Multiloop edgewise archwire in the treatment of a patient with an anterior open bite and a long face

Strategic treatment planning for anterior open bite: A comprehensive approach

Anterior open bite (AOB), characterized by the lack of vertical overlap between upper and lower anterior teeth, poses a considerable challenge in orthodontics. The condition depends on many factors that combine to render it difficult to achieve post treatment stability. AOB is commonly classified as dental, skeletal, or functional on the basis of the clinical presentation and causative factors. Traditionally, skeletal AOB necessitates surgical intervention, whereas nonsurgical approaches such as extrusion arches and the Multiloop Edgewise Archwire Technique (MEAW) can be employed in more straightforward cases. Functional appliances are reserved for situations in which a patient's growth potential offers the possibility of effectively addressing AOB. This review presents a strategic treatment approach for addressing AOB, taking into account the classification and severity of the condition. The proposed SHE framework describes the use of mini-screws (S) for anchorage and vertical control, encouragement to correct habits (H), and the utilization of extractions and elastics (E). By incorporating extra-radicular mini-screws, AOB closure is achieved through anterior retraction in extraction cases or whole arch distalization of dentition with elastics in non-extraction cases. This framework emphasizes habit correction through a regimen of oral myofunctional therapy (OMT) and habit-correcting appliances to enhance posttreatment stability. This review suggests that nonsurgical correction is viable in the majority of cases, whereas surgical intervention should be reserved for severe cases of skeletal vertical overgrowth or horizontal discrepancies.

Comparison of mesiodistal angulations of premolars and molars in anterior open bite subjects with different sagittal malocclusions: A retrospective study

INTRODUCTION

Mesiodistal angulation of premolars and molars can be altered by forces of open bite malocclusion. The aim of this study was to compare the mesiodistal angulations of the posterior teeth in class I, II, and III individuals with anterior open bite (AOB) versus individuals with harmonious occlusion.

METHODS

This comparative cross-sectional study used 299 lateral head radiographs of individuals with permanent dentition. There were 4 groups (harmonious occlusion [n=89], Class I open bite [OB] [n=75], Class II OB [n=66], and Class III OB [n=69]). Premolar (1UPM, 2UPM) and molar (1UM, 2UM) angulations were measured relative to the occlusal plane and the palatal or mandibular plane by a trained and calibrated evaluator. ANOVA and Scheffe tests were used for statistical analyses (P<0.05).

RESULTS

The mesial angulation of the upper premolars showed greater angulation of between approximately 2° and 5° in the OB groups compared to the harmonious occlusion group (P<0.05). Only in the Class II OB group did the first and second upper molars show distal angulation in relation to the palatal plane (1UM 81.85°±5.42°; 2UM 75.32±7.4°) (P<0.05). The Class III OB group presented the greatest distal angulations of the lower premolars and molars (between 3° to 5° of difference, P<0.05) in relation to those of the harmonious occlusion group.

CONCLUSIONS

The upper first premolars in all the AOB groups and the lower second premolars in the Class II OB group had greater mesioangulation. Additionally, the upper molars of the Class II OB group and the lower molars of the Class III OB group showed distoangulation compared with the molars in the group with harmonious occlusion.

Innovative Technique for Correction of Open Bite - A Case Report

Anterior open bite is defined as a condition in which upper incisor crowns fail to overlap the incisal third of the lower incisor crowns when the mandible is brought into full occlusion. The diagnosis, treatment, and successful retention of treated open-bite malocclusion continue to be a constant subject of discussion and study, contributing to the frustrations of clinicians. Various modalities have been used for the correction of open bite for the different age groups. In adult cases, an open bite can be corrected either by anterior extrusion or posterior intrusion, or a combination of both. Kim had described a method of using multiloop edgewise archwire for posterior intrusion. Here is a case report in which an innovative method is described which is a modification of Kim's method which is simpler, less time-consuming to place, hygienic, and they do not irritate the soft tissue. The bite closing mechanism and the treatment results are similar to Kim's method.

Nonsurgical Orthodontic Treatment of a Severe Open Bite Case Using Miniscrews with Modified Multiloop Edgewise Arch Wire Technique

Skeletal open bite is one of the most challenging malocclusions to treat and maintain due to the difficulty and instability of correction. Although a combination of orthodontic treatment and orthognathic surgery may be the ideal approach in most cases, the complications, risks, and costs of surgery have sparked an interest in alternative treatment options that use temporary anchorage devices to achieve orthognathic-like effects. Adult patients can be treated without the need for special compliance using temporary anchorage devices such as miniscrews. This case report demonstrates a goal-oriented strategy for nonsurgical treatment of a complex skeletal open bite malocclusion in an adult patient using miniscrews and a modified multiloop edgewise arch wire (MEAW) technique, with the results evaluated clinically and cephalometrically.

Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study

Colorectal endoscopic submucosal dissection (ESD) is a difficult procedure, and its introduction to trainees has been debated. Although the criteria for performing colorectal ESD vary among institutions, it is often allowed after gaining experience performing surgeries in animals and upper gastrointestinal ESD. This pilot study aimed to compare the treatment outcomes of ESD performed by trainees using the multi-loop traction device (MLTD group) and those of conventional ESD performed by experts (control group). It also aimed to determine whether the MLTD can be used to safely introduce colorectal ESD to trainees. We included 26 colorectal ESD patients (13 in the MLTD group and 13 in the control group) treated at our hospital from October to December 2021. There were no significant differences in the procedure time (50 min vs. 30 min), dissection speed (19.9 mm²/min vs. 28.7 mm²/min), and intraoperative perforation (0% vs. 0%) of the two groups. Furthermore, the rate of ESD self-completion in the MLTD group was 100%. Therefore, the use of the MLTD allowed the safe introduction of colorectal ESD, even among endoscopists with no experience performing colorectal ESD. Consequently, the use of the MLTD may replace animal and upper gastrointestinal ESD when introducing colorectal ESD to trainees.

Multiloop edgewise archwire treatment for a patient with a severe anterior open bite and amelogenesis imperfecta

Amelogenesis imperfecta is a rare hereditary disorder that affects dental enamel and is often associated with an anterior open bite. Orthodontic treatment of a 16-year-old female patient with hypocalcified amelogenesis imperfecta and a 9-mm anterior open bite was presented. Radiographic examination revealed a steep mandibular plane angle, an increased lower face height, a Class II skeletal pattern, and a convex profile. Additionally, the patient had stainless steel crowns on all upper and lower posterior teeth and composite veneers on the upper anterior teeth. The patient was treated nonsurgically using a multiloop edgewise archwire (MEAW). MEAW mechanics allowed for successful correction of the anterior open bite, with significant reduction in the mandibular plane angle and improvement in the patient's profile. No fixed retainers were used, and the results remained stable 78 months after removal of orthodontic appliances. MEAW mechanics should be considered for patients with large anterior open bites, although this technique requires excellent patient compliance.

Multiloop edgewise archwire technique and denture frame analysis: a systematic review

Background

The Multiloop Edgewise Archwire (MEAW) appliance is an orthodontic treatment method suitable for the therapy of severe types of malocclusions such as open bites or anterior crossbites. The cephalometric Denture Frame Analysis (DFA) provides a supportive diagnostic tool for patient-specific treatment planning concerning the rearrangement of occlusion within the “denture frame”. The objective of this study is to give a comprehensive overview of the national and international scientific literature about MEAW and DFA regarding the general therapeutic effects, advantages and limitations.

Methods and materials

A computerized literature search was performed using four principal medical databases (PubMed/Medline, Google Scholar, Web of Science and Cochrane Central Register of Controlled Trials) and supplemented by manual searching of the references listed in the retrieved articles. The results were screened and assessed following the PRISMA guidelines.

Results

Six hundred seventy-seven full articles were assessed for eligibility. A number of 134 articles went through qualitative analysis and 3 studies were finally involved in comparative synopsis. The findings reveal advantageous characteristics of the MEAW technique such as a high degree of three-dimensional individual tooth control and a comparatively low load deflection rate, causing mostly dentoalveolar changes without significantly influencing the skeletal structures.

Conclusion

Based on current literature, the MEAW technique appears to have several therapeutic benefits and serves as a sufficient alternative treatment method for dentoalveolar compensation, when measures of orthognathic surgery are rejected. Concerning the deficient data basis of available literature and the low level of scientific evidence, further studies are required in order to expand on the knowledge in this subject area. Several aspects like the effectiveness or the long-term stability have to be evaluated more extensively. Moreover, the transferability of the DFA to ethnic groups other than the Asian ethnicity should be examined further.

Effect of piezocision on molar intrusion in open-bite treatment using a modified MEAW technique

PURPOSE

The aim of this retrospective study was to investigate whether a piezocision technique influences molar intrusion in open-bite cases.

METHODS

In all, 30 patients with open-bite malocclusion were assigned to one of two groups: the piezocision group comprised 15 patients who were treated using curved arches and anterior elastics with the simultaneous combination of piezocision which was performed interdentally in the upper posterior region, while the control group comprised 15 patients who were treated with the same treatment mechanics without piezocision. In both groups, after leveling and aligning, upper 0.017 × 0.025 accentuated curve and lower 0.017 × 0.025 reversed curve of Spee NiTi archwires were placed. Anterior vertical elastics were applied between laterals and the canines on both sides. The effects of treatments were investigated on cone-beam computed tomography images acquired before use of elastics and after correction of open-bite.

RESULTS

Open-bite closure was achieved in 2.85 ± 0.85 and 4.1 ± 1.58 months in the piezocision and control groups, respectively, while total treatment lasted 1.4 ± 0.42 and 1.7 ± 0.43 years, respectively. Extrusion of lower posterior teeth (p < 0.05) was observed together with extrusion of incisors and canines (p < 0.001) in the piezocision group, while only incisors and canines were extruded in the control group (p < 0.001). There were no significant differences between the groups (p > 0.05) except significant lower incisor extrusion (p < 0.05) and counter-clockwise rotation of the lower occlusal plane in the piezocision group (p < 0.001).

CONCLUSION

The duration of open-bite correction was significantly shorter in the piezocision group. No molar intrusion was observed in either group. Open bite correction was achieved mainly by extrusion and retrusion of the incisors while maintaining upper molar positions.

Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Photoelastic analysis of tension distribution in different orthodontic approaches for closing anterior open bites

BACKGROUND

This study aims to evaluate tension distribution in the anterior region of the mandible during two orthodontic mechanical approaches to treat anterior open bite.

METHODS

It was an in-vitro experimental study, that analyzed 5 models of photoelastic resin, simulating a lower dental arch. The anterior teeth underwent orthodontic forces of the Blue Elgiloy® 0.016" x 0.022" (MEAW technique) and Gummetal® 0.018"x 0.022" (GEAW technique) archwires. Tension distribution was assessed on three different points in the lower dental midline and was measured using a reflection polariscope. The archwires were evaluated with and without anterior elastic bands (6 oz, 170 g) installed between lateral incisors and lower canines, as recommended for anterior open bite.

RESULTS

The highest magnitudes of tension generated by the archwires were observed in the cervical regions of the teeth (on average 50% higher than those at the most apical point) regardless of the technique used. Comparatively, the GEAW technique showed significantly (P<0.05) lower tension values (16 MPa) than the MEAW technique using Blue Elgiloy (24 MPa).

CONCLUSIONS

The GEAW technique showed a more favorable tension distribution pattern than the MEAW approach. The use of elastic bands improved tension distribution, regardless of the technique. The results also suggest that the use of anterior elastic bands in both techniques reduced the tensions released by the intrusive forces generated by the archwires.

Efficiency of ODI and APDI of Kim's cephalometric analysis in a Latin American population with skeletal open bite

Objective:

The objective of this research was to demonstrate the efficiency of the overbite depth indicator (ODI) and the anteroposterior dysplasia indicator (APDI) from Kim’s cephalometric analysis, regarding the determination of the vertical and sagittal patterns of Latin American individuals.

Methods:

Two hundred lateral cephalometric radiographs were selected and divided into four study groups, with 50 radiographs each, for carrying out a cross-sectional study. The control group included radiographs of balanced individuals, and the other three groups had lateral cephalometric radiographs of subjects with Class I, II and III malocclusions and with skeletal open bite. After the pilot test was performed to calibrate the investigator, the ODI and APDI were measured. Descriptive statistics were performed and the one-way ANOVA with post-hoc Tukey HSD, or Kruskal-Wallis and Mann-Whitney U-test were used. Also a multiple linear regression was employed.

Results:

Statistically significant differences were found for the ODI of all groups (p< 0.001), except between Class I group (65.87 ± 4.26) and Class II open bite group (67.19 ± 3.58), both with similar values to each other. For APDI, statistically significant differences were also found for all groups (p< 0.001). However, no statistically significant differences were found between the balanced group (83.18 ± 1.71) and Class I group with skeletal open bite (81.78 ± 2.69).

Conclusions:

ODI and APDI are reliable indicators to evaluate the sagittal and vertical patterns of an individual, demonstrating their efficiency when a Latin American population was evaluated.

Three-dimensional evaluation of open-bite patients treated with anterior elastics and curved archwires

INTRODUCTION

One nonsurgical treatment method for a patient with open bite is to use curved nickel-titanium arches and anterior elastics. The aim of this study was to investigate the effects of this technique with cone-beam computed tomography.

METHODS

Eighteen open-bite patients' treatment records were used for this retrospective study. The treatment methods were identical for all patients, beginning with the levelling and alignment of the teeth and the placement of maxillary accentuated and mandibular reverse curved archwires with anterior elastics. Cone-beam tomography images were taken and analyzed 3 dimensionally. The paired-samples t test statistical analysis was performed.

RESULTS

A-point moved anteriorly (0.33 mm) and the SN-MP angle increased slightly (1.17°). Maxillary and mandibular incisors were extruded by 2.16 and 1.49 mm, respectively. Overbite increased (4.38 mm). There were no significant changes in the vertical parameters of the premolars and molars.

CONCLUSIONS

The open bite was eliminated by retraction and extrusion of the anterior teeth while maintaining the vertical positions of the molars.

Orthodontic Treatment Timing and Modalities in Anterior Open Bite: Case Series Study

OBJECTIVE

The purpose of this study was to present early and adult cases of anterior open bite that were treated efficiently using different treatment approaches and mechanics.

MATERIALS AND METHODS

Five patients of different age groups (from 7 to 27 years), suffering from a clear Anterior open bite deformity, were properly diagnosed and relevant treatment modality for each was selected.

RESULTS

Positive overbite was efficiently achieved for all patients.

CONCLUSION

Patient compliance is a key factor in using removable habit breakers. However, fixed palatal crib gave the same results but in shorter time. Anterior open bite of skeletal components should be thoroughly evaluated before selecting camouflage or orthognathic surgery treatment modality.

Morphology of open bite

OBJECTIVES

The purpose of this work was to define and illustrate the skeletal morphology of open-bite patients against the background of sagittal jaw relationships on the basis of lateral cephalograms.

MATERIALS AND METHODS

Lateral cephalograms of 197 untreated adults were analyzed in dental imaging software (Onyx Ceph 3™; Image Instruments, Chemnitz, Germany). Four groups were formed based on vertical (Index scores) and sagittal (individualized ANB values) parameters. Ninety-nine patients were defined as the control group due to their neutral sagittal and vertical relationships. The remaining patients were found by their vertical relationships to represent open-bite cases and were divided by their sagittal relationships into three study groups: neutral (Class I, n = 34), distal (Class II, n = 26), and mesial (Class III, n = 38). A geometric morphometric approach was used to analyze the x,y-coordinates of 28 skeletal landmarks on each cephalogram. Relative size was captured based on centroid size (CS). The shape-determining factors in the groups were compared by permutation testing after Procrustes transformation, and intergroup differences were visualized in the form of thin-plate splines.

RESULTS

While size (CS) was significantly increased in the Class III group, the other two groups were not different from the control group. After Procrustes transformation, characteristic and invariably significant (p < 0.001) differences in shape were detected. Neutral (Class I) open bite involved compression in the mandibular ramus and the upper anterior facial third, including vertical expansion in the lower molar and anterior nasal spine areas. Mesial (Class III) open bite was associated with pronounced vertical and sagittal size reductions in the upper posterior segments and reduced lengths of the mandibular ramus. Distal (Class II) open bite involved expansion in the pterygoid area and compression in the mandibular ramus.

CONCLUSION

Open bite is not a homogeneous group. Our geometric techniques of morphometric analysis revealed typical patterns, thus, confirming the differences observed by traditional morphometry. True skeletal overdevelopment appears to be present only in open-bite cases having a mesial jaw relationship. All open-bite groups have in common that the mandibular ramus is compressed, but marked differences are seen in terms of vertical development of the maxilla. This differentiated view of open-bite cases should be taken into consideration during individual etiology assessment and treatment planning.

Influence of maxillary posterior discrepancy on upper molar vertical position and facial vertical dimensions in subjects with or without skeletal open bite

OBJECTIVES

To determine the influence of maxillary posterior discrepancy on upper molar vertical position and dentofacial vertical dimensions in individuals with or without skeletal open bite (SOB).

MATERIALS AND METHODS

Pre-treatment lateral cephalograms of 139 young adults were examined. The sample was divided into eight groups categorized according to their sagittal and vertical skeletal facial growth pattern and maxillary posterior discrepancy (present or absent). Upper molar vertical position, overbite, lower anterior facial height and facial height ratio were measured. Independent t-test was performed to determine differences between the groups considering maxillary posterior discrepancy. Principal component analysis and MANCOVA test were also used.

RESULTS

No statistically significant differences were found comparing the molar vertical position according to maxillary posterior discrepancy for the SOB Class I group or the group with adequate overbite. Significant differences were found in SOB Class II and Class III groups. In addition, an increased molar vertical position was found in the group without posterior discrepancy.

LIMITATIONS

Some variables closely related with the individual's intrinsic craniofacial development that could influence the evaluated vertical measurements were not considered.

CONCLUSIONS AND IMPLICATIONS

Overall maxillary posterior discrepancy does not appear to have a clear impact on upper molar vertical position or facial vertical dimensions. Only the SOB Class III group without posterior discrepancy had a significant increased upper molar vertical position.

Breaking the Thumb Sucking Habit: When Compliance Is Essential

The anterior open bite (AOB) and posterior cross bite are the most frequent malocclusions associated with prolonged sucking habits. This clinical case illustrates and discusses the use of a Haas-type palatal expander for stopping a thumb sucking habit. The improvement in closing the open bite with discontinuation of the habit was observed. But with the return of the habit and lack of cooperation, the relapse of anterior open bite occurred. Therefore, different approaches are necessary. The need of a multidisciplinary approach, consent, and cooperation are keys to a good prognosis.

Anterior maxillary dentoalveolar and skeletal cephalometric factors involved in upper incisor crown exposure in subjects with Class II and III skeletal open bite

OBJECTIVE

To compare the anterior dentoalveolar and skeletal maxillary cephalometric factors involved in excessive upper incisor crown exposure (UICE) in subjects with skeletal open bite Class II (SOBCIIG) and Class III (SOBCIIIG) against an untreated control group (CG).

MATERIALS AND METHODS

Seventy pretreatment lateral cephalograms of orthodontic young adult patients (34 men, 36 women) were examined. The sample was divided into three groups according to both sagittal and vertical growth pattern and occlusion. The CG group (n  =  25) included Class I, normodivergent cases with adequate overbite, and the SOBCIIG group (n  =  25) and SOBCIIIG group (n  =  20) included skeletal Class II or III malocclusions, respectively, with hyperdivergent pattern and negative overbite. Several cephalometric measurements were considered (skeletal and dental). Analysis of variance, multivariate analysis of covariance, and Tukey HSD post hoc tests were used. Principal component analysis (PCA) was used for reducing the number of cephalometric variables related to UICE. Finally, a multiple linear regression was calculated.

RESULTS

Significant differences in UICE were found between the groups (P < .05). UICE was 3.9 mm in SOBCIIG, 2.5 mm in SOBCIIIG, and 0.4 mm in CG. PCA showed that a nondental component-including vertical maxillary height (VMH) and upper lip height (ULH)-was the only component significantly associated with UICE. The regression model had a moderate prediction capability.

CONCLUSIONS

Although the UICE was statistically different in SOBCIIG, the values were within the esthetic standards. The UICE was mainly influenced by VMH and ULH.

Severe anterior open bite with mandibular retrusion treated with multiloop edgewise archwires and microimplant anchorage complemented by genioplasty

In this case report, we introduce the combined use of multiloop edgewise archwire and microimplant anchorage to treat an 18-year-old Chinese woman who had a severe anterior open bite and a retrusive chin. Her diagnosis included a skeletal Class II base with severe anterior open bite, backward rotated mandible, and mesially tipped buccal dentition. The treatment plan emphasized vertical control of the posterior dentoalveolar dimension. Microimplant anchors were placed in the mandibular buccal segment to provide rigid anchorage and deliver intruding forces to the posterior teeth; a multiloop edgewise archwire was applied to generate uprighting forces to the maxillary and mandibular posterior teeth. Intrusion and uprighting of the posterior teeth contributed to the counterclockwise rotation of the mandibular plane, which consequently contributed to the facial profile improvement. Orthognathic genioplasty was implemented to further improve the chin prominence. After 1.5 years of retention, ideal intercuspation was evident, and the improved facial contour was stable.

Molar heights and incisor inclinations in adults with Class II and Class III skeletal open-bite malocclusions

INTRODUCTION

The aim of this research was to compare maxillary and mandibular molar heights and incisor inclinations in patients with skeletal open-bite Class II, patients with skeletal open-bite Class III, and an untreated control group.

METHODS

Pretreatment lateral cephalograms of 70 orthodontic patients (34 men, 36 women) between 16 and 40 years of age were examined. The sample was divided into 3 groups according to facial growth pattern and overbite. The control group (n = 25) included normodivergent Class I subjects with adequate overbite; the skeletal open-bite Class II group (n = 25) and the skeletal open-bite Class III group (n = 20) included hyperdivergent Class II or Class III subjects with negative overbite. Measurements considered were ANB angle, palatal and mandibular plane angles, maxillary incisor palatal plane angulation, and mandibular incisor mandibular plane angulation, as well as the distance from the palatal or the mandibular plane to the mesial cusp of the molars. Multivariate analysis of covariance and multivariate analysis of variance tests were used to determine the differences between the groups, followed by the Tukey post-hoc test. Additionally, the Mann-Whitney U test and Kruskall-Wallis test were performed.

RESULTS

Significant differences in molar height were found (P <0.001). A 4-mm difference in maxillary molar height between the skeletal open-bite and control groups was found. Mandibular molar height was greater in the skeletal open-bite Class II group (P <0.001). Maxillary incisor palatal plane angulation was greater in the skeletal open-bite Class III group by approximately 6°. Mandibular incisor to mandibular plane angulation was 10° more lingual in the skeletal open-bite Class III group (P <0.001).

CONCLUSIONS

The skeletal open-bite groups had greater molar heights than did the control group. The skeletal open-bite Class II group had more eruption of the mandibular molars. The maxillary incisors were more proclined and the mandibular incisors were more lingual in the skeletal open-bite Class III group.

Glossectomy as an adjunct to correct an open-bite malocclusion with shortened maxillary central incisor roots

A young man, 19 years of age, with the chief complaint of an anterior open bite, came for orthodontic treatment with a skeletal Class I relationship, anterior open bite, shortened maxillary incisor roots, and relative macroglossia. The malocclusion was treated by extracting the maxillary first premolars and using a fixed edgewise appliance. A partial glossectomy was performed before the orthognathic surgery with a 3-piece segmental LeFort I mandibular setback, and advancement was achieved with a reduction genioplasty. A functional and esthetic occlusion with an improved facial profile was established, and the apex of the maxillary left central incisor became slightly rounded after prolonged and significant tooth movement. Four years after treatment, there was occlusal stability of the results, and no further root shortening was observed.

Eight-year stability of a severe skeletal anterior open bite with a hyperdivergent growth pattern treated with an edgewise appliance and chin cup therapy

An adolescent boy with an Angle Class II Division 1 malocclusion had a hyperdivergent growth pattern with an excessive lower facial height and an anterior open bite. Combined orthodontic and surgical treatment should be considered for patients with a skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, a 0.022 × 0.028-in nontorqued, nonangulated fixed appliance with a chincup as adjunct therapy is an alternative that can have excellent results. The final outcome of this treatment were great improvements in function, esthetics, and posttreatment stability after 8 years.