Nonsurgical treatment of severe Class II malocclusion with anterior open bite using mini-implants and maxillary lateral incisor and mandibular first molar extractions

Class II and anterior open bite malocclusion treated with mini-implants, intermaxillary elastics, speech therapy, and retained with a night-wear palatal crib wraparound

The teeth position in anterior open bite malocclusion depends on a balance of pressure between the tongue and lips and the treatment planning should include such variables. The objective of this study was to report an orthodontic case of an adult with maxillary protrusion and anterior open bite treated with skeletal anchorage and intermaxillary elastics. The patient presented a Class II malocclusion with anterior open bite, without a history of non-nutritive habits, and mandibular missing teeth at 54 years old. Mini-implants were inserted in the maxillary molars region to produce distal movement of the maxillary dentition while controlling molar extrusion, and in the mandibular anterior region on the left side to produce mesial movement of posterior teeth. Up and down intermaxillary elastics were worn in the area of the incisors to treat the open bite together with Class II intermaxillary elastics. Cleats were bonded in the lingual surface of the anterior teeth as spurs to the tongue posture. However, the best result on the anterior open bite treatment was coincident with the speech therapy. Normal relationships between the maxillary and mandibular occlusal plane of cusps, correct anterior overbite, and adequate proximal relationships were obtained at the end of treatment. The retention modality to the maxillary arch was daily wear of a removable standard wraparound and a night-time wraparound with the palatal crib. The new technology allows for more effective treatment in adults and speech therapy was helpful to achieve balanced pressure between the tongue and lips.

For four sixes, revisited

Rarely is the extraction of the four first molars the ideal choice in the course of orthodontic treatment, particularly in older patients. Although this approach can offer distinct advantages in carefully selected patients, it is also associated with a number of well-recognized problems, including the extension of treatment times, anchorage management, and control of second molars during space closure. However, by careful use of contemporary materials and techniques, a high standard of treatment can be achieved, even in patients with complex malocclusions. This is illustrated in a report of a case that highlights both the challenges and some of the solutions this treatment modality can offer.