ETIOLOGIA, DIAGNÓSTICO E TRATAMENTO DA MORDIDA ABERTA ANTERIOR NA DENTADURA MISTA / ETIOLOGY, DIAGNOSIS AND TREATMENT OF ANTERIOR OPEN BITE IN THE MIXED DENTITION

A mordida aberta anterior (MAA) é considerada uma das anomalias de mais difícil correção, principalmente em relação a sua pouca estabilidade. Sendo mais predominante na dentadura decídua e mista, ela é caracterizada pela falta de contato vertical entre dentes antagonistas na região anterior, promovendo comprometimento estético-funcional. É de extrema importância que o profissional tenha conhecimento para executar a intervenção precoce, por meio de diversos tipos de abordagens. Sendo notória a necessidade do contato entre ortodontistas e fonoaudiólogos no atendimento integral do paciente portador da anomalia, através de uma abordagem interdisciplinar. A compreensão da etiologia e patogênese dessa anomalia é indispensável para sua identificação e prevenção, aumentando a probabilidade de sucesso da terapêutica ortodôntica quando determinada precocemente. O objetivo desse estudo é avaliar a etiologia, diagnóstico e tratamento da mordida aberta anterior e seu mecanismo de atuação na dentadura mista.

Anterior open bite (AOB) is considered one of the most difficult anomalies to correct, especially in relation to its low stability. Being more predominant in the deciduous and mixed dentition, it is characterized by the lack of vertical contact between opposing teeth in the anterior region, promoting a esthetic-functional impairment. It is extremely important that the professional has the knowledge to execute the early intervention, through several types of approaches. Being aware of the need for contact between orthodontists and speech therapists in the integral care of patients carrying the anomaly, through an interdisciplinary approach. The understanding of the etiology and pathogenesis of this anomaly is indispensable for identification and prevention, increasing the probability of success of orthodontic therapy when early identified. The aim of this study is to evaluate the influence of etiology, diagnosis and treatment of the anterior open bite and its mechanism of action in the mixed dentition.

Comparison of Japanese and European overbite depth indicator and antero-posterior dysplasia indicator values.

This study evaluated cephalometric differences between 113 Japanese (43 males and 70 females, aged 14.1 ± 5 years) and 106 European subjects (36 males and 70 females, aged 13.5 ± 7.3 years) using two compound angular measurements and their single components: the overbite depth indicator (ODI) for the assessment of vertical skeletal relationships and the antero-posterior dysplasia indicator (APDI) for an evaluation of sagittal dysgnathia. Both populations were assigned to groups representing Angle Classes I, II, and III, and an anterior open bite (AOB) group. Two sample t- and Wilcoxon signed-ranks tests were performed (P < 0.05). The ODI values showed no statistically significant differences between the Japanese and European samples. The Japanese sample showed a significantly smaller APDI but only in the Class II group. In the Japanese Class II and III subjects, the malocclusion patterns were more pronounced than those in the Caucasian sample (overbite, overjet, and APDI).

Cephalometric and electromyographic study of patients of East African ethnicity with and without anterior open bite.

INTRODUCTION: A review of the literature showed that there are disturbances of muscle activity and tongue function in patients with anterior open bite (AOB). However, most studies have had white subjects, even though open bite is more prevalent in black populations. In this pilot study, we examined jaw muscle activity and tongue pressure in East African black subjects. METHODS: Ten subjects (4 boys, 6 girls; ages, 10.1-13.2 years) were recruited. A cephalometric comparison of subjects with and without AOB was performed. Surface electrodes were placed on the bilateral anterior temporalis, superficial masseter, superior orbicularis oris, and anterior digastric muscles. Electromyograms were recorded at rest, maximal voluntary clenching, chewing, and swallowing. Tongue pressure during rest and swallowing, and maximal bite force were also measured. RESULTS: There was no statistically significant difference between the 2 groups in cephalometric measures (except in amount of open bite and overbite) and maximum bite force. During chewing, both groups showed similar coordinated activity patterns in the muscles, but the AOB subjects tended to show more electromyographic activity in the muscles of the balancing side. During clenching, the AOB subjects exhibited lower electromyographic activity compared with the controls. AOB subjects also had greater anterior tongue pressure during swallowing. Data from tongue pressure at rest were inconclusive. CONCLUSIONS: East African blacks appear to have neuromuscular and skeletal predispositions to AOB, but their vertical incisor relationships are variable. Factors in addition to those investigated might be involved.

Pueden los elementos endógenos y exógenos alterar el crecimiento y desarrollo y determinar una mordida abierta anterior severa; pueden ser susceptibles de tratamiento miofuncional las mordidas abiertas anteriores severas, en cualquier edad? / Can endogenous or exogenous elements alter growth and development and determine a severe anterior open-bite; can severe anterior open-bites be susceptible of myofunctional therapy at any age?

El objetivo de este artículo es demostrar cómo múltiples factores derivados de las funcionaes pueden producir mordidas abiertas anteriores, bien sean esqueléticas y funcionales o ambas, y cómno podemos ayudar a solucionarlas, no sólo con un tratamiento temprano en la dentición mixta, sino también buscando una mayor o menor respuesta funcional orgánica después del período de desarrollo y crecimiento. La eficacia del tratamiento ortopédico funcional, entendiéndose como funcional la orientación de las fuerzas neutomusculares de los músculos masticadores, orofaciales, faciales y del cuello que es lo que se ha llamado terapia miofunciona, es ayudada por las condiciones eugnácicas que va dando la aparatología ortopédica y su aplicación no sólo en pacientes en crecimiento sino también en pacientes después del desarrollo, es decir adultos. Este es el resultado obtenido tras 25 años de estudio y de múltiples valoraciones en diferentes pacientes, sexos, edades y terapéuticas utilizadas para obtener un equilibrio funcional estable, mantenido a través del tiempo.