Anterior open bite self-correction after cessation of non-nutritive sucking habits: a systematic review.

BACKGROUND: Non-nutritive sucking habits likely may cause occlusal changes such as anterior open bite (AOB) if they persist over extended time. OBJECTIVES: To assess if there is self-correction of AOB after cessation of non-nutritive sucking habits in children older than 4 years old, through a systematic review. SEARCH METHODS: Data sources included PubMed, Scopus, Web of Science and Latin American and Caribbean Health Sciences (LILACS) databases, gray literature as Google Scholar, the database System for Information on Gray Literature in Europe (OpenGrey) and ProQuest Dissertations and Theses Database, also hand searches of the included studies references. SELECTION CRITERIA: Studies assessing occlusal changes in children aged 4-12 years with AOB traits and non-nutritive sucking habits after the discontinuation of the habit were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility and extracted data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale and the Joanna Briggs Critical Appraisal Checklist for quasi-experimental studies. The confidence in cumulative evidence was assessed using the GRADE criteria. RESULTS: Over 3100 studies, only 5 met the inclusion criteria. There is often self-correction of AOB after discontinuing the non-nutritive sucking habit, even in cases older than 4 years old. The improvement ranged between 50 and 100%. The overall quality of evidence was very low. CONCLUSIONS: AOB self-correction after discontinuing a non-nutritive sucking habit is possible, even after 4 years old, although with very low certainty in the body of evidence. It is not clear after what age the removal from the habit is unlikely to facilitate AOB self-correction. REGISTRATION AND CONFLICT OF INTEREST: International Prospective Register of Systematic Reviews code: CRD42016052171. There was no conflicting interest from the review authors.

Repeat Flow Diversion for Cerebral Aneurysms Failing Prior Flow Diversion: Safety and Feasibility From Multicenter Experience.

BACKGROUND: Aneurysmal persistence after flow diversion (FD) occurs in 5% to 25% of aneurysms, which may necessitate retreatment. There are limited data on safety/efficacy of repeat FD-a frequently utilized strategy in such cases. METHODS: A series of consecutive patients undergoing FD retreatment from 15 centers were reviewed (2011-2019), with inclusion criteria of repeat FD for the same aneurysm at least 6 months after initial treatment, with minimum of 6 months post-retreatment imaging. The primary outcome was aneurysmal occlusion, and secondary outcome was safety. A multivariable logistic regression model was constructed to identify predictors of incomplete occlusion (90%-99% and <90% occlusion) versus complete occlusion (100%) after retreatment. RESULTS: Ninety-five patients (median age, 57 years; 81% women) harboring 95 aneurysms underwent 198 treatment procedures. Majority of aneurysms were unruptured (87.4%), saccular (74.7%), and located in the internal carotid artery (79%; median size, 9 mm). Median elapsed time between the first and second treatment was 12.2 months. Last available follow-up was at median 12.8 months after retreatment, and median 30.6 months after the initial treatment, showing complete occlusion in 46.2% and near-complete occlusion (90%-99%) in 20.4% of aneurysms. There was no difference in ischemic complications following initial treatment and retreatment (4.2% versus 4.2%; P>0.99). On multivariable regression, fusiform morphology had higher nonocclusion odds after retreatment (odds ratio [OR], 7.2 [95% CI, 1.97-20.8]). Family history of aneurysms was associated with lower odds of nonocclusion (OR, 0.18 [95% CI, 0.04-0.78]). Likewise, positive smoking history was associated with lower odds of nonocclusion (OR, 0.29 [95% CI, 0.1-0.86]). History of hypertension trended toward incomplete occlusion (OR, 3.10 [95% CI, 0.98-6.3]), similar to incorporated branch into aneurysms (OR, 2.78 [95% CI, 0.98-6.8]). CONCLUSIONS: Repeat FD for persistent aneurysms carries a reasonable success/safety profile. Satisfactory occlusion (100% and 90%-99% occlusion) was encountered in two-thirds of patients, with similar complications between the initial and subsequent retreatments. Fusiform morphology was the strongest predictor of retreatment failure.

Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review.

BACKGROUND: Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed. SUMMARY: The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123-81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

Characterisation of anterior open bite in primary school-aged children: A preliminary study with artificial neural network analysis.

BACKGROUND: Non-nutritive sucking habits, bottle feeding, and facial hyperdivergency have been suggested as the influencing factors of anterior open bite (AOB). There was inconsistent reporting of prevalence and a gap of knowledge in the literature. AIM: The aim of this study was to investigate the prevalence of AOB in 7- to 12-year-olds, with a special interest to characterise the determinants of this malocclusion. DESIGN: A sample of 203 children aged 7 to 12 years were selected from a primary school in regional Australia. The legal guardian of each child completed a self-administered questionnaire. Data were assessed using methods of univariate statistics and neural analysis. RESULTS: The prevalence of AOB and thumb sucking was 24.1% and 23.2%, respectively. AOB was associated with the habit (correlation = 0.754) and duration (correlation = 0.574) of thumb sucking. Age, gender, birth order, feeding modality, sleep patterns, history of orthodontic treatment and tonsil, adenoid or grommet surgery, and parents' level of education were not related to AOB (correlation absolute value ≤ 0.474). CONCLUSIONS: Thumb sucking, specifically for prolonged duration, increases the risk of development of AOB. Cessation of thumb sucking habits should be encouraged at an early age to avoid the development of AOB.

Pathways to anterior open bite after changing of pacifier sucking habit in preschool children: A cohort study.

BACKGROUND: Pacifier use is a major cause of anterior open bite (AOB), which negatively impacts the quality of life of children affected. AIM: To assess the direct and indirect pathways related to pacifier sucking habit and AOB in preschool children. DESIGN: This 2-year cohort study evaluated a random sample of preschool children (2-5 years of age) from Southern Brazil. Caregivers answered a questionnaire addressing socio-economic and behavioural characteristics. Anterior open bite was recorded following the criteria recommended by Foster and Hamilton. Structural equation model was performed to assess the direct and indirect pathways among variables at baseline (T1) to predict the AOB at follow-up (T2). RESULTS: Regarding the AOB, 407 children were evaluated at T1 and 187 at T2. The prevalence of AOB was 32.9% at baseline and 16.0% at follow-up. The presence of AOB at follow-up was directly affected by the change in pacifier sucking habit from T1 to T2. Considering the indirect paths, the AOB at T1 influenced the AOB in T2 via a change of pacifier sucking habit. CONCLUSION: These findings suggest that the non-habit of sucking pacifiers is a fundamental strategy for the prevention of AOB as well as the promotion of health in childhood.

Occlusal traits and longitudinal dental changes in children and adolescents with congenital or childhood onset myotonic dystrophy.

BACKGROUND/OBJECTIVES: This research aimed to study the malocclusions of children and adolescents with myotonic dystrophy type 1 (DM1), in respect to healthy individuals, and trace the occlusal changes that occurred in these individuals during growth. MATERIALS/METHODS: Thirty-six dental casts, from children and adolescents with DM1 living in western and southern Sweden, were compared with a control group of 50 healthy individuals. To identify potential changes in occlusal traits, 26 casts were assessed and followed-up over a median time of 9 years. Independent samples t-tests were used to compare the two groups and their changes over time. Paired samples t-tests tested changes over time within each group (P < 0.05). RESULTS: DM1 patients had a higher prevalence of anterior open bite, posterior crossbite, and Class III malocclusions. When compared to controls, patients presented smaller upper and lower intermolar as well as intercanine widths. In both groups, the individuals revealed longitudinal changes with a decrease in both upper and lower arch lengths and an increase on the palatal vault height. During the follow-up period, the prevalence of malocclusions remained almost the same, only significantly differing regarding the changes that occurred between groups referred to the upper intermolar width, which decreased among DM1 patients. CONCLUSIONS/IMPLICATIONS: In comparison to healthy controls, children and adolescents with DM1 have shown already at an early age a higher prevalence of both anterior open bite and posterior crossbite. These occlusal traits did not change with time apart from the upper narrow intermolar width, which further decreased with time.

Long-term Management of a Patient with Apert Syndrome.

AIM AND OBJECTIVE: To present an Apert syndrome patient with midfacial growth deficiency treated with Le Fort III distraction osteogenesis and subsequent two-jaw surgery. BACKGROUND: Apert syndrome is expressed as a severe and irregular craniosynostosis, midfacial hypoplasia, and symmetric syndactyly in the fingers and toes. For craniosynostosis syndromes, treatment planning is complex due to the disharmony between facial profile and occlusion. CASE DESCRIPTION: A 4-year-and-5-month-old boy, diagnosed with Apert syndrome, showed a concave profile accompanied with midfacial hypoplasia, moderate exorbitism, a reversed occlusion of -10.0 mm, an anterior open bite of -5.0 mm, and skeletal class III jaw-base relationship. The patient, aged 15 years and 4 months, underwent a Le Fort III osteotomy, and subsequent osteodistraction was performed via a rigid external distraction (RED) device. His midfacial bone was advanced by approximately 7.0 mm. One year after the distraction, preoperative treatment with 0.018-in preadjusted edgewise appliances was initiated. Two-jaw surgery with a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy was performed after 42 months of preoperative orthodontic treatment. At the age of 20 years and 9 months, his facial profile dramatically changed to a straight profile, and an acceptable occlusion with an adequate interincisal relationship was obtained. A functional occlusion with an excellent facial profile was maintained throughout the 2-year retention period, although the upper dental arch width was slightly decreased, resulting in the recurrence of the left posterior crossbite. CONCLUSION: Our report indicates the necessity of long-term follow-up in patients with craniosynostosis because of syndrome-specific growth and methodologically induced relapse. CLINICAL SIGNIFICANCE: The two-stage operation combining early distraction osteogenesis and postgrowth orthognathic surgery proves to be an effective therapy for correcting midfacial hypoplasia and skeletal mandibular protrusion caused by Apert syndrome.

Anterior open bite due to idiopathic condylar resorption during orthodontic retention of a Class II Division 1 malocclusion.

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.

Relationship Between Occlusal Features and Enzyme Replacement Therapy in Patients With Mucopolysaccharidoses.

PURPOSE: The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. MATERIALS AND METHODS: A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. RESULTS: Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. CONCLUSION: Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Anterior open bite due to temporomandibular joint osteoarthrosis with muscle dysfunction treated with temporary anchorage devices.

Skeletal Class II high-angle open bite is often accompanied by osteoarthrosis of the temporomandibular joint (TMJ-OA). This type of malocclusion is challenging to correct, and it has been reported that patients with TMJ-OA treated with orthognathic surgery often experience skeletal relapse and a poor prognosis. This case report describes the treatment of a 25-year-old woman with retrognathia and TMJ-OA, whose masseter and temporal muscle activities were weak. Temporary anchorage devices were placed in the maxilla and the mandible, and the first molars were intruded. We used improved superelastic nickel-titanium alloy wires with tip-back bends for both arches, and intermaxillary elastics were used to upright the molars. After treatment, intrusion of the maxillary and mandibular first molars, counterclockwise rotation of the mandible, and improvement of occlusion and profile had been achieved. The patient's condyles were repositioned into ideal positions, and masticatory muscle activity was augmented and balanced. After 2 years of retention, the mandibular and condylar positions were stable, and acceptable occlusion was maintained without recurrence of TMJ symptoms; harmonious activity of the masticatory muscles was retained. The findings of this case report suggest that molar intrusion using temporary anchorage devices for a patient with severe anterior open bite and TMJ-OA may be useful for improving stomatognathic function, occlusion, and facial esthetics.

Beckwith-Wiedemann Syndrome: Open bite evolution after tongue reduction.

BACKGROUND: Macroglossia causes functional deficits such as airway obstruction, drooling, phonation difficulties, and leads to protrusion of dentoalveolar structures resulting in an anterior open bite and a prognathic mandibular appearance. Macroglossia is present in the majority of patients with Beckwith-Wiedemann syndrome (BWS) and surgical treatment may be indicated. MATERIAL AND METHODS: A retrospective review was conducted including BWS patients who underwent surgical tongue reduction between 2000 and 2015 at the Hospital Universitario La Paz, Madrid. RESULTS: Out of 16 patients with BWS, surgery was performed in 11 cases. Tongue protrusion with open bite was the main indication for surgical treatment. Reduction glossectomy was performed using the keyhole technique. We analysed the relationship between age at surgery and evolution of open bite. Complications were minimal and satisfactory outcomes were observed with a decrease in anterior open bite. CONCLUSIONS: In this study we have observed that surgical treatment in patients with BWS and open bite accompanied by macroglossia seems to provide positive results with a satisfactory outcome in dentoskeletal alterations.

Bilateral Condylar Hyperplasia-Nonsurgical Management: A Clinical Report.

Background: Patients present with malocclusions in the form of bilateral open bite with functional and esthetic challenges. These are particularly so whereby these are acquired through growth anomalies that create a change in the occlusal status whereby a patient has to adapt to the challenge of the occlusal change. While surgical intervention is a considered option to correct such changes, not all patients are willing to endure the consequences of this intervention and as such this report presents a conservative minimally invasive approach. Aim: This clinical report demonstrates a nonsurgical approach in the management of a patient with bilateral metabolically active condylar hyperplasia. Case report: The patient presented with a bilateral open bite with occlusal contacts only present on her second molars. The severity of the open bite was reported to be recently progressing and getting worse. This condition had impaired her chewing function and quality of life over an 8-year period. Bone scintigraphy was performed and metabolically active bilateral condylar hyperplasia was diagnosed. The patient refused surgical intervention and instead a conservative overlay denture was prescribed, which successfully restored her function and esthetics. Conclusion: Removable overlay dentures can be a relatively simple and effective treatment option for patients presenting with newly acquired bilateral open bites to give a functional and esthetic outcome. Clinical significance: This clinical report shows the conservative management of bilateral condylar hyperplasia with a simple removable overlay appliance. The occlusion has stabilized and the patient functions well. Keywords: Bone scintigraphy, Condylar hyperplasia, Open bite, Overlay denture.

Nonsurgical treatment of severe Class II malocclusion with anterior open bite using mini-implants and maxillary lateral incisor and mandibular first molar extractions.

This clinical case report presents the nonsurgical orthodontic treatment of a patient with skeletal Class II malocclusion, posterior crossbite, anterior open bite, accentuated dental discrepancies in both arches, and an odontoma. The proposed treatment involved maxillary expansion, extraction of atypical maxillary lateral incisors and mandibular first molars, and intrusion of maxillary teeth with the aid of mini-implants. The results obtained with these procedures included good tooth alignment, normal overbite and overjet, removal of the odontoma, and a harmonious smile. In complex cases, an accurate diagnosis is the key to a favorable outcome.

Characteristic of Malocclusion among Saudi Special Need Group Children.

INTRODUCTION: The present study analyzed the characteristics of malocclusions, occlusal traits among Special Health care Needs (SHCN) children with Down syndrome (DS) and autism disorder (AD) in Riyadh City, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A total of 100 DS and 100 AD children from five rehabilitation centers in and around Riyadh, Kingdom of Saudi Arabia, were included in the study. Any children with history of ongoing medical treatment, extraction, or orthodontic treatment were excluded from the study. Out of the 200 patients examined, 131 were males and 69 were females and the age of the children ranged from 6 to 14 years. The children were examined for malocclusion characteristics using the Angle's classification of malocclusion, and also other occlusal traits, such as overjet, overbite, cross bite, and open bite were also determined. The data obtained were analyzed using Statistical Package for the Social Sciences, version 16 to generate descriptive statistics for each variable. RESULTS: The analyzed data of the right and left permanent molar relation showed higher incidence of class III malocclusion (66%) in DS children as compared with (3-4%) AD children. The AD children presented with higher percentage of class I malocclu-sion (40-41%) as compared with (10-14%) DS children. During examination of the primary molars, the analyzed data showed that left primary molar had more mesial shift in AD children as compared with DS children. CONCLUSION: Down syndrome children had high incidence of class III malocclusion and autistic children had high incidence of class I malocclusion. Overall, the DS children were more prone to malocclusion. CLINICAL SIGNIFICANCE: This study provides database for health professionals in Saudi Arabia in regard to malocclusion of autis-tics and DS patients.

Surgical Orthodontic Treatment for Open Bite in Noonan Syndrome Patient: A Case Report.

Noonan syndrome, characterized by short stature, facial anomalies, and congenital heart defects, may also be associated with hematopoietic disorders. Craniofacial anomalies in affected patients include hypertelorism and severe open bite associated with masticatory dysfunction. We treated a Noonan syndrome patient with a skeletal open bite. Surgical orthodontic treatment including two-jaw surgery established a good occlusal relationship after correction of severe anemia. Both upper and lower incisors were moved to upright positions, while clockwise rotation of the palatal plane and decreased mandibular plane angle were accomplished. Lower masticatory activity may affect posttreatment occlusion in such cases.

Preoperative and postoperative examination of occlusal and maxillofacial changes after osteochondroma extirpation.

A patient came with left-side temporomandibular arthralgia, limited mandibular opening, frontal facial asymmetry, and a significant anterolateral open bite. Severe alterations in the occlusal and maxillofacial anatomy resulted from an osteochondroma associated with the mandibular condyle. We describe the changes associated with extirpation of the mandibular condylar osteochondroma and subsequent orthodontic treatment. These clinical changes resulted in improved facial symmetry and a satisfactory functional occlusion.

Rapid maxillary expansion in a pediatric patient with exocrine pancreatic insufficiency.

Exocrine pancreatic insufficiency is a condition capable of promoting changes in craniofacial growth and development. This case report describes treatment of a 9-year-old patient with chronic pancreatic insufficiency, highlighting the diagnostic aspects involved and clinical implications of this condition with respect to dental treatment. The treatment plan involved oral hygiene recommendations and correction of bilateral posterior crossbite and anterior open bite. Just 2 weeks after orthodontic treatment, the corrected dentition relapsed completely, confirming the difficulty of promoting ossification in the median palatine suture. Orthodontists should be careful to develop an individualized treatment plan for each patient with this abnormality, because these determinations could mean the difference between success and failure of the treatment approach.

Children using Day Nurseries' Facilities can be Associated with more Risk to Nonnutritive Sucking Habits.

INTRODUCTION: This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. MATERIALS AND METHODS: The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. RESULTS: The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. CONCLUSION: Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. CLINICAL SIGNIFICANCE: The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that the permanence of the children in day nurseries may be linked with deleterious oral habits, and it discusses strategies to minimize the occurrence of alterations in the normal occlusion.

Anterior Open Bite In 27 Months Old Children after Use of a Novel Pacifier - A Cohort Study.

OBJECTIVES: The aim of the present cohort study was to evaluate the influence of a novel pacifier on the first formation of malocclusion, the anterior open bite in children. STUDY DESIGN: 129 newborn children whose parents had decided to use pacifiers were randomly attributed to two experimental groups (D=Dentistar, n=56, Novatex, Pattensen, Germany; N=NUK, n=73, Mapa, Zeven, Germany). Children (n=42) who did not use a pacifier were not randomized and served as reference (C). Primary outcome was the presence of anterior open bite. It was hypothesized that D would result in lower incidence when compared to N. At the age of 27 months the children were examined with respect to anterior open bite. Fisher's exact test served to detect significant differences between groups D and N (SPSS 22.0). RESULTS: 121 children with a mean age of 26.7 months were included in the final analysis (D: n=45; N: n=42; C: n=34). In group D three children (6.7%) showed an anterior open bite. The respective values were 21 (50.0%) for N and 0 for C. The results for group D compared to N were significantly different (chi(2)-test, p<0.001). CONCLUSION: In comparison to a commonly used pacifier the novel one causes significantly less anterior open bites.

Infraoccluded Upper Deciduous Second Molars Leading to Caries in the Permanent Dentition.

Infraocclusion of primary teeth is a problem that can be recognized early by the general dental practitioner. Allowing affected teeth to deteriorate beyond a point where active intervention would be recommended can make treatment of the condition more complex or may lead to unexpected sequelae. The case described in this report of infraoccluded primary teeth, suffered pathology in adjacent teeth, leading to multiple extractions and fixed orthodontic treatment post surgery. This case highlights the need for early recognition of infraocclusion by the GDP and will suggest interceptive treatment options. CPD/CLINICAL RELEVANCE: To highlight the need of interceptive orthodontics in primary care when required.