Combined orthodontic and surgical open bite correction.

OBJECTIVES: To examine the stability of combined surgical and orthodontic bite correction with emphasis on open-bite closure. All study patients were treated with strict and consistent orthodontic and surgical protocols. MATERIALS AND METHODS: Study inclusion required all patients to have anterior open bites, maxillary accentuated curve of Spee, 36-month minimum follow-up, and no temporomandibular joint pathology. Thirty patients met the inclusion/exclusion criteria. Importantly, segmental upper arch orthodontic preparation (performed by EG) was used. Surgery consisted of a multisegment Le Fort I (MSLFI) combined with a bilateral sagittal osteotomies (BSSO). Surgery was performed (by ADA and LT) at the Department of Dentistry and Maxillofacial Surgery of the University of Verona, Italy. RESULTS: The long-term open bite and overjet relapse were not statistically significant. The mean transverse relapse of the upper and lower molars was statistically significant. Of great importance, the upper and lower arch widths narrowed together, maintaining intercuspation of the posterior dentition which prevented anterior open bites from developing. CONCLUSIONS: This study revealed stability of three-dimensional occlusal correction including anterior open bite. Stable open bite closure was achieved by using rigid protocols for orthodontic preparation, surgical techniques, surgical follow-up, and orthodontic finishing.

Idiopathic bilateral mandibular condylar resorption causing anterior open bite - A case report.

Introduction: Mandibular condylar resorption (MCR) is a rare pathological entity, often affecting young females. Patient Concerns: It is accompanied by pain, malocclusion and compromised quality of life including aesthetic perception. Due to this multiplicity of features, the diagnosis, treatment and management of MCR are always a challenge. Diagnosis: This article reports a 25-year-old female suffering from progressive temporomandibular joint pain and compromised aesthetics. This article describes the clinical and radiological findings of this case. Treatment: The possible aetiopathogenesis and treatment are described.

Upper airways evaluation in young adults with an anterior open bite: A CBCT retrospective controlled and cross-sectional study.

OBJECTIVE: To compare the dimensions of the upper airway in young adults with anterior open bite versus matched individuals with an adequate overbite (control group) using different measurement approaches (linear, area, and volume measures). MATERIALS AND METHODS: The sample included 137 cone-beam computed tomographies (CBCTs) of young adults (74 men and 63 women) divided into two groups: 47 CBCTs of individuals (mean age 27.89) with open bite (overbite depth indicator (ODI) 56.84°±9.48° and Frankfort mandibular plane angle (FMA) 31.21°±6.44°) and 90 CBCTs of individuals (mean age 26.87) without an open bite (ODI 62.24°±9.47°, FMA 26.79°±5.81°). Two trained and calibrated orthodontists made all linear, area, and volume measurements on the CBCT records of the upper airways using Planmeca Romexis software. The Mann-Whitney U-test, chi-squared test, and multiple linear regression were applied. Significance was set at P<0.05. RESULTS: There were no differences in linear or volume measurements between groups, but there was a greater area in the open bite group (greater mean difference between groups 928.3 mm2) than the control group. No variable influenced nasopharyngeal airway volume, but ANB angle affected oropharyngeal airway volume (ß=-623.87) and total airway volume (ß=-651.48). CONCLUSIONS: Orthodontists should be aware that the airways diagnosis can vary depending on the measurement approach used, the volumetric method being the gold standard. The pharyngeal airway volume was similar in individuals with vs. without an open bite and is mainly influenced by ANB angle in both groups.

Skeletal open bite cranial base characteristics in young Latin-American individuals with class I, II and III malocclusions: An observational study.

OBJECTIVE: This study aimed to compare cranial base linear and angular measurements between individuals with skeletal open bite and different sagittal skeletal relationships. MATERIALS AND METHODS: This observational and cross-sectional study included 101 lateral radiographs of young Latin-American individuals with skeletal open bite that met the inclusion criteria and were collected from a private radiological centre. Three groups were formed. Groups 1, 2 and 3 included individuals with skeletal open bite (negative overbite and FMA>30°) and Class I (n=31), II (n=35) and III (n=35) sagittal skeletal relationship, respectively. The anterior and posterior cranial bases (SN and SBa), and cranial base angles (BaSN and ArSN) were measured. Groups were compared with one-way analysis of variance and post-hoc Scheffé tests. The influence of predictor variables on the cranial base were evaluated with linear regressions (α=0.05). RESULTS: The cranial base angles were significantly smaller (approximately 3° to 5°) in the skeletal open bite Class III group (BaSN=127.97°± 5.86°, ArSN=120.19°±6.12°) when compared with the other groups. BaSN angle, Class I versus Class III (p<0.001) and Class II versus Class III (p<0.001). ArSN angle, Class I versus Class III (p=0.005) and Class II versus Class III (p=0.026). Multiple linear regressions showed that sex had a significant influence on both cranial base dimensions with men showing larger values than women. CONCLUSIONS: Skeletal open bite Class III individuals show a smaller cranial base angle than Skeletal open bite Class I or II individuals.

The normal range of maximal incisal opening in pediatric population and its association with physical variables.

Background: Restricted mouth opening is a common complaint in patients suffering from temporomandibular joint disorders, ankylosis, impaired masticatory muscle function, rheumatic disease, infection, or malignancy. As with any disease, the aim of treatment of disorders affecting mouth opening is to restore the mouth opening to its normal value. It is thus of paramount importance to determine the normal value. Objective: To establish the normal range of maximal incisal opening (MIO) in children aged 4 to 15 years and to investigate the correlation between MIO and age, gender, height, and body weight. Materials and Methods: Six hundred and two children from various schools in Bengaluru, India, participated in the study. The children were divided into the following age groups: 4-5, 6-7, 8-9, 10-11, 12-13, and 14-15 years. MIO for the children was recorded using Therabite® scale. The measurements of MIO were then correlated with gender, body weight, and height of the children in different age groups. Results: It was observed that MIO gradually increased with age with a mean MIO of 41.34 mm at 4-5 years to a mean MIO of 51.73 mm at 14-15 years. The mean MIO value for males (48.90 ± 6.49 mm) was found to be higher when compared to that of females (46.17 ± 5.58 mm). The results indicated a strong positive correlation of MIO with height and weight. Conclusion: MIO gradually increased with age in both the genders, and a strong positive correlation of MIO with height and weight was observed.

RésuméContexte: L'ouverture restreinte de la bouche est une plainte fréquente chez les patients souffrant de troubles de l'articulation temporo-mandibulaire, d'ankylose, d'altération de la fonction musculaire masticatoire, de rhumatisme articulaire, d'infection ou de cancer. Comme pour toute maladie, le traitement des troubles de l'ouverture de la bouche a pour objectif de ramener cette ouverture à sa valeur normale. Il est donc primordial de déterminer la valeur normale. Objectif: Établir la plage normale d'ouverture maximale de l'incision (OMI) chez les enfants âgés de 4 à 15 ans et étudier la corrélation entre l'ouverture maximale de l'incision et l'âge, le sexe, la taille et le poids corporel. Conception de l'étude: Six cent deux sujets de diverses écoles de Bangalore, en Inde, ont participé à l'étude. Les sujets ont été répartis dans les groupes d'âge suivants: 4-5, 6-7, 8-9 ans, 10-11 ans, 12-13 ans et 14-15 ans. L'ouverture incisive maximale des sujets a été enregistrée avec l'échelle Therabite®. Les mesures de MIO ont ensuite été corrélées avec le sexe, le poids corporel et la taille des enfants dans différents groupes d'âge. Résultats: Il a été observé que le MIO augmentait progressivement avec l'âge, avec un MIO moyen de 41,34 mm à 4-5 ans, pour atteindre un MIO moyen de 51,73 mm à 14-15 ans. La valeur moyenne maximale de l'ouverture incisive chez les hommes (48,90 ± 6,49 mm) s'est avérée plus élevée que celle des femmes (46,17 ± 5,58 mm). Les résultats ont montré une forte corrélation positive entre le MIO et la taille et le poids. Conclusion: le MIO a augmenté progressivement avec l'âge chez les deux sexes et une forte corrélation positive entre le MIO et la taille et le poids a été observée.

Effect of Trimetazidine Dihydrochloride Therapy on Exercise Capacity in Patients With Nonobstructive Hypertrophic Cardiomyopathy: A Randomized Clinical Trial.

Importance: Hypertrophic cardiomyopathy causes limiting symptoms in patients, mediated partly through inefficient myocardial energy use. There is conflicting evidence for therapy with inhibitors of myocardial fatty acid metabolism in patients with nonobstructive hypertrophic cardiomyopathy. Objective: To determine the effect of oral therapy with trimetazidine, a direct inhibitor of fatty acid ß-oxidation, on exercise capacity in patients with symptomatic nonobstructive hypertrophic cardiomyopathy. Design, Setting, and Participants: This randomized, placebo-controlled, double-blind clinical trial at The Heart Hospital, University College London Hospitals, London, United Kingdom was performed between May 31, 2012, and September 8, 2014. The trial included 51 drug-refractory symptomatic (New York Heart Association class ≥2) patients aged 24 to 74 years with a maximum left ventricular outflow tract gradient 50 mm Hg or lower and a peak oxygen consumption during exercise of 80% or less predicted value for age and sex. Statistical analysis was performed from March 1, 2016 through July 4, 2018. Interventions: Participants were randomly assigned to trimetazidine, 20 mg, 3 times daily (n = 27) or placebo (n = 24) for 3 months. Main Outcomes and Measures: The primary end point was peak oxygen consumption during upright bicycle ergometry. Secondary end points were 6-minute walk distance, quality of life (Minnesota Living with Heart Failure questionnaire), frequency of ventricular ectopic beats, diastolic function, serum N-terminal pro-brain natriuretic peptide level, and troponin T level. Results: Of 49 participants who received trimetazidine (n = 26) or placebo (n = 23) and completed the study, 34 (70%) were male; the mean (SD) age was 50 (13) years. Trimetazidine therapy did not improve exercise capacity, with patients in the trimetazidine group walking 38.4 m (95% CI, 5.13 to 71.70 m) less than patients in the placebo group at 3 months after adjustment for their baseline walking distance measurements. After adjustment for baseline values, peak oxygen consumption was 1.35 mL/kg per minute lower (95% CI, -2.58 to -0.11 mL/kg per minute; P = .03) in the intervention group after 3 months. Conclusions and Relevance: In symptomatic patients with nonobstructive hypertrophic cardiomyopathy, trimetazidine therapy does not improve exercise capacity. Pharmacologic therapy for this disease remains limited. Trial Registration: ClinicalTrials.gov identifier: NCT01696370.

Differential Identification of Three Young Housefire Victims: Methods when Age Assessment Fails.

Multiple fatality incidents involving more than one child of statistically same age (including twins) can be challenging from an identification standpoint. This case details an urban fire, in which four children perished. Age assessment on three of the victims utilizing maturity staging described by Moorrees, Fanning, and Hunt yielded insignificant results. However, a plot of the MFH data shows the difference between two identical twins and a third child. The twins share a similar growth pattern, whereas the other was different. Based on this graphical interpretation, the nontwin victim was positively identified through exclusion. These results were verified through statistical testing. This case demonstrates a method to repurpose age assessment data to graphically distinguish between child victims. Further, it is shown that radiographic and clinical presentation in childhood identical twins can elicit genetic versus acquired similarities and differences, which can be used for identification of individuals and exclusion of others.

Dentoalveolar effects produced by different appliances on early treatment of anterior open bite: A randomized clinical trial.

OBJECTIVES:: To compare different appliances for early anterior open bite (AOB) correction. MATERIALS AND METHODS:: This was a parallel, randomized clinical trial. A prospective sample of patients with AOB was recruited consecutively. Eligibility criteria included angle class I malocclusion with AOB equal to or greater than 1 mm. Participants were allocated by simple randomization to 4 groups: bonded spurs, chin cup, fixed palatal crib, and removable palatal crib. Dentoalveolar changes among the groups were assessed by blinded observers by comparing lateral cephalograms taken before (T1) and 12 months after treatment (T2; analysis of variance followed by Tukey test). Of the measurements, 30% were reassessed for reliability (intraclass correlation coefficient and Bland-Altman agreement test; α = 5%; 95% confidence interval). RESULTS:: A total of 99 patients with a mean AOB of 3.7 mm (mean age 8.4 ± 0.8 years, both genders) were recruited. Dropouts occurred in all the groups, yielding a final sample size of 81 analyzed individuals. Intergroup comparisons of differences (T2-T1) showed significant differences for the incisor positioning variables (1.1, 1-PP, 6-PP, IMPA, 1.NB and 1-GoMe). However, there was no significant difference in AOB reduction among the groups, with an average correction of 3.1 mm. CONCLUSIONS:: All of the tested devices promoted dental changes, especially in the anterior region, and contributed to AOB reduction during the study period. However, fixed palatal crib demonstrated greater impact on the positioning of the incisors.

Long-term evaluation of rapid maxillary expansion and bite-block therapy in open bite growing subjects: A controlled clinical study.

OBJECTIVE: To evaluate the long-term effects of rapid maxillary expansion (RME) and posterior bite block (BB) in prepubertal subjects with dentoskeletal open bite. MATERIALS AND METHODS: The treatment group (TG) comprised 16 subjects (14 girls, 2 boys) with dentoskeletal open bite with a mean age of 8.1 ± 1.1 years treated with RME and BB. Three consecutive lateral cephalograms were available before treatment (T1), at the end of the active treatment with the RME and BB (T2), and at a follow-up observation at least 4 years after the completion of treatment (T3). The TG was compared with a control group (CG) of 16 subjects (14 girls, 2 boys) matched for sex, age, and vertical skeletal pattern. An independent sample t-test was used to compare the T1 to T3, T1 to T2, and T2 to T3 cephalometric changes between the TG and the CG. RESULTS: In the long term, the TG showed a significantly greater increase in overbite (+1.8 mm), reduced extrusion of maxillary and mandibular molars (-3.3 mm), and, consequently, a significant decrease in facial divergence (-2.8°) when compared with untreated subjects. CONCLUSIONS: The RME and BB protocol led to successful and stable recovery of positive overbite in 100% of the patients considered. Correction of open bite was associated with reduced extrusion of maxillary and mandibular molars with a significant improvement in vertical skeletal relationships when compared with the CG.

Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion.

OBJECTIVES: To evaluate quantitatively the relationship between molar intrusion (change [Δ] maxillary first molar [U6]-palatal plane [PP]) and changes in vertical and sagittal cephalometric parameters and to determine the center of mandibular autorotation. MATERIALS AND METHODS: Twenty-one patients diagnosed with anterior open bite and successfully treated with molar intrusion (overbite [OB] > 0 mm) were retrospectively enrolled. Lateral cephalograms taken before and after molar intrusion were used to measure changes in vertical and sagittal cephalometric parameters. The center of mandibular autorotation was calculated by measuring displacement of gonion (Go) and pogonion (Pog). Paired t-tests were used to compare variables, and linear regression analysis was used to examine the relationship between ΔU6-PP and other variables. RESULTS: The mandible exhibited counterclockwise rotation after maxillary molar intrusion, which led to closure of anterior open bite. Strong linear relationships, in descending order, between ΔU6-PP and ΔOB, Δanterior facial height (AFH), Δvertical reference plane (Pog), and Δsella-nasion to Go-menton (SN-GoMe), were observed. When the maxillary molar was intruded 1 mm, OB increased by 2.6 mm, AFH decreased by 1.7 mm, Pog moved forward by 2.3 mm, and SN-GoMe decreased by 2°. The center of mandibular autorotation was located 7.4 mm behind and 16.9 mm below condylion after molar intrusion. CONCLUSIONS: The mandible exhibited counterclockwise rotation after maxillary molar intrusion; the center of mandibular autorotation was located behind and below condylion with individual variations.

Non-orthodontic intervention and non-nutritive sucking behaviours: A literature review.

Anterior open bite (AOB) is one of the most complex malocclusions to manage. AOB is caused by either by skeletal, genetic or environmental factors. Numerous treatment options are currently utilised to manage AOB. These vary from non-invasive behavioural shaping to orthodontic and surgical interventions. This paper reviews the available orthodontic and non-orthodontic interventions used in the management of AOB. The literature review was carried out using the PubMed search engine from the first of January 2000 to the first of June 2017. Two major keywords (open bite and anterior open bite) were used in addition to 23 minor keywords in the review. AOB is one of the most complex malocclusions to treat with high relapse rates. Long term outcome in treatments of patients with AOB was substantially low. Relapse rates were not taken into consideration for some of the literature reviewed. Despite limitations of the literature, it is recommended that orofacial myofunctional therapy (OMT) and non-orthodontic intervention (NOI) be used in conjunction as an effective treatment option for Anterior Open Bite.

Long-term stability of soft tissue changes in anterior open bite adults treated with zygomatic miniplate-anchored maxillary posterior intrusion.

OBJECTIVES: To evaluate soft tissue changes and their long-term stability in skeletal anterior open bite adults treated by maxillary posterior teeth intrusion using zygomatic miniplates and premolar extractions. MATERIALS AND METHODS: Lateral cephalograms of 26 patients were taken at pretreatment (T1), posttreatment (T2), 1 year posttreatment (T3), and 4 years posttreatment (T4). RESULTS: At the end of treatment, the soft tissue facial height and profile convexity were reduced. The lips increased in length and thickness, with backward movement of the upper lip and forward movement of the lower lip. The total relapse rate ranged from 20.2% to 31.1%. At 4 years posttreatment, 68.9% to 79.8% of the soft tissue treatment effects were stable. The changes in the first year posttreatment accounted for approximately 70% of the total relapse. CONCLUSIONS: Soft tissue changes following maxillary posterior teeth intrusion with zygomatic miniplates and premolar extractions appear to be stable 4 years after treatment.

Radiographic evaluation of dental and cervical vertebral development for age estimation in a young Brazilian population

Age estimation is guided by the evaluation of events that happen during the processes of bone and dental development. The purpose of this study was to validate the method of age estimation proposed by Lajolo et al. (2013) through oro-cervical radiographic indices in Brazilians. The study aimed to verify the effectiveness of age estimation equations through dental and cervical vertebrae examinations, in addition to including dental and cervical vertebrae data in new age estimation equations. The sample consisted of panoramic radiographs and teleradiographs from 510 subjects (8-24.9 years). Age estimation methods were applied by assessing the development of seven mandibular teeth, cervical vertebrae and third molars. Techniques used previously have been combinations of radiographic indices: Oro-Cervical Radiographic Simplified Score (OCRSS) and Oro-Cervical Radiographic Simplified Score without Wisdom Teeth (OCRSSWWT). In the second phase of the study, dental maturation, vertebral measurements, and real age were estimated by regression equations. OCRSS and OCRSSWWT had success rates of 67.4% (R2=0.64) and 70.8% (R2=0.62), respectively. When age estimation equations for tooth evaluations were applied, the average error was 1.3 years, and for cervical vertebrae measurements, the error was 1.9 years. When dental variables and the measurements of cervical vertebrae were included, the average error of equations was 1.0 year. Radiographic indices were easy to perform, and after adequate training, are reliable and can be used in forensic practice. The use of the new equations presented in this study is recommended because including cervical vertebrae and dental data provides greater accuracy for age estimation.

Characteristic of Malocclusion among Saudi Special Need Group Children.

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

Posterior teeth angulation in non-extraction and extraction treatment of anterior open-bite patients.

BACKGOUND: This study cephalometrically evaluated the posterior teeth angulation changes of anterior open-bite non-extraction and extraction treatment in the permanent dentition, with anterior vertical elastics. METHODS: The sample consisted of initial and final lateral headfilms of 60 patients divided into 2 groups: Group 1 consisted of 30 patients treated with non-extraction with an initial mean age of 15.26 years and treated with fixed appliances for a mean period of 2.46 years. Group 2 consisted of 30 patients treated with extractions, with an initial mean age of 14.03 years, and treated with fixed appliances for a mean period of 2.49 years. Within-group treatment changes were evaluated with paired t tests. Results were considered statistically significant at P < 0.05. RESULTS: The mandibular posterior teeth were significantly uprighted in both groups with both treatment protocols. CONCLUSIONS: Correction of anterior open bite with either non-extraction or extractions with continuous archwires and vertical anterior elastics uprights the mandibular posterior teeth.

Comparisons of two protocols for early treatment of anterior open bite.

Aim: The purpose of this study was to compare the outcomes of the treatment with the quad-helix/crib (Q-H/C) appliance with those of a combination of transpalatal arch, high-pull headgear, and lip bumper (TPA/HG/LB) in growing patients with anterior open bite malocclusion. Methods: The TPA/HG/LB sample consisted of 22 subjects, 16 girls and 6 boys (mean age 7.5±1.4 years at the start of treatment, T1, and 8.7±1.5 years at the end of active treatment, T2). The Q-H/C sample consisted of 28 subjects, 17 girls and 11 boys (mean age 8.2±1.3 years at T1, and 8.7±1.6 years at T2). Both treated groups were compared with a control group of 20 untreated subjects matched for dentoskeletal disharmony and observation interval. The changes from T2 to T1 between the three groups were compared with the analysis of variance. Results: Both TPA/HG/LB and Q-H/C groups exhibited greater reduction of the palatal plane to mandibular plane angle (-1.7° and -1.9°, respectively) and a significantly greater increase in overbite (2.2 and 2.3mm, respectively) with respect to controls. Conclusions: Q-H/C and TPA/HG/LB protocols were equally effective in correcting the anterior open bite.

[Treatment of a unilateral Brodie's syndrome by surgical contraction of the maxillae]. / Traitement d'un syndrome de Brodie unilatéral par contraction chirurgicale des maxillaires.

INTRODUCTION: Brodie's syndrome consists in a transverse occlusal discrepancy in relation with an excessive width of the maxilla, a narrow mandible or a combination of both, leading to lateral scissors bite. This kind of infrequent malocclusion is usually treated by orthodontics alone in children. In adults, additional orthognathic surgery id often required. We present a case of unilateral Brodie's syndrome treated by surgical contraction of the maxillae. OBSERVATION: A 22-year-old patient presented with a left scissors bite and severe unilateral molar overbite. After failure of an attempt to ingress the left molars by help of a sub-apical corticotomy and anchorage mini-screws, the patient was referred for surgery. The mandible being considered as normal, a segmented Le Fort I osteotomy was planned, combining a contraction (4mm) and an impaction (4mm) of the left maxilla. This allowed for an immediate correction of the skeletal discrepancy and for the achievement of orthodontics in less than 6 months. DISCUSSION: Le Fort I osteotomy provides a good access to the sagittal suture. Maxillary contraction is an uncommon procedure that enables a quick management of scissors bite and doesn't need any patient cooperation. Treatment time is reduced and the need for intraoral devices is limited.

Retrospective study of maxillary sinus dimensions and pneumatization in adult patients with an anterior open bite.

INTRODUCTION: The aim of this study was to evaluate differences in the maxillary sinus floor levels between adults with an anterior open bite and those without. METHODS: This retrospective study included 30 subjects: 15 adults with an anterior open bite (mean age, 21.5 ± 4.3 years) and 15 control subjects with normal occlusion (mean age, 21.7 ± 3.1 years). Cone-beam computed tomography and lateral cephalograms were analyzed before treatment. RESULTS: The open-bite group exhibited a significantly greater maxillary posterior alveolar height (P <0.05). The craniocaudal heights of the maxillary sinus in the region between the first and second molars and between the second premolar and first molar were significantly greater in the open bite group (40.5 and 39.0 mm, respectively) than in the control group (36.7 and 34.7 mm, respectively; P <0.05 for both). The basal bone heights in the regions between the first and second molars, the second premolar and first molar, and the first and second premolars were significantly smaller in the open-bite group than in the control group (P <0.001 for all). CONCLUSIONS: Vertical pneumatization of the maxillary sinus floor in the region between the first and second molars and between the second premolar and first molar is greater in adults with an anterior open bite than in those without, whereas basal bone height in the maxillary posterior region is lower in the open-bite patients.

Defining the location of the dental midline is critical for oral esthetics in camouflage orthodontic treatment of facial asymmetry.

When considering camouflage orthodontic treatment of a malocclusion associated with significant facial asymmetry, it is important to define the location of the dental midline. The patient, a 19-year-old Japanese woman, had an anterior open bite and a dental midline discrepancy associated with facial asymmetry. A nonsurgical treatment plan was considered. The main treatment objective was to correct the anterior open bite and the dental midlines in both arches. The dental midline discrepancy was eliminated, and proper overjet and overbite were achieved. Although the facial asymmetry remained, oral esthetics dramatically improved and a favorable occlusion was obtained. The results suggest that appropriately defining the location of the dental midline is critical for successful camouflage treatment of facial asymmetry.