OPEN BITE – TREATMENT PLANS
INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
INTRODUCTION Anterior open bite is one of the most difficult orthodontic problems to correct. The etiology of anterior open bite may be both complex and difficult to establish and yet is critical in developing treatment regimen that will produce stability and satisfactory cosmetic results www.indiandentalacademy.com
SIMPLE OPEN BITE Tongue thrust causing anterior deformation is called simple open bite.
Moyers(1964) www.indiandentalacademy.com
COMPLEX OPEN BITE Combined tongue thrust causing both an anterior and posterior open bite is called complex open bite. It is more difficult to treat. Moyers(1964) www.indiandentalacademy.com
ETIOLOGY
EPIGENETIC AND
ENVIRONMENTAL FACTORS ARE BOTH OF CONCERN IN THE ETIOLOGY OF OPEN BITE.
www.indiandentalacademy.com
EPIGENETIC FACTORS • Includes 1. Posture,morphology and size of the tongue. 2. Skeletal growth pattern of maxilla & mandible. 3. Vertical relationship of the jaw base. www.indiandentalacademy.com
ENVIRONMENTAL FACTORS •
Abnormal function and improper respiration are the most significant.
•
Disturbed or occluded nasal respiration can cause a change in the function of both tongue and mandible which can lead to open bite. www.indiandentalacademy.com
TREATMENT •
Treatment depends on localization and etiology of malocclusion.
• Treatment plan varies for dentoalveolar and skeletal open bite.
www.indiandentalacademy.com
DENTO ALVEOLAR OPEN BITE 1. Habit control 2. Elimination of abnormal perioral musculature function
www.indiandentalacademy.com
SKELETAL OPEN BITE • Redirection of growth is possible during the active growth period. • Management in adults is by surgery/ orthodontic treatment.
www.indiandentalacademy.com
TREATMENT IN THE MIXED DENTITION • Control of abnormal habits. • Elimination of dysfunction. • Deforming muscle activity -treatment with screening appliance or activator. • Skeletal open bite-extra oral orthopaedic appliances such as chin caps can be used www.indiandentalacademy.com
(Contd.) Selection of appropriate treatment depends on the type of open bite.Three types of open bites may be differentiated: • Dento alveolar • Skeletal • Combined www.indiandentalacademy.com
DENTO ALVEOLAR OPEN BITE • It occurs as a consequence of various dysfunctions. • Early mixed dentition Screening therapy is indicated. • Late mixed dentition Multi attachment fixed appliance is indicated. www.indiandentalacademy.com
SKELETAL OPEN BITE Treatment depends on at least 2 factors: • Severity of malocclusion. • Possibility of dentoalveolar compensation Treatment options include: • Growth modification • Orthodontic camouflage www.indiandentalacademy.com
COMBINED OPEN BITE Because of the dual nature of etiology a combined treatment approach is recommended. Treatment follows 2 possible combinations. • Elimination of abnormal perioral muscle function. • Improvement of skeletal relationship. www.indiandentalacademy.com
TREATMENT IN THE PERMANENT DENTITION Multiattachment fixed mechanotherapy is the method of choice with guided extraction procedures to correct dento alveolar problems and compensate for any skeletal problems that exist. www.indiandentalacademy.com
(Contd.) • Functional appliances are helpful in the retention phase of therapy. • In adults surgical intervention with pre/post surgical orthodontics needs to be considered. www.indiandentalacademy.com
CASE I :23/F C/OForwardly placed teeth DIAGNOSISPatient has tongue thrust and anterior open bite TREATMENT PLANTongue spike given. Begg mechanotherapy with all 5’s extraction. www.indiandentalacademy.com
PRE TREATMENT
www.indiandentalacademy.com
CURRENT STATUS
www.indiandentalacademy.com
CASE II: 22/F. C/O- Spacing in the anterior region DIAGNOSIS-Patient has anterior open bite due to simple tongue thrust and thumb sucking habit with posterior crossbite on the right side. TREATMENT PLANNiti palatal expander. All 5’s extraction with PAE Mechanotherapy followed by Advancement Genioplasty.
www.indiandentalacademy.com
PRE TREATMENT
www.indiandentalacademy.com
CURRENT STATUS
www.indiandentalacademy.com
CASE III:22/F C/O-Protruded upper teeth. ON EXAMINATION-Patient has a tongue thrust habit. DIAGNOSIS-Dento alveolar class 1 malocclusion on a class 2 skeletal base with anterior open bite. TREATMENT PLAN-Fixed Tongue Crib with PAE mechanotherapy & all 4’s extraction.
www.indiandentalacademy.com
PRE TREATMENT
www.indiandentalacademy.com
CURRENT STATUS
www.indiandentalacademy.com
CASE IV: 18/M: C/O-Inability to chew. DIAGNOSIS-Dento alveolar Class 2 subdivision on a Class 2 skeletal base with an anterior open bite and right side posterior cross bite. TREATMENT PLAN SURGERY-Le Fort 1 with mid palatal osteotomy and expansion assisted with hyrax and vertical impaction of the maxilla ORTHODONTICS: All 4�s with PAE mechanotherapy www.indiandentalacademy.com
PRE TREATMENT
www.indiandentalacademy.com
PRE SURGICAL
POST SURGICAL
www.indiandentalacademy.com
POST SURGICAL
www.indiandentalacademy.com
PRE TREATMENT
POST TREATMENT
www.indiandentalacademy.com
PRE TREATMENT
POST TREATMENT
www.indiandentalacademy.com
www.indiandentalacademy.com Leader in continuing dental education
www.indiandentalacademy.com