Management of open bite in orthodontics...

Management of open bite in orthodontics

1. MANAGEMENT OF OPEN BITE IN ORTHODONTICS PREPARED BY DR. WESAM GOUDA PhD IN ORTHODONTICS PROFESSOR IN ORTHODONTIC DEPARATMENT FACULTY OF DENTAL MEDICINE ALAZHR UNIVERSITY

2. MANAGEMENT OF OPEN BITE

3. What is open bite ? Open bite is characterized by lack of vertical overlap of the maxillary dentition over the mandibular dentition. It can occur anteriorly Which may defined as A negative overbite between the incisal edges of the maxillary and mandibular anterior teeth.

4. Or posteriorly Which characterized by lack of contact between the posterior teeth when they are brought to centric occlusion .

5. Or combined Which icludes the anterior as well as posterior teeth

6. The extent of open bite can vary from being simply dental in nature to more complicated skeletal open bite.

7. What is the problem with open bite ?

8. I can not bite I can not smile

9. Lisping Lack of self esteem

10. I can not chewing my food In case of posterior open bite

11. Can we differentiate between dental and skeletal open bite ???

12. Skeletal open bite Patient with skeletal open bites may have Adenoid faces or Long face syndrome They are said to have what is known as  Hyperdivergent Growth Pattern  which includes characteristics such as: 1- Increased Lower Anterior Facial Height 2- Occlusal plane diverges after the 1st molar contact

13. 3- Narrow nostrils with upturned nose 4- Dolicofacial face pattern

14. 5- Constricted maxillary arch 6- Bilateral Posterior Crossbite

15. 7- High and narrow palatal vault 8- Presence of crowding in teeth 9- Mentalis muscle strain upon forcibly closing of lips 10- Possible gummy smile with increased interlabial gap

16. Cephalometric analysis   features of skeletal open bite may include: Increased Frankfurt-Mandibular Plane angle Steep Occlusal Plane Angle Increased SN-MP Angle Short Mandibular ramus Increased mandibular body length

17. Increased gonial angle Proclined upper incisors, retroclined or upright lower incisors Posterior part of maxilla is tipped downwards Posterior facial height equals 1/2 of anterior facial height Increased hard tissue Lower Anterior Facial Height Increased total anterior facial height Downward and backward position of mandible

18. Dental open bite Normal lower anterior facial height Horizontal/ Hypodivergent growth pattern Occlusal plane diverges after the premolar contact Under-eruption of the anterior incisors

19. Over-eruption of the posterior incisors Proclined upper and lower incisors No vertical maxillary excess or gummy smile Presence of habits such as thumb sucking, tongue thrusting Spacing between anterior incisors due to their proclination

20. Causes of open bite

21. 1- Heredity The growth pattern of maxilla and mandible is controlled by GENES that inherited from parents.

22. 2- Macroglossia Mismatch between skeletal size and size of tongue that inherited from the parents may result in anterior and/or posterior open bite

23. 3- Tongue thrusting Tongue thrusting may be a causative factor of open bite OR it is a result of open bite Anterior tongue thrusting

24. Tongue thrusting may be a causative factor of open bite OR it is a result of open bite Lateral tongue thrusting

25. 4- Thumb sucking Prolonged thumb sucking habit is one of the chief etiological factor of open bite

26. 5- Nasopharyngeal air way obstruction (Adenoid) Nasopharyngeal air way obstruction may result in open bite and tongue thrusting

27. 6- Infra-eruption of dento -alveolar structures So open bite may be transient during eruption of anterior or posterior teeth

28. MANAGEMANT OF OPEN BITE

29. The first aid treatment is removal of the cause to prevent relapse.

30. Tongue guard in case of thrusting and/or thumb sucking

31. Adenoidectomy in case of nasal air way obstruction

32. Oral screen to learn the patient to be nasal breather instead of oral breather

33. Active orthodontic treatment Mild to moderate open bites can be treated with fixed orthodontic appliances and box elastics

34. Active orthodontic treatment Mild to moderate open bites can be treated with fixed orthodontic appliances and box elastics

35. Anterior open bite treatment using bite block

36. Anterior open bite treatment through molar intrusion

37. Orthognathic surgery Severe skeletal open bite should be treated with Orthognathic surgery

38. Stability and relapse Surgery vs. non-surgery Geoffrey Greenlee and others published a meta-analysis in 2011 which concluded that patients with orthognathic surgical correction of open bite had 82% stability in comparison to non-surgical correction of open bite which had 75% of stability after 1or more year of treatment. Both the groups started with 2-3mm of open bite initially.

39. Stability and relapse Molar intrusion Man- Suk Baek and others evaluated long-term stability of anterior open bite by intrusion of maxillary posterior teeth. Their results showed that the molars were intruded by 2.39mm during treatment and relapsed back by 0.45mm or 22.8%. The incisal overbite increased by 5.56mm during treatment and relapsed back by 1.20mm or 17%. They concluded that majority of the relapse occurred during first year of treatment.