Evaluation of temporomandibular joint space and condylar morphology in patients with anterior open-bite based on cone-beam CT / 口腔疾病防治

Objective@#To investigate the difference of the temporomandibular joint between patients with anterior open-bite and normal overbite with cone beam CT (CBCT).@*Methods @# Fifty-four patients with anterior open bites and 54 patients with normal overbites were selected from the Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University from June 2014 to August 2020. Sagittal and coronal images of the temporomandibular joint were reconstructed with multiplanar reconstruction techique. The Kamelchuk method was used to measure the superior, posterior and anterior space of the temporomandibular joint, and the condylar morphology was divided into two types: normal and abnormal. The joint space and condylar morphology of the anterior open-bite group and the normal overbite group were statistically analyzed. The anterior open-bite group was divided into 3 subgroups: ① Ⅰ° open-bite (open bite distance < 3 mm), ② Ⅱ° open-bite (open bite distance ≥ 3 mm and ≤ 5 mm) and ③ Ⅲ° open-bite (open bite distance > 5 mm). The difference of overbite spaces of the temporomandibular joint was compared among these three subgroups.@*Results@#Compared to the normal group, no significant differences were found for the anterior and superior space of the temporomandibular joint in the anterior open-bite group (P > 0.05), but the posterior space increased significantly (P < 0.01). A total of 52.8% of patients in the anterior open-bite group had abnormal condyles, whereas 21.3% of patients in the normal group, overbite significant differences was found between the two groups (P < 0.01). Compared with patients with Ⅰ° and Ⅱ° openbite, the condyle of patients with III° open bites was more forward in the fossa (P < 0.05).@*Conclusion @#The position of the condyle in the fossa of patients with anterior open bites is more forward, and abnormal condylar bone is more common found.

Protraction facemask followed by mandibular cervical headgear: an alternative in the treatment of class III malocclusion with severe anterior open-bite / Máscara facial para protração seguida de aparelho extra-bucal mandibular: uma alternativa para o tratamento da má oclusão de classe III com mordida aberta anterior severa

The present case report describes a conservative and uncommon treatment for class III malocclusion in a woman growing patient with aged eight years and four months. An unconventional treatment modality was used for the treatment of this malocclusion, reverse-pull headgear and distalisation of lower teeth using mandibular cervical headgear in the lower arch. At the end of the treatment (after 33 months), there was correction of the transversal and sagittal occlusal relationship between maxilla and mandible and correct dental intercuspation (AU)

O presente relato de caso descreve um tratamento conservador e incomum para má oclusão de classe III em uma paciente em crescimento com idade de oito anos e quatro meses. Uma modalidade de tratamento não convencional foi utilizada que consistiu no uso de tração reversa maxilar e aparelho extra-bucal inferior para distalização. Ao final do tratamento (após 33 meses), houve correção da relação oclusal sagital e transversal entre maxila e mandíbula e correta intercuspidação dentária (AU)

Treatment and retention of relapsed anterior open-bite with low tongue posture and tongue-tie: A 10-year follow-up / 대한치과교정학회지

The purpose of the current report is to present 6-year long-term stability and 10-year follow-up data for an adult patient who was treated with a tongue elevator for relapsed anterior open-bite. The 19-year-old male patient presented with the chief complaint of difficulty in chewing his food. Collectively, clinical and radiographic examinations revealed an anterior open-bite, low tongue posture, and tongue-tie. The patient opted for orthodontic treatment alone, without any surgical procedure. A lingual frenectomy was recommended to avoid the risk of relapse, but the patient declined because he was not experiencing tongue discomfort. Initial treatment of the anterior open-bite with molar intrusion and tongue exercises was successful, but relapse occurred during the retention period. A tongue elevator was used for retreatment, because the approach was minimally invasive and suited the patient's requirements regarding discomfort, cost, and time. The appliance changed the tongue posture and generated an altered tongue force, which ultimately resulted in intrusive dentoalveolar effects, and a subsequent counterclockwise rotation of the mandible. The results showed long-term stability and were maintained for six years through continual use of the tongue elevator. The results of this case indicated that a tongue elevator could be used not only as an alternative treatment for open-bite, but also as an active retainer.

Associação entre história de aleitamento e relatos de hábitos orais e alergia em crianças / Association between history of breastfeeding and reports of oral habits and allergy in children

Objetivo: Este trabalho teve como propósito verificar a associação entre o tipo e o tempo de amamentação fornecida ao bebê com a presença de hábitos de respiração bucal, bruxismo, mordida aberta anterior e presença de processos respiratórios alérgicos. Materiais e métodos: Foram analisados todos os prontuários clínicos de crianças entre 0 a 12 anos de idade atendidos nos ambulatórios odontológicos do Centro Universitário Franciscano (UNIFRA), no período de 2005 a 2010. De um total de 507 prontuários, foram incluídos no estudo prontuários de 390 crianças. Resultados: Os resultados demonstraram haver associação entre o tipo de amamentação com a presença de respiração bucal, bruxismo e mordida aberta anterior (p<0,05). No entanto, não foram encontradas associações entre o tipo de amamentação fornecida ao bebê e a presença de processos respiratórios alérgicos, bem como o período de amamentação e a presença de hábitos de respiração bucal, bruxismo, mordida aberta anterior e alergia. Alem disso, constatou-se que a maioria das crianças atendidas nos ambulatórios odontológicos da UNIFRA recebeu mais amamentação natural (85%) que artificial (14%). Conclusão: Concluiu-se, portanto, que o tipo de amamentação fornecida ao bebê pode colaborar para o correto desenvolvimento da face e assim evitar o surgimento de alterações no sistema estomatognático.

Aim: The purpose of this study was to assess the association between type and duration of breastfeeding with the presence of mouth breathing habits, bruxism, anterior open bite and presence of respiratory allergic conditions. Materials and Methods: It was analyzed all dental records of children aging between 0 and 12 years old who were attended by dental students Franciscan University Center (UNIFRA) since 2005 to 2010. Of a total of 507 dental records, 395 were included in the study. Results: The results showed an association between breastfeeding the presence of mouth breathing, bruxism and anterior open bite (p <0.05). However, there was no association between breast feeding and the presence of respiratory allergy as well as time of breastfeeding and the presence of mouth breathing, bruxism, and anterior open bite allergy. The majority of children UNIFRA received more natural breastfeeding (85%) than artificial (14%). Conclusion: The breastfeeding provided the baby can contribute to the proper development of the face and thus prevent the emergence of changes in the stomatognathic system.

Post-operative Stability of Counter Clockwise Rotation of the Mandibular Plane in Skeletal CIII with Anterior Openbite Patients

3degrees).CONCLUSION: This study evaluated the amount of horizontal relapse, and the degree of relapse. Stable results were obtained. Although there was no statistical significance between the degree of openbite and the amount of horizontal relapse, the group with a greater amount of openbite had a greater amount of relapse.

Tratamento ortocirúrgico da classe III e mordida aberta severa / Ortho-surgical treatment of class III with severe open-bite

Relato de caso ortocirúrgico de uma paciente classe III com mordida aberta total. A cirurgia consistiu em recuo de 6 mm da mandíbula, avanço e elevação posterior de 4 mm da maxila, pelas técnicas de osteotomia sagital do ramo mandibular e Le Fort I, associadas à fixação interna rígida. Após a obtenção da harmonia facial e dentoesquelética observou-se leve recidiva dentária, com diastema na distal dos caninos inferiores, na fase de contenção. Esse caso demonstra que a cirurgia ortognática é um valioso recurso no tratamento das má-oclusões esqueléticas, em especial, a Classe III.

A case report of a Class III ortho-surgical treatment with a full open bite. The surgery of choice was 6 mm mandibular setback, and anterior displacement and posterior elevation of the maxilla in 4 millimeters, by the sagital split technique for the mandibular ramus and Le Fort I, associated to internal rigid fixation. After facial, skeletal and tooth harmonies were acquired, slight dental relapse in orthodontic treatment long-term was observed. This case report elucidates that orthognatic surgery is a valuable resource in treatment of skeletal malocclusions, especially in Class III cases.

Management of Open Bite.

Open bite is a malocclusion that occurs in the vertical plane, characterized by lack of vertical overlap between the maxillary and Mandibular dentition. The anterior open bites particularly skeletal open bites are called as “stigmata of malocclusion”. The varied etiological characterstic features of openbite are discussed in this article. Openbites are easy to diagnose but difficult to retain. The various modes of treatment are also discussed depending upon the age of the patient.

The structural change in the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients using 3-dimensional computed tomography / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to investigate the structural changes of the hyoid bone and upper airway after orthognathic surgery for skeletal class III anterior open bite patients, and make comparisons with normal occlusion. METHODS: Pre- and post-operative computed tomography (CT) examinations were performed on 12 skeletal class III anterior open bite patients who were treated with mandibular setback osteotomy. Using the V-works 4.0(TM) program, 3-dimensional images of the total skull, mandible, hyoid bone, and upper airway were evaluated. RESULTS: In the Class III openbite group, the hyoid bone were all positioned anteriorly, compared to the Normal group (p < 0.05). The angle between the hyoid plane and mandibular plane in the Class III openbite group before surgery was greater than in the Normal group (p < 0.05), and the difference increased after surgery (p < 0.01). In the Class III openbite group, the volume of the upper airway decreased after surgery (p < 0.001) and the volume of the upper airway was smaller than the Normal group before and after surgery (p < 0.001). CONCLUSIONS: The narrow upper airway space in skeletal Class III openbite patients decreased after mandibular setback osteotomy. This may affect the post-surgical stability.

Non-surgical treatment and retention of open bite in adult patients with orthodontic mini-implants / 대한치과교정학회지

Successful treatment of the non-growing patient with an open bite of either dental skeletal pattern often presents a difficult challenge. The morphologic pattern in anterior open bite is characterized by longer vertical dimensions, an increase in development of the maxillary posterior dento-alveolar structure and a steep mandibular plane. In such cases, molar intrusion would be a good remedy for treatment. This article reports the successful treatment and retention of two anterior open-bite cases. We used orthodontic mini-implants for treatment and a circumferential retainer with posterior bite block or skeletal fixed retainer for retention. The diagnostic criteria and mechanics for appropriate treatment are discussed. Our results suggest that open bite can be reduced successfully with intrusion of molars using orthodontic mini-implants (OMI) without orthognathic surgery, and that circumferential retainer with posterior bite block and skeletal fixed retainer are effective for retention.

Treatment and posttreatment changes following intrusion of maxillary posterior teeth with miniscrew implants for open bite correction / 대한치과교정학회지

OBJECTIVE: This study investigated the skeletal and dentoalveolar changes after intrusion of maxillary posterior teeth using miniscrew implants during the treatment and posttreatment period. METHOD: The subjects consisted of 11 adults (1 male, 10 females) whose open bites were treated by posterior teeth intrusion with miniscrew. The lateral cephalometric x-rays of pre-treatment, post-treatment, and the retention period were evaluated. RESULTS: The average intrusion of maxillary posterior teeth at the end of the treatment period was 2.22 mm (p < 0.001) and the average extrusion of maxillary posterior teeth at the end of the 17.4 month retention period was 0.23 mm (p = 0.359). The relapse rate was calculated at 10.36%. A decrease in overbite after the 17.4 month retention period was 0.99 mm (p < 0.05). The relapse rate was calculated at 18.10%. The skeletal changes and vertical height change of maxillary posterior teeth during the retention period was statistically insignificant, but there was a significant decrease in overbite (mean 0.99 mm, p < 0.05). The amount of intrusion and the overbite improvement from treatment significantly correlates to the degree of relapse. CONCLUSIONS: The results indicate that intrusion of the maxillary posterior teeth using miniscrews is an effective, non-surgical treatment modality which can reasonably be used to address adult open bite.

Central tongue reduction for macroglossia

Macroglossia can cause dentomusculoskeletal deformities, instability of orthodontic and orthognathic surgical treatment, and create masticatory, speech and airway management problems. To determine whether a reduction glossectomy is necessary, it will important to identify the signs and symptoms of macroglossia. Development of dentoskeletal changes directly related with tongue size, such as an anterior open bite or a Angle Class III malocclusion tendency, would indicate that reduction glossectomy may be beneficial. For reduction glossectomy, several techniques have been reported. However, in most techniques the tip of tongue is removed. So its excision causes the loss of most mobile and sensitive portion of the tongue, and creates ankylosed, globular tongue. To avoid such problems, central tongue reduction technique have been proposed. This article will introduce central tongue reduction for anterior openbite case associated with macroglossia.

Compensation of female adults with openbite tendency / 대한치과교정학회지

The purposes of this study were to observe the compensation pattern of human female adults with openbite tendency and to provide the decision criteria of the diagnosis and treatment planning for those patients. Fifty patients with anterior openbite and fifty-five patients without anterior openbite patients were selected as a control and a test group. ODI of the all patients was below 66. Mean ages of the control and the test group were 23.88+/-4.53 and 24.7+/-6.20 years, respectively. Lateral cephalograms were taken and forty-one variables were measured. To identify the morphological differences between the groups, statistical analyses were performed. Statistically significant differences were found in the measured variables of lower face height, N-Me, ANS-Me, ANS-Me/N-Me ratio, Mx1-SN, Mx1-FH, Mx1-NA(mm), Mx1-APo, PP to Mx6, Mn1-NB(degree), Mn1-NB(mm). The test group showed decreased lower face height, N-Me, ANS-Me, ANS-Me/N-Me ratio, more uprighted and retruded maxillo-mandibular incisors. Overeruption of the maxillary first molar was found in the control group.

Evaluation of skeletal stability after BSSRO in skeletal class III with anterior open bite

OR = 1mm). Serial lateral cephalometric radiographs were taken within 2 weeks preoperatively, within 1 week postoperatively and at a follow up period that ranged from 7 to 24 months postoperatively. All cephalometric radiographs were traced and digitized using the Quick ceph image Pro for analysis. And then, horizontal and vertical changes of reference points(B point, Pogonion, L1) were assessed by the linear measurements in millimeters on both axes. The results were as follows: 1. Mean horizontal relapses were 0.67+/-0.93mm (11%) at B point (P0.05). 3. The mean angular change of occlusal plane to SN was 0.24+/-1.19 (P>0.05) and that of mandibular plane to SN was 1.03+/-1.85 (P<0.05). 4. There was correlation between the extent of preoperative overbite and the postsurgical relapse at B point and Pogonion. 5. There was no correlation between the amount of surgically produced horizontal movement and the postoperative horizontal relapse at B point.

Postoperative stability and occlusal plane alternation by orthgnathic surgery of skeletal Class III malocclusion with anterior open bite / 대한치과교정학회지

The purpose of this study is to investigate the stability of counterclockwise rotation of mandible by sagittal split ramus osteotomy to correct the skeletal Class III malocclusion with anterior open bite. Twenty five skeletal Class III open bite patients(mean age 20.6 years) who were treated by the sagittal split ramus osteotomies with rigid fixation were examined in this study. Cephalometric radiographs were taken for ach patients preoperative(T1), early postoperative(T2), and late postoperative period(T3). Mean postoperative period(T3).Mean postoperative period was 8.0 months. Cephalomerric analysis was done and data from T1, T2, and T3 were analyzed statistically by paired t-test and pearson correlation analysis. The following results were obtained. 1. Mandibular plane angle decreased 2.9degrees and mandibular occlusal plane angle related to SN plane decreased 2.7degrees after orthognathic surgery(T2). At 6 months after orthgnathic surgery(T3), mandibular plane angle increased 1.0degrees, but mandibular occlusal plane angle did not changed. 2. The amount of horizontal relapse long time after orthornathic surgery(T3) was 1.6mm at B point and it was 22% of the total posterior movements. There was no vertical relapse in the anterior facial height. 3. The related factor with horizontal relapse at late postoperative period was mandibular plane angle(p<0.01). The related factors with decreasing posterior facial height were amount of mandibular setback(p<0.01), increasing of mandibular ramus height(p<0.01), and decrease of the mandibular plane angle during operation(p<.01). 4. There was no relationship between the amount of changes in mandibular occlusal plan angle during operation and the amount of relaspe after surgery.

The diagnosis and treatment of anterior openbite malocclusion / 대한치과교정학회지

There are varieties of severe malocdusions, which can be treated orthodontically, but with a great deal of effort. Anterior openbite, in particular, is one malocclusion thought to be more difficult to treat, and therefore, most of them have to be corrected by means of surgical intervention. To solve these problems, numerous studies pertinent to treatment modalities have been introduced with controversies on the effectiveness of treatment. Suggested treatment-modalities for anterior openbite are based directly or indirectly on the neuromuscular and morphological features and on the etiologic and/or the environmental factors. Even though the vertical relationship of the face is increased due to the growth variation, the normal occlusal relationship can be achieved by the adequate dentoalveolar compensatory mechanism, but in the case of inadequate or negative dentoalveolar compensation, openbite is likely to be present. If the skeletal dysplasia is too severe to be solved by orthodontic treatment alone, combined treatment with surgery should be done to restore the function and the esthetics of the orofacial complex. In many cases, however, orthodontic alteration of the dentition pertinent to the given skeletal pattern with the proper diagnosis and treatment planning can bring satisfactory results. The treatment changes with the Multiloop Edgewise- Archwire(MEAW), therapy occurred mainly in the dentoalveola~ region and showed a considerable similarity to the natural dentoalveolar compensatory mechanism. In other words, the MEAW technique allows orthodontists to produce the natural dentoalveolar compensation orthodontically. Even if an openbite is corrected by the orthodontic dentoalveolar compensation suitable for the skeletal pattern, relapse may still occur by the persisting etiologic factors which originally prohibited the natural dentoalveolar compensation. The etiologic factors should be determined at the time of initial diagnosis and should be controlled during treatment and retention.

SURGICAL CORRECTION OF CLASS II OPENBITE WITH TMD ; Report of Cases

PURPOSE: This is to evaulate the efficacy of orthognathic surgical aids to imporve the painful TMJ in Class II open-bite deformites. CASES: Four patients who had been sufferred from temporo-mandibular disorders with open-bite retrognathic deformities underwent orthognathic surgeries. The presurgical orthodontic treatment and conservative management for temporomandibular disorders could not be continued due to progressive pain loading on TMJs and muscle tenderness. Bilateral ramus oseotomy with semirigid internal fixation were followed for 2 years by radiologic changes including MRI, bone scan, clinical examination of jaw opening. pain(VAS) and occlusal changes. RESULTS: Open-bite deformites with painful TMJ showed DJD findings without reduction of disc and hot spots on bone scans. The surgeries helped pain reduction to VAS 0.5 from 8.0 and improved jaw opening to 45 mm. Hot spots of TMJ were decreased or disappeared in one year. There were no signs or evidence of openbite-recurrence. CONCLUSION: In the standpoint of sequential management of TMD, the orthognathic surgery is a good option and modality to treat the class II openbite deformities with temporomandibular disorders with temporomandibular disorders which are not respond to conservative management during orthodontic treatment.

Treatment of open bite with multiloop edgewise archwire technic / 实用口腔医学杂志

objective: To evaluate the effects of multiloop edgewise archwire(MEAW) therapy in the treatment of open bite. Methods: 20 cases of open bite (male 7 ,female 13 ,aged 13～25 yrs old) were treated by MEAW technique.The effects were evaluated by cephalometry. Results: After treatment ANB *, U1 SN *, L1 MP ** , U 6 SN *, U6 PP(mm) *, L6 MP * and L6 MP(mm) * decreased, L1 MP(mm) ** , U1 L1 ** and OB(mm) ** increased( * P

Cephalometric characteristics of open-bite cases with degenerative joint disease(DJD) of TMJ / 대한치과교정학회지

The purpose of this study is to investigate the cephalometric characteristics of the open-bite patients with DJD of TMJ. The DJD open-bite cases were compared with normal samples and Class II open-bite cases with normal TMJ respectively. Twenty three open-bite patients with bilateral DJD of TMJ(13.9~35.3 years old, Group I) were selected from the Department of Orthodontics, SNUDH. Group II consisted of thirteen Class II open-bite cases(13.2-27.4 years old) with no TMD signs/symtoms and good condylar shapes. Group III samples were the forty eight healthy dental students who have Class I molar relationships with no history of orthodontic treatment, good facial balance and no TMD symptoms(20.0-26.8 years old). First, sixty measurements in the lateral cephalometric radiographs and analysis of variance(p<0.05, Scheffe) were used to compare these three groups. The seven measurements showed significant difference(P<0.05) between Group I and Group II. After analysis of variance, six of them were used for the discriminant analysis(Wilks', stepwise analysis) and the discrminant function for Group I/Group II was obtained. The results and conclusions were as follows: In most of the measurements, Group I and Group II showed the same skeletal and dental characteristics. But seven of the sixty measurements(FH-PP angle, SNB, FH-ArGo angle, articulare angle, gonial angle, upper gonial angle and Ar-Go length) were significantly different(p<0.05) between Group I and Group II. These differences may be explained by the fact that in DJD cases the mandible rotated backward due to the shortening of the ramus following the degenerative destruction of condylar head and its surrounding structures. The resulting discriminant function was: D = -0.l20X1 + 0.066X2 + 0.144X3 - 0.058X4 + 2,000, where X1=ArGo length(mm), X2=SArGo angle(degree), X3=FH-PP angle(degree), X4=Gonial angle(degree), Mean of the group centroids was -0.555 and percent of the "grouped" cases correctly classified was 88.89%.

Change of condylar position after orthodontic treatment of anterior open bite / 대한치과교정학회지

This study was aimed to evaluate the changes in condylar position when severe anterior open bite patients were treated with MEAW. The subjects consisted of 11 patients(21 TMJs) who visited the department of orthodontics in SNUH, having severe anterior open bite as a chief complain. They were supposed to wear the up and down elastics and MEAW after finishing the leveling. The condylar position was evaluated with individualized corrected tomography in centric occlusion taken before and after treatment. The results were as follows; 1. In the change of condylar position after treatment, there were no statistically significant differences in right and left TMJs. 2. In the change of condylar position after treatment, there were no statistically significant differences in each malocclusion groups. 3. There were no statistically significant differences in percent displacement of condyle between before and after treatment. 4. There were no statistically significant differences in the amount of change in condylar change.

An electromyograghic study of muscular activities of tongue and lip muscles in anterior open-bite / 대한치과교정학회지

The purpose of the present study was to investigate the difference of muscular activities of the tongue and lip muscles between anterior open-bite and normal occlusion during various function. Thirty eight subjects of 12.1-39.6 years were employed in this study: Eighteen subjects were anterior open-bites and twenty subjects were normal occlusions. During rest position, maximum effort of lip sealing, command swallow of saliva and sucking & swallowing of juice, the electromyographic datas of the genioglossus, superior longitudinal muscle of tongue, upper and lower orbicularis oris were recorded and integrated with Medelec MS 25 electromyographic machine. Lateral cephalometric radiographs were taken on all subjects for the analysis of tongue posture and size. All data were recorded and statistically processed. The findings of this study can be summerized as follows: 1. During the rest position, muscular activity of tongue was higher than that of lip muscle in open-bite, but no difference in normal occlusion group. 2. During the swallowing of juice, the activity of orbicularis oris was higher than that of genioglossus in open-bite. But the normal occusion was showed higher activity of tongue during the swallowing of juice. 3. The open-bite, compared to the normal occlusion, had higher value of tongue muscle activity during the rest position. 4. Compared to normal occlusion group, the open-bite had higher value of lip muscle activity during the sucking and swallowing of juice. 5. During the command swallow of saliva, the normal occlusion was showed harmonious swallowing pattern, but the open-bite showed much variation and disharmony in muscular contraction sequence, tended to absent of lip muscle activity. 6. At the lateral cephalometric radiographs, compared to the normal occlusion, the open-bite was showed lower tongue posture. But no difference was found in intermaxillary space. It is suggested that the open-bite, compared to the normal occlusion, had higher muscular activity of tongue during the rest position and various functions, showed lower tongue posture on the lateral cephalogram. In the development of anterior open-bite malocclusion, these factors may be an etiologic factor.