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.

Oral health-related quality of life, adaptation/discomfort during open bite treatment with spurs: complementary analysis from a randomized clinical trial.

This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7-11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ8-10) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (ß) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the 'functional limitations' domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P < 0.001). Patients in both treatment groups showed similar and easy adaptation to the appliances. Independent of the type of treatment, tongue-related discomfort decreased over time. One week and one month after the appliance's delivery, the discomfort scores were 0.19 (i.e., ~ 81% reduction; exp (ß) = 0.19; 95% CI: 0.13, 0.28; P < 0.001) and 0.02 (i.e., ~ 98% reduction; exp (ß) = 0.02; 95% CI: 0.01, 0.07; P < 0.001) times, respectively, those issued immediately after the installation of the appliances. Regardless of treatment type; overall OHRQOL improved from the first to the twelfth month of AOB treatment. The functional limitations score decreased in the S group. Children showed easy adaptation, and their discomfort decreased 1 week after the installation of the appliances.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.

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.

Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial.

OBJECTIVE: The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB). MATERIAL AND METHODS: Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used. RESULTS: AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed. CONCLUSION: The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.

Biomechanical and clinical considerations in deep bite treatment using temporary skeletal anchorage devices.

Deep bite is usually treated by intrusion of the anterior teeth, extrusion of the posterior teeth, or a combination thereof. Various traditional methods have been used to correct deep bites, but they can cause negative side effects. Recently, temporary skeletal anchorage devices (TSADs) have been used to intrude the anterior teeth simply and efficiently without side effects. The amount of incisal exposure at rest should be considered as the first factor in determining which tooth segment should be intruded to correct a deep bite. The center of resistance of the anterior teeth should be considered to achieve the proper biomechanics when intruding them. The location of TSADs should be determined to ensure sufficient interradicular bone to achieve the desired tooth movement. Therefore, clinicians should understand the biomechanical and clinical considerations to correct a deep bite using TSADs.

Anterior open bite correction via molar intrusion: Diagnosis, advantages, and complications.

Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal anchorage devices, prompts counterclockwise rotation of the mandible. This rotation not only corrects anterior open bite but also contributes to a decrease in anterior facial height, improvements in lip incompetency, and forward movement of the chin. For successful outcomes, temporary skeletal anchorage devices, installed on both the buccal and palatal sides, must deliver equivalent intrusion force to the maxillary teeth. Treatment planning should consider factors such as skeletal discrepancies, vertical excess, incisor exposure, and configuration of the occlusal plane. Clinicians are advised to closely monitor periodontal changes and consider overcorrection to ensure lasting stability and maintenance of incisal overlap post-treatment.

Adult female skeletal anterior open bite treated by customized lingual orthodontic appliance with miniscrews-assisted in vertical control for perfect orthodontic compensation: A case report with 5-year follow-up.

The benefits of lingual orthodontics go beyond appearance. In this case study, a 30-year-old female patient was treated with a custom lingual orthodontic appliance for a Class II high-angle malocclusion, anterior open bite, incisor biprotrusion and crossbite, unilateral second molar scissor bite and dysfunctional tongue thrust. To achieve a counterclockwise rotation of the mandible, implant anchorage was used to control the vertical height. To complete the compensatory therapy, four first premolars were removed. As well as ensuring aesthetics over the 20-month treatment period, the treatment also established a Class I molar relationship, normal overbite and overjet, and improved the facial profile. After a five-year follow-up, the treatment results remained stable.

Orthodontic correction of anterior open bite using skeletal anchorage: systematic review and meta-analysis.

The purpose of this study was to investigate the scientific evidence on the short- and long-term effects of orthodontic correction of anterior open bite (AOB) using skeletal anchorage (SA). Clinical studies on the use of SA for AOB in patients with permanent dentition, or at least 12 years of age, were searched. Short- and long-term (≥2 years) outcomes were collected. Mean differences were calculated from pooled data. Twenty-four eligible articles with a total of 362 subjects were selected for inclusion in the meta-analysis. There was a significant increase in overbite (3.88 mm, P < 0.001) and maxillary molar intrusion (-2.15 mm, P < 0.001). The mandible showed counterclockwise rotation with anterosuperior chin movement (all P < 0.001). Long term, the decrease in overbite was 19.9% and decrease in molar intrusion was 22.9%. The decrease in the mandibular projection was 14.6% for ANB (A-point-nasion-B-point angle) and 46.2% for mandibular anteroposterior position. The overall risk of bias in the included studies was rated as moderate to high, and publication bias existed for several key variables. SA for maxillary molar intrusion effectively improved dental and skeletal outcomes, but there was a long-term decrease in overbite and maxillary molar position. The variable data quality, heterogeneity, and publication bias in investigated outcomes are limitations in interpreting the findings.

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.

Nonextraction anterior open bite treatment with distalization and intrusion.

This case report describes successful orthodontic retreatment for vertical control with nonextraction orthodontic therapy. A 31-year-old woman complained of anterior open bite and crowding. She had slightly protrusive lips but wanted to correct her malocclusion without extraction. Two palatal temporary skeletal anchorage devices were used for the distalization of the maxillary arch along with posterior intrusion. Mandibular distalization was performed with Class III elastics. The duration of active treatment was 22 months. The plain and efficient mechanics used contributed to the effective distalization of both arches, the intrusion of the maxillary posterior teeth, and favorable profile changes. The results were still stable at the five-year follow-up period.

Orthodontic treatment of an open bite after splint therapy for a patient with idiopathic condylar resorption.

In the treatment of orthodontic patients with idiopathic condylar resorption, symptoms of temporomandibular joint disorders and constantly changing occlusions caused by an instability of mandibular position make it difficult for orthodontists to confirm definitive orthodontic diagnosis and treatment plans. Therefore, these patients' temporomandibular joint (TMJ) structures need to be stabilized with splint therapy before active tooth movement to identify and maintain the true mandibular position. For some idiopathic condylar resorption patients, orthognathic surgery can cause further resorption on the vulnerable condyles of the mandible; thus, effective orthodontic camouflage treatment after joint stabilization should be considered. During the orthodontic camouflage treatment, adverse loads on the TMJ structures, which could change the position of condyles, should be avoided, and TMJ-friendly mechanics must be applied.

Assessment of the efficacy of various maxillary molar intrusion therapies: a systematic review.

AIMS: To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events. METHODS: A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal. RESULTS: A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low. CONCLUSIONS: Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.

Root resorption during maxillary molar intrusion with clear aligners: a randomized controlled trial.

OBJECTIVES: To compare changes in maxillary molar root resorption, intrusion amount, dentoskeletal measures, and maximum bite force (MBF) between clear aligners (CA) and fixed appliances with miniscrew (FM) during molar intrusion. MATERIALS AND METHODS: Forty adults with anterior open bite were randomized into either CA or FM groups. Lateral cephalograms, cone-beam computed tomography (CBCT), and MBF were collected at pretreatment (T0) and 6 months of treatment (T1). Maxillary molar intrusion in FM were intruded by nickel-titanium (NiTi) closed-coil spring delivered force (150 grams/side) while clear aligners combined with squeezing exercise were performed in CA. Parametric tests were used for statistical analysis. RESULTS: After 6 months of treatment, significant root resorption of 0.21-0.24 mm in CA and 0.38-0.47 mm in FM were found while maxillary molars were intruded 0.68 and 1.49 mm in CA and FM, respectively. CA showed significant less root resorption and intrusion than FM. Overbite, bite closing, and MBF increased significantly. CA showed significantly less overbite and SN-MP changes but more MBF increase than FM. MBF in CA was correlated with the amount of maxillary molar intrusion (r = 0.736, P < .05). CONCLUSIONS: Maxillary molar intrusion and root resorption in CA were half the amount in FM in 6 months. The amount of maxillary molar root resorption was one-third of the intrusion distance. CA displayed less overbite increase and bite closing but more MBF increase than FM. MBF in CA was positively correlated with the molar intrusion amount.

Stability of anterior open bite cases treated with upper and lower extrusion arches in adults: a follow-up study.

OBJECTIVES: To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults. MATERIALS AND METHODS: 23 patients with AOB were treated with extrusion arches and evaluated for dentoskeletal changes using lateral cephalometric radiographs before treatment (T0), after treatment (T1), and 12 months post-treatment (T2). Patients received bondable tongue spurs and vacuum-formed retainers as post-treatment retention/stability measures for 12 months. Post-treatment stability was further assessed qualitatively by the Photographic Openbite Severity Index. RESULTS: All the cases showed positive overlap between the anterior teeth at the end of orthodontic treatment, and 20 of 23 treated patients attended the recall visit after 12 months. A total of 85% of the cases maintained positive overlap at least 1 year post-treatment, 10% showed edge-to-edge bite, and only 5% showed no overbite. CONCLUSIONS: Treatment of AOB in adults with extrusion arches proved to be stable 1 year post-treatment. Changes in the overbite after 1 year of follow-up were not significant.

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.

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.

The efficacy of anterior open bite closure when using Invisalign's optimized extrusion versus conventional attachments.

BACKGROUND: Clear aligners are reported to control anterior open bites. Despite this, anterior extrusion remains difficult with aligners. Optimized extrusion attachments on incisors may facilitate anterior extrusion to correct open bite with Invisalign. The aim of this retrospective study was to compare the efficacy of anterior open bite correction with Invisalign when using optimized extrusion versus conventional attachments. METHODS: This was a retrospective cohort study. The pre- and post-treatment intraoral scans of patients with anterior open bite treated with Invisalign aligners were assessed. Patients were divided into two groups: group A, patients with horizontal conventional attachments and group B, patients with optimized extrusion attachments on incisors. The pre and post-treatment overbite and the planned overbite change were measured and compared between the groups. Descriptive statistics were computed and statistical significance was set at P < 0.05. RESULTS: A total of 86 patients were included. Both groups showed significant increases in overbite, but there was no difference in the open bite correction efficacy in patients with conventional versus optimized attachments. Shorter treatment times for open bite closure were reported for patients with optimized attachments. CONCLUSIONS: Anterior open bite can be corrected regardless of the attachment type. Optimized attachments are no more effective than using conventional attachments in incisor extrusion to correct open bite. Patients with anterior open bite with optimized attachments observed shorter treatment times for overbite correction. When correcting anterior open bite with Invisalign, the attachment type does not improve the success rate. Optimized extrusion attachments on incisors may shorten the treatment time compared to conventional attachments.