetric. In cases of digit sucking the maxillary
arch may also be narrow with proclination of the upper incisors and retroclination of the
lower incisors. In patients with a forward tongue posture proclination and spacing of the
upper and lower incisors is often seen, Esthetically Unattractive Particulary during speech
When Tongue pressed between the teeh and lips

4-Vertical proportions of face: Facial Height
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Trichion, Hairline
Nasion, Glabella
Subnasale
Gnathion, Menton
Midface
Lower face
Upper face
Open bite-Increased lower anterior facial height-Decreased upper anterior facial height

4-Diagnosis: Planes of face are diverging in case of skeletal open bite
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Cephalometric measurements-open bite
Normal
*SN–MP =32 °
*PP-MP= 28 °
*FH-MP= 20 °
*MP-OP =
PP
MP
FH
N
S
PNS
ANS
Go
Me
The patient may often
has a long and
narrow face
-Divergent
cephalometric planes
-Steep anterior cranial
base
-Downward and
forward rotation of the
mandible
-Vertical maxillary
increase
OP
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Normal:
*Goniac angle= 128°
*SNA= 82° ± 3
*SNB=79° ± 3
*ANB=3± 2
*U1-SN= 116 °
*L1-MP= 90° ±3
*SN-MP
**Ramus height GO CF = 55mm
*SN-TH=7 °
*SN PP=
*UOP-SN=
GO
CF
S
N
A
B
U1
TH
PFH
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Normal :
*Basion – Nasion= 63 mm ± 3
*Me – ANS = 72.0 mm ± 3
*Co-Gn=128.2 mm ± 4.2 mm
*AFH-PFH (NA- ME)-(S-GO ) = 60-62.
*Xi-PM.=65.0 mm ± 2.7 mm
*L6-MP 27 (mm) ± 2.30
*U6-PP 19(mm) ± 2.22
N
Ba
ANS
Me
Co
Gn
S
GO
XI
PP
MP
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4-Diagnosis: Skeletal anterior open bite
• Features:
• -Increased lower anterior facial
height
• -Decreased upper anterior facial
height
• -Increased anterior and decreased
posterior facial height
• -A steep mandibular plane angle
• -Small mandibular body and ramus
• -The patient may have short upper
lip with excessive maxillary incisor
exposure
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Marie-José Boileau , Jean Casteigt , Laure Frapier , Pierre Canal, Traitements chirurgico-orthodontiques

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Patient exhibits ‘typical’ skeletal openbite features including an increased lower facial
height, lip strain, anterior openbite, steep mandibular plane angle, antegonial notching
and decreased ramal height, mouth breathing, tongue trusting..
www.aso.org.au

4-Diagnosis: Long face syndrome-Open bite
-long face
-Skeletal openbite
often include a long face
-Lip incompetence, an anterior
Openbite
-Steep mandibular plane angle
- Marked antegonial notching
-Increased anterior facial height
-Decreased posterior facial height.
-Posterior and downward rotation of the
mandible.
-Maxillary constriction with buccal segment
crossbites
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5-Open bite traitement
5a-Dental Open bite Treatment- Principes
5b-Dental Openbite Treatment with tongue crib or tongue spurs
5c-Dental Openbite Treatment with Quadhelix -tongue Crib
5d-Dental Openbite - Treatment with elastics
5e-Early tooth extraction in the treatment of anterior openbite in hyperdivergent patients
5f-Open bite treated by intruding posterior teeth-miniscrews
5g-Correction of Minor Open Bite -Incisor Extrusion
5h-Open bite, treated with extraction of permanent teeth
5i-Orthodontics-surgical combination therapy for class III skeletal open bite
5j-Open-bite non-extraction treatment
5k-Class III mechanics employed for vertical control- J-hooks
5l-Treatment of Anterior Open Bite with the Invisalign System
5m-Class III mechanics employed for vertical control- J-hooks

5a-Dental Open bite Treatment- Principes
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http://www.speareducation.com/spear-review/2014/10/anterior-open-bites-part-vii-frank-spear/
Molar ingression, Incisor extrusion, Tongue Thrust Therapy

5b-Dental Openbite Treatment with tongue crib or tongue
spurs
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GUILHERME JANSON

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Márcio Rodrigues de ALMEIDA, Renato Rodrigues de ALMEIDA, Ana Claúdia de Castro Ferreira CONTI,J Appl Oral Sci . 2006;14(6):470-5
Lateral and frontal views at the beginning of treatment
Frontal and occlusal views after the placement of a fixed palatal crib soldered on the bi-helix
Frontal and lateral views after interceptive treatment (10 years old)
5c-Dental Openbite Treatment with Quadhelix -tongue
Crib

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Pretreatment extraoral and intraoral photographs.
Intraoral progress photographs show the use of intermaxillary elastics to correct the left posterior
crossbite and vertical elastics to close the left lateral open bite.
Cabrera et al, American Journal of Orthodontics and Dentofacial Orthopedics May 2010

5d-Dental Openbite Treatment with elastics
Ravindra Nanda- http://www.orthodonticproductsonline.com/2011/07/open-bite-correction-2011-07-03/
For mild open-bite malocclusions (1 to 3 mm), placing step bends and meticulous bracket positioning
can help reduce the open bite
without any significant side effects. In this patient, the anterior brackets were placed more gingivally
as compared to the
posterior brackets, to aid in correction of the open

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5e-Early tooth extraction in the treatment of anterior openbite in
hyperdivergent patients
Marcio Antoniode Figueiredo and col, World journal of orthodontic
Initial intraoral photographs
Quadhelix and Bihelix
Open bite correction after expansion
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5f-Open bite treated by intruding posterior teeth-
miniscrews
Young H. Kim, Anterior Openbite and its Treatment with Multiloop Edgewise Archwire, Angle Orthod 1987:57(4):290-321
Palatal miniscrews
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miniscrews
1.Place a mid-palatal mini-implant(1.6 mm x 6 mm) , as far distally as
possible (usually between 6 and 7). 2. Use a TPA with hooks. 3. Insert
an 019x025” ss archwire. 4. Apply a power chain tightly.
Young H. Kim, Anterior Openbite and its Treatment with Multiloop Edgewise Archwire, Angle Orthod 1987:57(4):290-321
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miniscrews
We will get greater vertical intruding vector than horizontal constricting vector, It will
be more efficient for intruding the second molars.

Nonextraction treatment of an open bite with
microscrew implant anchorage
Pretreatment records show anterior open bite.
Hyo-Sang Park,a Oh-Won Kwon,b and Jae-Hyun Sungc
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Biomechancis showing closing of anterior open bite after intrusion force at molars.
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A, Placement of microscrew implants into palatal alveolar bone between first and second
molars. Intrusive force was applied from microscrew implants to hooks on transpalatal bar,
placed to prevent linguoversion of maxillary molars. B, Microscrew implants between
mandibular first and second molars from which intrusive force was applied, and lingual arch to
prevent buccal tipping of molars.
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Retention records at 8 months.
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Synergic effect of TAD, muscle training and extraction of 3rd molars
Cheol -Ho Paik,, AAO Annual Session Philadelphia, 9:35AM-10:20AM 5 May 2013
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Use of temporary anchorage devices for molar intrusion
JADA, Vol. 138 http://jada.ada.org January 2007 Neal D. Kravitz, DMD; Budi Kusnoto, DDS, MS; T. Peter Tsay,
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Treatment of an open bite with microscrew implant anchorage
Bilateral insertion of miniscrews in buccal and palatal of premolars
Ahmad Sodagar , Farhad Sobouti, Negin Shahsavari , Occlusal plane flattening by miniscrew in skeletal
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5g-Correction of Minor Open Bite (Incisor Extrusion)
RAVINDRA NANDA, ROBERT MARZBAN, ANDREW KUHLBERG, www.jcoonline.com,VOLUME 32 : NUMBER 12 : PAGES (708-715) 1998
Mandibular Connecticut Intrusion Arches
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5h-Nonsurgical Treatment of a Case With Skeletal Class III
Malocclusion and Total Open
Open bite, treated with Molar extraction
Nihal HAMAMCI, Emin Caner TUMEN , Güvenc BASARAN , Engin AGACKIRAN, International Dental and Medical
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5h-Open bite, treated with extraction of permanent
teeth
Mírian Aiko Nakane Matsumoto, Dental Press J Orthod 126 2011 Jan-Feb;16(1):126-38
Initial intraoral photographs
Final intraoral photographs.
Extraction of the first upper and lower premolars.
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5h-Open bite, treated with extraction of first permanent
molars
Suliaman E. AL-Emran, Saudi Dental journal, vol3 , NO3, September –December 2001
Intial
Final
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5i-Orthodontics-surgical combination therapy for class III
skeletal open bite
M S RAVI, NILLAN K SHETTY, B PRASAD, Contemporary Clinical Dentistry , jan mar 2012 vol 3 issue 1
Intial
Final
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Anterior Open Bite Correction with Maxillary Impaction Surgery
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Class II, Anterior Open Bite Correction with Maxillary Impaction
and Mandibular Advancement

Orthodontics-surgical combination therapy -open bite
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Before and After treatment

5j-Open-bite non-extraction treatment
GUILHERME JANSON
Treatment with elastics , Tongue Thrust Therapy
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5l-Treatment of Anterior Open Bite
with the Invisalign System
JCO/AUGUST 2010,VOLUME XLIV NUMBER 8,WERNER SCHUPP, JULIA HAUBRICH, IRIS NEUMANN

Close an open bite by intruding over- erupted posterior teeth.
http://accutech3.rssing.com/chan-14662235/all_p1.html
The Fisher BCA (Bite Closing Appliance) is a maxillary appliance designed to close an open
bite by intruding over- erupted posterior teeth, This appliance, utilizes a bonded posterior
bite plate fitted with 4 special ball-end hooks which attach with closed coil springs to
TADS (temporary anchorage devices) placed in the zygomatic process,When anchored
against the TADS the force of the closed coil springs on the posterior bite plate is directed
in a superior direction affecting the intrusion of posterior teeth., A rapid palatal
expansion option is available. Transpalatal wires (or RPE screw) are positioned a
minimum of 5 mm off of the palate to allow for intrusion

Correction of dental Class III with posterior open bite by simple
biomechanics using an anterior C-tube miniplate
http://ekjo.org/search.php?where=aview&id=10.4041/kjod.2012.42.5.270&code=1123KJOD&vmode=PUBREADER#!po=62.5000

5m-Class III mechanics employed for vertical control- J-
hooks
Márcio Costa Sobral1 , Fernando A. L. Habib2 , Ana Carla de Souza Nascimento3 Dental Press J Orthod. 2013 Mar-Apr;18(2):141-59
Class III mechanics employed for vertical control, anchored on J-hooks in the lower arch.
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5m-Class III mechanics employed for vertical control- J-
hooks
Márcio Costa Sobral1 , Fernando A. L. Habib2 , Ana Carla de Souza Nascimento3 Dental Press J Orthod. 2013 Mar-Apr;18(2):141-59
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6a-Biomechanics of open-bite treatment
The step bend creates equal
and opposite forces on the
anterior and posterior
segments (green arrows).
However, the moments (in blue)
are in the same direction,
causing worsening of the open
bite condition by canting the
posterior occlusal plane
Ravindra Nanda http://www.orthodonticproductsonline.com/2011/07/open-bite-correction-2011-07-03/
Ravindra Nanda

6b-Biomechanics of open-bite treatment
An extrusion arch (in blue) tied to a
rigid anterior segment creates a one-
couple force system that generates a
single force (F) anteriorly (in green).
The moments (M) generated (in blue)
are counteracted by another set of
moments (in red) using elastics
(yellow) as shown. This example is
assuming that the center of resistance
of the posterior segment is between
the roots of the premolars.
Ravindra Nanda

6c-Biomechanics of open-bite treatment
A case report based on
Figure illustrating the
application of elastics and
an extrusion arch in the
successful management of
an open-bite malocclusion.
Note how the judicious
application of elastics in
combination with the
extrusion arch results in the
correction of the open bite
and also provides the
necessary overcorrection for
long-term retention
Ravindra Nanda

6d-Using reverse-curved archwires to close an
anterior open bite
Using reverse-curved archwires to close an anterior open bite. The strong anterior
box elastics prevent the premolars from erupting, while the molars intrude and tip
back and the incisors extrude. These mechanics work quite effectively in a very
short time, but they are heavily dependent on patient cooperation. Elastics must be
worn all day, otherwise the bite may open with quick extrusion of the premolars.
Ram S. Nanda, Yahya S. Tosun

6e-Mechanotherapy and Open Bite Malocclusions
Jack C. Fisher, Jay B. Burton, http://www.orthodonticproductsonline.com/2013/10/mechanotherapy-and-open-bite-malocclusions
TSADs are used in combination with an appliance incorporating
bite blocks, a midpalatal acrylic button, and four nitinol springs.

6f-Bracket placement for treatment of open bites
In patients with open bite, the bracket height for the maxillary anterior teeth, which are
out of occlusion, is increased by 0.5 mm. The bracket height for posterior teeth, which are
in occlusion, is decreased by 0.5 mm ], The amount of curve of Spee in the mandibular arch
can be used to determine if any change in bracket height is necessary. If there is significant
reverse curvature to the mandibular occlusal plane, then the bracket heights are adjusted
in both the maxillary and the mandibular arches.
http://pocketdentistry.com/principle-7-build-treatment-into-bracket-placement/
Anterior and Posterior bracket placement, right side.
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6g-Bracket placement for treatment of open bites
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6h-Bracket placement for treatment of open bites
http://pocketdentistry.com/principle-7-build-treatment-into-bracket-placement/
Postion top
of slot 5 mm
from incisal
edge
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6i-Open bite malocclusion
(A) Examples of open bite: (i) an asymmetrical AOB caused by digit
sucking, (ii) a severe symmetrical AOB caused by an increased lower
anterior face height and macroglossia and (iii) a severe skeletal AOB
extending backwards to produce a posterior open bite

6j-Mechanotherapy and Open Bite Malocclusions
The typical results when the new mechanotherapy is used to
treat an open bite

6k-Mechanotherapy and Open Bite Malocclusions
The nitinol springs are attached to two TSADs
placed in the infrazygomatic crests bilaterally.

6l-Mechanotherapy and Open Bite Malocclusions
The lower appliance
uses two to four
TSADs for intrusion.
TSADs have been placed between
the first and second molars and/or
mesial to the first molars.

6m-Modified Transpalatal Arch (M-TPA) For
Intrusion Of Maxillary 2nd Molars
These two hooks on the M-TPA can now be used for engaging an elastic or E-chain,
crossing over the occlusal surface of the extruded maxillary second molar
http://orthocj.com/2009/01/modified-transpalatal-arch-intrusion-maxillary-2nd-molars/

Dentoalveolar comparative study between removable and fixed
cribs, associated to chincup, in anterior open bite treatment
Chincup with the force vector directed to the condyle
Fernando César TORRES, Renato Rodrigues de ALMEIDA, Renata Rodrigues de ALMEIDA-PEDRIN, J Appl Oral Sci.

Bibliography
• http://www.orthodonticproductsonline.com/2011/07/open-bite-
correction-2011-07-03/
• http://www.slideshare.net/drnabilmuhsen/management-of-open-bite-dr-
nabil-alzubair?related=1
• http://www.slideshare.net/indiandentalacademy/biomechanics-of-
openbite-2
• http://www.authorstream.com/Presentation/eshagarg88-1209119-ortho-
seminar/
• http://www.slideshare.net/ravikanthlakkakula/mangement-of-openbite
• http://www.intechopen.com/books/a-textbook-of-advanced-oral-and-
maxillofacial-surgery/corticotomy-and-miniplate-anchorage-for-treating-
severe-anterior-open-bite-current-clinical-applicat
• http://www.slideshare.net/drnabilmuhsen/management-of-deep-bite-dr-
nabil-alzubair?related=1

REFERENCES
• 1. Justus R. Correction of Anterior Open Bite with Spurs: Long-Term Stability. World J Orthod. 2001;2:219–31.
• 2. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 4th ed. St. Louis: mMosby Elsevier; 2007.
• 3. Cozza P, Mucedero M, Baccetti T, Franchi L. Treatment and posttreatment effects of quad-helix/crib therapy of
dentoskeletal open bite. Angle Orthod. 2007 Jul;77(4):640-5.
• 4. Greenlee GM, Huang GJ, Chen SS, Chen J, Koepsell T, Hujoel P. Stability of treatment for anterior open-bite
malocclusion: a meta-analysis. Am J Orthod Dentofacial Orthop. 2011 Feb;139(2):154-69.
• 5. Janson G, Valarelli FP, Henriques JF, de Freitas MR, Cancado RH. Stability of anterior open bite nonextraction
treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2003 Sep;124(3):265-76.
• 6. de Freitas MR, Beltrao RT, Janson G, Henriques JF, Cancado RH. Long-term stability of anterior open bite
extraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2004 Jan;125(1):78-87.
• 7. Janson G, Valarelli FP, Beltrao RT, de Freitas MR, Henriques JF. Stability of anterior open-bite extraction and
nonextraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2006 Jun;129(6):768-74.
• 8. Baek MS, Choi YJ, Yu HS, Lee KJ, Kwak J, Park YC. Long-term stability of anterior open-bite treatment by
intrusion of maxillary posterior teeth. Am J Orthod Dentofacial Orthop. 2010 Oct;138(4):396 e1-9; discussion -8.
• 9. Deguchi T, Kurosaka H, Oikawa H, Kuroda S, Takahashi I, Yamashiro T, et al. Comparison of orthodontic
treatment outcomes in adults with skeletal open bit between conventional edgewise treatment and implant-
anchored orthodontics. Am Orthod Dentofacial Orthop. 2011 Apr;139(4 Suppl):S60-8.
• 10. Sugawara J, Baik UB, Umemori M, Takahashi I, Nagasaka H, Kawamura H, et al. Treatment and posttreatment
dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system
(SAS) for open bite correction. Int J Adult Orthodon Orthognath Surg. 2002;17(4):243-53.
• 11. Janson G, Crepaldi MV, de Freitas KM, de Freitas MR, Janson W. Evaluation of anterior open-bite treatment
with occlusal adjustment. Am J Orthod Dentofacial Orthop. 2008 Jul;134(1):10-1.
• 12. Janson G, Crepaldi MV, Freitas KM, de Freitas MR, Janson W. Stability of anterior open-bite treatment with
occlusal adjustment. Am J Orthod Dentofacial Orthop. 2010 Jul;138(1):14 e1-7; discussion -5.

Conclusions
• Dental favorable pronostic
• Anterior open-bite in adults is a challenging malocclusion to be treated and many therapies have
been advocated to increase the stability
• Scientific available data on the stability of open-bite treatment provides only weak evidence about
certain treatment modalities, which is not enough to predict the success of clinical choices.
Orthodontic treatment with extractions seemed to be more stable than nonextraction, as well as
one-jaw surgery compared with bimaxillary surgery. The available data on TADs is still scarce.
Nevertheless, the decision to treat with orthognathic surgery is not limited to the malocclusion,
because it also addresses correction of dentofacial deformities that will improve facial aesthetics.
• Anterior open bite is considered a malocclusion that still defies correction,
• especially in terms of stability. The literature reports numerous studies on the subject
• but with controversial and conflicting information. Disagreement revolves around
• the definition of open bite, its etiological factors and available treatments. It is probably
• due to a lack of consensus over the etiology of anterior open bite that a wide range of
• treatments has emerged, which may explain the high rate of instability following the
• treatment of this malocclusion.

Open-Bite Treatment of a Case by means of
Zygomatic Plate Anchorage
NiTi Coil springs attached to the Zygomatic MultiPurpose
implants applying intrusive force to the posterior teeth

Ppt +
http://e-
kjo.org/search.php?where=aview&id=10.4041
/kjod.2012.42.5.270&code=1123KJOD&vmode
=PUBREADER#!po=95.8333

Anterior Open Bite Correction with Maxillary Impaction Surgery

Posttreatment records (11 months).
www.orthofree.com

Two-year retention intraoral photos.
www.orthofree.com

2f-Open bite -Etiologic Factors
g-Imbalances between jaw posture, and eruptive forces and head position.
www.orthofree.com

Open Bite Correction Made Easy
http://www.orthodonticproductsonline.com/2012/10/open-bite-correction-made-easy-2/

C, At 8 months, anterior open bite was closed.
www.orthofree.com

Upper-Molar Intrusion Using Anterior Palatal
Anchorage
JCO/MAY 2013 ,Wilmes, Nienkemper, Ludwig, Nanda, and Drescher
Mousetrap appliance design and mechanics: one or two lever arms connect to palatal
plate, anchored by two mini-implants in anterior palate. In passive state, distal ends of
lever arms are located cranial to centers of resistance of molars. By pulling lever arms
downward and connecting them to molars, constant intrusive force is produced.

How to intrude the upper and lower molars efficiently ?
Cheol -Ho Paik,, AAO Annual Session Philadelphia, 9:35AM-10:20AM 5 May 2013

Treatment of open-bite with occlusal adjustment

Lower molar extrusion prevents mandible
from rotating counterclockwise.

Cephalometric linear measurements

Cephalometric angular measurements
-SNA
-SNB
-ANB
-SN-MP
-SN-PP
-UOP-SN
-U1-SN-
-Goniac angle

2-Open bite -Etiologic Factors
f1-Nasopharyngeal Airway Obstruction associated Mouth Breathing
www.orthofree.com

Dental Openbite Treatment with elastics
Pretreatment extraoral and intraoral photographs.

links
http://pocketdentistry.com/13-management-
of-vertical-problems-open-bites-and-deep-
bites/
https://www.rmortho.com/wp-
content/themes/rmo/rmods/rmods_syllabus.p
df
http://www.thetoothmover.com/open-bite/

Cas cliniques
Avant et après traitement

Béance dissymétrique avant et après traitement

Correction de la béance latérale
.

5e-Anterior open bite treated with extraction
of permanent teeth
http://dpjo.dentalpresspub.com/pdf/a25v18n
2en.pdf
http://www.iortho.co.nz/cases.html

Correction de la béance après réeducation
linguale

Marie-José Boileau , Jean Casteigt , Laure Frapier , Pierre Canal

Skeletal anterior open bite
long face,
skeletal openbite
often include a long
face, lip incompetence,
an anterior
openbite, steep
mandibular plane angle,
marked antegonial
notching, increased
anterior facial height
and decreased
posterior facial height.
posterior and downward
rotation of the
mandible.
maxillary constriction
with buccal segment
crossbites,
www.orthofree.com
Clinica
There
skelet
morph
(Cang
Skelet
Extra-
openb
often
anteri
openb
marke
notch
decre
poster
presen
a Clas
deficie
to pos
mand
Intra-o
with u
lower
bucca
crossb

Aetiological factors include:
• 1. Heredity
• 2. Environmental Factors
• (a) Thumb, finger or foreign body sucking
• (b) Abnormal tongue function; however there are varying opinions with some
believing it is a cause of the openbite, while others see it as adaptive (Straub
1960, Tulley 1964)
• (c) Trauma or pathology to one or both condyles
• (d) Neurologic disturbances
• (e) Iatrogenic factors, e.g. extruding molars during treatment
• (f ) Airway pathology. An oral breathing pattern is generally considered to be an
aetiological factor, although earlier studies have shown that only minor infl
uences on vertical and transverse jaw dimensions occur in humans who are
mouth breathers.
• (Linder-Aronson 1972, Harvold et al 1981).

Orofacial Myology/Tongue Thrust
Therapy
http://www.speech-therapy.com.au/childrens-
speech-pathology/orofacial-myologytongue-
thrust-therapy/#.VL4BpNKUe4k
http://www.orofacialmyology.com/files/Equilib
rium_Theory_Proffit.pdf

Cephalometric Evaluation of Patients with Anterior Open-bite
http://www.scielo.br/scielo.php?script=sci_pdf&pid=S0103-64402006000100015&lng=en&nrm=iso&tlng=en

http://www.cleber.com.br/macnamar.html

http://ejo.oxfordjournals.org/content/29/5/500

Upper-Molar Intrusion Using Anterior Palatal
Anchorage
JCO/MAY 2013 ,Wilmes, Nienkemper, Ludwig, Nanda, and Drescher

A New Method f w Method for Correction of ection of Anterior Open Bit erior Open
Bite
http://www.ortodonti.com/pdf/bilimsel_yayinlar/World_Journal_of_Orthodontics_Husam_article.pdf

http://solutions.3m.com/wps/portal/3M/en_EU/Unitek-patients/Smile-at-me/Teens/Reasons-for-Braces/Open-bite/

Miniscrwes ++++
http://pocketdentistry.com/chapter-2-miniscrews-and-biomechanics-in-orthodontics/

http://www.legacyortho.com/before-and-after.php

Dentoalveolar class III treatment using retromolar miniscrew
anchorage third molar extractions
we report the successful use of miniscrews in the distalization of the lower dentition to correct an A
locclusion with lower anterior crowding in a dolichofacial adult patient. Conventional intraoral and
ppliances have many disadvantages, including the need for patient cooperation, potential for ancho
ertical extrusion of upper molars and lower incisors. Extrusion should be prevented or minimized wh
ng-faced patients with reduced overbite. After third molar extractions, miniscrews were placed in th
area. A sliding jig was applied to distalize the lower molars, while the anterior teeth were bonded a
econdarily to avoid round tripping. After 18 months of treatment, molar and canine class I relations
al overjet and overbite were achieved. In addition, there was an esthetic improvement in the profile
l increase of the lower anterior facial height. These results remained stable at a 12-month follow-up

https://www.orthodontisteenligne.com/blogu
e/impaction-maxillaire-mini-vis-dancrage/

https://showyou.com/v/y-2NXcMjfzfXI/open-bite-correction-using-palatal-mini-screws

Le Fort I Osteotomy for Maxillary
Repositioning and Distraction
Techniques
http://cdn.intechopen.com/pdfs-
wm/35330.pdf
https://www.google.com.lb/?gws_rd=cr,ssl&ei
=IlnKVNP2KsmBU9PnguAC#q=le+fort+I+osteot
omy+pdf

XR -3D –Open bite
www.orthodontisteenligne.com

http://www.forp.usp.br/bdj/bdj11%281%29/t0
5111/t05111.html

4-Diagnosis: Cephalometric Evaluation of Patients with skeletal open
bite
www.orthofree.com

4-Diagnosis: Features of skeletal anterior open bite
-
The patient may often has a
long and
narrow face
-Divergent cephalometric
planes
-Steep anterior cranial base
-Downward and forward
rotation of the mandible
-Vertical maxillary increase
www.orthofree.com

4-Diagnosis: Posterior Growth rotation
Growth
rotations of the
mandible occurs
when there is a
discrepancy in
the amount of
growth in
anterior and
posterior facial
heights
www.orthofree.com

-Increased lower anterior
facial height
-Decreased upper anterior
facial height
-Increased anterior and
decreased posterior facial
height
-A steep mandibular plane
-Small mandibular body and
ramus
-Short lip , excessive maxillary
incisor exposure
www.orthofree.com

• Measurements Skeletal class I (n = 30) Skeletal class II (n = 30) Skeletal class III (n = 30)
• Mean ± SD Mean ± SD Mean ± SD
• Pre- Post- Differences Pre- Post- Differences Pre- Post- Differences
• Skeletal frame
• SNA°a 81.99 ± 2.85 81.54 ± 3.72 −0.46 ± 1.57 81.33 ± 2.88 81.30 ± 2.85 −0.76 ± 1.15 78.33 ± 3.67 78.74 ± 3.46 0.42 ± 1.21
• SNB° 79.32 ± 2.95 79.36 ± 3.81 0.04 ± 1.35 76.60 ± 3.06 77.16 ± 2.67 0.56 ± 1.40 79.45 ± 3.38 79.66 ± 3.92 0.22 ± 1.38
• ANB° 2.68 ± 0.64 2.18 ± 0.87 −0.49 ± 0.99 5.44 ± 0.88 4.15 ± 1.24 −1.29 ± 1.11 −1.11 ± 0.96 −0.93 ± 1.10 0.18 ± 1.22
• MP-SN° 31.52 ± 4.04 32.09 ± 4.78 0.57 ± 1.55 34.59 ± 4.71 34.75 ± 4.59 0.16 ± 1.88 32.04 ± 6.00 32.07 ± 6.20 0.03 ± 1.48
• Occlusal plane
• BOP-SN° 14.57 ± 3.82 15.29 ± 4.29 0.72 ± 2.59 17.34 ± 4.43 18.85 ± 4.12 1.51 ± 3.11 14.41 ± 4.29 14.67 ± 4.72 0.26 ± 2.32
• FOP-SN° 14.70 ± 4.10 14.00 ± 4.68 −0.69 ± 3.61 17.36 ± 4.58 17.96 ± 4.44 0.60 ± 2.96 14.65 ± 4.47 14.16 ± 4.78 −0.49 ± 2.98
• MxOP-MnOP° 8.10 ± 2.44 3.50 ± 1.43 −4.60 ± 2.82 8.77 ± 3.30 3.70 ± 1.08 −5.07 ± 3.01 5.69 ± 3.22 3.83 ± 1.38 −1.86 ± 3.29
• Dental
• Overbite (mm) 3.79 ± 1.31 1.63 ± 0.70 −2.16 ± 1.46 4.30 ± 1.70 1.73 ± 0.63 −2.57 ± 1.51 2.34 ± 1.66 1.67 ± 0.68 −0.67 ± 1.71
• Overjet (mm) 4.01 ± 1.28 2.76 ± 0.58 −1.25 ± 1.30 4.81 ± 1.86 2.63 ± 0.57 −2.18 ± 1.96 2.54 ± 1.37 2.53 ± 0.66 0.24 ± 1.39
• Maxillary
• dentoalveolar
• U1-SN° 103.02 ± 6.41 108.36 ± 5.91 5.33 ± 7.72 99.53 ± 6.19 105.68 ± 4.74 6.16 ± 7.88 105.23 ± 5.07 109.73 ± 5.98 4.50 ± 5.65
• U1-PP (mm) 26.29 ± 2.59 26.70 ± 2.58 0.41 ± 1.54 26.66 ± 3.11 27.31 ± 3.40 0.65 ± 1.21 25.49 ± 3.05 26.42 ± 3.42 0.93 ± 1.51
• U6-PP (mm) 19.98 ± 2.22 21.30 ± 2.39 1.32 ± 1.49 19.56 ± 2.64 20.83 ± 2.55 1.28 ± 1.20 20.17 ± 2.55 21.67 ± 2.65 1.50 ± 1.33
• Mandibular
• dentoalveolar
• L1-SN° 54.79 ± 6.33 51.20 ± 5.83 −3.60 ± 6.26 49.38 ± 6.96 44.65 ± 5.26 −4.73 ± 4.56 59.94 ± 6.69 59.10 ± 6.62 −0.84 ± 5.09
• L1-MP° 93.68 ± 6.82 96.71 ± 5.31 3.03 ± 6.77 96.04 ± 6.37 100.43 ± 6.06 4.40 ± 4.31 88.02 ± 5.88 88.89 ± 5.79 0.87 ± 5.21
• L1-MP (mm) 37.30 ± 3.08 38.78 ± 3.27 1.48 ± 2.28 38.21 ± 2.79 39.38 ± 3.70 1.16 ± 2.47 36.23 ± 3.13 37.70 ± 3.38 1.47 ± 1.09
• L6-MP (mm) 27.52 ± 2.30 29.91 ± 2.47 2.39 ± 1.81 27.86 ± 2.58 30.69 ± 2.61 2.82 ± 1.75 26.81 ± 2.46 28.79 ± 2.40 1.98 ± 1.01

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