Taming the vertical growth of mandible in a growing patient with skeletal open bite: A case report

Abstract

Skeletal open bite poses a significant challenge due to its association with downward and backward mandibular rotation and vertical maxillary overgrowth. Early intervention is critical, especially in patients with a hyperdivergent skeletal phenotype, as facial growth patterns are established early in development. This case report details the treatment of a 9-year-old male with a severe anterior open bite of 6 mm, vertical growth pattern, and class I skeletal relationship. Initial treatment included high-pull headgear with an intraoral transpalatal arch and tongue cribs to control the molar eruption and tongue posture. Over nine months, this approach reduced the open bite by restricting maxillary molar movement and promoting mandibular autorotation. In the second phase of treatment, temporary anchorage devices (TADs) were placed in the parasagittal region along with a transpalatal arch to achieve active molar intrusion and improve incisor exposure. The combination of orthopedic appliances and TADs successfully eliminated the open bite and corrected overjet, while improving incisor alignment, facial profile, and smile esthetics. Cephalometric analysis revealed a reduction in the mandibular plane angle, lower anterior facial height, and improved incisor extrusion. This case highlights the efficacy of early skeletal open bite correction using non-surgical methods, with TADs providing effective molar intrusion and stable long-term results. The integration of headgear and skeletal anchorage offers an effective treatment modality for young patients with severe open bites, potentially eliminating the need for more invasive surgical procedures in the future.