Noninvasive conservative management of anterior open bite treated with TADs versus clear aligner therapy.

OBJECTIVES: Anterior open bite can be treated non-surgically via molar intrusion using temporary skeletal devices (TAD). Clear aligner therapy (CAT) is recognized as a viable therapeutic modality for non-extraction treatment of adults with mild open bite. This study aimed to compare the treatment effect and mechanisms of open bite closure between patients treated with braces and TADs double arch intrusion and those treated with CAT. Treatment success at T3 was based on 1- positive overbite on ceph; 2- Change in the vertical dimension 3- post treatment POSI score equal to zero. MATERIAL AND METHODS: The TAD group includes 18 consecutively treated patients from the main author. The CAT group consisted of 16 selected patients from three different orthodontists. The observation time points were as follows: pretreatment (T1), end of molar intrusion and positive overbite achieved (T2), end of treatment (T3), at least 6-month follow-up (T4). Treatment changes were assessed by cephalometric analysis and frontal intraoral photo. RESULTS: At the end of treatment, 100% of the patient of the TAD group and 78,6% of the CAT group had a posi score of 0. The TAD group showed a significant reduction in vertical measurements (SN-MPA: -1,55° ± 0.41, LAFH: -3,05 ± 0.51 mm, U6-PP: -1.48 ± 0.30 mm), but the CAT group did not have significant changes for these variables. Both groups had significant increases in overbite from T1 to T3 (TAD: 4,32 ± 0,5 mm; CAT: 2,33 ± 0.56 mm), and overbite remained stable at T4. The CAT group did not have a significant upper molar intrusion, but a significant extrusion of 1.22 ± 0.42 mm of the lower incisor occurred. CONCLUSION: The TAD group achieved bite closure by upper molar intrusion, lower molar and incisors vertical control, and mandibular plane counterclockwise rotation, resulting in an improved AP and vertical relationship. The CAT group achieved bite closure through the lower incisor extrusion without significant change in the vertical dimension. CLINICAL RELEVANCE: This study provides relevant information about the skeletal and dental changes of open bite treatment with TADs double arch intrusion. The comparison with a control group treated with CAT confirms known information.

Orthodontic correction of acquired open bite with TMJ degeneration: A retrospective study of outcomes and stability.

BACKGROUND/PURPOSE: Newly developed temporary anchorage devices (TADs) serve a strong orthodontic anchorage to intrude molars for correction of anterior open bite (AOB). We measured cephalometric changes in skeletal open bite patients which developed subsequently to temporomandibular joint disorders with bilateral point contacts at terminal molars. METHODS: We retrospectively recruited 32 patients who had been treated their TMD before orthodontic correction (overbite: -3.14 ± 1.86 mm). Partial orthodontic appliances were used to intrude posterior teeth using TADs until positive OB obtained (T1). Full fixed appliances were then used to achieve proper overjet and overbite (T2). We collected lateral cephalograms before (T0), during (T1) and after (T2) treatment, and at follow-ups (T3). Using ANOVA, we analyzed the differences among these time points to determine treatment changes and stability of orthodontic results. RESULTS: In this group predominantly comprising young adult women, orthodontic treatment with TADs significantly reduced upper posterior dental heights (T2-T0:-1.84 ± 0.66 mm) and facilitated the retraction and uprighting upper incisors (T2-T0: -9.92 ± 1.72°), to achieve appropriate OJ (T2-T0: -3.21 ± 0.49 mm) and OB (T2-T0: 4.10 ± 0.28 mm) with p < 0.05. Except upper posterior dental height, most of cephalometric changes including OJ, OB, and upper incisal axis remained significant at follow-ups with retention time of 3.7 ± 2.6 years. Only three out of 30 patients experienced small amount of open bite at T3. CONCLUSION: Orthodontic correction of OJ remained relatively stable among 90 % of patients with TMJ degeneration by intrusion via TADs. This modern but conservative orthodontic approach can improve occlusal functions in skeletal open bites.

Surgery-first in interdisciplinary class II cases.

OBJECTIVES: To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment. CLINICAL CONSIDERATIONS: After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile. CONCLUSIONS: A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability. CLINICAL SIGNIFICANCE: An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.

Orthodontic camouflage treatment of a hyperdivergent adolescent patient with anterior open bite and TMD: a case report.

BACKGROUND: In orthodontics, anterior open bite is a common malocclusion that recurs frequently. Because the causes of anterior open bite are so varied, medical professionals must create customized treatment programs for each patient based on their unique etiology. Through the lowering of the posterior teeth, closure of the anterior teeth gap, and cooperation with intermaxillary traction, the treatment plan outlined in this case study sought to achieve a stable occlusion. CASE PRESENTATION: This case report aims to describe an orthodontic camouflage treatment of a 15-year-old female patient with anterior open bite, arch width discrepancy and a history of temporomandibular joint disorder. The patient was treated with intermaxillary vertical elastics and the multiple edgewise arch wire (MEAW) approach. A satisfactory occlusion with a neutral molar relationship was attained after 29 months of orthodontic therapy. The condylography recording showed that this patient's occlusion tended to be more stable both before and after our treatment. The purpose of this case study is to provide an overview of an orthodontic camouflage treatment for a female patient, who had a history of temporomandibular joint disease, anterior open bite, and arch width disparity. CONCLUSIONS: Our results demonstrated that more attention should be paid to levelling the occlusal plane, intrusion of the molars, decompression of temporomandibular joints and the etiology factors of malocclusion during the orthodontic period for those patients with anterior open bite.

Effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite: A systematic review and meta-analysis.

INTRODUCTION: Bonded spurs, fixed or removable palatal cribs have been used to treat anterior open bite (AOB) in growing children. Different conclusions have been brought out by different authors. This meta-analysis aimed to evaluate the effect of bonded spurs, fixed and removable palatal cribs in the early treatment of AOB. METHODS: A comprehensive electronic search was carried out through PubMed, Embase (via Ovid), MEDLINE (via Ovid), Cochrane Central Register of Controlled Trials, and Web of Science up to May 1, 2022. This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The work was carried out by 2 reviewers in duplicate and independently, including electronic searching, data extracting, risk of bias assessment, quality of evidence grading, heterogeneity and statistical power analysis, and eligibility evaluation of the retrieved articles. RESULTS: Four studies out of 181 articles were recruited in the meta-analysis after applying the inclusion and exclusion criteria. The results showed that bonded lingual spurs and fixed palatal crib or spurs produced similar overbite changes (mean difference, -0.32; 95% confidence interval, -1.06 to 0.43; P = 0.41; I2 = 27%; meta power = 0.099). Fixed palatal crib and removable palatal crib also exhibited comparable effects in correcting AOB (mean difference, -0.02; 95% confidence interval, -0.90 to 0.86; P = 0.96; I2 = 0%; meta power = 0.2182). The quality of evidence about these 2 outcomes assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was low. CONCLUSIONS: Bonded lingual spurs, fixed palatal crib or spurs, and removable palatal crib had similar effects in the early treatment of AOB. Because the number of included studies was limited and only the overbite changes before and after treatment were assessed, more clinical randomized controlled studies with longer follow-ups are needed to get more clinically significant advice.

Short-term stability of anterior open bite treatment with clear aligners in adults.

INTRODUCTION: This study aimed to examine the stability of anterior open bite (AOB) treatment with clear aligners. METHODS: This retrospective cohort study included 52 adult AOB patients (aged >18 years; 15 males, 37 females) who underwent nonextraction clear aligner treatment and were at least 1 year posttreatment. Eleven cephalometric measurements were evaluated at pretreatment, end of active treatment, and at least 1-year posttreatment. Overbite change, the primary outcome variable, and other cephalometric changes during treatment and retention were calculated, and repeated measures analysis of variance were performed. Stepwise multiple regression was used to make a prediction equation for open bite relapse. RESULTS: The mean retention period was 2.1 ± 1.1 years. The mean change in overbite during treatment was 3.3 ± 1.5 mm; 6% of patients presented relapse at least 1 year after treatment completion. The mean change of overbite (0.2 ± 0.5 mm) during the retention period was not statistically significant (P = 0.59). None of the 11 cephalometric measurements showed significant change during the retention period. The prediction model showed that only the coefficient for a tongue posture issue at the initial examination was statistically significant. CONCLUSIONS: AOB was successfully corrected in all 52 patients using only clear aligners with no additional adjunctive aids such as microimplants. When retained with maxillary and mandibular fixed retainers and maxillary and mandibular vacuum-formed retainers, there was no significant change in cephalometric measurements during the short-term retention period.

Mini-implant assisted posterior intrusion: A quantification of anterior bite closure in nongrowing subjects.

INTRODUCTION: This study aimed to identify the vertical radiographic changes in nongrowing patients after treatment of anterior open bites (AOBs) using mini-implant assisted intrusion and to provide a predictive model to quantify the achievable intrusion. METHODS: This retrospective radiographic study evaluated the dentoskeletal changes in adults using orthodontic mini-implants in 53 treated patients with AOB. Radiographs before and after posterior intrusion were utilized to evaluate the associated changes. Conventional cephalometric analyses provided data for assessment. A paired t test was used to identify significant changes. A regression model (best subsets selection algorithm) was generated to quantify the relationship between mini-implant-assisted intrusion and the resultant change in overbite. A matched, untreated control sample was used for comparison. RESULTS: One hundred percent of AOBs were corrected using mini-implant-assisted intrusion of the maxillary molars. The overbite increased by an average of 3.6 mm. The average amount of maxillary first molar intrusion was 2.67 mm. The mandibular first molar moved an average of 1.93 mm closer to the palatal plane because of an average clockwise mandibular rotation of 0.78°. The occlusal plane steepened by an average of 3.95°. If all other inputs are held constant, 1 mm of intrusion of the maxillary first molar results in a 0.86 mm increase in overbite. CONCLUSIONS: Mini-implant-assisted intrusion successfully treated AOB in adults with significant dentoalveolar but no significant skeletal changes. An average of 2.67 mm of intrusion of the maxillary first molars is achievable with this method showing that 1 mm of intrusion of the maxillary first molar increased overbite by 0.86 mm. Longer periods of intrusion resulted in greater amounts of bite closure.

Bias in the superimposition of lateral cephalograms in adult patients with anterior open bite.

INTRODUCTION: Anterior open bite malocclusion can be treated nonsurgically using fixed appliances, clear aligners, or temporary anchorage devices (TADs). Proponents of clear aligners and TADs often attribute bite closure to molar intrusion and counterclockwise rotation of the mandibular plane. These changes may be supported by superimpositions. However, the process of creating a superimposition is subjective and may be influenced by practitioner bias. METHODS: The initial and final lateral cephalograms from 30 adult anterior patients with open bite were used in this study. Ten patients were treated with fixed appliances, 10 with clear aligners, and 10 with TADs. We asked 6 orthodontic graduate students and 6 orthodontic practitioners to complete superimpositions using these radiographs in 3 separate sessions. In the first session, the raters were told that all patients only received treatment with fixed appliances. In the second session, the raters were told that all patients were treated with clear aligners only, and in the third session, they were told all patients were treated with fixed appliances and TADs. Superimpositions were performed using Dolphin software, and each superimposition was saved as a Portable Document Format image. Change in the mandibular plane was the primary outcome and was assessed categorically (closed, no change, opened). Cephalometric values were measured and used to investigate the dental and skeletal changes associated with treatment. RESULTS: Although the raters demonstrated a slight tendency toward the mandibular plane closing or staying the same when told the treatment was clear aligners or TADs, these differences were not statistically significant. A high degree of intrarater and interrater variability in the mandibular plane change was present in all 3 superimposition sessions. The measurements from the lateral cephs showed significant changes for overbite and incisor vertical and angular movements. Almost no change was observed in anterior facial height, mandibular plane angle, or vertical movement of the first molars. CONCLUSIONS: This study did not observe a significant amount of superimposition bias. However, there was considerable intrarater and interrater reliability. This suggests that the same initial and final cephs may be interpreted very differently on the basis of the subjective superimposition of the raters.

Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient.

Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.

Predictability of anterior open bite treatment with Invisalign.

INTRODUCTION: Anterior open bite correction with Invisalign has been claimed to have relatively good predictability because of the proposed function of clear aligners to function as occlusal bite-blocks, limiting extrusion of the posterior teeth or possibly even intruding posterior teeth. This proposal, however, remains relatively unsubstantiated. The objective of this study was to investigate and determine the accuracy of Invisalign treatment in correcting anterior open bite by comparing the predicted outcome from ClinCheck to the achieved outcome for the initial aligner sequence. METHODS: A retrospective study used pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 76 adult patients from private specialist orthodontic practices. Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners. Geomagic Control X software was used to measure overbite and overjet in the pretreatment, posttreatment, and predicted outcomes stereolithography files for each patient. RESULTS: Approximately 66.2% of the programmed open bite closure was expressed compared with the prescribed ClinCheck outcome. The use of posterior occlusal bite-blocks and prescribed movement of teeth via anterior extrusion, posterior intrusion, or a combination of the 2 made no difference to the efficacy of open bite closure. Two-week aligner changes resulted in 0.49 mm more bite closure on average. CONCLUSIONS: The prescribed bite closure in ClinCheck software overestimates the bite closure that is clinically achieved.

Combined orthodontic-orthognathic management of a patient with generalized short root anomaly and anterior open bite.

Short root anomaly is a rare dental disorder affecting tooth root development. It is characterized by reduced root-to-crown ratios (1:1 or less) and rounded apices. The short roots introduce a potential complication during orthodontic treatment. This case report describes managing a girl with generalized short root anomaly, an open bite, impacted maxillary canines, and a bilateral crossbite. In the first phase of treatment, the maxillary canines were extracted, and the transverse discrepancy was corrected with a bone-borne transpalatal distractor. In the second phase of treatment, a mandibular lateral incisor was removed, fixed appliances were placed in the mandibular arch, and bimaxillary orthognathic surgery was performed. A satisfactory result was obtained without further root shortening, adequate smile esthetics, and 2.5-year posttreatment stability.

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.

Combined orthopedic-orthodontic treatments of adolescent skeletal open-bite with severe molar-incisor hypomineralization: a case report and literature review.

The treatment of adolescent skeletal open-bite malocclusion with severe molar-incisor hypomineralization (MIH) remains challenging. Though conducive to open-bite treatment and endodontic management, early molar extraction may trigger a series of negative impacts on occlusion and stomatognathic development. In addition, molars' crown restoration was shown to worsen open-bite malocclusion considering the intrinsic vertical increment of hyperdivergent growth. This case report describes the successful multidisciplinary therapy combined with orthopedic and orthodontic treatment of a 10.2-year-old girl with mixed dentition, a protruding profile and skeletal open-bite malocclusion with severe MIH and crowding. During the mixed and early permanent dentition, function regulator-4 (FR-4), resin-bonding transpalatal arch (TPA) and modified spring-loaded bite blocks were implemented to correct abnormal swallowing and control the facial vertical growth. Radiographic results, including the counterclockwise rotation of the occlusion plane, decreasing mandibular angle and increasing posterior-anterior face height ratio accompanied by obvious mandibular vertical growth, indicated that the performed orthopedic treatments efficiently controlled hyperdivergent open-bite growth during puberty. After the maxillary and mandibular second molars were occluded, all first permanent molars were extracted, and fixed appliances combined with implant anchorage were used to correct malocclusion and convex profile. Ultimately, a stable Class I functional occlusion and satisfying facial improvement were achieved and maintained following a 2-year follow-up.

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.

Comparison and reproducibility of three methods for maxillary digital dental model registration in open bite patients.

OBJECTIVE: To compare and assess the reproducibility of 3 methods for registration of maxillary digital dental models in patients with anterior open bite. Settings and sample population Digital dental models of 16 children with an anterior open bite in the mixed dentition were obtained before (T1) and after 12 months of treatment with bonded spurs (T2). METHODS: Landmarks were placed on all T2 models and 3 registration methods (R1, R2 and R3) were independently performed by 2 observers. R1 was based on 10 landmarks placed on posterior teeth. R2 was based on 5 landmarks on the palate (2 anterior, 2 posterior and 1 central). R3 used regions of interest around the 5 palatal landmarks used in R2. The differences between the registration methods were calculated by comparing the mean differences and standard deviations between the corresponding x, y and z coordinates of 6 corresponding landmarks in the T2 registered models. Repeated measures analysis of variance followed by post-hoc Bonferroni tests were used for comparisons (P < .05). The agreement between methods and the intra and interobserver reproducibility were assessed with Bland-Altman tests and intraclass correlation coefficients (ICC). RESULTS: Comparisons of R2 with R3 methods showed greater agreement, mean differences ≤0.50 mm for all landmarks, than comparisons of R1 with R2, and R1 with R3, mean differences >0.50 mm for most of the y and z coordinates (P < .05). The R1 and R3 methods presented excellent intra and interobserver reproducibility and R2 method had moderate interobserver reproducibility. CONCLUSIONS: Longitudinal assessments of open bite treatment using digital dental models could consider the posterior teeth and/or the palate as references. The R1 and R3 methods showed adequate reproducibility and yield different quantitative results. The choice will depend on the posterior teeth changes and dental models' characteristics.

Influence of rapid maxillary expansion in the stability of anterior open bite treatment.

OBJECTIVES: This study aimed to compare the stability of anterior open bite (AOB) in patients treated with and without rapid maxillary expansion (RME) before fixed palatal crib (PC) therapy in the mixed dentition. MATERIAL AND METHODS: Expansion/palatal crib group (EPC) was comprised of 25 patients (10 male, 15 female, mean initial age of 7.8 years) with AOB treated with RME before PC therapy. Palatal crib group (PC) included 25 patients with AOB (10 male, 15 female, mean initial age of 8.0 years) treated only with PC therapy. Lateral cephalograms were analyzed at pre-treatment (T0), after PC therapy (T1), and 3 years after PC removal (T2) in both groups. AOB relapse was considered when a negative overbite was observed at T2. Intergroup comparisons of interphase changes were performed using t and Mann-Whitney tests (p < 0.05). RESULTS: Treatment and post-treatment alterations showed similar changes in both groups for all cephalometric variables. Overall changes from T0 to T2 were similar between the groups except for the maxillary incisors that tipped lingually in PC group (1.PP = - 3.37°) and labially in EPC group (1.PP = 1.76°). The frequency of AOB relapse was 8% and 4% in the EPC and PC groups, respectively. Treatment time in the EPC group (9.7 months) was shorter (p = 0.024) when compared to the PC group (11.0 months). CONCLUSIONS: In the mixed dentition, stability of AOB treated with RME before fixed PC therapy was similar to PC therapy alone. However, treatment time with fixed PC was slightly shorter in the group treated with RME. CLINICAL RELEVANCE: This study aims to understand if RME performed previously to fixed palatal crib contributes to the index of stability of AOB treatment in the mixed dentition.

A comparative assessment of the dentoskeletal effects of clear aligners vs miniplate-supported posterior intrusion with fixed appliances in adult patients with anterior open bite. A multicenter, retrospective cohort study.

INTRODUCTION: This study aimed to retrospectively evaluate the dentoskeletal effects of clear aligners (Invisalign) vs miniplate-supported posterior intrusion (MSPI) and identify factors associated with posttreatment overbite in adults with anterior open bite. METHODS: Twenty-nine patients treated with Invisalign and 24 with MSPI combined with full-fixed orthodontic appliances were included from 5 orthodontic practices. Pretreatment and posttreatment lateral cephalometric measurements were included as outcomes. Comparisons across groups and identification of final overbite predictors were assessed with regression modeling and machine learning techniques. RESULTS: MSPI induced significantly greater maxillary molar intrusion (1.5 mm; 95% confidence interval [CI], 0.83-2.17; P <0.001), with subsequent reduction of anterior face height (ANS-Me) (-2.77 mm; 95% CI, -3.64 to -1.91; P <0.001), Mp-SN° (-1.95°; 95% CI, -2.77 to -1.12; P <0.001), and ANB° (-1.69°; 95% CI, -2.44 to -0.94; P <0.001) compared with Invisalign. MSPI resulted in a significantly larger increase in SNB° (0.94°; 95% CI, 0.23-1.65; P = 0.01) and point-Pog projection (2.45 mm; 95% CI, 1.12-3.77; P = 0.001). Compared with MSPI, Invisalign had a significantly greater increase in the distance of maxillary (1.05 mm; 95% CI, 0.38-1.72; P = 0.003) and mandibular (0.9 mm; 95% CI, 0.19-1.60; P = 0.01) incisal edges relative to their apical bases, with borderline greater lingual tipping of only the maxillary incisors (2.82°; 95% CI, -0.44 to 6.09; P = 0.09). Appliance type and initial overbite were significant final overbite predictors across all models. However, this difference was only evident in male patients (males [1.65; 95% CI, 0.99-2.32; P <0.001]; female [-0.04; 95% CI, -0.52 to 0.44; P = 0.87]). CONCLUSIONS: Both appliances effectively improve overbite. MSPI applied the correction via molar intrusion and counterclockwise mandibular autorotation, whereas Invisalign via maxillary and mandibular incisor extrusion.

Unplanned molar intrusion after Invisalign treatment.

INTRODUCTION: The objectives of this study were to analyze and quantify molar intrusion after the use of clear aligners and to analyze the relationship with other variables such as age, duration of treatment, and a series of cephalometric osseous and dental measurements at the start of treatment. METHODS: A retrospective descriptive-analytical study was designed with a sample of 58 patients aged 18-60 years who had undergone treatment with Invisalign. The cephalometric measurements were carried out after lateral x-rays were taken of the cranium; these were compared at the start (T0) and conclusion of treatment. Parametric and nonparametric tests were used to compare means, whereas Pearson correlations and multivariate lineal regression analyses were used to establish the variables associated with molar intrusion. RESULTS: Approximately 74.2% of the patients presented some degree of molar intrusion after treatment. Furthermore, 32.8% of patients presented intrusion only at the mandibular molar, whereas 25.9% experienced intrusion at both molars, maxillary and mandibular, simultaneously. However, 15.5% presented intrusion only at the maxillary molar. The average magnitude of intrusion here was 0.98 ± 0.54 mm, whereas the mandibular molar was 0.84 ± 0.29 mm. Statistically significant reductions exist for the distance L6_MP and U6_SN between T0 and at conclusion of treatment. Maxillary molar intrusion correlates negatively with mandibular molar intrusion (r = -0.270). The number of days of treatment did not correlate with either maxillary or mandibular molar intrusion. CONCLUSIONS: Clear aligners give rise to molar intrusion in 74.2% of patients. The cephalometric variables L6_MP T0, mandibular plane angle T0, and facial axis T0 were negatively and significantly associated with maxillary molar intrusion, whereas age and facial axis T0 were negatively associated with mandibular molar intrusion allowing smaller magnitudes of intrusion to be predicted when these variables present high values at T0.

Cephalometric evaluation of intrusion of maxillary posterior teeth by miniscrews in the treatment of open bite.

INTRODUCTION: The objective of this research was to investigate the effectiveness of orthodontic miniscrews for skeletal anchorage during anterior open bite treatment using cephalometric radiographs. METHODS: This study sample included 20 patients (mean age, 14.71; standard deviation, 1.77) with an anterior open bite. A total of 250 g of force was applied using elastic chains with anchorage from palatal miniscrew to an occlusal splint covering the posterior maxillary teeth. Cephalograms were obtained at the beginning of the treatment when the appliance was first applied and at the 8-month visit when treatment was completed. Paired t tests were used to identify statistically significant differences between initial and final measurements of skeletal and dental parameters. RESULTS: A decrease of 2.72 ± 1.90° in the SN-GoGn angle and 3.63 ± 1.87 mm in the anterior height (N-Me) parameter in the cephalometric evaluations indicated a significant improvement of vertically increased facial dimensions, with the intrusion of the maxillary posterior teeth (P <0.05). Anterior rotation of the mandible was determined by a 1.76 ± 1.09° increase in the SNB angle and a 1.86 ± 0.90° decrease in the ANB angle (P <0.05). Reductions in the open bite amount by 5.8 ± 0.90 mm, Mx6-SN by 4.00 ± 1.01 mm, and Mx6-PP by 4.01 ± 1.00 mm were indicative of significant intrusion in the maxillary posterior teeth (P <0.05). CONCLUSIONS: The present study confirmed that palatal miniscrew and maxillary occlusal splint caused intrusion of the maxillary posterior teeth, a decrease in the anterior open bite, and mandibular advancement, with anterior rotation after the maxillary posterior intrusion. We concluded that the treatment method in our study was appropriate for patients with Class I and mild Class II malocclusions and open bite anomalies.

A clinical approach to managing open-bite malocclusion associated with severe crowding.

Open bite has been identified as one of the most challenging malocclusions in orthodontics. The treatment approach is complex, the resulting esthetics may not meet the patient's expectations, and the chance of recurrence is high. A 13-year-old girl presented a skeletal Class II malocclusion associated with anterior and posterior open bite, maxillary transverse deficiency, severe anterior crowding, and a hyperdivergent facial pattern. Orthodontic treatment was performed with a Haas expander and subsequent standard edgewise appliances, and the 4 first premolars were extracted. The vertical control of facial growth was undertaken with vertical pull chincap therapy, mini-implants associated with a titanium-molybdenum alloy cantilever on the right and left buccal sides, and a stainless steel alloy transpalatal arch. Posttreatment records showed a bilateral Class I molar relationship, ideal overbite and overjet, and improved facial profile and gingival health. The cephalometric analysis revealed a good balance of the skeletal pattern and facial profile, with an appropriate inclination of the maxillary and mandibular incisors. After a 7-year retention period, the outcome was pleasant facial esthetics and smile and stability of the dental occlusion. This case shows that the clinical approach was adequate, with treatment outcomes achieving positive aspects of function, esthetics, and stability.