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Anterior open-bite has been grouped into two broad categories. The first
ca tegory consists of the a cquired or denta l open-bites which do not show a ny
distinguishing craniofacial malformations. The second group consists of patients
with craniofacial dysplasia in addition to the open-bite.
The dental open-bites are believed to result from obstructed eruption of
t h e a n t er ior t eet h (F ig. 1). Ma n y of t h ese sh ow spon t a n eou s r em ission s, a n d
75 t o 80 per cen t h a ve m a r ked im pr ovem en t wit h ou t a n y for m of treatment.8
P r esen t ed befor e t h e Kor t h ea st er n Societ y of Or t h odon t ist s, Nov. 8, 1974.
*Associa t e P r ofessor of Den t ist r y, Colu m bia Un iver sit y Sch ool of Den t a l a n d Or a l
Surgery.
513
Fi g.
1.
initia te d
The d e ntitio n o f a p a tie nt w ith a ha b itua l a nte rio r o p e n-b ite w hic h w a s p ro b a b ly
the
a sym m e tric
o p e ning
c a use d
b y p la c ing
the
thum b
on
Fi g . 2 .
A,
Th e d e n t i t i o n o f a p a t i e n t w i t h a t r a n si t i o n a l o p e n - b i t e w i t h a C l a ss II
m a lo c c lusio n a nd
m ild
d e ntitio n o f the
sa m e
m e n t w i t h c e rv i c a l e x t ra o ra l f o rc e . A l o w e r l i n g u a l a rc h i s i n p l a c e a n d i s b e i n g u se d
t o m a i n t a i n a rc h l e n g t h . Th i s p a t i e n t h a s t h e sk e l e t a l c o n t ig u ra t io n
w ith
c lo se -b ite s.
(Tra c ing s in
Fig .
t h a t i s a sso c i a t e d
5.)
PI L c
Class I
Class1
Normal d
Cla ssII
@
Fig . 3. A, Tra c ing
of a
p a tte rn
(S-N-M e -G o -S]
p a tte rn
of
no rm a l
sub je c t w ith a
sho w ing
c o ntro l
o c c lusa l
m a tc he d
N o rm a l O p e n Bi t e - - -
p o lyg o n
a nd
Ave ra g e
a g a inst
p a la ta l
a ve ra g e
p la ne s.
of
No rm a l
c o ntro ls.
C la ss II o p e n-b ite
C,
su b ie c t s.
No t e
d if f e re n c e s in S- G O , g o n ia l a n g le , m a n d ib u la r p la n e , f a c e h e ig h t , a n d c a n t o f t h e
o c c lu sa l p la n e s a n d o f t h e p a la t a l p la n e . Su p e rim p o sit io n a lo n g S- N re g ist e re d a t S.
The ratio of the upper anterior fact height to the lower anterior fact> height
serves as one of the diagnostic criteria. (The normal IJFII/LFH ratio is 0.800,
open-bite < 0.700 and closed bite > 0.900.) An obtuse genial angle is seen
with a steep, notched mandibular plane. In addition, there are two distinct
occlusal planes. The maxillary occlusal plant may bc tipped upward ankriorly
in conjunction with the palatal plane, while the mantlibular ocelusal plam is
canted downward. Our studies indicated that dcntoalvcolar height is ctf I( trsf
normal except for the mandibular molar, whkh is significantly shorter.: Thr
5 16
Fig.
Na h own
4.
treatment
taken
A
by
and
a
at 4-month
B,
Patient
trained
with
therapist
skeletal
for
anterior
period
of
open-bite
6
who
months.
received
myofunctional
Cephalometric
films
were
e Xpt Y%d,
Fig. 5. A, The skeletal configuration that is typical of a subject with a deep-bite. Note
that this patient has a transitional open-bite. (UFH/LFH is 1.017.) B, Same patient 2
years later, after treatment of Class II malocclusion with cervical EOF. Note tendency to
close-bite.
.I i,, J. O?.thod.
.Ilrr !, 1 9 i i
5 1 8 Nahounz.
1965
1965
com pon en t s wh ich a r e in it ia t ed a n d execu t ed on a su bcon sciou s level.lx Swallowin g occu r s 1,200 t o 1,500 t im es a da y, a n d t h e pa t ien t is n ot a wa r e of t h is
activity.l! Th er e is n o evidence to support the cla im of beneficia l thera peutic
effects of myofunctional therapy in skeletal open-bite patients20-22 (F ig. 4).
Th e dia gn osis of a gr owin g ch ild is different fr om t h a t of a n a du lt . Th e a du lt
pr esen t s u s wit h a fa it a ccom pli. Th er e is n o h ope for im pr ovem en t wit h ou t
treatment. The child presents us with an unusual challenge to make an educated
guess a s to the potentia l for fa vora ble growth. Although genera liza tions ma y be
m a de, it is ext r em ely difficu lt t o m a ke pr ecise pr edict ion s for t h e in dividu a l
pa t ien t . Con sequ en t ly, we a r e u n a ble t o r en der a n a ccu r a t e a ssessm en t of ou r
pa t ien t a n d a va lid pr ogn osis. An illu st r a t ion m a y ser ve t o em ph a size t h e im por t a n ce of t h is con cept . A ch ild wit h t h e skelet a l con figu r a t ion t h a t is t ypica l
of a close-bite will continue to grow a s a close-bite pa tient (Fig. 5). It is unlikely that he will develop a skeletal open-bite. A similar, but opposite, generali-
P.
- 7-63
- - - - 6-66
0
Fig. 7. A, Pa tient with severe open-bite who wa s trea ted with vertica l ela stics. 6, Superimposed
tra cings
to
indica te
minima l
closure
of
open-bite.
ma lforma tion
is
una ffe c te d.
zation may be made about an open-bite patient (Fig. 4). However, minor
changes in the growth pattern may facilitate treatment, so that a poor prognosis
can become a, favorable one. Apparently, growth makes the difference.
If we think of the first or second molar as a fulcrum, consider what 1 or 2
mm. of additional posterior face height growth would mean to a patient with an
anterior open-bite! Relatively small changes in strategic locations can modify
the subjects position within the spectrum of the deformity (Fig. 6).
In a recent publication, Nemeth and Isaacson reported that orthodontically
treated patients who exhibited anterior open-bite relapse showed greater combined sutural and alveolar growth of the maxilla and alveolar growth of the
mandible than posterior facial height increase. This study indicated that some
open-bite patients continued to have insufficient vertical growth of the posterior
face as the other components continued their normal growth. Conversely, we
may assume that, if the trend reverses itself and there is adequate growth in
posterior face height, an open-bite may close. This is one area where we can
observe structural differences in growing patients who exhibit the anterior
open-bite syndrome. However, it should be stressed that this is not the only site
of deformation.
The patient with a craniofacial malformation should not be treated by elongation of anterior teeth. Dentoalveolar height is finite. Incisors should not be
extruded without restraint. Even if the bite were closed, facial improvement
would be limited except t.hrough
favorable growth or surgical intervention
(Fig. 7).
It is not surprising that orthodontists would look for and readily accept
some method of determining the severity of the overbite-positive or negative.
Such an indicator has been suggested by Kim, who utilizes a combined measurement of the palatal plane angle to FH and the angle of the AB plane to the
mandibular plane. It is referred to as the ODI. Although the use of the palatal
and
conclusion
3. A detailed description of the open-bite subject, with a craniofacial malformation is given in order to diffrrentiate this malocclusion from the acquired
open-bite.
2. The reasons for the failure of various modes of treatment ilr( presented
in the light of neuromuscular and anatomic variations that, are inhcrcnt in these
patients.
3. The importance of growth in strategic: sites is emphasized as a determining
factor in successful treatment.
Th e a u t h or gr a t efu lly a ckn owledges t h e su ggest ion s of Kicbolns
I,. H or owit z in t h e pr epa r a t ion of t h is a r t icle.
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1974.
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3. Na bou m , 11. I., H or owit z, H. I,., a n d Benedicto, E .: Varirt.ies of a n t er ior open -bit e, A&z.
J. ORTHW. 61: 486.492,
1972.
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A nterior
open-bite
521
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