Effect of molar intrusion with temporary anchorage devices in patients with anterior open bite: a systematic review

The prevalence of an anterior open bite ranges in the literature from 1.5% to 11%, with great racial variance. Stable non-surgical treatment of an anterior open bite is notoriously unpredictable, with a high risk of relapse and an uncertainty of true skeletal change. Temporary anchorage devices (TADs) are increasingly used to enhance and simplify orthodontic biomechanics, enabling clinicians to push the boundaries of orthodontic treatment. In anterior open bite cases, TADs may be used predictably for molar intrusion and improvement of the overbite. We describe a 16-year-old male with a Class I incisal relationship on a skeletal I base and increased vertical proportions, complicated by a 4-mm anterior open bite secondary to a previous digit sucking habit. Treatment involved fixed orthodontic appliances on an extraction basis, and molar intrusion using TADs. TADs provide a safe and effective alternative to reducing an anterior bite in a patient whose growth is complete. CPD/Clinical Relevance: Understanding the options for the treatment of an anterior open bite and the limits of orthodontic camouflage will help clinicians provide their patients with the necessary information with which to make informed decisions.

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Outcomes and Stability of Anterior Open Bite Treatment with Skeletal Anchorage in Non-Growing Patients and Adults Compared to the Results of Orthognathic Surgery Procedures: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10235682 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5682

Author(s):

Piotr Malara ◽

Susanne Bierbaum ◽

Beata Malara

Keyword(s):

Systematic Review ◽

Orthognathic Surgery ◽

Data Extraction ◽

Open Bite ◽

Long Term Results ◽

Published Data ◽

Skeletal Anchorage ◽

Anterior Open Bite ◽

Molar Intrusion ◽

Molar Teeth

The objective of this review is to evaluate, on the basis of the available literature, if anterior open bite (AOB) can be successfully treated with the intrusion of molar teeth using skeletal anchorage in non-growing patients and adults and if this treatment modality provides comparable results to those obtained by orthognathic surgery procedures. Methods: A systematic review of published data in major databases from 2000 to 2021 was performed. Results: In total, 92 articles were included in title and abstract screening, and only 16 articles (11 concerning AOB correction by molar intrusion with skeletal anchorage, and five considering AOB treatment by orthognathic surgical intervention) qualified for thorough data extraction and analysis. Conclusions: On the basis of this review, it seems to be possible to obtain successful results for AOB treatment in non-growing patients and adults by means of the intrusion of molar teeth with skeletal anchorage. However, due to the different methods of assessing treatment outcomes used by different authors, it is not possible to state conclusively whether the treatment of AOB by means of molar intrusion with skeletal anchorage provides long-term results that are comparable to orthognathic surgery procedures.

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Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis

Progress in Orthodontics ◽

10.1186/s40510-020-00328-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Daybelis González Espinosa ◽

Paulo Eliezer de Oliveira Moreira ◽

Amanda Silva da Sousa ◽

Carlos Flores-Mir ◽

David Normando

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Open Bite ◽

Skeletal Anchorage ◽

Anterior Open Bite ◽

Molar Intrusion

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Invisalign System as a Treatment of a Skeletal Open Bite: A Case Report With a 5-Year Follow-up

10.37191/mapsci-jdr-2(1)-016 ◽

2021 ◽

Author(s):

Linda Sangalli

Keyword(s):

Case Report ◽

Open Bite ◽

Anterior Open Bite ◽

Night Time ◽

Myofunctional Therapy ◽

Temporary Anchorage Devices ◽

Molar Intrusion ◽

Skeletal Open Bite ◽

Lower Molar

Background: Orthodontic treatments of skeletal open bite are among the most challenging and at high relapse. Available therapies vary from behaviour-modifying appliances in growing patients to surgical approach in adults. Recently, clear aligners, such as Invisalign®, have also been proposed as a treatment modality, to be used alone or in combination with temporary anchorage devices. Case report: A 19-year-old female presented with 3-mm anterior open bite, peg-shaped upper lateral incisors, incorrect tongue posture at rest and during function. Due to aesthetic request, an orthodontic camouflage with Invisalign® was carried out for 17½ months, along with myofunctional therapy and composite veneers on upper lateral incisors. During the first months of retention, intermaxillary vertical elastics were maintained at night-time as positive feedback to the tongue. A 5-year follow-up confirmed stability of the results. Conclusions: A system of clear aligners in combination with myofunctional therapy was effective in the treatment of a skeletal open bite malocclusion, with stability at 5 years. The closure of the anterior open bite was obtained through a combination of lower molar intrusion, incisor extrusion and counterclockwise rotation of the mandible. In selected cases of optimal compliance, Invisalign® may constitute a feasible treatment option in management of open bite in non-growing patients.

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Oral Myofunctional and Articulation Disorders in Children with Malocclusions: A Systematic Review

Folia Phoniatrica et Logopaedica ◽

10.1159/000516414 ◽

2021 ◽

pp. 1-16

Author(s):

Zoë Thijs ◽

Laura Bruneel ◽

Guy De Pauw ◽

Kristiane M. Van Lierde

Keyword(s):

Systematic Review ◽

Risk Of Bias ◽

Open Bite ◽

Anterior Open Bite ◽

Eligibility Criteria ◽

High Prevalence ◽

Tongue Position ◽

Articulation Disorders ◽

Level 2 ◽

Unclear Risk

Background: Relationships between malocclusion and orofacial myofunctional disorders (OMD), as well as malocclusions and articulation disorders (AD) have been described, though the exact relationships remain unclear. Given the high prevalence of these disorders in children, more clarity is needed. Summary: The purpose of this study was to determine the association between OMD (specifically, bruxism, deviate swallowing, caudal resting tongue posture, and biting habits), AD, and malocclusions in children and adolescents aged between 3 and 18 years. To conduct a systematic review, 4 databases were searched (MEDLINE, Embase, Web of Science, and Scopus). The identified articles were screened for the eligibility criteria. Data were extracted from the selected articles and quality assessment was performed using the tool of Munn et al. [Int J Health Policy Manag. 2014;3:123–81] in consensus. Using the search strategy, the authors identified 2,652 articles after the removal of duplicates. After reviewing the eligibility criteria, 17 articles were included in this study. One of the included articles was deemed to have an unclear risk of bias, whereas all other articles were considered to have a low risk of bias. The articles showed a relationship between anterior open bite and apico-alveolar articulatory distortions, as well as between anterior open bite and deviate swallowing. For the biting habits, bruxism, and low tongue position no clear conclusions could be drawn. Key Messages: The current review suggests a link between specific types of malocclusion and OMD and AD. However, more high-quality evidence (level 1 and level 2, Oxford Levels of Evidence) is needed to clarify the cooccurrence of other OMD, AD, and malocclusions.

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Prevalence of anterior open bite in children and adolescents: a systematic review and meta-analysis

European Archives of Paediatric Dentistry ◽

10.1007/s40368-021-00683-6 ◽

2021 ◽

Author(s):

M. T. Avrella ◽

D. R. Zimmermann ◽

J. S. P. Andriani ◽

P. S. Santos ◽

J. C. Barasuol

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Meta Analysis ◽

Open Bite ◽

Anterior Open Bite

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Optimization of Loading Condition for Maxillary Molar Intrusion with Midpalatal Miniscrews by Using Finite Element Analysis

Applied Sciences ◽

10.3390/app112411749 ◽

2021 ◽

Vol 11 (24) ◽

pp. 11749

Author(s):

Ornnicha Pooktuantong ◽

Takeshi Ogasawara ◽

Masayoshi Uezono ◽

Pintu-on Chantarawaratit ◽

Keiji Moriyama

Keyword(s):

Finite Element ◽

Open Bite ◽

Unit Load ◽

Anterior Open Bite ◽

Element Analysis ◽

Molar Intrusion ◽

Apical Direction ◽

Root Injury ◽

Maxillary Molar ◽

Transpalatal Arch

An anterior open bite is one of the most difficult malocclusions in orthodontic treatment. For such malocclusion, orthodontic miniscrew insertion into both buccal and palatal alveolar regions has been indicated for molar intrusion, but it involves a risk of tooth root injury. To solve the problem, a midpalatal miniscrew-attached extension arm (MMEA) is adopted. However, this method causes palatal tipping of the molar because intrusive loads were applied only from the palatal side. Currently, a transpalatal arch is added to avoi0d tipping movement, but it induces the patient’s discomfort. Hence, the objective of this study was to evaluate the loading conditions for maxillary molar intrusion without tipping movement, only by MMEA through finite element (FE) analysis. FE models of maxillary right first molar and surrounding tissues were created. Three hook positions of MMEA were set at 6.0 mm perpendicular intervals in the occluso-apical direction along the mucosal contour. An intrusive unit load was applied from the palatal side of the molar, and various counter loads were applied from the buccal side. An optimal counter load for molar intrusion without palatal tipping was observed in each hook position. In conclusion, an ideal maxillary molar intrusion can be achieved only by MMEA with an optimal counter load.

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Intrusion of upper molars with mini-implants for open bite correction is effective? A systematic review

Brazilian Dental Science ◽

10.14295/bds.2018.v21i4.1603 ◽

2018 ◽

Vol 21 (4) ◽

pp. 461

Author(s):

Ana de Lourdes Sá De Lira ◽

Gustavo Pinho Nascimento ◽

Tennessee Felipe Costa Freitas

Keyword(s):

Systematic Review ◽

Scientific Evidence ◽

Evaluation Process ◽

Risk Of Bias ◽

Open Bite ◽

Inclusion Criteria ◽

Mini Implants ◽

Molar Intrusion ◽

Upper Molar ◽

Implant Treatment

<pre>Introduction: The open bite is a malocclusion defined by the absence of a positive vertical overlap of the upper incisors over the lower ones. It is believed that the correction of this malocclusion with mini-implants is as effective as another technique. Objective: To verify by scientific evidence the effectiveness of upper molar intrusion with mini-implants for correction of open bite. Material and Methods: This systematic review was conducted according to the PRISMA guidelines. Cochrane Handbook for Systematic Reviews of Interventions (version 5.3) was used to assess the methodological quality and risk of bias of the included studies. Results: During the selection and evaluation process, 795 of the 1297 papers were eligible for research in their titles and abstracts. Repeated articles were removed and as a result, 21 articles were retrieved and read completely. Those who did not meet the inclusion criteria were excluded, resulting in only 6 articles that were included. Conclusion: The intrusion of the upper molars with the use of mini-implants as a skeletal anchor is effective for open bite correction. When the technique of upper molar intrusion with mini-implants was compared with the technique of posterior high pull and incisor extrusion, the first one was more effective for the correction of open bite. The recurrence of molar intrusion does not invalidate mini-implant treatment for open bite correction because the benefits achieved outweigh the small dental relapse.</pre><pre>Keywords</pre><pre> Orthodontics, corrective; Tooth intrusion; Open bite.</pre>

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