TAMING Anterior Open Bite with Mini Screws By Juan C. Echeverri, DDS, FAOS, and Elsa A. Echeverri DDS, FAAPD This case report presents the treatment of a patient with anterior open bite and treated with straight archwire sequence for initial alignment and leveling of the arches. The technique of using segmental arches allowed anterior extrusion and posterior intrusion combined with anterior elastics. The addition of intrusion forces of the posterior segments, based on bone anchorage with mini-screws placed on the buccal posterior segments, was introduced to allow a better control and result of the orthodontic treatment. T reatment of anterior open bite in older adoles-cents is filled with difficult to resolve issues. The primary cause of the condition is difficult to diagnose and treat. Habits such as tongue thrust, fingers or other items in the mouth and prolonged use of pacifiers have been blamed. Another important cause is partial airway obstruc-tion. This may force the patient to have an anterior, Fig. 1: Initial clinical images. Observe the anterior open bite, with uneven cant. Facial asymmetry is noticeable and face is clinically long. lower positioned tongue with little molar contact that will stimulate formation of a narrow deep palatal vault, posterior crossbite, and supra-eruption of the molars, creating a permanent anterior open bite. Some patients have an anterior open bite due to a genetic predisposi-tion with no other apparent cause. Prevention and interception of negative habits, as those mentioned, are paramount in prevention of development of anterior open bite, a condition that such be corrected as early as possible. Treatment of allergies, and/or removal of overgrown or inflamed tissues that cause airway obstruction can be accom-plished by our medical colleagues and help the patient hold his mouth and associated oral structures in a more ideal position and avoid development of an open bite. It is important that we, as dentists, learn to recognize the signs and symptoms of airway obstruction, as we may be the first to bring attention to this issue. It is important to resolve anterior open bite in the occlusal scheme of our patients. The condition affects their esthetics and influences the perception they have of themselves. It is also important, from a mechanical point of view, to create and preserve anterior and lateral guidance as they have been proven to be key factors in protection of the posterior teeth, and the temporo-mandibular joints. Options to eliminate anterior open bite range from the very simple, such as using anterior elastics, to highly complicated surgical procedures. 24 September/October 2011 JAOS
Journal of the American Orthodontic Society September-October 2011: Page 24
