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Anterior open bite has a multi-factorial aetiology comprising: genetically inherited skeletal pattern, soft tissue effect and digit-sucking habits. To formulate an appropriate treatment plan, accurate diagnosis is essential. Simple open bites may sometimes resolve completely during the transition from mixed to permanent dentition, if the digit-sucking habit is broken. More significant open bites, however, sometimes extending right back to the terminal molars, rarely resolve spontaneously and will often require complex orthodontic treatment, involving active molar intrusion or even major orthognathic surgery. Unfortunately, surgery has associated risks attached, including pain, swelling, bruising, altered nerve sensation and, occasionally, permanent anaesthesia, as well as involving significant costs, as with any major surgical procedure under general anaesthesia.
The introduction of Temporary Anchorage Devices (TADs) has expanded the possibilities of orthodontic treatment, beyond traditional limitations of tooth movement. Molar intrusion can be successfully carried out without the need for major surgical intervention, thus avoiding all the attendant risks and disadvantages. This paper provides an overview of anterior open bite and uses an illustrative case where open bite was successfully treated with a combination of fixed appliance therapy and TADs.
Clinical Relevance: Anterior open bite is commonly seen in general practice. A knowledge of the possible aetiological factors and their potential management should be understood by general dental practitioners. The increased popularity of TADS allows a new and less invasive approach to management of these cases.
Article
Anterior open bite (AOB) is defined as no vertical overlap of the incisors, when buccal segment teeth are in occlusion.1 This malocclusion has a multifactorial aetiology, including the inherited skeletal pattern and soft tissue influences, as well as digit-sucking habits, which can contribute enormously to an open bite (Figure 1). The incidence of anterior open bite varies with age and ethnic group. In the UK, reported incidence in children is 2–4%, reducing from age 9 years to early teens. The reduction is due to normal occlusal development and neural maturation, which means the child stops digit-sucking habits and establishes a normal swallowing pattern. Incidence has been reported as increasing in mid-teens to late vertical growth.2
Correcting this aspect of the malocclusion can be very challenging. Orthodontists and dentists need to be able to diagnose the problem accurately before they can formulate an appropriate treatment plan.
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