The different methods of anterior open bite treatment during the deciduous and mixed dentition periods .

1. Anterior Open Bite
Treatment in the Deciduous
and Mixed Dentitions
Dr.Marwan Mouakeh, Consultant Orthodontist
Academic Adviser, Al-Hokail Polyclinic – Khobar ( KSA)

2. Treatment Objectives
• Esthetics
• Functional :
 Install normal swallowing pattern
 improve the ability to incise and
chew food
 improve the speech function .

3.  Treatment Objective
»Allow normal vertical developmental and
eruption of the anterior teeth through
eliminating:
 Sucking Habits
 Tongue Thrusting
 Eruption Obstacles
Open Bite treatment in the deciduous and mixed dentition

4.  Overbite Measurement
 The Accurate Method :
Measure the distance between the
maxillary and mandibular incisor
borders perpendicularly to the
functional occlusal plane.
G. Janson &F.Valarelli , Open –Bite Malocclusion Treatment and Stability . 2014

5. Open Bite Treatment in the Deciduous and Mixed Dentition
 In about 95% of the AOB cases there is a dentoalveolar
involvement
 Skeletal open bites are very rare in this stage
 Treatment is easier than the correction in the
permanent dentition .
 in the Deciduous Dentition

6. - Effects of Digit Sucking may include the dentoalveolar and
facial structures in all 3 planes ….
Sagittal
Vertical
Transverse

7. Open Bite Treatment
 Treatment is mainly “ Etiological” : elimination of
deleterious habits and correction of altered tongue
posture .
 No orthodontic treatment before the age of 5 years .
 Parents should encourage spontaneous abandonment
of the habits:
- positive motivation
- reward strategy
 in the Deciduous Dentition

8. •Approach to anterior open bite treatment before 5 years of age
( Janson & Valarelli,2014 )

9.  After 5 years , if AOB still exist in spite of habit
abandonment ( unusual tongue thrust and posture ) :
 Fixed or removable tongue crib
 Speech therapy
 in the Deciduous Dentition
Open Bite Treatment

10. Open Bite Treatment in the Mixed Dentition
 Skeletal component of the AOB is greater than in the
deciduous dentition stage
 Spontaneous correction is more difficult and takes
longer time
 Treatment is indicated for cases :
 Not improving with time
 Negative overbite ≥ 2 mm.

11. Open Bite Treatment in the Mixed Dentition
 Treatment Methods :
 Appliances used to control the deleterious habits or
anterior tongue posture and thrust :
 Palatal ( tongue) cribs associated with fixed or
removable appliances
 Tongue spurs
 Posterior Bite Blocks in cases with accentuated vertical
pattern .

12. Open Bite Treatment in the Mixed Dentition
 Treatment Methods :
 Management of airways problems and mouth breathing:
• Refer to ENT specialist
• Respiratory physiotherapy to restore nasal
breathing
 Speech Therapy ( after closure of the AOB )
o To Reeducate the buccofacial musculature during
swallowing and speech

13. Open Bite Treatment in the Mixed Dentition
 Treatment Duration :
• 3 to 18 months depending on :
 patient compliance
 patient age
 malocclusion severity and characteristics
• The younger the patient and the milder the open bite
,the faster is the correction.

14.  The aim is to stop the (non-nutritive )
sucking habits before the age of 6 years in order
to create a favorable environment for the
eruption of permanent teeth .
• Treatment Modalities
1 - Habit Control & Therapy
Open Bite treatment in the mixed dentition

15.  Means :
Or,
- intra-oral appliances designed to
act as a “ reminder” and
“ habit breaker” .
• Treatment Modalities
1 - Habit Control & Therapy
- Self-correction ( patient and parents cooperation )
Open Bite treatment in the mixed dentition

16. 2 - Palatal Cribs and Tongue Spurs
to modify abnormal tongue behavior .
• Treatment Modalities
Open Bite treatment in the mixed dentition

17.  Palatal Cribs
may be associated to other removable
or fixed appliances
They act :
- as a reminder to avoid thumb sucking ,
or
- as a mechanical barrier against tongue
thrust and abnormal tongue posture .
Open Bite treatment in the deciduous and mixed dentition

18.  Palatal Cribs
-May act as a mechanical barrier against tongue thrust
and abnormal tongue posture .
Open Bite treatment in the mixed dentition

19.  Palatal Cribs
 The tongue(palatal) cribs should present adequate
length to actually prevent tongue thrust , usually extending
next to the cervical third of the mandibular incisors .
Open Bite treatment in the mixed dentition

20. - Palatal cribs
To Modify the abnormal
tongue posture at rest and
during deglutition in order to
allow a normal development
of the anterior alveolar
structures.
• Treatment Modalities
Open Bite treatment in the mixed dentition

21. - Tongue spurs
Are useful when incorrect
tongue posture is the primary
concern.
• Treatment Modalities
Open Bite treatment in the deciduous and mixed dentition

22. 3 - Refer to ENT specialist to resolve the mouth
breathing related to chronic respiratory
obstruction ( enlarged adenoids , large tonsils, chronic
inflammation of the nasal mucosa , deviated nasal
septum , allergies …. ) .
Eliminate “ habitual “ mouth
breathing and restore normal
breathing through the nose.
• Treatment Modalities
Oral screen
Open Bite treatment in the mixed dentition

23. 4 - Myofunctional and Speech therapy (after AOB Correction )
aiming to retrain the muscle activity and correct the deleterious
resting and functional posture of the tongue .
• Treatment Modalities
5 - Mastication exercises , particularly in patients
with neuromuscular deficiencies .
Open Bite treatment in the mixed dentition

24. 6 - Partial Glossectomy in patients with true
macroglossia or increased tongue size .
• Treatment Modalities
Open Bite treatment in the mixed dentition

25. Helal Md. 7y 3m
• Anterior open bite
• Prolonged fingers sucking
• Interceptive Treatment

26. Helal Md. 7y 3m
05-2006
07-2007
09 - 2009
• Removable expansion plate with palatal cribs

27. • Prolonged thumb sucking , anterior OB
• Tendency Class III
•KH Mohammed, 8y7m.
• Interceptive Treatment

28. •Posterior bite blocks with palatal cribs + Vertical chin cup
•KH Mohammed, 8y7m.

29. •Posterior bite blocks with palatal cribs + V. chin cup ( 10 months)
•KH Mohammed, 8y7m.
Before After

30. •Posterior bite blocks with palatal cribs + V . chin cup ( 10 months)
•KH Mohammed, 8y7m.
Before After

31. Open Bite Treatment in the Mixed Dentition
 Retention
 Hawley plate with an orifice in the incisive papillae
region for, at least , 6 months
 Modified Hawley plate with tongue crib and posterior
bite blocks
 Tongue spurs ,especially when incorrect tongue posture
is the primary concern
 Speech therapy in cases with abnormal tongue function
and posture.

32.  Growing patients :
Vertical growth modification
 Non-growing patients :
Intrude posterior teeth
Treatment – Skeletal Open Bites

33.  Growing patients :
 Overall Treatment Goal :
to Reduce or Redirect Vertical Skeletal Growth .
Treatment – Skeletal Open Bites

34.  Growing patients :
 Methods :
1 - The vertical holding appliance ( TPA with acrylic pad )
to induce intrusion of the upper maxillary 1st molars
2 - Posterior bite blocks made of wire or plastic and can
be spring-loaded or fitted with magnets
3 - Functional appliances such as Bionator or Frankel
Regulator FR IV .
Treatment – Skeletal Open Bites

35. •Functional Regulator ( FR IV )
Treatment – Skeletal Open Bites
Growing patients

36. • Bionator (modified )
 Posterior bite blocks
 HP Headgear tubes
 Palatal crib
 Mandibular labial bow
Treatment – Skeletal Open Bites
Growing patients

37. •Posterior Bite Blocks with
Magnets
•Intrusion of posterior teeth
Growing patients
Treatment – Skeletal Open Bites

38.  Growing patients :
 Methods :
4 - High-pull headgear combined with mandibular splint
covering the posterior teeth and impede any secondary vertical
movement of these teeth.
5 - A combination of Activator and High-pull headgear ,
particularly if skeletal open bite is associated with Class II
pattern
6 - Vertical Chin Cup associated with removable or fixed
appliance therapy.
Treatment – Skeletal Open Bites

39.  Growing patients
- Extra-oral forces with Headgear :
 Vertical or occipital headgear on the
maxillary 1st molars
 Cervical headgear on the mandibular
1st molars ( Pearson )
Treatment – Skeletal Open Bites

40. Treatment – Skeletal Open Bites
•High-pull Headgear on maxillary 1st molars
Growing patients

41. Treatment – Skeletal Open Bites
Posterior Bite Block
(impede lower molars extrusion )
•High-pull Headgear on maxillary 1st molars
Growing patients

42. Treatment – Skeletal Open Bites
•Low-Pull Headgear on mandibular 1st molars
•The longer outer bow, the more vertical the component
of the force that is achieved (distal tipping moment of the
force is also increased ).
Growing patients

43. Treatment – Skeletal Open Bites
•To induce a clockwise rotation of the
maxilla & maxillary dentition.
CR.dent
CR.max
Force vector
Growing patients
•High pull HG combined with functional appliance or
maxillary splint .

44. •High pull HG combined with functional appliance
Treatment – Skeletal Open Bites
Growing patients

45. • Line of Action of the Orthodontic Force should pass Below
the Centre of Resistance of Both the Maxilla and the
Maxillary Dentition .
Occipital Headgear included in a maxillary splint
Treatment – Skeletal Open Bites

46.  Growing patients :
 Posterior bite blocks combined with
Vertical Pull Chin Cup or Vertical pull
headgear
 Rapid palatal expander combined with
Vertical Pull Chin Cup .
Treatment – Skeletal Open Bites

47. • Vertical Pull Chin Cup (VPCC) with Rapid Maxillary Expansion
Treatment – Skeletal Open Bites
Growing patients
Hyrax RM Expander
with bite blocks

48. Treatment – Skeletal Open Bites
• Vertical chin cup with Posterior bite
blocks included in removable plates.
Growing patients

49. Treatment – Skeletal Open Bites
•Posterior bite blocks combined
with Vertical pull headgear
Growing patients

50. • Vertical Pull HG with Rapid Maxillary Expansion & Tongue crib
Treatment – Skeletal Open Bites

51. • Sh. Hana , 9 y
• Anterior open bite
• Posterior cross bite(bilateral)
• Low tongue posture
Treatment – Skeletal Open Bites

52. • Sh. Hana , 10 y
• Cap splint with Hyrax expander + V. Chin Cup
Treatment – Skeletal Open Bites

53. • Sh. Hana , 9 y
Early treatment of anterior open bite
9 yrs
10 yrs
12 yrs

54. • Sh. Hana , 9 y
9 yrs
12 yrs
Treatment – Skeletal Open Bites

55. Female patient , 06 -2014 – Age 10 yr.

56. • Skeletal Open Bite with Dentoalveolar Biprotrusion
Female patient , 06 -2014 – Age 10 yr.

57. Female patient , 06 -2014 – Age 10 yr.

58. 12 -2014
• Cap Splint with High-pull Headgear (6 months )
06 -2014
Female patient , Age 10 yr.

59. • BAJ Roqaia, 10 y
05 -2015
• Removable maxillary plate with tongue crib ( 6 months)

60. • BAJ Roqaia, 10 y
06 -2014 05 -2015 Treatment Progress

61. 06 -2014 05 -2015
Female patient , Age 10 yr.

62. • Anterior open bite (asymmetric ) /Skeletal Class III
Female patient , Age 11 yr.

63. 02-2015
05-2015
• Tongue crib +Lingual arch + Vertical chin cup
Female patient , Age 11 yr.

64. Aleppo - SYRIA

65. Anterior Open Bite
Treatment in the Permanent
Dentition
Next : Part 3 ….
Dr.Marwan Mouakeh, Consultant Orthodontist
Academic Adviser, Al-Hokail Polyclinic – Khobar ( KSA)