Ministry of higher education and science research

Osoul Al-Deen university college

Dentistry Department
Endodontics
Fourth stage

MANAGEMENT OF OPEN BITE

Name: Shahad Oday Hassan

Grade: 38
Group: B
Super

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☆☆ Introduction……………………………………………...3
☆☆ Anterior open bite……………………………………….4
☆☆ etiology of anterior open bite…………………………4
☆☆ Management open bite………………………………….5
☆☆Posterior open bite…………………………………….9
☆☆ Causes of open bite………………………………….9
☆☆ Management open bite……………………………….9

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Introduction:
An open bite is said to exist when there is a lack of vertical overlap
between the maxillary and mandibular teeth. In normal circumstances
the mandibular dental arch is contained within the maxillary arch. Tn
other words the maxillary teeth overlap the mandibular teeth labially
and buccally. Depending upon the lack of this overlap an open bite is
said to exist.

Open bites can exist in the anterior as well as the posterior region.
Extent can vary from being simply dental in nature to involving the
underlying skeletal structures. The classification and treatment will
depend mainly on the location, etiology and the extent of the open bite.

An open bite present in the anterior segment is the most unesthetic, as

the patient has to bring his tongue anteriorly between the teeth and the
lips during speech and while swallowing. Posterior open bites
mayhamper mastication and are more difficult to treat.

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CLASSIFICATION OF OPEN BITE:

1_ Based on the location of the open bite, they may be classified as:

• Anterior open bite

• Posterior open bite.

2_ Based on the dental or skeletal components involve, open bites can

be classified as:

• Skeletal open bite.

• Dental open bite.

Open bite is primarily caused by four factors:

1. Thumb or pacifier sucking: When someone sucks on their thumb or

a pacifier (or another foreign object like a pencil), they strain the
alignment of their teeth. This can cause an open bite.
2. Tongue thrusting: An open bite can occur when a person speaks or
swallows and pushes their tongue between their upper and lower
front teeth. This can also create gaps between teeth.
3. Temporomandibular joint disorder (TMD or TMJ): TMJ
disorders cause chronic jaw pain. Sometimes people use their
tongue to push their teeth apart and comfortably reposition their
jaw, which can cause an open bite.
4. Skeletal problem: This occurs when your jaws grow apart as
opposed to growing parallel to each other and is often influenced by
genetics.

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Anterior open bite (AOB): there is no vertical overlap of the
incisors when the buccal segment teeth are in occlusion.

Etiology of anterior open bite:

● Skeletal pattern:

indivuals with tendency to vertical rather than horizontal facial growth

exhbit increases skeletol proportion Ins interocclusal when lowerface
height increased distance b/w maxilla & Mandible ,the labial segment
teeth able to compensate for this to a limited extentent by further
eruption when interocclusal distance exceeds this compensatory ability
=> ANTERIOR OPEN BITE WIL OCCUR AND worsened by
downward and backward facial growth

● Mouth breathing:

It has been suggested that the open-mouth posture adopted by

individuals who habitually mouth breathe, either due to nasal
obstruction or habit, results in overdevelopment of the buccal segment

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teeth. This leads to an increase in the height of the lower third of the
face and consequently a greater incidence of an AOB.

● Habits:

Oral habits are common in young children and the consequences of

a habit will depend upon its duration and intensity. If a persistent digit-

sucking habit continues into the mixed and permanent dentitions, this

can result in an AOB due to restriction of development of the incisors

by the finger or thumb

● biteLocalized failure of developmentThis is seen in patients with a

cleft of the lip and alveolus , although rarely it may occur for no
apparent reason.

● Trauma:. Trauma to the upper anterior teeth can lead to intrusion

injuries which can result in an AOB.

● Soft tissue pattern: Patients with the anterior open bite due to digit-
sucking habit has the tendency to push the tongue forward between the
anterior teeth to achieve anterior oral seal during swallowing.

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Management of anterior open bite : Treatment is dependent on
the age of the patient and the aetiology of the malocclusion:

● Digit Habit Cessation: Management depends on the age of the

patient

at presentation, advice alone has not worked, then a deterrent

appliance is effective in a compliant patient. This can be either
removable or fi xed in nature. It must be retained in place for a
minimum of 6 months after

sucking has apparently ceased, to ensure the habit has truly stopped

. patients who have already passed the pubertal growth spurt. In this
case further orthodontic treat-ment may be indicated.

● Prevention of Habits.

● Myofunctional Therapy: Passive posterior bite - blocks are

functional appliances that are used to open the bite 3 – 4 mm

beyond the rest position. In growing patients, this inhibits the increase
in height of the buccal dentoalveolar processes, thus preventing a
downwards and backwards rotation of the mandible. It also allows
differential eruption to occur as the labial segments can erupt unhin-
dered, hence closing the AOB. High - pull head-gear to the bite - blocks
increases their effi ciency. Where the AOB is associated with a Class II

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 Twinblockmyofunctionalappliancewithex
traoral traction tubes for high - pull
headgear.

skeletal pattern, a twin block appliance with high - pull headgear can
be utilised to correct the anteroposterior discrepancy while controlling
the vertical dimension.
● Fixed Appliances: Anterior open bites can be closed using fixed
appliances and vertical intermaxillary elastics to extrude the anterior
teeth. This may be com-bined with a transpalatal arch (TPA) and high -

pull headgear to limit vertical development of the maxillary molar

teeth. The TPA functions to prevent buccal rolling of the fi rst molars,
which

could cause the bite to be propped open on their palatal cusps.

TPA in situ to prevent buccal flaring of the

molars when the intrusion elastics are
.placed

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Fixed appliance

● Extraoral Traction: Vertical pull chin - cup therapy has been used
to limit excessive vertical growth and has been shown to close AOBs
when combined with pre-molar extractions and fi xed appliances.
However, chin - cup therapy generally has poor compliance rates and
there is a concern that it may cause condylar damage.

High - pull headgear applied to the maxillary molar teeth and worn for
14 hours per day has been used to inhibit eruption of the posterior

teeth and hence limit vertical growth. Headgear can be applied directly
to the upper molar bands of a fi xed appliance or used in conjunction
with a functional appliance or maxillary intrusion splint. Headgear
should not be used in Class III open bite cases as maxillary restraint

may worsen the skeletal III discrepancy

● Molar Intrusion Using Skeletal Anchorage: Dental implants,

mini- plates, mini - screws and ankylosed teeth have been used to

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provide absolute anchorage in orthodontic treatment. Mini - screws,
also known as temporary anchor-age devices (TADs), are rapidly
gaining in pop-ularity due to their ease of placement and their high
success rate. A number of case reports have shown that TADs are
effective in intrud-

ing molar teeth and closing anterior open bites. This may become the
most predictable way of closing anterior open bites of dental origin in
the future, especially as it does not depend on patient compliance.

● Orthognathic Surgery: A combination of fixed appliance

orthodontics and orthognathic surgery may be required to treat skeletal
open bites. This should not be commenced until growth has ceased, as
further growth is very likely to be unfavourable. Presurgical
orthodontics is aimed at individual arch alignment and arch
coordination .Where there is an obvious step in the occlusal plane, this
should not be levelled

but maintained using segmental mechanics. Surgery may be segmental

or involve the whole jaw. Surgery to the maxilla is mandatory and

frequently bimaxillary surgery is required.

Posterior open bite:

Posterior open bite occurs when there is no contact between the

posterior teeth of the upper and lower arch while the rest of the teeth
are in occlusion. The posterior open bite is very rare and the exact
etiology is not clearly know.

The possible causes may be:

 Failure of eruption of molar teeth due to unknown etiology.

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 The arrest of the eruption of molar teeth. The affected tooth seems to
erupt normally but the cessation of occlusal development as the rest of
the dentition and the alveolar process continues to develop.

The etiology is not understood yet.

 Rarely in unilateral condylar hyperplasia.

 Early extraction of first permanent molars with the resulting lateral

tongue spread.( can occur due to tongue thrust habit)

Management posterior open bite:

The elevation of the etiology remains the main stay of treatment. Since
lateral tongue thrust is the most frequently encountered etiologic
factor, the use of lateral tongue spikes either fixed or incorporated in a
removable appliance. form the first line of treatment Vertical elastics
used along with fixed orthodontic appliances can be used once the
lateral tongue thrust habit has been controlled. It has been noted that,
most of the posterior open bites close spontaneously following the
cessation of the tongue thrust habit.Fixed appliances are the most
frequently used means for the correction of submerged and impacted
teeth.

● Reference:

● Carano A, Velo S, Incorvatic, Poggio P (2004) Mini -Screw -

Anchorage - System in the maxillary alveolar bone. J Ind Orthod Soc
37: 74-84.

● Romano R (2006) Concepts on Control of the Anterior Teeth Using

the Lingual Appliance. Semin Orthod 12: 178-187.

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● Nanda R . Biomechanics and Esthetic Strategies in Clinical
Orthodontics . Elsevier/WB Saunders , St Louis , 2005 : 164 – 5 .

● Park YC , Lee HA , Choi NC , Kim DH . Open bite correction by

intrusion of posterior teeth with miniscrews . Angle Orthod 2008 ; 78 :
699 – 710 .

● Proffi t WR , Fields HW , Sarver DM . Contemporary Orthodontics ,

4th edn . Mosby , St Louis , 2007.

● Orthodontics and combined maxillary and Bhalaji SI (2015)

Orthodontics: The art and science. Arya publishing house, New Delhi,
India.

● Tulloch JFC, Proffit WR, Phillips C. Outcomes in a 2-phase

randomized clinical trial of early class II treatment. Am J Orthod
Dentofac Orthop. 2004;125(6):657–67.

● Patel A. Digit sucking habits in children resident in Kettering (UK). J

Orthod. 2008;35:255–61.

● Fleming PS, Scott P, DiBiase AT. Compliance: getting the most from
your orthodontic patients. Dent Update. 2007;34(9):565–6, 569–70,
572.

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