Outcomes and stability in patients with anterior open bite and long anterior face height treated with temporary anchorage devices and a maxillary intrusion splint

Abstract

Introduction Temporary skeletal anchorage devices now offer the possibility of closing anterior open bites and decreasing anterior face height by intruding maxillary posterior teeth, but data for treatment outcomes are lacking. This article presents outcomes and posttreatment changes for consecutive patients treated with a standardized technique. Methods The sample included 33 consecutive patients who had intrusion of maxillary posterior teeth with a maxillary occlusal splint and nickel-titanium coil springs to temporary anchorage devices in the zygomatic buttress area, buccal and apical to the maxillary molars. Of this group, 30 had adequate cephalograms available for the period of treatment, 27 had cephalograms including 1-year posttreatment, and 25 had cephalograms from 2 years or longer. Results During splint therapy, the mean molar intrusion was 2.3 mm. The mean decrease in anterior face height was 1.6 mm, less than expected because of a 0.6-mm mean eruption of the mandibular molars. During the postintrusion orthodontics, the mean change in maxillary molar position was a 0.2-mm extrusion, and there was a mean 0.5-mm increase in face height. Positive overbite was maintained in all patients, with a slight elongation (<2 mm) of the incisors contributing to this. During the 1 year of posttreatment retention, the mean changes were a further eruption of 0.5 mm of the maxillary molars, whereas the mandibular molars intruded by 0.6 mm, and there was a small decrease in anterior face height. Changes beyond 1 year posttreatment were small and attributable to growth rather than relapse in tooth positions. Conclusions Intrusion of the maxillary posterior teeth can give satisfactory correction of moderately severe anterior open bites, but 0.5 to 1.5 mm of reeruption of these teeth is likely to occur. Controlling the vertical position of the mandibular molars so that they do not erupt as the maxillary teeth are intruded is important in obtaining a decrease in face height.

Extreme skeletal open bite correction with vertical elastics

“…This is normally achieved with TADs. [11][12][13][14][15] However; when conventional orthodontics is planned, as in this case, posterior teeth intrusion is difficult to obtain. Treatment mechanics are based on maintaining vertical control of the posterior teeth, with different appliances, to control the vertical dimension, and the anterior open bite is generally corrected by means of extrusion of the anterior teeth.…”

“…The following three treatment options were considered: (1) surgical orthodontic treatment (ideal option), which could correct the vertical, transverse and sagittal problems and improve facial appearance; (2) combined maxillary and mandibular posterior teeth intrusion with TADs [11][12][13][14][15] and anterior teeth extrusion with elastics 6,8 ; (3) vertical control and uprighting of the posterior teeth combined with anterior teeth extrusion with MEAW mechanics and elastics. 3,10,16 The two nonsurgical options included dentoalveolar posterior expansion for posterior crossbite correction, maxillary right canine space creation, and mandibular right first premolar extraction to correct the maxillary and mandibular dental midline deviations, respectively, and to obtain acceptable overjet and bilateral functional Class III molar relationships.…”

“…[11][12][13] Temporary anchorage devices (TADs) are a good option when posterior teeth intrusion is planned. [11][12][13][14][15] The multiloop edgewise archwire (MEAW) technique could be used as an alternative to achieve proper vertical positioning of the anterior teeth, acceptable inclination of the maxillary and mandibular occlusal planes, and uprighting with vertical control of the posterior teeth. 3,10 The use of MEAW requires patient compliance with continuous use of elastics.…”

The Factors Affecting Long-Term Stability in Anterior Open-Bite Correction - A Systematic Review

“…• Duplicate report of previously published data (10) • Insufficient data to extract effect size (8) • No relevant otucomes (4) • Same intervention, different outcomes (2) to the directions of the tool, each criterion was rated as strong, moderate, or weak. Depending on the rating, overall assessment of the study was determined according to the guidelines of the tool (strong: weak rating nil, strong rating ≥4; moderate: weak rating 1, strong rating <4; weak: ≥2 weak ratings).…”

“…They include severity of AOB malocclusion prior to treatment, extractions of premolars, correction of open-bite with or without orthognathic surgery, or different methods of retention (4,5). Recently, many studies have been conducted to check the long-term stability of corrected AOB malocclusion (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). When we searched the literature, we came across two systematic reviews of case series studies conducted to assess the effectiveness of orthodontic and orthopedic treatment in AOB correction (4,5).…”