Corrective orthodontics- deep bite & open bite

C O R R E C T I V E O R T H O D O N T I C S :
D E E P B I T E & O P E N B I T E
P R E S E N T E D B Y :
D R S U S M I T A
S H A H
I I I M D S

C O N T E N T S :
1 . I N T R O D U C T I O N
2 . C O R R E C T I V E O R T H O D O N T I C S
3 . D E E P B I T E
A . I n t r o d u c t i o n
B . E t i o l o g y
C . C l i n i c a l F e a t u r e s
D . M a n a g e m e n t
4 . O P E N B I T E
A . I n t r o d u c t i o n
B . E t i o l o g y
C . C l i n i c a l F e a t u r e s
D . M a n a g e m e n t
5 . C O N C L U S I O N
6 . B I B L I O G R A P H Y
T U E S D A Y , A U G U S T 3 , 2 0 2 1 2

1 . I N T R O D U C T I O N
• Centric Occlusion- is that position of the mandibular condyle when
the teeth are in maximum intercuspation also called as intercuspal
position or convenience position.
• Centric relation- it is relation of the mandible to the maxilla when
the mandibular condyles are in the most superior and retruded
position in their glenoid fossa with the articular disc interposed also
called as interligamentous position or terminal hinge position.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 3

2 . C O R R E C T I V E O R T H O D O N T I C S
• Corrective orthodontics is that branch of orthodontics that recognizes
the existence of malocclusion and the need for employing certain
technical procedure to reduce or eliminate the problem and the
attendant sequele.
• Management of Class II & Class III malocclusions
• Management of Crossbite
• Management of Deep Bite
• Management of Open Bite
• Cleft Lip & Palate
T U E S D A Y , A U G U S T 3 , 2 0 2 1 4
Proffit W. Contemporary Orthodontics. 6th Edition. Elsvier publication

3. DEEP BITE
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A . I N T R O D U C T I O N
• Graber has defined deep bite as a condition of excessive
overbite, where the vertical measurement between the
maxillary and mandibular incisal margins is excessive when
the mandible is brought into habitual or centric occlusion.
• It can be of two types- incomplete overbite, complete overbite
• It can be calculated as a percentage of the clinical crown height of
one of the mandibular central incisors.
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• Normal bite: 2-4 mm
• Measurement
• Vernier caliper, graduated
probe.
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B . E T I O L O G Y
• Anterior deep overbite problems may either result from upward and forward rotation of
mandible during growth or from excessive eruption of the incisor teeth,(notably
mandibular incisors).
• Anterior teeth erupt until they make contact, either with opposing teeth, palatal mucosa or
resting tongue.
• Factors contributing to deep overbite can be:
• Skeletal
• Dental
• Soft tissue
T U E S D A Y , A U G U S T 3 , 2 0 2 1 8
Nanda R. Biomechanic & Esthetic Strategies in Clinical Orthodontic. Page No. 131-176. Elsvier
Publication 2005.

S K E L E TA L
• Forward rotation of the mandible in the direction of mouth closing, is due
to increased posterior vertical facial growth.
• Bjork 1969- seven structural signs on lateral cephalometric radiograph.
1. Forward inclination of condylar head
2. Increased curvature of inferior alveolar canal
3. Absence of antegonial notch
4. Forward inclination of mental symphysis
5. Increased interincisal angle
6. Increased intermolar angle
7. A reduced Anterior lower facial height
T U E S D A Y , A U G U S T 3 , 2 0 2 1 9
Nanda R. Biomechanic & Esthetic Strategies in Clinical Orthodontic. Page No. 131-176. Elsvier Publication
2005.

S K E L E TA L
C O N S I D E R AT I O N S
• Three factors significantly affect outcome of
overbite correction
• Vertical dimension
• Anteroposterior relationship of maxilla to
mandible
• Younger patients: amount of growth remaining
and its direction
T U E S D A Y , A U G U S T 3 , 2 0 2 1 10
2005.

D E N TA L
• Over eruption of mandibular incisors
• Class II div 1 malocclusion with increased overjet- mandibular
incisors erupt until they contact palatal mucosa.
• In class II div 2- deep overbite is due to retroclination of anterior
teeth
• Deep overbite may be partly due to over erupted maxillary incisor
teeth.
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2005.

S O F T T I S S U E
• In Class II div 2 malocclusion- High lower lip line which is thought to guide the
maxillary & mandibular incisors to erupt in more retroclined position.
• Short face individuals- increased mentalis muscle activity (Strap like lower lip).
• Forward resting tongue position and/or adaptive tongue position- overbite may
be deep.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 12
2005.

C . C L I N I C A L F E AT U R E S
• Horizontal growth patten
• Reduced anterior facial height
• Reduced interocclusal clearance
• Cephalometric evaluation
• Mandibluar plane, SN plane, FH
plane are parallel
T U E S D A Y , A U G U S T 3 , 2 0 2 1 13
Millett D, Welbury R. Clinical problem in Orthodontics and Pardiatric dentistry. Elsvier publication.

I N D I C AT I O N S F O R T R E AT M E N T
• Primary Dentition- Rarely indicated
• Early permanent dentition- indicated if it is causing soft tissue trauma,
maxillary incisors or labial to mandibular incisors.
• Deep overbite associated with increased overjet- often cannot be
corrected until overbite has been reduced.
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2005.

• Why does a deep bite need to be fixed?
• Besides looking better, there are four other reasons:
1. Over-erupted lower front teeth tend to wear down more quickly.
2. If a patient is biting into the roof of their mouth, painful sores or ulcers
may develop.
3. If a substantial amount of tooth structure has been lost, the orthodontist
will need to recreate the space needed for restoration by moving the
upper and lower teeth apart (opening the bite).
4. Unraveling the crowding and crookedness that usually accompanies
deep bites requires that the deep bite be corrected to allow room to
align the crowded teeth.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 15
American Association of Orthodontics.

D . M A N A G E M E N T
• Extrusion of Posterior teeth
• Intrusion of Incisors-
1. Relative
2. Absolute
• Proclination (flaring) of Labial
Segment
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• Factors to be considered
• Lip relationship
• Growth factor
• Vertical facial height
• Interocclusal space
Nanda R. Biomechanic & Esthetic Strategies in Clinical Orthodontic. Page No. 131-176. Elsvier Publication 2005.

1. ANTERIOR BITE PLANE- commonly used
removable appliance (Modified Hawley’s appliance).
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Patient bites
Mandibular
incisors contact
on bite plane
Dis-occludes
posterior teeth
Free
movement of
posterior teeth
Extrusion

• Adams clasp- retention
• Labial Bow- Counter forward
component of force
• Acrylic base plate
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2 . A C T I V A T O R
Indications:
• Class II div 1 malocclusion
• Class II div 2 malocclusion
• Class III malocclusion
• Class I open bite malocclusion
• Class I deep bite malocclusion
• Preliminary treatment to improve skeletal
jaw relation
• Post treatment retention
• Children with lack of vertical development
in lower facial height
• Contraindications:
• Class I malocclusion with crowding
• Children with excess lower facial height
• Lower incisors procumbent
• Children with nasal stenosis, Chronic
allergy
• Non growing individuals
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• Disadvantages:
• Patients Co-operation
• No precise detailing and
finishing in occlusion
• Produce moderate mandibular
rotation
• Bulky and uncomfortable
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• Advantages:
• Uses existing growth of jaw
• Minimal oral hygiene problems
• Long appointment intervals
• Short duration appointments due
to minimal corrections
• Night time wear
• No tissue injury
• Economical

M O D E O F
A C T I O N
• According to Andersen & Haupl
• Activator induces musculoskeletal
adaptation
• New patten of mandibular closure
• Loosely fits in mouth
• Patient has to move mandible forward
• Stretching of elevator muscles of
mastication
• Prevents further growth of maxillary
dentoalveolar process
• Condylar backward upward growth
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FA B R I C AT I O N O F A C T I VAT O R
Impression
• Study models & working models
Bite Registration
• Sagittal & vertical advancement of mandible
• Horse- shoe shaped wax block (2-3mm thicker)
• 1st maxillary 2nd mandibular
• Mandible guided in desired position
• Wax blocks transferred to models and checked
• Excess was trimmed off
• Hardened wax block again tried in patients’ mouth
Articulation of models
• Reverse articulation- incisors facing hinge
• Sufficient access to palatal & lingual surface
Wire Elements
• Labial Bow with two vertical loops
• Adams clasp
Acrylic Component
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3 . F I X E D A P P L I A N C E T H E R A P Y
• Use of Anchorage Bends
• Use of Arch wires with Reverse curve of
Spee
• Use of intrusion arches
• Use of Utility arches
• Use of fixed anterior bite planes
T U E S D A Y , A U G U S T 3 , 2 0 2 1 25
Naini F, Daljit SG, Sharma S, Tredwin C. The Aetiology, Diagnosis & Management of Deep Overbite. Dental
Updates. July- August 2006.

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The use of anchor bends in the tip-edge
appliance places an intrusive force on the
incisor and canine teeth.
Just mesial to 1st molar bands.
Rickets Utility Arch
Burstones Intrusion arch
Turbo Props
Naini F, Daljit SG, Sharma S, Tredwin C. The Aetiology, Diagnosis & Management of Deep Overbite. Dental
Updates. July- August 2006.

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T U E S D A Y , A U G U S T 3 , 2 0 2 1 28
Avicenna J Dent Res. 2018 June;10(2):63-66

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MANAGEMENT OF ANTERIOR DEEP BITE BY USING DIFFERENT TREATMENT MODALITIES - A REPORT OF THREE DIFFERENT
CASES Singh D et al Indian Journal of Comprehensive Dental Care JULY - DEC 2013 • VOL 3 • ISSUE 2

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A . I N T R O D U C T I O N
• In 1842 Caravelli coined the term “open bite” as a distinct classification of
malocclusion and can be defined in different manners.
• Classification (by Worms, Meskin, and Isaacson in 1971)
• Simple open bite - From canine to canine, with 4mm or more in centric
relation.
• Compound open bite - From premolar to premolar.
• Infantile open bite - From molar to molar.
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4 . O P E N B I T E

T Y P E S O F O P E N B I T E
• False or Dental open bite: In
this bite the teeth are proclined
as there is no alteration of the
osseous bases but it does not
extend beyond the canine. This
patient has normal facial
morphology, a correct bone
relation, a pesudo-bite and
dento-alveolar problem
T U E S D A Y , A U G U S T 3 , 2 0 2 1 32
• True or Skeletal open bite: In
this type of open bite the
alveolar processes are
involved or deformed and
dolichofacial characteristics
are also seen. This patient
present’s hyper-divergency in
maxilla, with their lower facial
third and vertical dimensions
increased

T U E S D A Y , A U G U S T 3 , 2 0 2 1 33
S I Bhalaji. Orthodontics the Art & Science. 6th Edition. Arya Publication2015.

• According to Moyer’s:
• Simple open bite:-This type of open bite is confined to the teeth and
alveolar process. The main problem regarding this type of open bite
is failure of some of the teeth to meet the line of occlusion.
• Complex open bite:-This type of open bite is caused by primary
vertical dysplasia. Complex open bite is frequently associated with
Class-I and Class-II malocclusions and occasionally associated
with Class III malocclusion.
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A c c o r d i n g t o z o n e :
• Posterior open bite: Posterior open bite is
characterized by failure of number of teeth in
either or both opposing buccal segments to
reach occlusion although there is incisor
contact.
It is seen rarely and can be because of
• Tongue interposition
• Disturbances in eruption (eg. ankylosis)
• Primary failure of eruption
• Complete open bite
T U E S D A Y , A U G U S T 3 , 2 0 2 1 35
• Anterior open bite: Anterior
open bite from its etiological
point of view are divided into
two categories:
• Dental
• Skeletal
• The dental anterior open bite
results from dental eruption
impediment.
• The skeletal open bite is due to
posterior facial growth

• It is defined as a
malocclusion with no
contact in the anterior
region of the dental arches
and the posterior teeth in
occlusion (Moyers 1991).
• The absence of any
vertical incisor overlap
between the upper and
lower incisors.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 36
A N T E R I O R O P E N B I T E

C L A S S I F I C AT I O N O F A N T E R I O R O P E N B I T E
T U E S D A Y , A U G U S T 3 , 2 0 2 1 37
Andrew
Richardson
Transitional
Open bite
Digit
Sucking
Open Bite
Anterior
Open bite
due to local
pathology
Open Bite
Due to
Skeletal
Pathology
Non
Pathological
Skeletal
Open Bite

T U E S D A Y , A U G U S T 3 , 2 0 2 1 38

B . P R E VA L E N C E
• Anterior open bite (AOB) is widespread among young children, with prevalence ranging
from 17% to 18% of children in the mixed dentition [Kasparaviciene et al., 2014; Tausche
et al., 2004; Silvestrini-Biavati, 2016].
• When associated with sucking habits, the prevalence increases to 36.3% [Cozza et al.,
2005].
• A tendency towards self improvement from the deciduous to the late mixed dentition is
expected during pre-pubertal growth [Worms et al., 1971; Phelan et al., 2014], and it is
demonstrated that, if AOB persists during the cranio-facial pubertal growth spurt, it hardly
ever self-corrects or even worsens [Phelan et al., 2014].
T U E S D A Y , A U G U S T 3 , 2 0 2 1 39
M. Rosa, Quinzi V, G. Marzo. The correction of anterior open bite in the mixed dentition: treatment or over-
treatment? European Journal of Paediatric Dentistry vol. 20/1-2019

P O S T E R I O R O P E N B I T E
• Posterior open bite can be defined as failure of contact
between the posterior teeth when the teeth occlude in
centric occlusion.
• Causes: 1. Mechanical interference with eruption, either
before or after tooth emerges from alveolar bone.(
ankylosis, trauma, supernumerary teeth, non resorbing
deciduous tooth roots/alveolar bone.)
2. Failure of eruptive mechanism of the tooth so that
the expected amount of eruption does not occur.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 40

C . E T I O L O G Y
• Hereditary factors
• The open-bite anomaly is most often associated with inherited facial growth.
Horizontal skeletal dysplasias appear to be inherited thus dysplasias in the vertical
plane may also be inherited.
• Three major theories, in the recent years have attempted to explain determinants of
craniofacial growth.
• Bone, like other tissues, is the primary determinant of its own growth.
• The determinant of skeletal growth is cartilage while bone respond secondarily
and passively.
• The primary determinant of growth is the soft tissue matrix in which skeletal
elements are embedded and both bone and cartilage are secondary follower’s.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 41

• Non-hereditary factors
• Subtelny and Sakuda (1964) and Tulley (1969), have stressed the
abnormal functional patterns of the tongue, pernicious oral habits (Figure
3), abnormal swallowing patterns (Figure 4) and speech problems, all
contributing to, and being part of, the open-bite phenomenon.
• A malfunction of the tongue can be a contributing cause or the result of an
abnormal swallowing behaviour.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 42

Digit sucking
habit
Lip & tongue
habits
Airway
Obstruction
Skeletal
growth
abnormalities
Iatrogenic
Open Bite
Pathological
Open Bite
Muscular
Dystrophy
T U E S D A Y , A U G U S T 3 , 2 0 2 1 43

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Title Authors
Journal
LOE Aim Methodology Results Conclusion
Association
between
psychologic
al factors,
socio-
demographi
c
conditions,
oral habits
and
anterior
open bite in
five-year-
old children
Gomesa M
C , Nevesa
ETB ,
Perazzob
MF ,
Martinsb
C, Paivab
S M,
Granville-
Garciaa A.
ACTA
ODONTOL
OGICA
SCANDIN
AVICA
2018
4 to evaluate
association
between
psychological
factors,
socio-
demographic
conditions, oral
habits and
anterior open
bite in five-
year-old
preschool
children.
A cross-sectional study was
conducted with 764 pairs of
children and
parents/caregivers in
preschools. The
parents/caregivers answered
questionnaires addressing oral
health-related quality of life
(OHRQoL), sense of coherence,
locus of control, oral habits and
sociodemographic
characteristics. The children
answered a self-report
questionnaire addressing
OHRQoL
and were submitted to a clinical
examination for the anterior
open bite by examiners.
Descriptive analysis
was conducted, followed by
Poisson’s regression analysis.
The prevalence of
anterior open bite was
15.2%. The following
variables remained
significantly
associated with anterior
open bite: pacifier use
(PR¼7.09; 95% CI: 4.06–
12.39), attending a public
preschool
(PR¼2.40; 95% CI: 1.68–
3.43), digit sucking
(PR¼2.15; 95% CI: 1.27–
3.62), greater number of
residents in the home
(PR¼1.67; 95% CI: 1.18–
2.36) and impact on
OHRQoL according to
child’s report
(PR¼1.56; 95% CI: 1.11–
2.20).
Anterior open
bite was
associated with
OHRQoL
according to the
children’s
reports.
Moreover,
attending a
public preschool,
a greater
number of
residents in the
home, digit
sucking and
pacifier sucking
were associated
with this type of
malocclusion.

T U E S D A Y , A U G U S T 3 , 2 0 2 1 45
Title Authors
Journal
Breastfee
ding and
non-
nutritive
sucking
patterns
related to
the
prevalenc
e of
anterior
open bite
in
primary
dentition
Camila
Campos,
Junior H S,
Garib D,
Ferreira A
C, Ferreira
R. J Appl
Oral Sci.
011;19(2):
161-8
4 the
association
between
breastfeeding
and non-
nutritive
sucking
patterns
and the
prevalence of
anterior open
bite in
primary
dentition
Infant feeding and
non-nutritive sucking
were investigated in a
3-6 year-old sample
of 1,377
children, from São
Paulo city, Brazil.
Children were
grouped according to
breastfeeding
duration: G1 – non-
breastfed, G2 –
shorter than 6
months, G3 –
interruption
between 6 and 12
months, and G4 –
longer than 12
months
The prevalence
estimates of anterior
open bite were:
31.9% (G1), 26.1%
(G2), 22.1%
(G3), and 6.2% (G4).
G1 would have
significantly more
chances of having
anterior open
bite compared with
G4
Breastfeeding and non-
nutritive sucking
durations demonstrated
opposite effects on the
prediction of anterior
open bite. Non-
breastfed children
presented
significantly greater
chances of having
anterior open bite
compared with those
who were
breastfed for periods
longer than 12 months

T U E S D A Y , A U G U S T 3 , 2 0 2 1 46
Title Authors
Journal
L
O
E
Aim Methodology Results Conclusion
The effect
of pacifier
sucking on
orofacial
structures:
a
systematic
literature
review
Schmid K,
Kugler R,
Prasad N,
Bosch C,
Verna C.
Progress
in
Orthodonti
cs (2018)
19:8
2a to find
scientifi
c
evidenc
e on
the
effect
of
pacifier
sucking
on
orofaci
al
structur
es.
A search on MEDLINE,
EMBASE, Cochrane Central
Register of Controlled Trials,
and Web of Science
databases was conducted to
find all pertinent articles
published from inception until
February 2018, based on the
Preferred Reporting Items for
Systematic Reviews and
Meta-Analyses (PRISMA)
guidelines. The quality of the
studies
was evaluated using the risk
of bias judgements in non-
randomized studies of
interventions (ROBINS-I).
Among the 2288 articles
found, 17 articles met the
selection criteria: seven
prospective cohort
studies, nine
cross-sectional studies,
and one randomized
clinical trial. Using
ROBINS-I, 12 studies
were evaluated to have a
serious overall risk of bias
and five, a moderate one.
These studies claimed a
strong association
between a pacifier
sucking habit and the
presence of an anterior
open
bite and posterior
crossbite.
High level of evidence of the
effect of sucking habits on
orofacial structures is missing.
The available studies show
severe or moderate risk of
bias; hence, the findings in the
literature need to be very
carefully evaluated.
There is moderate evidence
that the use of pacifier is
associated with anterior open
bite and posterior crossbite,
thus affecting the harmonious
development of orofacial
structures

D . C L I N I C A L F E AT U R E S
• Increased lower anterior facial height
• Decreased posterior facial height
• Steep mandibular plane angle
• Short upper lip with excessive maxillary incisor exposure
• Anterior open bite
• Class II malocclusion/ mandibular deficiency
• Narrow maxilla
• Sometimes posterior crossbite
T U E S D A Y , A U G U S T 3 , 2 0 2 1 47
Millett D, Welbury R. Clinical problem in Orthodontics and Pardiatric dentistry. Elsvier
publication

E . C E P H A L O M E T R I C F E AT U R E S
• Downward backward rotation of mandible
• Upward tipping of maxillary skeletal base
• Excessive eruption of maxillary posterior
teeth
• Excessive eruption of maxillary and
mandibular anterior teeth
T U E S D A Y , A U G U S T 3 , 2 0 2 1 48
Millett D, Welbury R. Clinical problem in Orthodontics and Pardiatric dentistry. Elsvier
publication

E . M A N A G E M E N T
T U E S D A Y , A U G U S T 3 , 2 0 2 1 50
Before 5
years of age
Habit
present
Orthodontic
Treatment after 5
years of age
Habit
abandoned
Bite did not
close
Orthodontic
Treatment
required
Bite Closed
Without tongue
Functional
Problem
No Treatment
Required
Tongue
functional
problem
Speech
Therapy

1 . R E M O VA L O F C A U S E
• Thumb Sucking or tongue thrusting habit:
• Awareness, contract of reward/ punishment,
positive reinforcement, Chemical aversion,
hand wraps.
• Removable or fixed appliances- with or without
arch expansion
T U E S D A Y , A U G U S T 3 , 2 0 2 1 51
Dr Deepika Chari

T U E S D A Y , A U G U S T 3 , 2 0 2 1 52
Nagan P, Henry W. Open bite: a review of etiology and management. American Academoyf
Pediatric Dentistry. 1997

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Bahadure R, Thosar N, Jain E, Meena D, Pendor S. Management of Open Bite in Primary Dentition: A
Case Report. Journal of Datta Meghe Institute of Medical Sciences University · December 2012.
Figure 1: Intraoral photograph
showing anterior open bite
Figure 2: A modified
fixed tongue thrusting
habit breaking appliance
Figure 3: Intraoral
photograph showing
modified fixed tongue
thrusting habit breaking
appliance
Figure 4: Follow up after 6 months
showing correction of anterior open
bite
Figure 5: Follow up after 4 years showing normal
occlusion

2 . M Y O F U N C T I O N A L T H E R A P Y
a. Bionator: Developed by Balters 1950s.
• Similar as activator- but less bulky and
more elastic
• Types: Standard Appliance, Class III
Appliance, The Open Bite appliance
T U E S D A Y , A U G U S T 3 , 2 0 2 1 54
Graber’s Textbook of Orthodontics Basic Principles & Practices. 4th Edition. Elsvier
Publication

• Components:
• Wire Components- palatal arch, vestibular wire
• Acrylic Components- maxillary plate covers only premolars and molars (distal to 1st
permanent molar)
• Occlusal surface covered to stabilize appliance
• Anterior region covered to prevent tongue thrusting
T U E S D A Y , A U G U S T 3 , 2 0 2 1 55
Publication

b . F u n c t i o n a l R e g u l a t o r s
• Myofunctional Appliance developed by Prof. Rolf Frankel in Germany.
• Also called as Frankel appliance, vestibular appliance, oral
gymnastic.
• Two main treatment effects-
1. Muscle function- artificial balancing of environment
2. Removes muscle forces in buccal and labial areas & restrict skeletal
growth thereby providing environment which enables skeletal growth.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 56
Publication

M O D E O F A C T I O N O F F R A N K E L A P P L I A N C E
Increase in transverse and sagittal intra-oral space
Increase in vertical space
Mandibular protraction
Muscle function adaptation
T U E S D A Y , A U G U S T 3 , 2 0 2 1 57
Publication

• Frankel 4 is similar as Frankel 1: difference- it lacks canine loops and protrusion bows
• Consists of 4 occlusal rests on maxillary 1st molars and 1st deciduous molars to prevent
tipping of the appliance.
• 1st few weeks: 2-4 hours /day (day time)
• After 3 weeks: 4-6 hours/day (day time)
• After 3rd visit (2 months): full time wear.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 59
Graber’s Textbook of Orthodontics Basic Principles & Practices. 4th Edition.
Elsvier Publication

T U E S D A Y , A U G U S T 3 , 2 0 2 1 60
Oliveira D. et. al. Orthodontic and orthopaedic treatment for anterior open bite in children. Cochrane
database systematic review. 2014 sept;24(9).

3 . O R T H O D O N T I C T H E R A P Y
• Mild to moderate open bites can be corrected
• Fixed mechano-therapy
• Consists of elastics stretched between upper and lower anterior
• Can be combined with transpalatal arch and high pull headgear (to limit vertical
development of maxillary molars.)
• TPA prevents buccal rolling of molars.
• Distal movement of teeth with headgear is contraindicated- class II/III malocclusion will
lead to worsening of open bite
T U E S D A Y , A U G U S T 3 , 2 0 2 1 61
Graber’s Textbook of Orthodontics Basic Principles & Practices by Shridhar Premkumar. 4th Edition. Elsvier
Publication

4 . R O L E O F E X T R A C T I O N S I N O P E N B I T E
• Anterior open bite associated with proclined anterior
• Bimaxillary proclination, Class II malocclusions- retraction of
anterior teeth help reducing open bite
• Extraction of premolars has been accepted by clinicians
T U E S D A Y , A U G U S T 3 , 2 0 2 1 62
Graber’s Textbook of Orthodontics Basic Principles & Practices by Shridhar Premkumar.
4th Edition. Elsvier Publication

5 . E X T R A O R A L T R A C T I O N
• High pull headgear prevents vertical eruption of upper molars, limits vertical growth of
dento-alveolus: minimize clockwise rotation of mandible.
• Can be used in conjunction with fixed orthodontic therapy and myofunctional appliances.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 63

6 . S U R G I C A L C O R R E C T I O N
• Skeletal open bites in adults
• Combination of fixed orthodontics and orthognathic surgeries
• Surgery may be segmental or whole jaw
• Treatment should be started after growth has ceased.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 64

R E T E N T I O N O F A N T E R I O R O P E N B I T E
• Continued vertical growth
• Eruption of posterior teeth until late teenage
• Vertical growth of maxilla till last stage of
maturation
• Retention of habit
T U E S D A Y , A U G U S T 3 , 2 0 2 1 65
• Maxillary removable retainer with
attached headgear
• Retainer with passive posterior bite
blocks

T U E S D A Y , A U G U S T 3 , 2 0 2 1 66

T U E S D A Y , A U G U S T 3 , 2 0 2 1 67
Title Authors
Journal
Effectivene
ss of the
open bite
treatment
in growing
children
and
adolescent
s. A
systematic
review
Feres N F,
Abreu G L,
Insabralde
M I ,
Almeida R,
Flores-Mi
C
1a to provide
a
comprehe
nsive
review
evaluating
the
effectiven
ess of the
orthodonti
c
correction
of AOB in
growing
individuals
.
Search was conducted
on PubMed, Embase,
Cochrane Library, Web
of Science,
Scopus, Google
Scholar, Scielo, and
Lilacs databases. Trials
registries were
consulted for ongoing
trials, and grey literature
was also contemplated.
The 22 studies
included in this review
mostly considered
mixed dentition
subjects, and there
was a considerable
variation regarding
therapeutic
approaches. Because
of poor-quality and/
or insufficient
evidence, consistent
results were not
found. However, some
useful clinical
inferences
and suggestions for
future studies were
provided for each
therapeutic modality
considered here
A comprehensive and
updated review
regarding the
effectiveness of
the orthodontic therapy
on the early correction of
dental or skeletal
open bite was provided.
Despite large variability
and methodological
inaccuracies, specific
inferences and
directions for future
studies were presented.
Even though the
methodological quality of
the studies has been
improving, additional
efforts must still be
directed to perform
better and conclusive
studies.

SUMMARY
T U E S D A Y , A U G U S T 3 , 2 0 2 1 68

 B I B L I O G R A P H Y
• Proffit W. Contemporary Orthodontics. 6th Edition. Elsvier publication
• Millett D, Welbury R. Clinical problem in Orthodontics and Pediatric dentistry. Elsvier
publication.
• Graber’s Textbook of Orthodontics Basic Principles & Practices. 4th Edition. Elsvier
Publication.
• Nanda R. Biomechanic & Esthetic Strategies in Clinical Orthodontic. Page No. 131-176.
Elsvier Publication 2005.
• Singh G. Textbook of Orthodontics. Second Edition. Jaypee Publication 2007.
• McDonald, Avery’s Pediatric dentistry for Child and Adolescent by Dean J. 10th Edition.
Elsveir Publication.
• S I Bhalaji. Orthodontics the Art & Science. 6th Edition. Arya Publication2015.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 69

• Naini F, Daljit SG, Sharma S, Tredwin C. The Aetiology, Diagnosis & Management of Deep Overbite.
Dental Updates. July- August 2006.
• Wajid M A, Chandra P, Kulshrestha R, Singh K, Rastogi R, Umale V. Open bite malocclusion: An overview
J Oral Health Craniofac Sci. 2018; 3: 011-020. DOI: 10.29328/journal.johcs.1001022.
• Li Z, Chen Z, Sun J, Yang L, Chen Z. Correction of Deep Overbite by Using a Modified Nance
appliance in an Adult Class II Division 2 Patient with Dehiscence Defect. Case Reports in
Dentistry. Volume 2018, Article ID 9563875.
• Sahu S, Sahoo N, Mohanty P, Gowd S, Srinivas B, Samantaray S. Orthodontic Intrusion: An
Insight. International Journal of Oral Health and Medical Research | ISSN 2395-7387 | MARCH-
APRIL 2017 | VOL 3 | ISSUE 6.
• M. Rosa, Quinzi V, G. Marzo. The correction of anterior open bite in the mixed dentition:
treatment or over-treatment? European Journal of Paediatric Dentistry vol. 20/1-2019
T U E S D A Y , A U G U S T 3 , 2 0 2 1 70

• Nagan P, Henry W. Open bite: a review of etiology and management. AmericaAn cademoyf
Pediatric Dentistry. 1997.
• Subtelny JD, Sakuda M: Open-bite: diagnosis and treatment. Am J Orthod 50:337-58, 1964
• Bahadure R, Thosar N, Jain E, Meena D, Pendor S. Management of Open Bite in Primary Dentition: A
Case Report. Journal of Datta Meghe Institute of Medical Sciences University · December 2012.
T U E S D A Y , A U G U S T 3 , 2 0 2 1 71

T U E S D A Y , A U G U S T 3 , 2 0 2 1 72

Corrective orthodontics- deep bite & open bite

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