Dr.

Hla Hla Yee

Anterior Open Bite

Anterior Open Bite
 The absence of any vertical incisor
overlap between the upper and lower
incisors.
Causes

( 1 ) Skeletal causes
 
– Excessive vertical growth of maxilla often
more posteriorly than anteriorly and
posterior growth rotation of the mandible.
 Clinical Features
 
– Incerased lower facial height
– Increased maxillary-mandibular plane
angle
– Increased Frankfort-mandibular plane
angle
– Obtuse gonial angle
– Upward slope of the maxillary plane
– Steep mandibular plane
– Short mandibular ramus
( 2 ) Dental causes

– Excessive eruption of posterior teeth

– Incisors eruption is impeded

 
( 3 ) Soft tissue

– Decrease in tonic muscle activity that

occur in muscle dystrophy , cerebral palsy
muscle weakness syndrome.

– Therefore – the mandible drops downward

from the rest of the facial skeletal.

– Therefore - excessive eruption of

posterior teeth and narrowing of the
maxillary arch and anterior open bite.
( 4 ) Habit

– Tongue thrust

– Thumb sucking

– Mouth breathing
( 5 ) Others

 Localized failure of maxillary dento-alveolar

development resulting in an open bite is
seen in clefts lip and palate.

 Hemimandibular hypertrophy – excessive

growth of mandible, the dental occlusion
shows open bite on the effected site.
 
 ( 6 ) Combination
Treatment
 
For skeletal open bite
 In mild case,

– case align arches and accept ( or )

– try to restrain vertical development of
maxilla and /or upper molars with
headgear ( or ) functional appliance with
posterior bite blocks.
– Extrusion of incisors is unstable.
 In more severe case
 surgery or combined treatment.
For dental open bite

– Intrusion of posterior teeth or extrusion of the

labial segment by using

( 1 ) High pull headgear to the upper molars is

the best approach if excessive vertical
development of the posterior maxilla.
This treatment will have to continued
until growth is nearly complete,
usually well into a retention period.
The headgear to the maxillary molars
directing the force upward as well as
posteriorly. The effect of this, in patients
who are still actively growing, is simply to
inhibit the eruption of posterior teeth,
allowing the anterior segment to catch up.
( 2 ) Interocclusal bite blocks is
controlled the eruption of lower teeth.
( 3 ) bite blocks incorporating repelling
magnets to facilitate posterior
tooth intrusion.
 
( 4 ) Fixed appliances and vertical
intermaxillary elastics.

( 5 ) Open bite associated with icreased

labioversion of the incisors
( Bimaxillary )
 Deep Bite
( Increased Overbite )
Excessive overlap of the anterior teeth
Causes
 ( 1 ) Skeletal cause – ( short face ) due to increased
posterior facial height (long mandibular ramus,
mandible rotates upward and forward direction).
 Clinical Features
– Reduced lower facial height
– Short nose – chin distance
– Low mandibular plane angle
– Flat mandibular plane
– Low maxilary – mandibular plane angle
– Acute gonial angle
 ( 2 ) Dental cause – due to

a. Supra-eruption of lower incisors and

infra-eruption of the molars.
Therefore, Curve of Spee is exaggrated.
b. Retroclined incisors
– Increased interincisal angle
( Average 130 degree ) Range 125-135 degree
– Above this value the tendency for the lower
incisors to erupt may be inadequately resisted.
( 3 ) Soft tissue
– Due to high lip line. Therefore the upper
incisors are retroclined.
Treatment

( 1 ) For skeletal deep bite

 ( 2 ) For dental cause

– ( 1 ) Extrusion ( eruption of molars )

 Passive eruption of lower molars
 An anterior bite plane is incorporated into a
removable appliance so that the mandibular
incisors occlude with the plastic plane lingual
to the maxillary incisors.
 This approach prevents the posterior teeth
from occlusion and encourages their eruption.

 Active extrusion of molars – in either

arch is possible by using a fixed – appliance.
– ( 2 ) Intrusion of incisors
( a ) Absolute intrusion
 Absolute intrusion of the upper and lower
incisors moving their root apices closer to the
nose and lower border of the mandible
respectively.
 In the absence of growth, the absolute
intrusion and extrusion are possible.
( b ) Relative intrusion
 Achieved by preventing eruption of incisors
while growth provide vertical space into which
the posterior teeth erupt.
Absolute intrusion
Relative intrusion
( growth required )

Extrusion
Utiity arch
– ( 3 ) Proclination of lower incisors.

– ( 4 ) Proclination or proclined upper

incisors – relative extrusion of incisor
teeth may be accomplished as a result
of reangulation by FA or RA.
 If space required for reangulation, extraction
may also be necessary to provide sufficient
space for retraction.