This document discusses open-bite treatment in the deciduous and mixed dentitions. It is divided into sections on treatment for each stage of dental development. For the deciduous dentition, treatment focuses on eliminating habits and tongue thrusting using removable or fixed palatal cribs. In the mixed dentition, bands can be placed on molars and fixed cribs used to correct habits. Open-bite cases are also illustrated for Class I, II, and III malocclusions. Stability of treatment is high in both dentition stages according to research.

1. Open-bite Treatment
In The Deciduous &
Mixed Dentitions
Done by: Mohamed Yassin
Orthodontic Resident : 2nd year
Supervisor: Dr.Mohammed Allabani
Associate clinical Professor of Orthodontics

2. Guilherme Janson
Professor of the Department of
Orthodontics at Bauru Dental School
– University of São Paulo.
Professor Janson has published
more than 450 articles in
Orthodontic Journals
Fabrício Valarelli
Master and PhD in Orthodontics
▫️Professor of Orthodontics
▫️Author of the book "Open Bite”
Their most recent publication is :
'Evaluation of a new method of oral
health education in children with
cleft lip and palate'.
2

3. “
The anterior open-bite treatment was
divided according to the different
stages of dental development ;
because the overbite seems to respond
differently in each stage
3

4. “
One has to bear in mind that the
response to open-bite treatment may
vary individually.
4

5. 1.
OVERBITE
MEASUREMENT

6. OVERBITE MEASUREMENT
● Some authors measure the distance from the
mandibular incisor border, following its long
axis, to the palatal surface of the maxillary
incisor
● in some situations,
it may present errors.
For example!
6

7. OVERBITE MEASUREMENT
● The overbite measuring technique used by
the authors :
● Measures the distances between the
maxillary and mandibular incisor borders
perpendicularly to the occlusal plane
7

8. 2.
TREATMENT IN THE
DECIDUOUS DENTITION

9. TREATMENT IN THE DECIDUOUS
DENTITION
● The deciduous dentition is the stage in which
treatment of the open bite is easier because
there is basically dentoalveolar involvement
(about 95%), with little skeletal involvement in
the malocclusion
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10. 10

11. TREATMENT IN THE DECIDUOUS
DENTITION
● The primary causes of open bite at this stage
are deleterious habits and anterior tongue
posture.
● However, no orthodontic treatment should
begin before 5 years of age because of child
immaturity.
11

12. 12

13. TREATMENT IN THE DECIDUOUS
DENTITION
● Treatment of the open bite with a removable
or fixed palatal crib may be instituted in the
deciduous dentition,
● But it is preferable, because of child
immaturity, to postpone it to the
mixed dentition period.
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14. Removable palatal tongue crib.
14

15. Fixed palatal tongue crib.
15

16. 3.
TREATMENT IN THE
MIXED DENTITION

17. TREATMENT IN THE MIXED DENTITION
● In the mixed dentition, the skeletal
component of an anterior open bite is greater
than in the deciduous dentition due to
persistency of the etiologic factors,
● Spontaneous correction when the
habit is abandoned in the mixed dentition is
a little more difficult than in the deciduous
dentition and may take longer
17

18. TREATMENT IN THE MIXED DENTITION
● Some amount of open-bite self-correction, a
period of 6 months of observation, without
any appliances, can be given to evaluate
whether the overbite is improving.
● If it is not, then treatment should be started.
18

19. Spontaneous correction of the open bite after abandonment
of the habit 19

20. TREATMENT IN THE MIXED DENTITION
● However, if the open bite is greater than 2mm,
no observation period should be instituted
● Because there is no self-correction when it is
equal or greater than this amount
20

21. TREATMENT IN THE MIXED DENTITION
● In the mixed dentition, bands can be placed on
the first permanent maxillary molars.
● The fixed tongue crib has great effectiveness to
correct the habit, but presents great adaptation
difficulties from the patients, especially during
speech and meals
21

22. TREATMENT IN THE MIXED DENTITION
● If there is nasal obstruction or tonsils
hypertrophy, the child has to be referred to an
otolaryngologist for adequate treatment,
22

23. TREATMENT IN THE MIXED DENTITION
● Elimination of the etiological habit allows natural
correction of the open bite by reestablishment of
the normal vertical development of the anterior
teeth and alveolar processes and uprighting of
the maxillary incisors
23

24. TREATMENT IN THE MIXED DENTITION
● Impressions of the maxillary and mandibular
arches are necessary for the correct construction
of the removable or fixed crib.
● Another important aspect is to grind the acrylic
contacting the palatal surfaces of the maxillary
anterior teeth in removable appliances to allow
their vertical development and close the bite
24

25. Fixed palatal crib preventing tongue thrust and
incorrect tongue posture
25

26. Undesirable side effects with correction, such as crowding
of the incisors
26

27. TREATMENT IN THE MIXED DENTITION
● In the deciduous dentition, an open bite is
considered to be corrected when an overbite of
1 to 2 mm is obtained.
● In the mixed dentition, it should be of 2–3 mm
27

28. TREATMENT IN THE MIXED DENTITION
● After correction, a Hawley plate with an orifice in
the incisive papillae region used to help correct
the positioning of the tongue in the rest position
during a retention period similar to the
speech therapy period (if necessary),
28

29. TREATMENT IN THE MIXED DENTITION
● A modified Hawley plate with a tongue crib and
posterior bite block to eliminate anterior tongue
posture and control vertical posterior
dentoalveolar development can be used as well
29

30. TREATMENT IN THE MIXED DENTITION
● With a series of muscle exercises, the objective
of speech therapy is to reeducate the buccofacial
musculature during swallowing and speech, with
also the intention of increasing stability of the
results
30

31. TREATMENT IN THE MIXED DENTITION
● Tongue spurs can also be used in the mixed
dentition but the authors are mostly experienced
with tongue cribs, which have provided excellent
results, with a rate of 90% correction in the
patients used
31

32. 4.
Open bite associated
with different types
of malocclusions

33. “
● Several cases treated in the mixed
dentition are sequentially illustrated
and described. They were divided
into cases, with open bite associated
with Class I, II, and III malocclusions
33

34. Open-Bite And Class I
Malocclusions
34

35. Case No.1
● AMB, aged 7 years, had anterior open bite
● They reported thumb-sucking at night
● Clinically, she presented a slightly convex facial profile
● balanced growth pattern, and passive lip seal
● Class I malocclusion, with mild crowding of the maxillary lateral
incisors
● Tongue thrust during swallowing
35
Clinical findings

36. 36

37. Fixed tongue crib to correct the open bite of patient AB.
37

38. 38
Beginning of fixed
appliance treatment
phase of patient
To assure maintenance of a positive overbite, vertical anterior
3/16-in elastics were used at nighttime during 4 months

39. Final records of patient AB.
39

40. Two-year follow-up records of patient
40

41. Five-year follow
up records of
patient
41

42. Case No.2
● MTM, a girl aged 8 years and 1 month,
● Had anterior open bite and complaints of speech problems.
● Thumb-sucking was also reported.
● Clinically, she had a balanced facial growth pattern, slightly
convex facial profile, and passive lip seal
● Class I malocclusion,
● Absence of the right mandibular lateral incisor
● Geminated deciduous tooth at this space,
42
Clinical findings

43. Initial records of patient MTM
43

44. Case No.2
● Treatment consisted of a fixed palatal crib, which produced a
fast response after a month, decreasing the open bite,
● After 4 months, a positive overbite was obtained
● The appliance had to be removed at this stag because its
contact With the palate was causing inflammation
● Therefore, the patient was followed up for 24 months without
any appliance, until eruption of the permanent teeth
44
Treatment Sequences

45. Treatment sequence in the mixed dentition.
45

46. Case No.2
● After eruption of the permanent teeth, preadjusted fixed
appliances were installed,
● leveling and alignment were improved up to rectangular
0.019 × 0.025-in stainless steel archwires.
● Elastic chains were used in both dental arches to close
remaining interdental spaces
● Class II elastics were used 20h/d on the right side
● The right mandibular canine would replace the absent lateral
incisor, and the first premolar would substitute the canine
46
Treatment Phase 2

47. Beginning of fixed appliance treatment phase of patient
47

48. Final records of patient MTM
48

49. 18-month
follow-
up
records.
48-month
follow-up
records
49

50. Open-Bite Associated To
Class II Malocclusions
50

51. “
o Only treatment of the open bite should be
instituted, after 5 years of age
o Initiating class II malocclusion treatment in the
deciduous dentition is usually not recommended
because it may overly extend the treatment time

52. “
o Later, at least in the stage of late mixed dentition,
class ii anteroposterior discrepancy is addressed
o Only severe Class II malocclusions that negatively
affects the child’s social life should begin earlier
than the late mixed dentition

53. palatal crib associated to a maxillary splint
53

54. Case No.3
● ACSB, aged 7 years and 8 months.
● She had a slightly vertical facial pattern and a convex profile .
● she had half bilateral Class II malocclusion,
● Absence of the maxillary left deciduous canine,
● Anterior open bite,
● Lack of space for the permanent incisors
● Anterior tongue thrust during swallowing,
● Interposed the lower lip between the incisors
54
Clinical findings

55. 55

56. Case No.3
● Extracting the maxillary right deciduous canine to provide space
for eruption of the permanent lateral incisor.
● The patient was oriented to abandon the pacifier with
nonpunitive support of her parents.
● After 6 months, although she had abandoned the habit, there
was still an open bite.
● Tongue crib associated with a high pull maxillary splint was
installed to correct the open bite and the Class II relationship
● A lip bumper was used to eliminate the lower lip pressure on
the maxillary incisors to help in closing the bite
56
Treatment Sequences

57. Initial treatment sequence of patient
57

58. Case No.3
● After 10 months, the Class II relationship and the open bite were
corrected
● Fixed preadjusted appliances were installed,
● Open coil springs were placed to open spaces for right canines
● elastic chains placed to close any remaining interdental space,
● vertical 3/16 intermaxillary elastics were used at the canine and
premolar areas to improve interdigitation
58
Treatment Phase 2

59. End of treatment with
the maxillary splint
and tongue crib in
the mixed dentition.
Beginning of fixed
appliance treatment
in the late mixed
dentition of patient
59

60. Final treatment
mechanics
Final records
of patient
60

61. Stability was
observed after
36 months
posttreatment
61

62. Open-Bite Associated To
Class III Malocclusions
62

63. “
o When the open bite is associated with Class III
malocclusion,
o Treatment of both problems can begin
simultaneously, after 5 years of age

64. Case No.4
● Patient AJA, aged 6 years and 4 months
● Complaining of anterior open bite & reported thumb-sucking.
● She had a prognathic mandible,
● Slightly vertical growth pattern
● Strained lip competence
● mild Class III malocclusion,
● Narrow maxilla & bilateral posterior crossbite,
● Anterior open bite
● Radiographically, she had a skeletal Class III
64
Clinical findings

65. Initial records of patient
65

66. Case No.4
● Treatment began with maxillary expansion, with the Hyrax
expander ,until 8mm of expansion was obtained
● After the expansion and 4 months of retention with the Hyrax
appliance, it was removed
● Fixed palatal crib was installed to interrupt the thumb-sucking
habit, to close the anterior open bite, and to act as retention for
the expansion
66
Treatment Sequences

67. Treatment sequence of patient
67

68. Case No.4
● To obtain spaces for the maxillary permanent teeth, it was
decided to install fixed appliances concurrently with the fixed
palatal crib because the patient still presented a negative
overbite and consequent anterior tongue thrust during speech
and swallowing
● NiTi open coil springs were used to provide spaces for the
maxillary canines and to protrude the maxillary incisors
68
Treatment Sequences

69. Fixed appliances were set up to complement
treatment of patient 69

70. * 3/16 Class III elastics were bilaterally used 20h/d
* intermaxillary elastics used to overcorrect the overbite
70

71. • Hawley plate with an
orifice in the region of
the incisive papillae
was used in the
maxillary arch,
• canine to canine
bonded retainer was
used in the mandibular
arch, as retention
71

72. 4.
STABILITY IN THE
DECIDUOUS AND
MIXED DENTITIONS

73. TREATMENT STABILITY
● There is unanimous opinion that treatment
stability is close to 100% in the deciduous and
mixed dentition.
● investigated the treatment and posttreatment
effects of the quad-helix associated with crib
therapy, confirming the earlier
mentioned speculations
73

74. ● No treatment approach is better than the level
of stability it is able to provide.
● Stability is a major concern in orthodontic
treatment, especially in open-bite treatment,
because of the esthetic implications on the
smile.
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75. Thanks!
Any questions?
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