Treatment of anterior open bites using non-extraction clear aligner therapy in adult patients

Abstract

Objective The purpose of this study was to examine the effectiveness and mechanism of clear aligner therapy for the correction of anterior open bite in adult nonextraction cases. Methods Sixty-nine adult patients with anterior open bite were enrolled and classified into Angle’s Class I, II, and III groups. Fifty patients presented with skeletal open bite (mandibular plane angle [MPA] ≥ 38°), whereas 19 presented with dental open bite. Fifteen cephalometric landmarks were identified before (T1) and after (T2) treatment. The magnitudes of planned and actual movements of the incisors and molars were calculated. Results Positive overbite was achieved in 94% patients, with a mean final overbite of 1.1 ± 0.8 mm. The mean change in overbite was 3.3 ± 1.4 mm. With clear aligners alone, 0.36 ± 0.58 mm of maxillary molar intrusion was achieved. Compared with the Class I group, the Class II group showed greater maxillary molar intrusion and MPA reduction. The Class III group showed greater mandibular incisor extrusion with no significant vertical skeletal changes. Conclusions Clear aligners can be effective in controlling the vertical dimension and correcting mild to moderate anterior open bite in adult nonextraction cases. The treatment mechanism for Class III patients significantly differed from that for Class I and Class II patients. Maxillary incisor extrusion in patients with dental open bite and MPA reduction with mandibular incisor extrusion in patients with skeletal open bite are the most significant contributing factors for open bite closure.

Effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face: a preliminary retrospective before-after clinical trial

“…According to the bone density classification, the bone in the posterior region of the maxilla is often of D4 type, which represents fine trabecular bone; whereas, In the posterior mandible, the bone is of type D3 or in some cases D2, which indicates porous cortical bone [ 19 ]. In agreement with our finding, Suh et al [ 20 ] as well did not observed significant intrusions in the posterior mandible, even despite planning for lower molar intrusion for 0.5 to 0.6 mm. However, Moshiri et al [ 21 ] stated that aligners cannot intrude posterior teeth without any planned design.…”

“…In the study of Talens-Cogollos et al [ 3 ], no significant changes in the mandibular plane were observed in any of the patients at the end of the treatment, which was attributed to the small amount of posterior intrusion. Suh et al [ 20 ] as well reported no significant changes in the vertical dimension, which can be related to the high number of hyperdivergent patients in their study. In other words, it might be said that clear aligners control the vertical dimension of the face rather than reducing it [ 20 ].…”

“…Suh et al [ 20 ] as well reported no significant changes in the vertical dimension, which can be related to the high number of hyperdivergent patients in their study. In other words, it might be said that clear aligners control the vertical dimension of the face rather than reducing it [ 20 ]. In addition, in two studies, treatment with clear aligners in open bite patients was associated with dental movements and not skeletal changes [ 21 , 23 ].…”

Correction of anterior open bite of varying severity using clear aligner therapy—A case series

“…Additional intermaxillary elastics or optimized attachments are not necessary for these maneuvers. According to the literature on anterior open bites treated using clear aligners, most of them suggest that the bite closure is achieved by a combination of maxillary and mandibular incisor extrusion along with maxillary and mandibular molar intrusion leading to a slight reduction in the mandibular plane angle 18‐21 . (Table 4).…”

Clinical application of maxillary tissue bone-borne expander and biocreative reverse curve system in the orthodontic retreatment of severe anterior open bite with transverse discrepancy: A case report

“…Orthodontic correction of anterior open bite in patients with hyperdivergent skeletal pattern was previously considered challenging, as the vertical problems usually combine with the transverse and sagittal problems, and the overall correction is prone to relapse. 1 Even though few cases with anterior open bite have been treated by extruding incisors using various methods, 2 intrusion of maxillary molars is required to promote the counterclockwise rotation of the mandible, which results in a decrease of the anterior facial height and advancement of the retruded chin. Moreover, in a recent systematic review and meta-analysis, it was concluded that the stability of anterior open bite treatment with molar intrusion was similar to the stability after surgical approaches.…”