Open Bite Malocclusion and Orofacial Dysfunction in Patients with Myotonic Dystrophy Type 1 and Duchenne Muscular Dystrophy.

Open bite (OB) is a common malocclusion in individuals with orofacial dysfunction and syndromes, especially in neuromuscular diseases. OBJECTIVES: The objectives were to explore the prevalence of OB in myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD) and to create and compare orofacial dysfunction profiles. METHODS: In this database study, 143 individuals with DM1 and 99 with DMD were included. The Mun-H-Center questionnaire and observation chart were used together with the Nordic Orofacial Test -Screening (NOT-S) to create orofacial dysfunction profiles. OB was categorised as: lateral (LOB); anterior (AOB); severe anterior (AOBS); or both types of anterior OB (AOBTot). Descriptive and multivariate statistics were used to compare the OB prevalence and to study associations with orofacial variables, respectively. RESULTS: There was a statistically significant difference in OB prevalence between the DM1 (37%) and DMD (49%) groups (p = 0.048). LOB was seen in < 1% of DM1 and 18% of DMD. LOB was associated with macroglossia and closed mouth posture, AOB with hypotonic lips, and open mouth posture and AOBS with hypotonic jaw muscles. The orofacial dysfunction profiles showed similar patterns, although the mean NOT-S total scores for DM1 and DMD were 4.2±2.8 (median 4.0, min-max 1-8) and 2.3±2.0 (median 2.0, min-max 0-8), respectively. LIMITATIONS: The two groups were not age- or gender-matched. CONCLUSION: OB malocclusion is common in patients with DM1 and DMD and is associated with different types of orofacial dysfunction. This study highlights the need for multi-disciplinary assessments to support tailored treatment strategies that improve or sustain orofacial functions.

Can malocclusion among children impact their oral health-related quality of life? parents' perspective.

Background and Aim: Malocclusion can negatively impact the quality of life of children. Therefore, this study assesses the impact of proxy-reported malocclusion and oral health-related quality of life among children in Riyadh, Saudi Arabia, from the parents or guardians' perspectives. Materials and Methods: A self-administered electronic questionnaire was used to assess the correlation between proxy-reported malocclusion conditions during the early mixed dentition stage (children age 6-12 years) and oral health-related quality of life using the OHIP-14 measure. All collected data were analyzed using SPSS. Results: Among the 353 participants in the study, anterior open-bite was the most common proxy-reported malocclusion with a prevalence of 19%, followed by unilateral posterior cross bite (13.3%). Furthermore, 31% reported that their children sometimes experienced negative impacts on quality of life from malocclusions. The results also show that OHIP-14 scores were significantly associated with all proxy-reported malocclusion (p < 0.05). The highest OHIP-14 score was found to be significantly associated with the presence of deep-bite from parents' or guardians' perspective. Conclusion: The presence of some proxy-assessed malocclusion was associated with negative impacts on children's oral health-related quality of life. This is very important to consider when assessing the need for orthodontic intervention, especially at this stage as this age is critical in building a child's confidence and self-esteem.

Association between atypical swallowing and malocclusions: a systematic review.

OBJECTIVE: This systematic review aims to answer the following focus question: "Is there an association between atypical swallowing and malocclusions?". METHODS: Appropriate word combinations were chosen and tailored specifically for each of the following electronic databases: EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, Web of Science, and gray literature, without any restrictions, up to February 2021. According to the selection criteria, only cross-sectional studies were included. The following inclusion criteria were considered: a sample composed of children, adolescents, and adults; patients clinically diagnosed with atypical swallowing; patients with normal swallowing; and outcome of interest of atypical swallowing in patients with malocclusion. The data consisted of study characteristics, sample characteristics, results, and conclusion of each study. The risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: 4,750 articles were identified. After a two-step selection, four studies were included. A higher frequency of distal occlusion, extreme maxillary overhang, and open bite was related to swallowing disorders; most studies pointed to posterior crossbite as a malocclusion more associated with atypical swallowing. All studies had a moderate to high risk of bias, and the certainty of evidence was very low. CONCLUSION: The results indicate that atypical swallowing is associated with malocclusions and that posterior crossbite is the main malocclusion found, but only in the young population (3-11 years). REGISTRATION: PROSPERO (42020215203).

Surgical Reduction of Chronic Bilateral Traumatic Dislocation of the Mandibular Condyles With Erosion of the Middle Fossa Floor: Case Report With Surgical Video.

BACKGROUND: Dislocation of the mandibular condyle (MC) is not a common condition, but when a traumatic case involves erosion of the middle fossa floor, it becomes a much more complicated and even rarer pathology. OBJECTIVE: To describe the management of traumatic dislocation of the MCs with erosion of the middle fossa floor. We provide a step-by-step surgical video demonstrating reestablishment of the condylar position and occlusion. METHODS: A 65-yr-old woman with rheumatoid arthritis presented after a ground-level fall. She was admitted to the intensive care unit with simultaneous complex medical conditions, intubated, and medically treated for over a month. She was seen in outpatient follow-up 2 mo later and noted to have an anterior open bite and bilateral temporomandibular joint pain. Computed tomography of the face showed bilateral dislocation of the MCs with erosion of the middle fossa floor. RESULTS: Open surgical treatment with bilateral eminectomies was performed to obtain adequate reduction, involving a multidisciplinary team including neurosurgery, oral-maxillofacial surgery, and otolaryngological surgery. She did well postoperatively. CONCLUSION: Multiple factors predispose a patient to MC dislocation, but we believe the catalyst in this case was significant manipulation of the jaw during endotracheal intubation. A chronic postoperative open bite can lead to much more difficult treatment, given bony erosion and fibrotic tissue formation. This case highlights the challenges of diagnosis and treatment of a bilateral traumatic dislocation and provides a surgical video reference description of repair and resolution.

Orthognathic surgery with two-segment le fort i and sagittal split ramus osteotomies of open bite deformity in an amelogenesis imperfecta patient via virtual planning: A case report.

Amelogenesis imperfecta (AI) is an enamel defect and is often associated with the anterior open bite (AOB) and transverse maxillary deficiency. It is known that in such cases when AI and AOB appeared together, posterior maxillary impaction with or without bilateral mandibular ramus osteotomies is a frequently preferred treatment option. Virtual planning is more reliable rather than the conventional model surgery planning, especially for complicated cases. Usage area of virtual 3D anatomical models reconstructed from Cone Beam Computed Tomography (CBCT) data is expanding day by day for both diagnosis and surgical planning. The aim of this study is to present a patient with AI and AOB and transverse maxillary deficiency and management of this case with virtually planned two-segment Le fort I and sagittal split ramus osteotomies followed by prosthetic rehabilitation.

Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series.

BACKGROUND: Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. CASE PRESENTATIONS: Our three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. CONCLUSIONS: These three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient's chronic insomnia to remit.

A comprehensive treatment approach for idiopathic condylar resorption and anterior open bite with 3D virtual surgical planning and self-ligated customized lingual appliance.

INTRODUCTION: We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right. METHODS: The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning. RESULTS: The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved. CONCLUSIONS: The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.

Prevalence of malocclusion in children with obstructive sleep apnoea.

OBJECTIVES: To describe the prevalence of malocclusions in 2- to 10-year-old children suffering from obstructive sleep apnoea (OSA) and to evaluate the association between occlusal variables and OSA. SETTING AND SAMPLE POPULATION: A total of 2101 consecutive patients referred to an otorhinolaryngology unit were considered for the study. One hundred and fifty-six children (range 2-10 years) with suspected OSA were selected for a sleep study. The final sample consisted of 139 children suffering from OSA and a control group of 137 children. MATERIALS AND METHODS: All patients included in the study underwent a clinical orthodontic examination to record the following occlusal variables: primary canine relationship, presence of a posterior crossbite, overjet and overbite. Odds ratios and 95% confidence intervals, comparing the demographic characteristics and dental parameters in OSA vs non-OSA children, were computed. Multivariable logistic regression models were developed to compare independent variables associated with OSA to non-OSA children. RESULTS: The prevalence of malocclusions in children with OSA was 89.9% compared to 60.6% in the control group (P < 0.001). Factors independently associated with OSA compared to the control group were posterior crossbite (OR = 3.38; 95%CI:1.73-6.58), reduced overbite (OR = 2.43; 95%CI:1.15-5.15.), increased overbite (OR = 2.19; 95%CI:1.12-4.28) and increased overjet (OR = 4.25; 95%CI:1.90-9.48). CONCLUSIONS: This study showed a high prevalence of malocclusion in children with OSA compared to the control group. The posterior crossbite and deviations in overjet and overbite were significantly associated with OSA. The presence of these occlusal features shows the importance of an orthodontic evaluation in screening for paediatric OSA.

Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach.

An anterior open bite is a challenge to orthodontic treatment; it has a multifactorial etiology and a wide range of intervention options. Temporomandibular joint (TMJ) disorders are a risk factor for the development of malocclusions such as the anterior open bite, especially in patients who have TMJ osteoarthritis with disc displacement. Articular disc repositioning surgery is an available option for treating this pathology, and it contributes to maintaining the condyles in a more stable position. The aim of this article was to report the case of a 20-year-old woman diagnosed with anterior open bite and TMJ osteoarthritis with bilateral disc displacement. The patient received both orthodontic treatment and TMJ disc repositioning surgery. Cone-beam computed tomography was used to create 3-dimensional models of the condyles with regional superposition, and assessment of bone remodeling was performed at different time intervals. Complete orthodontic and surgical treatment time was approximately 12 months. The results provided a stable correction of the patient's anterior open bite with a 2-year follow-up and favorable bone remodeling of the condyles due to functional improvement of the TMJ.

Curva de Spee: causas y tratamiento de su descompensación / Spee curve: causes and treatment of its discompensation

En el presente artículo se analiza y pasa revista a la bibliográfica acerca de la Curva de Spee: su etiología, los diferentes factores que pueden descompensarla, y los posibles tratamientos para corregirla en caso deestar alterada. Una mordida abierta esqueletal o dentaria, o una mordida profunda esqueletal o dentaria pueden modificarla, pudiendo utilizarse varios recursos y técnicas para tratar estos desórdenes, y así nivelar la curva.

In the present paper, the literature is analysed and reviewed the Curve of Spee: its aetiology, the different factors that can decompensate it, and the possible treatments to correct it in case of beingaltered. An open skeletal or dental bite, or a deep skeletal ordental bite can modify it, being able to use several resources and techniques to treat these disorders, and thus to level the curve.

Nonsurgical treatment for a severe anterior and lateral open bite and multiple congenitally missing teeth: a case report with 4-year follow-up

ABSTRACT This case report describes the treatment of a severe anterior and lateral open bite combined with multiple congenitally missing teeth. A 10-year-old girl presented with an open gonial angle, absence of lip sealing, and soft tissue pogonion retrusion. She had an open bite of 8.5 mm, agenesis of the upper right and left lateral incisors and the upper left first premolar, and transverse maxillary deficiency. Nonsurgical treatment was planned aiming at controlling the vertical pattern, establishing the correct overbite, and closing the spaces on the upper arch, to provide satisfactory occlusion and facial and dental esthetics.

RESUMO O presente caso clínico descreve o tratamento de uma mordida aberta anterior e lateral associada à ausência congênita de dentes permanentes. Paciente com 10 anos de idade, apresentava ângulo goníaco aberto, ausência de selamento labial passivo e retrusão do pogônio mole. Além disso, foi diagnosticada uma mordida aberta de 8,5 mm, agenesia de incisivos laterais superiores direito e esquerdo e de primeiro pré-molar superior esquerdo, além de deficiência transversa da maxila. O planejamento do caso envolveu um tratamento não cirúrgico, com controle vertical do crescimento, obtenção de correta sobremordida e fechamento dos espaços superiores. O caso foi finalizado com uma boa intercuspidação, contemplando a estética facial e dentária.

Long-term Stability of a Camouflage Retreatment of an Asymmetric Class III/Posterior Open Bite Using Sliding Jigs.

This article reports the camouflage retreatment of an adult patient presenting an asymmetric Class III malocclusion and posterior open bite. Sliding jigs (SJs) associated with intermaxillary elastics were used. The long-term stability of the excellent results suggests that the use of SJs to correct asymmetric posterior occlusions may be effective.

Lateral open bite and crossbite correction in a Class III patient with missing maxillary first premolars.

Posterior and Class III elastics were used to correct lateral open bite and anterior crossbite in a 29-year-old man. His occlusion, smile esthetics, and soft tissue profile were significantly improved after 25 months of active orthodontic treatment combined with 4 anterior restorations.

Miniplate With a Bendable C-Tube Head Allows the Clinician to Alter Biomechanical Advantage in Extremely Complicated Anatomic Structure.

BACKGROUNDS: This article reports C-tube miniplates as a practical temporary anchorage device choice to treat open bite patients with maxillary sinus pneumatization. METHODS: The C-tube components are titanium anchor plates and monocortical screws that are basically similar to any other miniplate systems, but it has the unique characteristic of the tube head to be malleable. The manipulation of the head part is easy due to the composition of pure titanium. The I-shaped C-tube with 3 holes and T-shaped C-tube miniplates were placed above the apices of maxillary molars as an absolute anchorage system to intrude the posterior maxilla. The bending of the tube heads assisted in reduction of severe open bite patient with maxillary sinus pneumatization. RESULTS: Sinus perforation during placement of skeletal anchorage system weakens stability of the anchorage and further cause complications. Placement of titanium C-tube miniplates allowed reliable skeletal anchorage and avoided maxillary sinus perforation in patients with extreme pneumatizations. Simple bending of C-tube miniplates ensured increased orthodontic intrusion force without having to replace them, and eliminated consequences such as perforation of maxillary sinus, sinusitis, soft tissue irritation, or infection. CONCLUSIONS: Anatomic difficulties in the placement of temporary anchorage device can be easily managed by using the bendable C-tube miniplate. It can serve as a great alternative over miniscrews or regular miniplates with reduced risk of sinus perforation and ability to bend the head portion to control orthodontic vectors and forces.

Nonsurgical treatment for a severe anterior and lateral open bite and multiple congenitally missing teeth: a case report with 4-year follow-up.

This case report describes the treatment of a severe anterior and lateral open bite combined with multiple congenitally missing teeth. A 10-year-old girl presented with an open gonial angle, absence of lip sealing, and soft tissue pogonion retrusion. She had an open bite of 8.5 mm, agenesis of the upper right and left lateral incisors and the upper left first premolar, and transverse maxillary deficiency. Nonsurgical treatment was planned aiming at controlling the vertical pattern, establishing the correct overbite, and closing the spaces on the upper arch, to provide satisfactory occlusion and facial and dental esthetics.

[Application of semi-buried curvilinear distraction devices in complex management of lower micrognathia in children].

The aim of the study was to apply an effective treatment protocol with low morbidity for children with syndromic and nonsyndromic micrognathia using curvilinear distractors, intraoral approach and early orthodontic treatment. We report 7 patients aged from 3 to 13 years with bilateral mandibular hypoplasia. These patients were characterized by severe malocclusion, esthetic facial deformation and respiratory disorders. In 3 patients mandibular hypoplasia was combined with anterior open bite. The intraoral surgical approach was used in all cases. Good functional and esthetic results were achieved during treatment. The less traumatic intraoral approach, curvilinear distractors, ultrasound callus formation control and early orthodontic treatment assure the good functional and esthetic results in severe cases facilitating the continuinty in complex rehabilitation of the growing child.

Abordagem multidisciplinar de mordida aberta anterior associada à sucção digital: caso clínico / Multidisciplinary performance to anterior open bite associated with finger sucking: case report

Este estudo tem como objetivo relatar o caso clínico de uma paciente com mordida aberta anterior(MAA) associada ao hábito bucal deletério (HBD) de sucção digital e a importância da interação entre profissionais no tratamento integral. Paciente (9 anos) e sua responsável procuraram atendimento com queixa de hábito de sucção digital prolongado, MAA, ausência de alguns dentes e mal posicionamento dentário, o que comprometia negativamente a estética e autoestima da paciente. Diagnosticou-se crescimento facial equilibrado, MAA, atresia dento alveolar superior, discrepância negativa e dentes 11 e 12 com atraso na irrupção. O tratamento consistiu na instalação do disjuntor de Haas associado à grade palatina para obter a expansão rápida da maxila e corrigir a atresia do arco superior, a fim de anular a discrepância negativa. Concomitantemente realizou-se o acompanhamento e tratamento psicológico e fonoaudiológico.A grade palatina, adaptada com barreira de acrílico, evitou que a língua interpusesse entre os incisivos,o que propiciou a irrupção dos mesmos. Entretanto a paciente ausentou-se por dois meses e retornou ao hábito de sucção digital. Diante disto, indicou-se um bihélice com grade para expansão dento alveolare a paciente manteve o tratamento fonoaudiológico e psicológico. Foi realizado também o acompanhamento para monitoramento da irrupção dentária e desenvolvimento da oclusão. Por meio deste estudo,conclui-se que a intervenção na MAA requer abordagem multidisciplinar a fim de restabelecer a oclusão,propiciar melhora na autoestima e consequentemente na qualidade de vida da criança.

The purpose of this study is to report to the clinical case of a patient with anterior open bite (AOB)associated to the oral deleterious habit of digital suction and the importance of interaction between professionals in the comprehensive treatment. Patient (9 years of age) and its guardian searched dental carewith main complaint of prolonged digital suction, AOB, absence of some teeth and bad dental positioning, which compromised negatively the aesthetic and self es teem of the patient. Balanced facial growth, AOB,upper alveolar dental atresia, negative discrepancy and teeth 11 and 12 with delayed eruption were diagnosed.The treatment consisted in installation of Hass expander associated to palatine grating in order toobtain a fast maxilla expansion and to correct the upper arch atresia that so neutralize the negative discrepancy. Concurrently, held the monitoring and psychological and speech treatment were performed. The palatine grating, adapted with acrylic barrier, prevented the tongue to be positioned between the incisors,which favored their eruption. However, the patient was absent for 2-month and the habit of digital suction was reestablished. In view of this, bi-helix with grating for expansion of the alveolar dental region was indicated and the patient continued speech therapy and psychological treatment. The follow-up to monitoring of the dental eruption and developing of the occlusion were conducted. By means of this study, it was concluded that the OPB intervention require multidisciplinary approach with the purpose of reestablishing the occlusion, propitiating improvement in the selfesteem and consequently in the child quality of life.

Gulossectomy and Skeletal Anchorage as Aajuncts to Orthodontic Correction of a Severe Open Bite Case.

Etiology of open bite malocclusion is multifactorial; therefore, elimination of the main etiologic factor is the key for successful treatment. Tongue size and posture can cause open bite; thus, glossectomy is one of the treatment choices in severe cases. A 19 year old girl with a chief complaint of extra-large tongue and anterior open bite due to hemangioma was referred to us. Hemangioma removal and partial glossectomy were performed. With no other intervention, the anterior open bite decreased 10 millimeters within 3 years. Since the patient refused orthognathic surgery, the remaining malocclusion was resolved by orthodontic treatment using skeletal anchorage.

Changes of some functional speech disorders after surgical correction of skeletal anterior open bite.

Skeletal anterior open bite (AOB) or apertognathism is characterized by the absence of contact of the anterior teeth and affects articulation parameters, chewing, biting and voice quality. The treatment of AOB consists of orthognatic surgical procedures. The aim of this study was to evaluate the effects of treatment on voice quality, articulation and nasality in speech with respect to skeletal changes. The study was prospective; 15 patients with AOB were evaluated before and after surgery. Lateral cephalometric x-ray parameters (facial angle, interincisal distance, Wits appraisal) were measured to determine skeletal changes. Before surgery, nine patients still had articulation disorders despite speech therapy during childhood. The voice quality parameters were determined by acoustic analysis of the vowel sound /a/ (fundamental frequency-F0, jitter, shimmer). Spectral analysis of vowels /a/, /e/, /i/, /o/, /u/ was carried out by determining the mean frequency of the first (F1) and second (F2) formants. Nasality in speech was expressed as the ratio between the nasal and the oral sound energies during speech samples. After surgery, normalizations of facial skeletal parameters were observed in all patients, but no statistically significant changes in articulation and voice quality parameters occurred despite subjective observations of easier articulation. Any deterioration in velopharyngeal insufficiency was absent in all of the patients. In conclusion, the surgical treatment of skeletal AOB does not lead to deterioration in voice, resonance and articulation qualities. Despite surgical correction of the unfavourable skeletal situation of the speech apparatus, the pre-existing articulation disorder cannot improve without professional intervention.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability.

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.