ORIGINAL ARTICLE

Surgical vs nonsurgical treatments in

patients with anterior open-bite have
similar effects in occlusal function:
A 2-year follow-up study
Joongoo Lee,a Yoon Jeong Choi,a Jae Hyun Park,b Chooryung J. Chung,c Ji-Hyun Lee,c and Kyung-Ho Kimc
Seoul, South Korea, and Mesa, Ariz

Introduction: This study aimed to investigate changes in bite force (BF) and occlusal contact area after anterior
open-bite (AOB) treatment and compare the changes in surgical vs nonsurgical treatment. Methods: This retro-
spective study included patients with AOB compared with normal occlusion. AOB was corrected by either intru-
sion of the maxillary molars (intrusion group, n 5 19) or orthognathic surgery (surgery group, n 5 37). The control
group (n 5 35) had a normal overbite relationship. Records of lateral cephalograms, BF, and occlusal contact
area taken before (T0), immediately after (T1), and 2 years after (T2) orthodontic treatment were compared
within and among the 3 groups. Results: The open-bite group, including intrusion and surgery groups, had a
lower BF and less occlusal contact area than the control group at T0 and T1 (P \0.001). However, there
were no significant differences among the 3 groups at T2 (P .0.05). The intrusion and surgery groups
showed no significant differences throughout the observation period extending from T0 to T2 (P .0.05).
Although BF and occlusal contact area decreased at T1 compared with T0, they increased during retention
and showed higher values at T2 than at T0. Conclusions: Treatment of AOB improved BF and occlusal contact
area 2 years posttreatment. Orthognathic surgery and molar intrusion using orthodontic miniscrews can improve
occlusal function similarly. Orthodontists can select either method depending on malocclusion severity and pa-
tient demand. (Am J Orthod Dentofacial Orthop 2024;165:38-45)

A
nterior open-bite (AOB) indicates a lack of incisal can be grouped into skeletal or dental open bite cate-
overlap or incisal contact, which can cause prob- gories depending on the etiology. Skeletal open bite re-
lems in mastication and pronunciation.1 AOB sults from genetically predetermined growth patterns
or condylar resorption because of osteoarthritis of the
a mandibular condyle and is characterized by backward
Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei
University College of Dentistry, Seoul, South Korea. rotation of the mandible,2 whereas dental open bite dis-
b
Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, plays a normal vertical skeletal pattern but lacks incisal
A.T. Still University, Mesa, Ariz.
c overlap because of labioversion of the anterior teeth or
Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute
of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South inadequate eruption of the anterior teeth associated
Korea. with a protrusive tongue thrust or thumb sucking habit.
Joongoo Lee and Yoon Jeong Choi are joint first authors and contributed equally
Treatment of AOB in adults can be performed by or-
to this work.
All authors have completed and submitted the ICMJE Form for Disclosure of thognathic surgery or orthodontic camouflage, depend-
Potential Conflicts of Interest, and none were reported. ing on etiology and severity.3 Orthognathic surgery is
Institutional Review Board (IRB) approval (IRB no. 3-2017-0306) was obtained
indicated to correct AOB if the vertical discrepancy is se-
from Gangnam Severance Hospital before data collection. The IRB waived
written informed consent because of the study’s retrospective nature. vere and is accompanied by a sagittal or transverse
This work was supported by the National Research Foundation of Korea (NRF) discrepancy, such as a Class III relationship and facial
grant funded by the South Korean government (MSIT) (no. NRF-
asymmetry. In contrast, if the degree of open bite is
2020R1F1A1069316).
Address correspondence to: Kyung-Ho Kim, Department of Orthodontics, Gang- mild to moderate, orthodontic tooth movement can
nam Severance Hospital, Yonsei University, 211 Eonju-ro, Gangnam-gu, Seoul resolve AOB by extrusion of the anterior teeth, intrusion
06229, South Korea; e-mail, khkim@yuhs.ac.
of the posterior teeth, or both. Historically, using con-
Submitted, December 2022; revised and accepted, June 2023.
0889-5406/$36.00 ventional orthodontic techniques, it has been difficult
Ó 2023 by the American Association of Orthodontists. All rights reserved. to intrude on both maxillary and mandibular buccal
https://doi.org/10.1016/j.ajodo.2023.06.024

38
Lee et al
segments. However, since the introduction of orthodon-
tic miniscrews, it has been possible to correct AOB non-
invasively by molar intrusion using orthodontic
miniscrews to produce counterclockwise rotation of
the mandible when exposure of the maxillary incisors
is appropriate.4,5 With orthognathic surgery, the masti-
catory muscles are detached, and immediate skeletal
changes are manifested, whereas, with nonsurgical
correction, slow intrusion of the buccal teeth allows
the mandible to rotate counterclockwise without any
need for muscular reattachment gradually. Changes in
skeletal pattern and dentition affect the masticatory
muscles and occlusal contact area (OCA), consequently
influencing the bite force (BF).6-8 Therefore, the
functional changes may differ depending on the
modality after AOB treatment.
Regardless of its etiology, patients with AOB have low
BF and less OCA.9 The low BF can decrease chewing ef-
ficiency, possibly attributing to AOB relapse.10,11 The BF
decreased immediately after orthodontic treatment,
including in orthognathic surgery patients but increased
gradually.6,12 As AOB treatment would increase the OCA,
which highly correlates with BF,6,12-14 BF can be
expected to increase after orthodontic treatment.
However, there has been little investigation of changes
in BF after orthodontic treatment in AOB patients.
BF can be measured using a BF transducer such as a
pressure-sensitive sheet6,12 or a digital occlusal analysis
system (Supplementary Fig 1).15,16 The Dental Prescale
System (Fuji Film Corp., Tokyo, Japan), which uses a
thin pressure-sensitive sheet, has been widely used for
the measurements because it best reflects the natural
dentition with few errors simply and objectively.17-19
The purpose of this study was to investigate changes
in BF and OCA after AOB treatment using the Dental
Prescale System (Fuji Film Corp.) and to compare the
changes according to treatment modality:
orthognathic surgery vs nonsurgical correction by
molar intrusion. The changes were also compared with
those of the control group, which had a normal
occlusion but had been treated with minor tooth
movement.
MATERIAL AND METHODS
This retrospective study included intrusion (n 5 19),
surgery (n 5 37), and control (n 5 35) groups. From
2,890 patients who had visited OOO Dental Hospital
for orthodontic treatment between 2008 and 2013,
overbite (OB) was used to select AOB (\0 mm; n 5
376) and control groups, whose AOB ranged from 1
mm to 4 mm (n 5 1002), initially. In addition, the
following inclusion and exclusion criteria were applied
(Fig 1). The inclusion criteria were (1) aged 18-40 years
American Journal of Orthodontics and Dentofacial Orthopedics
39
before treatment (T0); (2) female to minimize the effects
of sex difference; (3) hyperdivergent facial profile, which
was confirmed by Frankfort-mandibular plane angle
(FMA) of .28
; (4) mild facial asymmetry (menton
deviation \2 mm, which was confirmed from the initial
posteroanterior cephalogram); (5) full eruption of the
maxillary and mandibular second molars at T0; and (6)
availability of lateral cephalograms and records of BF
at T0, immediately after (T1), and 2 years posttreatment
(T2). The exclusion criteria were (1) any missing teeth
except for the third molars; (2) orthodontic extraction;
(3) temporomandibular disorder; (4) history of previous
orthodontic treatment; (5) systemic disease, cleft lip,
cleft palate, or craniofacial disorder; and (6) use of a
removable retainer to cover the occlusal surface. Of 97
patients who met the above criteria for the open bite
group, 41 patients were excluded because their maxillary
or mandibular anterior teeth showed extrusion during
treatment. Nineteen patients whose AOB had been
resolved by maxillary molar intrusion were assigned to
the intrusion group, whereas 37 who had had orthog-
nathic surgery were assigned to the surgery group. The
orthognathic surgery on those in the surgery group ad-
dressed mandibular prognathism or long face. The 191
subjects in the control group were screened on the basis
of the same inclusion/exclusion criteria. Then, 35 pa-
tients with Class I molar relationships (within a range
of 2 mm of the ideal Class I molar relationship) at T0
were finally selected for the control group, whereas
156 subjects were excluded because of Class II or III
molar relationships (Table I).
Institutional Review Board (IRB) approval (IRB no. 3-
2017-0306) was obtained from Gangnam Severance
Hospital before data collection. The IRB waived written
informed consent because of the study’s retrospective
nature.
In the intrusion group, 8 orthodontic miniscrews (Or-
lus, Ortholution, Seoul, South Korea) had been im-
planted into the buccal and palatal interradicular
alveolar bone between the first and second premolars
and between the first and second molars to intrude the
maxillary molars. The posterior teeth from the first pre-
molar to the second molar were splinted with brackets
(0.018-in slot) and sectional stainless-steel wires
(0.017 3 0.025-in) on the buccal side, and metal but-
tons were bonded on the lingual side of each tooth.
An elastic module, engaged between each tooth
bracket/button and miniscrew on the buccal/palatal
side, delivered 20-30 g of intrusion force per each pos-
terior tooth. Until $1 mm of OB was obtained, the
maxillary molars were intruded by an average of 1.7
mm over 5.2 6 1.3 months, as retrospectively measured
from lateral cephalograms. In the surgery group, all
January 2024  Vol 165  Issue 1
40 Lee et al

Fig 1. Study flow chart.

Table I. Demographic features of the subjects before treatment

Variables Intrusion (n 5 19) Surgery (n 5 37) Control (n 5 35) P value
Age (y) 21.4 6 5.6 22.2 6 5.7 21.1 6 5.7 0.744
Treatment duration (mo) 27.3 6 4.2a 23.8 6 4.2b 22.1 6 2.8b \0.001***
ANB (
) 5.8 6 1.5a 1.2 6 2.3b 2.9 6 1.7c \0.001***
FMA (
) 39.1 6 4.9 38.2 6 5.3 36.2 6 3.0 0.067
Gonial angle (
) 129.2 6 5.1 128.1 6 6.1 127.3 6 4.9 0.471
Anterior facial height (mm) 132.0 6 6.1a 136.4 6 3.5b 130.2 6 6.2a \0.001***
Posterior facial height (mm) 77.3 6 6.8 78.2 6 5.6 78.5 6 4.6 0.757
U6-HRP (mm) 81.0 6 3.9 81.8 6 2.6 80.9 6 3.0 0.867
Overbite (mm) 1.9 6 1.3a 2.3 6 1.8a 2.8 6 1.1b \0.001***
Overjet (mm) 5.0 6 2.1a 1.3 6 3.3b 2.9 6 0.9c \0.001***
Note. Data are presented as mean 6 standard deviations. One-way analysis of variance and Bonferroni correction for post-hoc test were performed.
Values with different superscript letters indicate a statistically significant difference among groups from the Bonferroni correction.
FMA, Frankfort to mandibular plane angle; U6-HRP, the perpendicular distance of the maxillary first molar to the horizontal reference plane.
***P \0.001.

subjects underwent preoperative and postoperative or-
thodontic treatment and bimaxillary surgery by the
same surgeon, LeFort I osteotomy, and bilateral intraoral
vertical ramus osteotomy. The amount of surgery was
precisely determined on the basis of surgical treatment
objectives for each patient. The average amount of pos-
terior impaction was 3.2 mm, and the mandible was
moved to fit the maxillary position. During the first 2
weeks of postsurgery, maxillomandibular fixation was
maintained; after that, all patients were asked to
perform active physical therapy until they could open
their mouths by at least 40 mm. Postoperative orthodon-
tic treatment was conducted for 6.2 6 1.9 months. In
the control group, crowding relief, space closure, or total
arch movement using interarch elastics or miniscrews
were performed to achieve ideal occlusion. After treat-
ment, fixed lingual retainers were bonded to the maxil-
lary and mandibular anterior teeth with additional

January 2024  Vol 165  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al 41

Fig 2. Cephalometric reference planes and measurements: A, Angular measurements: a, SNA; b,

SNB; c, ANB; d, Frankfort-mandibular plane angle (FMA); e, gonial angle; B, Linear measurements:
f, anterior facial height; g, posterior facial height; h, U6-HP; i, overjet; j, overbite. N, nasion; S, sella;
A, A point; B, B point; Ar, articulare; Me, menton; Go, gonion; U6, the mesiobuccal cusp of the maxillary
first molar; HRP, horizontal reference plane; SN, sella-nasion plane; FP, Frankfort plane; MP, mandib-
ular plane; U6-HRP, the perpendicular distance of U6 to HRP.

removable circumferential retainers in all groups. In both
the intrusion and surgery groups, a hole was created
around the incisive papilla to train tongue positioning,
as a protrusive tongue position at rest can contribute
to relapse.20,21 The orthodontic treatment for all 3
groups was carried out by 3 orthodontic residents under
the supervision of one expert orthodontist.
Lateral cephalograms and pressure-sensitive films
(Dental Prescale 50H, type R) taken at T0, T1, and T2
were used for measurements. A horizontal reference
plane (HRP) was registered on the lateral cephalograms
as a straight line passing through the nasion and rotated
7
clockwise to the SN plane (Fig 2). SNA, SNB, ANB,
FMA, and gonial angle were measured for angular mea-
surements, whereas anterior and posterior facial heights
(AFH and PFH, respectively), perpendicular distance of
the maxillary first molar (U6) to the HRP (U6-HRP),
OB, and overjet were measured for linear measurements
using V-ceph software (version 5.5; CyberMed, Osstem,
Seoul, South Korea).
The Dental Prescale System (Fuji Film Corp), repre-
senting the static occlusal function, was used to measure
BF and OCA. The patients were asked to bite on a thin
pressure-sensitive film in maximum intercuspation
with maximum force for 5 seconds while seated upright.
The films were scanned and analyzed using an image
scanner (Occluzer FPT 707), calculating BF and OCA
(Supplementary Fig 1).
One trained orthodontist (J.L.) scanned the pressure-
sensitive films for BF and OCA, whereas 2 trained ortho-
dontists (J.L. and Y.J.C.) independently measured all
lateral cephalograms.
Statistical analysis
Interexaminer reliability was tested using intraclass
correlation coefficients (ICC). The ICCs ranged from
0.877 to 0.965, indicating high reliability. In addition,
25 radiographs among lateral cephalograms taken at
T1, T2, and T3 were randomly selected, and degree of
agreement between 2 examiners was evaluated using
Bland-Altman plot (Supplementary Fig 2). Because the
measurements are highly reproducible, the measure-
ments by one orthodontist (J.L.) were used for the statis-
tical analysis. To test intraexaminer reliability, the
cephalometric measurements on 20 randomly selected
subjects were repeated at a 2-week interval by one
examiner (J.L.), and ICC were calculated. The ICCs
ranged from 0.906 to 0.999, indicating high reliability.
All the variables were tested for normality by Shapiro-

American Journal of Orthodontics and Dentofacial Orthopedics January 2024  Vol 165  Issue 1
42 Lee et al

Wilk’s tests and showed normal distributions. A power

P value

Note. Values are presented mean 6 standard deviation. Repeated measures analysis of variance and Bonferroni method for post-hoc test were performed. Values with different superscript letters

FMA, Frankfort to mandibular plane angle; AFH, anterior facial height; PFH, posterior facial height; U6-HRP, the perpendicular distance of the maxillary first molar to the horizontal reference plane;
0.004**
analysis confirmed the sample size should be .17 per
0.993
1.000
0.981
0.854
0.982

0.829
0.964
0.370

0.061
group with 95% power at a significance level of 0.05.
For the cephalometric measurements, 1-way and

2.2 6 0.6b
80.4 6 3.0
77.5 6 3.4
2.9 6 1.7
36.4 6 3.1
127.1 6 4.9

130.8 6 6.2
78.7 6 4.6
75.9 6 3.0

2.6 6 0.5
repeated measures analysis of variance were used to
T2

compare the measurements of the 3 groups at each

Control (n 5 35)

time point and among the 3-time points within each

group, respectively. A linear mixed model was used to

2.3 6 0.4b
80.3 6 3.0
77.5 6 3.4
2.9 6 1.7
36.5 6 3.2
127.0 6 5.0

131.0 6 6.2
78.8 6 4.6
76.0 6 3.0

2.5 6 0.4
assess changes in the BF and OCA by testing the inter-
T1

action among time and groups with age, FMA, gonial

angle, AFH, PFH, PFH/AFH, and U6-HRP as covariates.
All tests were conducted at a significance level of
P \0.05 using SAS (version 9.3; SAS Institute Inc,
2.8 6 1.1a
80.3 6 3.0
77.5 6 3.4
2.9 6 1.7
36.2 6 3.0
127.3 6 4.9

130.2 6 6.2
78.5 6 4.6
75.0 6 3.0

2.9 6 0.9

Cary, NC).
T0

RESULTS
\0.001***

\0.001***
\0.001***
\0.001***

\0.001***
\0.001***

The demographic features were different in the 3

P value
0.742
0.420

0.832
0.995

groups at T0 (Table I). Although age, FMA, gonial

Table II. Cephalometric measurements at T0, T1, and T2 in the intrusion, surgery, and control groups

angle, PFH, and U6-HRP were not significantly

different (P .0.05), treatment duration, ANB, AFH,
2.9 6 1.7b

132.8 6 3.1b
72.8 6 5.1b
72.8 6 2.7b

1.4 6 1.0b
3.3 6 1.1b
81.6 6 3.9
79.0 6 3.8

39.1 6 5.3
128.2 6 6.1

OB, and OJ were significantly different (P \0.001).

T2

Table II shows changes in the cephalometric measure-

Surgery (n 5 37)

ments of each group at T0, T1, and T2. In the intrusion

group, OB increased by 4.0 mm during treatment but
2.9 6 1.6b

131.8 6 3.3b
72.4 6 5.1b
72.1 6 2.8b

2.2 6 0.4b
3.0 6 0.6b

decreased by 0.9 mm during 2-year retention. In the

81.6 6 3.8
78.7 6 3.7

38.6 6 5.1
128.2 6 6.1

surgical group, it increased by 4.5 mm during treatment

T1

but decreased by 0.8 mm during 2-year retention. In the

control group, OB was approximately 2.2-2.8 mm
indicate a statistically significant difference among groups from the Bonferroni correction.

throughout the observation period.

1.2 6 2.3a

136.4 6 3.5a
78.2 6 5.6a
75.3 6 2.6a

2.3 6 1.8a
1.3 6 3.3a
81.0 6 3.4
79.8 6 4.4

38.2 6 5.3
128.1 6 6.1

BF and OCA differed depending on the group and

T0

the time point (P \0.05; Tables III and IV). Figure 3

shows BF and OCA in the intrusion and surgery groups
were less than in the control group at T0 and T1
\0.001***
\0.001***

(P \0.01), whereas there were no significant differ-

P value
0.895
0.940
0.165
0.598
0.985

0.582
0.966
0.322

ences among the 3 groups at T2 (P .0.05). BF and

OCA decreased at T1 compared with T0. However, those
at T2 had recovered or surpassed those at T0 (P \0.05).
1.2 6 0.8b
3.5 6 1.1b
79.6 6 3.6
74.6 6 3.7
5.0 6 1.5
37.7 6 5.2
129.5 6 5.1

130.4 6 6.3
76.8 6 6.8
73.6 6 3.9

Although BF was affected by interaction by group and

T2
Intrusion (n 5 19)

time (P\0.05), OCA was not affected by the interaction

(P .0.05). Table V shows that age and the cephalo-
metric parameters did not influence BF and OCA
2.1 6 0.8b
3.2 6 0.9b
79.6 6 3.6
74.7 6 3.8
4.9 6 1.6
37.3 6 5.3
129.5 6 5.2

129.9 6 6.3
76.7 6 6.8
73.3 6 4.0

(P .0.05).
T1

DISCUSSION
This study aimed to compare occlusal function in
1.9 6 1.3a
5.0 6 2.0a
80.1 6 3.6
74.3 6 3.7
5.8 6 1.5
39.1 6 4.9
129.2 6 5.1

132.0 6 6.1
77.3 6 6.8
75.0 6 3.9

terms of BF and OCA relative to treatment modality in

**P \0.01; ***P \0.001.
T0

AOB patients and to investigate the time-dependent

changes before and after orthodontic treatment. The
occlusal function did not show significant differences
OJ, overjet.
angle (
)
AFH (mm)
PFH (mm)

among surgical and nonsurgical methods in AOB pa-

Variables

OB (mm)
OJ (mm)
U6-HRP
FMA (
)

(mm)
ANB (
)
SNA (
)
SNB (
)

Gonial

tients throughout the observation period. It was lower

in AOB patients than in the control group before and

January 2024  Vol 165  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al 43

Table III. Time-dependent changes in BF by groups

Time Intrusion Surgery Control Significancey
T0 235.2 6 17.6 253.2 6 12.3 356.3 6 12.3 I, S \ C***
T1 207.3 6 13.9 187.8 6 9.7 265.0 6 9.7 I, S \ C**
T2 280.9 6 19.1 309.6 6 13.3 346.5 6 13.3 NS
Significancez T1 \ T2** T1 \ T0 \ T2* T1 \ T0, T2**
Overall P values Group: P \0.0001
Time: P \0.0001
Group 3 time: P 5 0.019

Note. Values (unit, N) are presented estimated mean 6 standard error. A linear mixed model and Bonferroni corrected post-hoc test were performed.
I, Intrusion; S, Surgery; C, Control; NS, Not significant.
y
Significance among groups (ie, intrusion, surgery, and control) at the same time; zSignificance among times (ie, T0, T1, and T2) within the same
group; *P \0.05; **P \0.01; ***P \0.001.

Table IV. Time-dependent changes in OCA by group

Time Intrusion Surgery Control Significancey
T0 6.0 6 0.6 6.5 6 0.4 9.1 6 0.4 I, S \ C***
T1 4.8 6 0.3 4.4 6 0.2 6.2 6 0.2 I, S \ C**
T2 6.8 6 0.5 7.1 6 0.4 8.1 6 0.4 NS
Significancez T1 \ T2** T1 \ T0, T2*** T1 \ T0, T2***
Overall P values Group: P \0.0001
Time: P \0.0001
Group 3 time: P 5 0.058

Note. Values (unit, mm2) are presented as estimated mean 6 standard error. A linear mixed model and Bonferroni corrected post-hoc test were
performed.
I, Intrusion; S, Surgery; C, Control; NS, Not significant.
y
Significance among groups (ie, intrusion, surgery, and control) at the same time; zSignificance among times (ie, T0, T1, and T2) within the same
group; **P \0.01; ***P \0.001.

immediately after treatment but showed no significant
differences between the groups 2 years posttreatment.
Occlusal function decreased immediately after treatment
but had recovered 2 years after posttreatment.
BF and OCA were not significantly different between
the intrusion and surgery groups, although the changes
both during treatment (T1  T0) and during retention
(T2  T1) were smaller in the intrusion group than in
the surgery group. In the intrusion group, skeletal and
dental changes occurred gradually as the maxillary mo-
lars were intruded, which might have allowed sufficient
time for the masticatory muscles to adapt. However,
rapid skeletal and dental changes occurred after orthog-
nathic surgery, which seems to have caused a decrease in
occlusal function more at T1 than the changes seen in
the intrusion group. Moreover, damage to the mastica-
tory muscles during dissection from the bone or atrophy
of the muscles during maxillomandibular fixation might
have influenced occlusal function. It is reported that BF
and electromyographic activity of the masticatory mus-
cles decreased in the 6-8 months after mandibular
setback surgery but increased gradually during the
postoperative observation period.12,22,23 Our study
showed the same tendency, but the changes were larger
than in the nonsurgical approach.
BF and OCA were lower/less in the AOB groups than
in the control group at T0, indicating that occlusal func-
tion was weaker in AOB patients. Less contact area
because of the nonocclusion might have been the reason
for the differences between the AOB and control sub-
jects.24 However, the occlusal function was not signifi-
cantly different between the 3 groups 2 years after
orthodontic treatment, which indicates that treatment
of AOB regardless of the method can improve occlusal
function up to the same level as that of the control group
by increasing OCA and achieving normal occlusion.
BF and OCA decreased immediately after treatment in
all groups but increased 2-years posttreatment. Although
the occlusion was improved by orthodontic treatment,
decreased muscular activities during the orthodontic
treatment might have caused a decrease in occlusal func-
tion immediately after treatment.25 However, settling of
the occlusion and adaptation of the muscles and sur-
rounding soft tissues to the new environment could

American Journal of Orthodontics and Dentofacial Orthopedics January 2024  Vol 165  Issue 1
44 Lee et al

Fig 3. Time-dependent changes in BF and OCA in intrusion, surgery, and control groups. ***P\0.001.

this study to female subjects aged 18-40 years and those

Table V. P values for the correlation coefficients of with a hyperdivergent facial profile and no extraction
the variables to influence changes in BF and OCA treatment. Furthermore, although the sagittal relation-
BF OCA ship differed among the 3 groups, it has been reported
that BF and OCA were affected not by the anterioposte-
Variables Univariable Multivariable Univariable Multivariable
rior skeletal pattern but rather by the vertical relation-
Group \0.001*** \0.001*** \0.001*** \0.001***
Time \0.001*** \0.001*** \0.001*** \0.001***
ship.13,14 This may account for the lack of any
Group 0.019* 0.014* 0.080 0.058 significant correlation between the cephalometric vari-
3 time ables and changes in BF and OCA.
Age 0.155 0.154 0.319 0.261 This study did not include occlusal function immedi-
FMA 0.252 0.248 0.337 0.912 ately after molar intrusion or orthognathic surgery. As
Gonial 0.146 0.249 0.405 0.331
angle
extrusion of the posterior teeth occurs by wearing inter-
AFH 0.275 0.763 0.297 0.195 maxillary elastics for settling of the occlusion during the
PFH 0.175 0.255 0.307 0.938 finishing stage, the data at T1 may not exactly represent
PFH/AFH 0.316 0.572 0.253 0.486 changes after AOB correction. Heterogeneity of the
U6-HRP 0.415 0.533 0.306 0.632 subjects because of the retrospective design was also a
Note. A linear mixed model and Bonferroni corrected post-hoc test limitation of this study. Moreover, the Prescale system
were performed. used in this study may not fully represent the occlusal
FMA, Frankfort to mandibular plane angle; AFH, anterior facial
function; therefore, future prospective studies are
height; PFH, posterior facial height; U6-HRP, the perpendicular dis-
tance of the maxillary first molar to the horizontal reference plane. needed to address these issues to yield more objective
*P \0.05; ***P \0.001. and accurate results.

have led to a gradual increase in occlusal function, which
should continue beyond the 2-year period.6,12,13,26 The
increase of occlusal function in the AOB groups during
the retention period despite a decrease in OB indicates
the importance of the posterior occlusion, which
improved spontaneously after treatment. OB and U6 ver-
tical position showed a 17%-23% relapse ratio in the AOB
groups during the retention period. Although AOB relapse
is reportedly to be more prominent in patients with a
weak BF because of extrusion of the posterior teeth,10,11
there was no significant correlation between U6-HRP and
BF in this study. Therefore, weak BF may not be the pri-
mary reason for open bite relapse.
BF and OCA can be affected by sex, age, number of
teeth, and vertical skeletal pattern.6,8,14 To minimize
the effects of the confounding variables, we limited
CONCLUSIONS
Although the AOB groups showed lower BF and less
OCA than the control group before and immediately after
orthodontic treatment, they had similar BF and occlusal
contact 2 years posttreatment regardless of treatment
modality. For treatment of AOB, orthognathic surgery,
and molar intrusion using orthodontic miniscrews seem
to have a similar effect in terms of occlusal function.
AUTHOR CREDIT STATEMENT
Joongoo Lee contributed to data collection, data anal-
ysis, and original draft preparation; Yoon Jeong Choi
contributed to conceptualization, data analysis, original
draft preparation, and manuscript review and editing;
Jae Hyun Park contributed to manuscript review and edit-
ing; Chooryung J. Chung contributed to data collection

January 2024  Vol 165  Issue 1 American Journal of Orthodontics and Dentofacial Orthopedics
Lee et al
and manuscript review and editing; Ji-Hyun Lee contrib-
uted to manuscript review and editing; and Kyung-Ho
Kim contributed to conceptualization, data collection,
data analysis, and manuscript review and editing.
SUPPLEMENTARY DATA
Supplementary data associated with this article can
be found, in the online version, at https://dx.doi.org/
10.1016/j.ajodo.2023.06.024.
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