The Open bite

Malocclusions

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 OPEN BITE
Lack of vertical overlap b/w the maxillary and mandibular dentition .
or
Absence of vertical overlap between maxillary and mandibular teeth in
centric relation
1- ANTERIOR OPEN BITE
No vertical overlap between the upper and lower anterior
teeth
a-Skeletal anterior open bite
b-Dental anterior open bite

2- POSTERIOR OPEN BITE

Failure of posterior teeth to occlude unilaterally or
bilaterally

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 Etiology of Anterior
Open Bite
1-Hereditary factors

2-Non hereditary factors

3-Combination of Two

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 GENETIC/HEREDETORY FACTORS
HUNTER----vertical dimentions of craniofacal skeleton are more genetically controlled
than are antropoterior dimentions


RELATED TO TONGUE a-Posture b-Morphology c-Size

MACROGLACIA/ ANKYLOGLOSIA
 Abnormal Skeletal growth pattern of maxilla and mandible
1-overgrowth of posterior dento alveolar complex resulting in clockwise rotation of
mandible
2-Superior repositioning of glenoid fossa due to underdevelopment of middle cranial
fossa.
3-Underderdevelopment of middle cranial fossa.
4- Underdevelopment of anterior portion of maxilla.
5-Or combination of these
 Vertical relationship of jaw bases

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 Non Hereditary factors
ENVOIRMENTAL FACTORS Obstructed eruption of anterior
teeth and/Or Eruption of posterior teeth with or withoutexcessive vertical
development
 Improper/altered function due to potentially deforming habit. e.g resting posture
of tongue
 Muscle weakness syndrome/Muscular disorders/Neurological disturbances
 Obstructed respiration
 Trauma
 Iatrogenic

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 ENVOIRMENTAL FACTORS

 Respiration. (disturbed or obstructed

a- Deviated nasal septum
b- Nasal polyps
c- Congenital enlargement of nasal
turbinates
d- Allergic reaction of nasal mucosa
e- Obstructive Adenoids
f- Localised benign tumors
h- Chronic infections
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 Thumb sucking
Effects depends
upon
a- DURATION
amount of
time
b-
FREQUENCY
No. of times
c- INTENCITY
The vigor of
performance 9
 EFFECTS OF THUMB
SUCKING
a-Labial tipping of maxillary incisors and proclination.
b-Lingual tipping of mandibular incisors
c-Anterior Open Bite due to restriction/interference of
incisor eruption and supra eruption of buccal teeth .
d Narrow maxillary arch and Posterior cross bite.
e-Tongue thrust as a result of open bite.
f-Hypotonic upper lip and hyperactive Mentalis muscle.
g-Excessive eruption of posterior teeth.
h-Disturbed balance b/w cheek and tongue
muscle

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 Tongue thrusting
ETIOLOGY (tongue resting pressure as well as
posture)
1-Genetic factors:-specific anatomical and neuromuscular
variations in orofacial region can precipitate tongue thrust
e.g. Hypertonic orbicularis oris muscle activity.
2-Learned behavior:-(Habits) Some predisposing factors
are
a- improper bottle feeding
b- prolonged thumb sucking
c- prolonged tonsillar and upper respiratory tract infections
d- prolonged duration of tenderness of gums or teeth (to avoid
pressure on tender zone

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 Tongue thrust
3-Maturational:-Persistance of Infantile swallow
4-Mechanical restrictions:-Presence of certain
conditions e.g. macroglosia, constricted dental arches
and enlarged adenoids
5-Neurological disturbances :-Hyposensitive
palate and moderate motor disability
6-Psychological :-Forced discontinuation of other
habits
7-Compensatory or adaptive behavior to
establish anterior oral seal when lips are unable to do so

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Classification of tongue thrust
(Clinical considerations)
(james S. Braner and Holt)
1-Non deformation
tongue thrust
1- Simple tongue thrust
2-Deformation anterior
tongue thrust
2- Complex tongue thrust
3-Deforming lateral
tongue thrust
3- Compound tongue
4-Deforming anterior
thrust
and lateral tongue
thrust
IATROGENIC

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Simple tongue thrust
a- Normal tooth contact during
swallowing act.
b-Presence of anterior open bite.
c-There is good interception of
teeth.
d-Tongue thrust is to establish
the anterior oral seal.
e-Abnormal mentalis muscle
activity is seen.
Complex tongue thrust
a-Characterized by teeth apart
swallow.
b-Anterior bite can be defuse or
absent.
c-possible poor occlusion of
teeth.
d-Contraction of circumoral
muscles during swallowing.
c-Absence of temporal muscle
contraction
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 TYPES 0F A.O.B

PSUEDO OPEN BITE

The simple open bite  Acquired or dental
The complex open open-bite
bite  Skeletal open-bite
The compound open
bite
(infantile)
The Iatrogenic open
bite

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 FEATURES OF A.O.B
AESTHETIC
DENTAL
SKELETAL
NEUROMUSCULAR
DENTAL OPEN BITE
Extra oral features
Intraoral features
-Negative overbite
-Proclined upper anterior teeth
-May have narrow maxillary
arch due to lower posturing
of tongue

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 FEATURES OF A.O.B
SKELETAL OPENBITE
EXTRAORAL FEARURES
 MOUTH BREATHER with significant nasal airway resistance
 VERTICAL MAXILLARY HYPERPLASIA
 LONG FACE
 INCOMPETANT LIPS
 STEEP MAXILO MANDIBULAR ANGLE
INTRAORAL FEATURES
 NEGATIVE OVERBITE
 ANTERIOR OPEN BITE
 UPRIGHTINCISORS WITH MILD CROWDING
 Supraerupted maxillary molars and incisors

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 FEATURES OF SKELETAL
A.O.B
Aesthetic considerations
1- The balance between the nose, lips and chin profile.
2- The nasolabial angle
3- The configuration of lips (competence)
4- The length of lower third of face (anterior facial
height.)
5- Reduced nasal width in the alar region.
6- lip incompetence with strain in mentalis muscle to
achieve lip closure.
7- Excessive exposure of maxillary incisors.
8- Posterior facial height

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 FEATURES OF A.O.B
CEPHALOMETRIC CRITERIA
ANGULAR MEASUREMENTS
 Decreased sela-nasion to
palatal plane angle(SN-PP)
 Increased sella-nasion to
occlusal plane angle(SN-O).
 Incresed sela-nasion(SN)
to mandibular plane
angle(SN-GoGn).
 Obtuse Gonial angle
articulare-gonion_menton)
 Increased Palato-
mandibular angle(ANS-
PNS)to mandibular
plane(PP-GoGn)

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 LINIEAR MEAREMENTS

 UAFH/LAFH
 Increased lower anterior facial height or
LAFH

 Shorter nasion basion distance

 Retrusive mandible
 Decreased post. facial height

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 POSTERIOR OPEN BITE
ETIOLOGY
 Excessive eruption or vertical development unilaterally
Deficient eruption on one side
a-obstruction b-eruption mechanism
Bilateral posterior deficient eruption
Abnormal muscle activity
cheek sucking
Lateral tongue thrust or distortion of tongue form unilaterally
lateral postural tongue thrust
Ankylosis of teeth

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 TOTAL OPEN BITE

 CLEIDOCRANIAL DYSPLASIA
 MACROGLOSIA

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 THERAPUTIC
CONSIDERATIONS

Type of open bite

Age of the patient and dentition
Extent and localization of open bite
Degree of facial dysplasia
Neuromuscular abnormalities

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 THERAPUTIC
CONSIDERATIONS
Deciduous dentition (THUMB SUCKING)
 Spontaneous correction
 Habit control (interceptive therapy)
 Psychological approach
 Beta hypothesis (Dunlop theory)
 Mechanical aids and Myofunctional appliances
a-Habit breaking appliances(Removeable or fixed habit breakers)
b -Myofunctional therapy to train and restrain(Vestibular shield)
c-Lip seal training
 Chemical approach
-Quinine
-Pepper dissolved I volatile medium

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mixed dentition EARLY: LATE MIXED DENTION
- DENTOALVEOLAR
STOP HABBIT
INTRUSIVE HEADGEAR
MAGNETS IN BITE BLOCKS
MULTILOOPED WIRES WITH VERTICAL ELASTICS
- SKELETAL (posibility of dentoalveolar compensation)
severity of malocclusion
a-extent of vertical growth pattern
b-inclination of maxillary base
a-habit breakers
b-Swallowing exercises
c-Multiattachment fixed appliances

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MYOFUNCTIONAL THERAPY
ORAL/VESTIBULAR SCREENS
1- Interceptive to change unfavouorable envoirmental influence and perioral muscle
function
2-Alter fuctional balance
3- substitute for anterior lipseal
Alone or in combination with TONGUE CRIB

MODIFIED ACTIVATOR
1- Intercept and control abnormal neuromuscular influences
2- Influence the unfavourable upward tipping of the maxillary base and reduce
maxillarsy prognatism
3- Initiate favorable growth of mandible and alveolar of maxilla and mandible.
4-Intrusion of molars with maximum ramus growth and no over eruption of
incisors

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MYOFUNCTIONAL THERAPY

FR APLLIANCE
HIGHPULL HEAD GEAR with or
with out CHIN CUP
BIONATOR

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Adult patients

Non Surgical (ORTHODONTIC)

Surgical (ORTHOGNATHIC)

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 SURGICAL ORTHODONTIC
TREATMENT
-It causes three dimensional correction of skeletal and
dentoalveolar components in patients with severe
anterior open bite
-Consider envelop of discrepancy.
MAXILLARY ARCH
a-surgically assisted rapid maxillary expansion is
performed early if needed in pre surgical orthodontic
treatment.
b-Multisegment Le Fort 1 osteotomy—One stage
surgical correction in three directions.
c-Le Fort 1 osteotomy for differential maxillary
impaction/maxillary translocation.

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MANDIBULAR SURGERY

 ANTERIOR SUBAPICAL
OSTEOTOMY
 BISAGITTAL SPLIT
OSTEOTOMY(BSSO)
REDUCTION OF TONGUE SIZE

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