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Cureus Jun 2023Digit sucking and tongue thrusting are parafunctional habits that are commonly observed and are recognized as major etiological factors in the development of dental...
Digit sucking and tongue thrusting are parafunctional habits that are commonly observed and are recognized as major etiological factors in the development of dental malocclusion. Treatment for these oral habits typically involves removal of the etiology, retraining exercises, and use of mechanical restraining appliances. A 13-year-old male patient reported a complaint of forwardly placed upper front teeth. The extraoral examination of the patient showed a convex profile, good facial symmetry, acute nasolabial angle, incompetent lips at rest, and a shallow mentolabial sulcus. Intraoral examination showed class I molar and canine relations on either side, a mild open bite tendency, a midline diastema, proclined upper and lower anteriors, an increased overjet, and tongue thrusting habit. A modification to the tongue crib was made by adding an acrylic bead in the center of the crib. The patient was trained to roll the bead posteriorly with the aim of retraining the tongue to posture away from the front teeth. Harmful forces of the tongue can result in excessive posterior teeth eruption, open bite, and increased overjet. Duration of appliance wear and type of appliance used are important considerations in treating patients with tongue thrust or open bite. A modified tongue crib was used for six months resulting in significant improvement in maxillary anterior dentition position, lip competence, arch forms, overbite, and midline diastema closure. A tongue crib is a useful tool for addressing tongue thrusting and digit-sucking behaviors by retraining the related muscles, providing physical restraint, and serving as a reminder to break the habit. It can be used in conjunction with a fixed appliance to improve its effectiveness.
PubMed: 37461777
DOI: 10.7759/cureus.40518 -
Journal of the World Federation of... Feb 2024Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal...
Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal anchorage devices, prompts counterclockwise rotation of the mandible. This rotation not only corrects anterior open bite but also contributes to a decrease in anterior facial height, improvements in lip incompetency, and forward movement of the chin. For successful outcomes, temporary skeletal anchorage devices, installed on both the buccal and palatal sides, must deliver equivalent intrusion force to the maxillary teeth. Treatment planning should consider factors such as skeletal discrepancies, vertical excess, incisor exposure, and configuration of the occlusal plane. Clinicians are advised to closely monitor periodontal changes and consider overcorrection to ensure lasting stability and maintenance of incisal overlap post-treatment.
Topics: Humans; Open Bite; Orthodontic Anchorage Procedures; Tooth Movement Techniques; Cephalometry; Molar
PubMed: 38185583
DOI: 10.1016/j.ejwf.2023.12.006 -
Journal of Esthetic and Restorative... Jun 2024To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment.
OBJECTIVES
To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment.
CLINICAL CONSIDERATIONS
After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile.
CONCLUSIONS
A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability.
CLINICAL SIGNIFICANCE
An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.
Topics: Humans; Malocclusion, Angle Class II; Orthognathic Surgical Procedures; Esthetics, Dental; Female; Orthodontics, Corrective; Retrognathia; Open Bite
PubMed: 38289013
DOI: 10.1111/jerd.13199 -
Dental Traumatology : Official... Apr 2021The literature does not clearly state whether the type of malocclusion is associated with a specific type of trauma and the severity of the injury. Hence, the aim of...
BACKGROUND/AIMS
The literature does not clearly state whether the type of malocclusion is associated with a specific type of trauma and the severity of the injury. Hence, the aim of this retrospective study was to assess the occlusal condition in children with traumatic dental injuries of the primary teeth, and the association between the occlusal characteristics and the type and severity of these injuries.
MATERIAL AND METHODS
Data were collected from records of children treated at a dental trauma center in Brazil over a period of 16 years. The data included age, gender, etiology of the trauma, place of occurrence, number of affected teeth, type of trauma, and injury severity. The occlusal condition was assessed by a trained dentist using photographs of the patients from their first visit. Chi-square tests and Poisson regression were used for data analyses.
RESULTS
This study included 209 patients, and most were aged between 2-4 years (50.55%). Multivariate regression analysis showed that children with an anterior open bite had a 47% higher prevalence of severe trauma than those who did not have an anterior open bite, and those with class II canines had a 56% higher prevalence of severe trauma than those with class I and III canines. Children with an anterior open bite had a 46% higher prevalence of injuries affecting multiple teeth than those without an anterior open bite.
CONCLUSIONS
Anterior open bite and class II canine relationship were associated with a higher prevalence of severe traumatic dental injury in primary teeth, and anterior open bite was associated with trauma affecting multiple teeth.
Topics: Brazil; Child; Child, Preschool; Cross-Sectional Studies; Humans; Malocclusion; Prevalence; Retrospective Studies; Tooth, Deciduous
PubMed: 33185027
DOI: 10.1111/edt.12615 -
European Journal of Dentistry Jul 2022To evaluate and compare the first tooth contact region, occlusion time, time to generate total force, and force distribution between open bite (OB) and non-OB (NOB)...
OBJECTIVE
To evaluate and compare the first tooth contact region, occlusion time, time to generate total force, and force distribution between open bite (OB) and non-OB (NOB) patients at the maximum intercuspation position using the T-Scan III system.
MATERIALS AND METHODS
Sixteen patients were divided into the OB and NOB groups ( = 8 for each group). The T-Scan III system was used to evaluate the first tooth contact region, occlusion time, time to generate total force, and force distribution.
STATISTICAL ANALYSIS
The mean patient age, overjet, overbite, occlusion time, and time to generate total force were compared between the groups by independent samples -test. Relative force distributions between groups and among regions were compared by the Mann-Whitney and Kruskal-Wallis -tests, respectively. A probability value of less than 5% ( < 0.05) was considered significant.
RESULTS
Differences in the first tooth contact region between groups were observed. The molar region was the first tooth contact region in the OB group, while first tooth contact was observed in all regions in the NOB group. Neither the occlusion time nor the time to generate total force was significantly different between the groups ( > 0.05). The highest force distributions were observed in the molar regions in both groups. Significant intragroup differences were found among all regions ( < 0.05), except between the anterior and premolar regions in the NOB group ( = 0.317). Intergroup differences in the force distributions in the anterior ( = 0.000), premolar ( = 0.038), and molar ( = 0.007) regions were significant.
CONCLUSION
Unlike in the NOB group, in which first tooth contact occurred in every region, in the OB group, first tooth contact occurred only in the molar region. Compared with those in the NOB group, the force distributions in the OB group were approximately 1.5 times higher in the molar region but were significantly lower in the anterior and premolar regions.
PubMed: 35016230
DOI: 10.1055/s-0041-1739438 -
American Journal of Orthodontics and... Oct 2022The objectives of this study were to analyze and quantify molar intrusion after the use of clear aligners and to analyze the relationship with other variables such as...
INTRODUCTION
The objectives of this study were to analyze and quantify molar intrusion after the use of clear aligners and to analyze the relationship with other variables such as age, duration of treatment, and a series of cephalometric osseous and dental measurements at the start of treatment.
METHODS
A retrospective descriptive-analytical study was designed with a sample of 58 patients aged 18-60 years who had undergone treatment with Invisalign. The cephalometric measurements were carried out after lateral x-rays were taken of the cranium; these were compared at the start (T0) and conclusion of treatment. Parametric and nonparametric tests were used to compare means, whereas Pearson correlations and multivariate lineal regression analyses were used to establish the variables associated with molar intrusion.
RESULTS
Approximately 74.2% of the patients presented some degree of molar intrusion after treatment. Furthermore, 32.8% of patients presented intrusion only at the mandibular molar, whereas 25.9% experienced intrusion at both molars, maxillary and mandibular, simultaneously. However, 15.5% presented intrusion only at the maxillary molar. The average magnitude of intrusion here was 0.98 ± 0.54 mm, whereas the mandibular molar was 0.84 ± 0.29 mm. Statistically significant reductions exist for the distance L6_MP and U6_SN between T0 and at conclusion of treatment. Maxillary molar intrusion correlates negatively with mandibular molar intrusion (r = -0.270). The number of days of treatment did not correlate with either maxillary or mandibular molar intrusion.
CONCLUSIONS
Clear aligners give rise to molar intrusion in 74.2% of patients. The cephalometric variables L6_MP T0, mandibular plane angle T0, and facial axis T0 were negatively and significantly associated with maxillary molar intrusion, whereas age and facial axis T0 were negatively associated with mandibular molar intrusion allowing smaller magnitudes of intrusion to be predicted when these variables present high values at T0.
Topics: Cephalometry; Humans; Maxilla; Molar; Open Bite; Orthodontic Appliances, Removable; Retrospective Studies; Tooth Movement Techniques
PubMed: 35305889
DOI: 10.1016/j.ajodo.2021.03.019 -
The Angle Orthodontist Nov 2023To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults.
OBJECTIVES
To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults.
MATERIALS AND METHODS
23 patients with AOB were treated with extrusion arches and evaluated for dentoskeletal changes using lateral cephalometric radiographs before treatment (T0), after treatment (T1), and 12 months post-treatment (T2). Patients received bondable tongue spurs and vacuum-formed retainers as post-treatment retention/stability measures for 12 months. Post-treatment stability was further assessed qualitatively by the Photographic Openbite Severity Index.
RESULTS
All the cases showed positive overlap between the anterior teeth at the end of orthodontic treatment, and 20 of 23 treated patients attended the recall visit after 12 months. A total of 85% of the cases maintained positive overlap at least 1 year post-treatment, 10% showed edge-to-edge bite, and only 5% showed no overbite.
CONCLUSIONS
Treatment of AOB in adults with extrusion arches proved to be stable 1 year post-treatment. Changes in the overbite after 1 year of follow-up were not significant.
Topics: Humans; Adult; Open Bite; Follow-Up Studies; Tooth; Malocclusion, Angle Class II; Overbite; Cephalometry
PubMed: 37922388
DOI: 10.2319/030623-155.1 -
Frontiers in Psychiatry 2023Drug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to...
INTRODUCTION
Drug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to investigate clinical characteristics including detailed complaints in patients with drug-induced open bite.
METHODS
Of the outpatients who first visited the psychosomatic dental clinic at the Tokyo Medical and Dental University Hospital between September 2013 and September 2022, the patients diagnosed with drug-induced open bite were involved in this study. The clinical characteristics including sex, age, detailed complaints, duration of illness, abnormal findings, psychotropic medications, and other medications that were taken at the first examination, psychiatric comorbidities, the duration of psychiatric diseases, and other medical histories were collected retrospectively by reviewing their medical chart.
RESULTS
Drug-induced open bite was found in 11 patients [women: 7, men: 4, median of age: 49 (36.5, 53) years old]. Difficulty in eating especially chewing was the major complaint (9/11, 81.6%) with the duration of illness as 48.0 (16.5, 66) months. Various degrees of open bite were observed. While some showed no occlusal contact on frontal teeth, some showed occlusal contact only on the second molars; moreover, the jaw showed a horizontal slide in a few patients. Three cases could be followed up for prognosis; while in one case the drug-induced open bite improved with 6 months of follow-up, two cases did not improve, and one showed extrusion of molars. All of them had psychiatric comorbidities with the most common diagnosis being schizophrenia ( = 5) and depression ( = 5) followed by insomnia ( = 1) and autism spectrum disorder ( = 1) including duplicated diagnosis. Nine patients (81.6%) had been undergoing treatment with antipsychotics of which three patients were also taking antidepressants.
DISCUSSION
Although a drug-induced open bite is a rare symptom, prudent medical interviews about symptoms, psychiatric comorbidities, and psychotropic medication history besides oral assessment are necessary to provide a precise diagnosis and appropriate management in collaboration between dentists and psychiatrists.
PubMed: 37056404
DOI: 10.3389/fpsyt.2023.1137917 -
Journal of Maxillofacial and Oral... Dec 2023The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite.
INTRODUCTION
The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite.
MATERIALS AND METHODS
A total of 11 patients with an anterior open bite treated with a combined surgical-orthodontic therapy were retrospectively analysed via lateral cephalometric radiographs and models before treatment, 7-10 days after surgery (T1), one year post-operatively (T2) and two years post-operatively (T3).
RESULTS
Ten patients continued to experience a positive overbite at T2. This decreased to 8 at T3. Three patients experienced relapse and had a negative overbite at T3. The average pre-treatment overbite was greater in the positive overbite group compared to the relapse group. Spearman's correlation analysis revealed a correlation between preoperative maxilla-mandibular plane angle (MMPA) with the overall change in overbite. Friedman's test followed by Bonferroni post-hoc analysis was carried out to identify any statistical significance.
CONCLUSION
In conclusion, combined surgical-orthodontic treatment achieves good results for anterior open bite. Patients with a high pre-operative MMPA have a higher risk of relapse. Lower anterior facial height ratio to total anterior facial height (LAFH/TAFH) and the amount of impaction do not significantly contribute to the risk of relapse. Long-term stability of overbite for anterior open bite patients should be around 75%.
PubMed: 38105834
DOI: 10.1007/s12663-021-01642-w -
Journal of Personalized Medicine Nov 2023Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to...
Anterior Open Bite Malocclusion: From Clinical Treatment Strategies towards the Dissection of the Genetic Bases of the Disease Using Human and Collaborative Cross Mice Cohorts.
Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to difficulties with speech, chewing, and biting. Its etiology is multifactorial, involving a combination of genetic, environmental, and developmental factors. Genetic studies have identified specific genes and signaling pathways involved in jaw growth, tooth eruption, and dental occlusion that may contribute to open bite development. Understanding the genetic and epigenetic factors contributing to skeletal open bite is crucial for developing effective prevention and treatment strategies. A thorough manual search was undertaken along with searches on PubMed, Scopus, Science Direct, and Web of Science for relevant studies published before June 2022. RCTs (clinical trials) and subsequent observational studies comprised the included studies. Orthodontic treatment is the primary approach for managing open bites, often involving braces, clear aligners, or other orthodontic appliances. In addition to orthodontic interventions, adjuvant therapies such as speech therapy and/or physiotherapy may be necessary. In some cases, surgical interventions may be necessary to correct underlying skeletal issues. Advancements in technology, such as 3D printing and computer-assisted design and manufacturing, have improved treatment precision and efficiency. Genetic research using animal models, such as the Collaborative Cross mouse population, offers insights into the genetic components of open bite and potential therapeutic targets. Identifying the underlying genetic factors and understanding their mechanisms can lead to the development of more precise treatments and preventive strategies for open bite. Here, we propose to perform human research using mouse models to generate debatable results. We anticipate that a genome-wide association study (GWAS) search for significant genes and their modifiers, an epigenetics-wide association study (EWAS), RNA-seq analysis, the integration of GWAS and expression-quantitative trait loci (eQTL), and micro-, small-, and long noncoding RNA analysis in tissues associated with open bite in humans and mice will uncover novel genes and genetic factors influencing this phenotype.
PubMed: 38003932
DOI: 10.3390/jpm13111617