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D e n ti s tr y / Od o n to l o g i a

Etiology and treatment of anterior open bite

Eti o l o g i a e tr a ta m e n to d a m o r d i d a a b e r ta a n te r i o r

José Márcio Lenzi de Oliveira 1 , André Luiz Tannus Dutra 1 , Cláudio Maranhão Pereira 1 , Orlando Ayrton de Toledo 2

1 DentalSchool,UniversityPaulista,Brasília-DF,Brasil; 2 DentalSchool,UniversityofBrasília,Brasília-DF,Brasil.

Abstract

Thetermanterioropenbite,whichmeansnocontactbetweenanteriorteeth,standsoutincurrentorthodonticbythecomplexityofthetreat-

ment,associatedwithhighlevelsofinstabilityandrecurrence.Thepurposeofthisstudyistoemphasizethatearlyetiologicaldiagnosisis

essentialtothesuccessfuloutcomeofthetechnicalintervention.Thebibliographicalstudyshowsthat,oncethemalocclusionindeciduous

and mixed dentition is diagnosed, it simplifies the aparatology that is used, decreases the treatment time and conditions are created for a

possibleself-correction.Inthepermanentdentition,theauthorsrecommendtheremovaloftheetiologicalfactorandthecontrolofthever-

ticalgrowth.Thediversityofcausesrequiresamultidisciplinarytherapeuticapproach.

Descriptors:Openbite;Malocclusion;Mouthbreathing;Dentition,primary;Dentition,permanent

Resumo

Aexpressãomordidaabertaanterior,quedesignaausênciadecontatoentreosdentesanteriores,destaca-senaortodontiaatualpelacom-

plexidadedotratamento,associadaaaltosníveisdeinstabilidadeerecidiva.Oobjetivodestetrabalhoéenfatizarqueodiagnósticoetio-

lógicoprecoceéfundamentalparaobomresultadodaintervençãotécnica.Oestudobibliográficomostraque,diagnosticadaamaloclusão

nadentaduradecíduaemista,simplifica-seaaparatologiautilizada,diminui-seotempodetratamentoecriam-secondiçõesparaumapos-

sívelautocorreção.Nadentadurapermanente,osautoresrecomendamaremoçãodofatoretiológicoeocontroledocrescimentovertical.

Adiversidadedecausasrequerabordagemterapêuticamultidisciplinar.

Descritores:Mordidaaberta;Máoclusão;Respiraçãobucal;Dentiçãoprimária;Dentiçãopermanente

Introduction

Anterioropenbitecanbedefinedasamalocclusionwithoutcon-

tactintheanteriorregionofthedentalarches,beingtheposterior teeth in occlusion.When it extends to the posterior segment, it is calledcombinedopenbite 1 . Amongthemalocclusionswhichwerefoundintheorthodontic clinic,theopenbiteisoneofthemostprevalentandhasthemost

difficulttreatment.Frommultifactorialetiology,thepathologycau-

sesaestheticchanges,damagetothearticulationofcertainphone-

mesandunfavorablepsychologicalconditions 2-3 .

In early ages, the open bite can undergo self-correction by the

or a slight degree of overbite could not be characterized as open bite 1,3 (Figure1).

not be characterized as open bite 1 , 3 (Figure1). C l a s s i

C l a s s i fi c a ti o n

growthandeliminationofharmfulhabits.However,thosethatper-

sistafterthegrowthmayhaveanunfavorableprognosis,ifitisas-

sociated with the abnormal facial pattern or an atypical behavior

ofthetongueinswallowingorphonation.Theearlydiagnosisand treatmentarecrucial,especiallyindeciduousandmixeddentitions, duetotherelationshipwiththeperiodofgrowthanddevelopment. Inthissense,theuseofpreventivetherapeuticmeasuresallowsto normalizethedevelopmentofdental-facialestructures 4 .

Thisbibliographicalreviewaimstostudythemainetiologicalfac-

torsoftheanterioropenbiteinthedeciduous,mixedandperma- Figure1.Openbite

nentdentition.Moreover,themostsuitabletreatmentsareapproa-

ched,aimingtocontributetothediagnosis,prognosisandtreatment

ofthispathology.

Theopenbitescanbeclassifiedintothreeanatomicalcomponents:

dentalcomponent,whentheproblemisonlytheabsenceeruption

oftheincisors;alveolar,whenthecommitmentofthedentalelement

occursduetoachangeinthegrowthofthealveolarcomponent(cau-

sedbythelackofanteriorteetheruptionandbytheexcessofthepos-

incisors,fromabout1to2mm,makingtheedgesoftheinferiorin- terior ones); and basal, caused by a pattern of unfavorable vertical

growthofthebonebases,notoffsetbythealveolarincrease 2 .

Theopenbitecanbethesimpletype,withoutabnormalmeasu-

restotheverticalcephalometricanalysis;andcomplex,whenthe cephalometryshowsdisharmonyintheskeletalcomponentsofthe anteriorfacialheight 1 . Theopenbitescanbeclassifiedindental,whichresultsfromthe obstruction of the normal eruption of the anterior teeth, without

inboththeanteriorandposteriorregion,betweentheoppositeseg-

mentsoftheteeth,orbetweentheteethandthegums,inalimited

region,rarelyoccurringinthroughoutthedentalarch,whenincen-

tricocclusion.Theauthorsemphasizethatatoptotoprelationship

Literature review

C o n c e p ts

In the normal dentition there is a vertical trespass between the

cisorstouchthelingualsurfaceoftheupperincisorsatorbelowthe cingulum 5 .

Theopenbiteischaracterizedbyalackofthisverticalcontact,

J Health Sci Inst. 2011;29(2):92-5

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compromisingthealveolarheight;thedentoalveolar,inwhichthe

dental and skeletal changes involve the alveolar process; and the

skeletalopenbites,withmanifestedcraniofacialdysplasia,ofsimi-

larpattern,butvariableseverity 3 .

Eti o l o g y

The anterior open bite has multifactorial origin.They refer to a

combinationofvariables,suchassuctionofobjects,prematureden-

tal loss, hypertrophic tonsils, mouth breathing, tongue thrust, ma-

croglossia,temporomandibularjointinternaldisorder,supernume-

raryteeth,amongothers 2 .Nasalobstruction,beforeandduringthe pubertalgrowthshouldalsobeconsidered 5 . Theexcessiveactivityofthetongue,intheactofswallowingoreven atrest,canaltertheaxialinclinationsoftheincisorsandcausetheopen bite 6 .Thecompensatorycoordinationofthetonguemovement,themo- vementofthesoftpalateandthepharyngealconstrictormuscleactivity wouldstilloccurduringtheswallowing 7 .Thiswouldbeobservedquite frequentlyinpatientswithsomedegreeofneurologicimpairment 8 .

Pr e v a l e n ce

Itwasverifieda12%prevalenceofanterioropenbite,morefre-

quentlyinmales,inpatientswithClassIandintheagegroupof7

quentlyinmales,inpatientswithClassIandintheagegroupof7 Figure2.BiteBlocks

Figure2.BiteBlocks

Figure2.BiteBlocks Figure3.Thefixedpalatalgrid,adaptedtotheupperarch,standsout

Figure3.Thefixedpalatalgrid,adaptedtotheupperarch,standsout

amongthecorrectiveproceduresofthedentalanddentoal-

veolaranterioropenbiteswithnormalocclusalrelationship,

causedbythesuckinghabitandtongueinterpositon

Lenzi JM, Dutra ALT, Pereira CM, Toledo OA.

93

to9,showingthesignificantdifferenceifitiscomparedtothepre-

valencefoundinthepermanentdentition 9 .Inthemixeddentition

theprevalenceoftheanterioropenbitecanreachupto18,5%,de-

creasingwithage 4 .

Tr e a tm e n t

D e c i d u o u s d e n ti ti o n

The main cause of open bite in deciduous dentition is the pro- longedhabitofthumbsucking 10 .Thus,themostimportantmeasure

tofixitwouldbetobreakthebadhabit,throughtechniquesofbe-

havioralchange.Itwasobservedsignificantchangesinthecepha-

lometricmeasurements,intheinterincisaland1.Naangles,before

andafterthetreatmentwithmethodsofawarenessandpositiverein-

forcement,withoutanyuseoforthodonticbraces.Thecorrectionof openbitealsodependsontherestorationofnasalbreathing 5 .

M i x e d d e n ti ti o n

Thecasesofopenbiteinwhichthetonguecausesorkeepsthe

infra-occlusionofthemaxillaryandmandibularincisors,theuseof

thefunctionalbracesofBaltersBionator 11 .Theinstrumenthaslateral biteblockstopreventtheeruptionoftheposteriorteeth,leavingthe

anteriorteethoutbreakingfreely.TheSemi-FlexibleActivator(mo-

difiedBionator)asanindicationofchoiceintheearlytreatmentof skeletalopenbiteandthehypotonicmasticatorymuscles 12 .

Theuseofafunctionalbraces(functionalfins)torestorethemus-

clefunctionoftheanterioropenbite 13 .Theactiononthetoneofthe buccinator,inthemaxillaryatresiaandthelackofstabilityduring theswallowing,guidestheclosing.

Whentheanterioropenbiteischaracterizedbyextrusionofthean-

teriorteeth,theintrusionoftheuppermolarsisaformoftreatment,

mayuse“high-pull”,verticalelasticsinanteriorregion,thecombina-

tionoftwomechanicalorbite-blocks 14 .Theuseofposteriorbite-blocks

intheearlytreatmentoftheskeletalopenbite,producesmandibular

rotationforwardandupward,bytransmittingthemasticatoryforcesto

thedentoalveolarregions,inhibitingtheverticalgrowth 15 (Figure2). Thefixedormobilepalatalgrid,adaptedtotheupperarch,stands

outamongthecorrectiveproceduresofthedentalanddentoalveo-

laranterioropenbiteswithnormalocclusalrelationship,causedby

thesuckinghabitandtongueinterposition(Figures3and4).Theuse

ofpalatalbartoavoidtheextrusionofthepermanentmolars,inad-

ditiontocontributetotheintrusionofthesame,performstheverti-

calcontrolofthegrowthincasesofopenbite 5 .Theassociationof therapidpalatalexpansionappliancewithverticaltractionchincup, isthemostrecommendedtechniquetocorrecttheskeletalopenbite withpatternofverticalgrowth(hyper-divergent) 16 (Figure5).

It is observed that, after the orthodontic treatment of open bite,

somepatientsdonotcorrectthereflexionlearned,keepingtheab-

normalityoflingualfunction.Thisconditioncompromisestheresults

andreinforcesthetendencytorecurrence,anditisrecommended

andreinforcesthetendencytorecurrence,anditisrecommended Figure4.Themobilepalatalgrid J Health Sci Inst.

Figure4.Themobilepalatalgrid

J Health Sci Inst. 2011;29(2):92-5

thestrengthenofthefacialmusclesbydoingdailyspecificmuscle exercises 16 .

Pe r m a n e n t d e n ti ti o n

Inadultpatientswithsevereopenbite,thetreatmentaimstoen-

sure the containment and the stability over time, indicating ort-

hognathicsurgery 17 .Theaditionalbilateralsagittalsplitosteotomy

does not affect the stability, while the multisegmental Le Fort I os- teotomy, stabilized by rigid internal fixation, provides a superior transversestabilityifitiscomparedtotheintraosseousfixationwith surgicalthread,andmaxillomandibularfixation.Therecurrenceof

theinter-premolarandinter-molarwidthoftheupperarchareun-

relatedtotheinterpositionofthetongue,lossofintercuspal,chan-

gesinoverbiteoroverjet.However,therearesignificantcorrelations

withtheclockwiserotationofthemandible 18 .Theclockwiserota-

tion of the palatal plane, which moves the anterior jaw structures down,isaneffectivewaytoproduceareasonablystablecorrection

ofanterioropenbite.Ontheotherhand,therepositioningoftheup-

per maxilla which rotates the mandible toward the end should be appliedwithcaution 19 .Thedecreaseofoverbite,observedafterthe treatment,canberesultoftheinfluenceofskeletal,dentalandsoft tissuefactors,moreobviousthananyotherisolatedfactor 20 . Theinterpositionoflingual“brackets”andintermaxillaryelastics betweenthetongueandtheincisor,correctthemalocclusionbythe newpostureimposedtothetongue 21 .

Theeffectivenessoftheactionoftemporaryimplantationofamini titaniumplate,inthemaxillaormandible,providestheintrusionof themolars 22 .Thisminimallyinvasivetechniquemakeschangesto

the occlusal plane, mandibular plane and anterior portion of the face,closingtheanterioropenbite 22-23 .Withthesamepurpose,it

isindicatedtheapplicationofminiimplantsinthepalatalandves-

tibularportion 24 .

Skeletalchangesgreaterthanthosethatwereverifiedinuntrea-

tedadultswereobservedafterayearofsurgicalcorrectionofade-

formityoflongfaceinadultpatients 20 .

Discussion

Overthepast20years,Orthodonticsgavespecialattentiontothe

interdependenceoffacialproportionsinthethreeplanesofspace andtheverticaldysplasiasbegantoreceivegreatercare. Infact,the

treatmentofthemalocclusionsofverticaloriginismoredifficultand hasmoreunstableresults 2 . Manystudiesshowthemultifactorialnatureofanterioropenbite, whichmayresultfromablockageoftheeruptionofatoothdueto

thedevelopmentoftheunionbetweenthecementumandthead-

jacentbone(ankylosis).Sometimes,inthechild'sgrowth,excessive

proliferation of lymphoid tissue, associated with chronic allergic conditions and infections, may lead to an obstruction of the nasal airways,leadingtochronicmouthbreathing.Tokeepthenecessary

breathingspace,thechildwouldleavethemouthopened,theton-

breathingspace,thechildwouldleavethemouthopened,theton- Figure5.Hyper-divergent J Health Sci Inst. 2011;29(2):92-5

Figure5.Hyper-divergent

J Health Sci Inst. 2011;29(2):92-5

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guewouldbedisplaceddownwardandforward,andthemandible couldbeputatarestpositionlowerthanusual 4,9 . Suckinghabitscanbeconsideredasextrinsicfactorsresponsiblefor theanterioropenbite.Theinstallationofthismalocclusionmayalso dependonthefacialgrowthpatternthatthechildrenhas,aswellasthe

duration,intensityandfrequencywithwhichthehabitiscarriedout 25 .

Amongtheoralhabitsthatcausetheanterioropenbite,theab-

normalpressureofthetongue,mainlyduringtherest,canleadto changesinaxialinclinationoftheincisors,leadingtomalocclusion. However, despite the lower frequency, the suction of the lips can causetheanterioropenbite,aswellasfavortheappearanceofnew

habits, such as the interposition of the tongue.The elimination of thesehabitscanleadthespontaneouscorrectionofmalocclusion. The permanence of suction, a physiological need of child's deve-

lopment,isnotconsiderednormalafter3years.However,theha-

bitoffingersuckingorpacifieruse,amechanismofchildemotio-

nalsupply,preferablyshouldnotbeinterfered.Fromtheageoffive,

thechildwouldgothroughaphaseofsocializationandemotional

maturityand,inmostcases,thechildabandonthesehabits.Nasal

obstructionisstillconsideredasanetiologicalfactorofopenbite,

whichcancreateananatomo-functionalimbalance,favoringexa-

cerbateverticalskeletalgrowth,dentaleruptiondisordersandhe-

reditaryoverdoneverticalskeletalgrowth 25 .

With respect to the prevalence of open bite, the numbers vary.

However,theauthorscontendthattheprevalenceofopenbitede-

creaseswithincreasingage 2,4 . Withreferencetothecharacteristicsofanterioropenbite,these

malocclusionsoccurinseveralskeletalpatterns,buttheyhasaten-

dencytothefirstdivisionclassII,whichcandisplayachangedin-

terincisalangle 14 .Thisdataisexpected,sincetheinclinationofthe incisorsbetweenthemisasupportingfactorofanterioropenbitein

alargenumberofcases.Thedifferencesthatwerefoundintheto-

talverticaldimensionofthefaceareduetotheincreaseinsizeof

thelowerthird.Thereisahigherprevalenceinindividualsclassified

asAngleClassIandIII 26 .Theshortercranialbase,theincreaseofthe

gonialangleandthemandibularplane,aswellastheincreasedan-

teriorfacialheight,arecharacteristicfindingsofanterioropenbite. Differential diagnosis requires data of heredity, severity of ma- locclusionandenvironmentalfactors,apartfromthecephalometry todeterminatethegrowthpatternanddegreeofinvolvementofthe

bone and dental elements 2 . Based on this elements, the treatment

isdefined,commonlymultidisciplinaryinthefaceofthemultifac-

torialetiologyofthepathology. The treatment should preferentially be performed in the mixed and deciduous dentitions, phases that offer better physiological conditionstotherestorationofthenormalrelationship 27 .

Eventheopenbiteofpuredentalnature,untreatedandkeptby bad habits, can develop to the dentoalveolar malocclusion in mi- xeddentitionstageand,later,inthepermanentdentition,whenthe facialgrowthstopsandtheskeletalcharacterbegins 5 . Inthemixeddentition,theextra-oralbraces,Thurowtype,with high pull and orthopedic strength, associated to a palatal grid, should be used for a period of 12 to 16 hours per day.The braces

be used for a period of 12 to 16 hours per day.The braces Figure6.Theextra-oralbraces,Thurowtype,withhighpullandort-

Figure6.Theextra-oralbraces,Thurowtype,withhighpullandort-

hopedicstrength

Etiology and treatment of anterior open bite

Figure7.Theextractionofthefourpremolars isindicatedtorestrictthegrowthofthemaxilla,inverticalandan-

Figure7.Theextractionofthefourpremolars

isindicatedtorestrictthegrowthofthemaxilla,inverticalandan-

teroposterior,andallowstherotationofthemandibleinacounter-

clockwisedirection 28 (Figure6).

In adults who have biprotrusion, the extraction of the four pre-

ticalsizeofmandibularplaneangleisdoneand,consequently,the closureofopenbiteisproduced 29 (Figure7).

7.FujikiTTY,HaruhiroN,TakashiY,GuoqiangG,KeijiT.Acineradiographicstudy

ofdeglutivetonguemovementandnasopharyngealclosureinpatientswithante-

rioropenbite.AngleOrthod.2000;70(4):284.

8.PedrazziE.Treatingtheopenbite.JGenOrthod.1997;8(1):5-16.

9. Borges CL. Estudo cefalométrico da mordida aberta anterior [dissertação de mestrado].RiodeJaneiro:FaculdadedeOdontologiadaUniversidadeFederaldo

RiodeJaneiro;1984.

10.WriedtS,BuhlV,Al-NawasB,WehrbeinH.Combinedtreatmentofopenbite-

long-termevaluationandrelapsefactors.JOrofacOrthop.2009;70(4):316-26.

11.GraberTM,NeumannB.Aparelhosortodônticosremovíveis.2ªed.SãoPaulo:

Panamericana;1987.p.383-402.

12.LevriniA.Novostiposdeaparelhosfuncionaiselásticos.RevDentPress Or-

todonOrtopMaxilar.1997;2(1):64-5.

13.GomesS,GomesVF,GomesS.OusodasaletasfuncionaisGomesnostrata-

mentosdasmordidasabertasanteriores.JBrasOrtodonOrtopMaxilar.2(11):69-76.

14.ParraSLN.Mordidaabertaanterior:estudosdepacientestratadosortodonti-

camente e 5 anos pós-contenção [dissertação de mestrado]. Rio de Janeiro: Fa-

culdadedeOdontologiadaUniversidadeFederaldoRiodeJaneiro;1997.

15.IscanHN,SorisoyL.Comparisonoftheeffectsofpassiveposteriorbite-blocks

withdifferentconstructionbitesonthecraniofacialanddentoalveolarstructures.

AmJOrthodDentofacOrthop.1997;112(2):171-8.

molarsproducesexcellentresults.Thus,thedecreasingofthever- 16.EnglishJD.Earlytreatmentofskeletalopenbitemalocclusions.AmJOrthod

DentofacOrthop.2002;121(6):563-5.

17. Bisase B, Johnson P, Stacey M. Closure of the anterior open bite using man-

Inadultswhohaveoutstandingdiscrepancybetweenthemaxil- dibularsagittalsplitosteotomy.BrJOralMaxilloffacSurg.2010;48(5):352-5.

lary and mandibular bone bases, causing severe dental-facial de- formities, the recommended treatment is the combination of ort- hodonticproceduresandoralandmaxillofacialsurgery 30 . Themaingoaloftheorthodontictreatmenthasbeenthestability, afundamentalconditiontotheaestheticandfunctionalcorrection. Itisimportanttoensuretheproperocclusionpreservingthenormal musclebalance.Thus,amongtheexperts,itseemstobeconsensus thatthesatisfactorycontentionofamalocclusion,toadulthood,is abiggerchallengethanitsownfix.

18.HoppenreÿsTJ,HackmanEC,Van’tHofMA,StoelingaPJ,TuinzingDB,Breihofer

HP.Psychologicimplicationsofsurgical-orthodontictreatmentinpatientswithan-

terioropenbite.IntJAdultOrthodonOrthognathSurg.1999;14(2):101-12.

19. Moldez MA, Sugawara J, Umemori M, Mitani H, Kawamura H. Long-term

dentofacial stability after bimaxillary surgery in skeletal Class III open bite pa-

tients.IntJAdultOrthodonOrthognathSurg.2000;15(4):309-19.

20. Proffit WR, Bailey LJ, Phillips C,TurveyTA. Long-term stability of surgical

open-bitecorrectionbyLeFortIosteotomy.AngleOrthod.2000;70(2):112-7.

21. Fillion D. La correction des béances de l’adulte par orthodontie linguale.

Infact,therearemanyexplanationsfortheinstabilityofthecor- OrthodFr.1997;68(1):307-10.

rectionofanterioropenbite,amongthemthenonadaptationofthe

tongue,independentlyoftheinterventionthatwasperformed,even

the orthognathic surgery. However, the early identification of de-

22. Faber J, MorumTFA, Leal S, Berto PM, Carvalho CKS. Miniplacas permitem

tratamentoeficienteeeficazdamordidaabertaanterior.RevDentPressOrtodon

OrtopFacial.2008;13(5)144-57.

viationandtheeliminationofthecauses,byaccuratecontrols,in- 23.KakuM,KawaiA,KosekiH,AbediniS,KawazoeA,Sasamoto et al. Correction

ofsevereopenbiteusingminiscrewanchorage.AustDentJ.2009;54(4):374-80.

24.AraújoTM,NascimentoMHA,BezerraF,SobralMC.Ancoragemesquelética

em ortodontia com miniimplantes. Rev Dent Press Ortodon Ortop Facial.

2006;11(4):126-56.

25. Ramirez-Romito ACD, Zardetto CGDC, Salim DA, Sant’anna GR, Tollara

MCRN,BegazoPMV e t a l . Odontopediatria:resoluçõesclínicas.Curitiba:Maio,

2000.

26.TsangWM,CheungLK,SammanN.Cephalometriccharacteristicsofanterior

open bite in a southern Chinese population. Am J Orthod Dentofac Orthop.

1998;113(2):165-72.

27.SuguinoR,FurquimLZ,RamosAL,TeradaHH,MaedaL,SilvaFilhoOG.Uti-

lização e confecção do “Bite Block”. Rev Dent Press Ortodon Ortop Facial.

1997;2(1):89-117.

28.PintoAS,MartinsLP,MeloACM,PaulinRF,OshiroL.Oaparelhoextra-bucal

deThurowmodificadonotratamentodaClasseIIcommordidaaberta:casoclí-

nico.RevDentPressOrtodonOrtopFacial.2001;6(1):57-62.

1.MoyersRE.Ortodontia.4ªed.Trad.coord.PorAloysioCariello.RiodeJaneiro:

References

creasessignificantlythestabilityofthecorrection 14 .

Conclusion

Inthedeciduousandmixeddentition,theearlydiagnosisofthe anterioropenbitedecreasesthetimeoftreatmentandsimplifiesthe aparatologythatisusedforcorrection. The treatment of anterior open bite requires, mostly, multidisci- plinaryapproach. Duetothehighrateofunstableresultswithrelationtotheperiod of treatment and post-treatment of anterior open bite, more re- searchisneededinthisarea.

GuanabaraKoogan;1991.

2. UrsiWJS,Almeida RR. Mordida aberta anterior, conceitos, etiologia, caracte-

rísticas,classificaçãoecasosclínicos.RGO(PortoAlegre),1990,38(3):211-8.

3. FarretMMB,ToméMC, JurachEM,PiresRTT.Efeitosna mordida aberta ante-

rior a partir do reposicionamento postural da língua. Ortodon Gaúcha.

1999;3(2):119-24.

4. Bastos ECML. Mordida aberta anterior [dissertação de mestrado]. Rio de Ja-

neiro: Faculdade de Odontologia da Universidade Federal do Rio de Janeiro;

1992.

5.AlmeidaRR,SantosSCBN,SantosECA,InsabraldeCMB,AlmeidaMR.Mordida

aberta anterior – considerações e apresentação de um caso clínico. Rev Dent

PressOrtodonOrtopFacial.1998;3(2):17-29.

6. Sodré AS, Franco EA, Monteiro DF. Mordida aberta anterior. J Bras Ortodon

OrtopFacial.1998;3(17):80-94.

29.ChuYM,BergeronL,ChenYR.Bimaxillaryprotusion:anoverviewofthesur-

gical-orthodontictreatment.SeminPlastSurg.2009;23(1):32-9.

30. Ritter DE, Mendes AM, Medeiros PJD, Locks A, Condeixa DC.Tratamento

orto-cirúrgicoempacienteportadordeClasseII,Divisão1commutilaçãoemor-

didaabertaanterior.RevDentPressOrtodonOrtopMaxilar.2000;5(1):45-50.

Corresponding author:

JoséMárcioLenzideOliveira

SQN102BlocoDapto.307–AsaNorte

Brasília-DF,CEP70722-040

Brazil

E-mail:marcio.lenzi@gmail.com

ReceivedMarch4,2011

AcceptedApril13,2011

Lenzi JM, Dutra ALT, Pereira CM, Toledo OA.

95

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