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Yuan G, Zhang Y, Meng Q, Li Y. Post-condylectomy orthodontic treatment for a severe asymmetrical open bite in a condylar hyperplasia patient. Int Orthod 2024; 22:100896. [PMID: 38981305 DOI: 10.1016/j.ortho.2024.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
A satisfactory treatment of an 18-year-old lady was reported with right combination-type condylar hyperplasia (CH) in active phase. The chin severely deviated to the left, with the right gonial angle locating at a lower level. Intraorally, the lower centre line shifted to the left, the scale of which reached the width of one lower incisor. The right molar relation was mesial. Right maxillary second molar over-erupted without contact to lower teeth. There had been 2.5-mm anterior open bite (AOB) before surgery (T1) due to the tongue-spitting habit. After judging the benefits and disadvantages of all treatment alternatives, the decision was made to perform a right condylectomy and post-surgery orthodontics. Before orthodontics (T2) when the chin was positioned centred, an asymmetrical open bite occurred, caused by pre-contact between the right maxillary and mandibular second molars. Meanwhile, the AOB at T2 became 11.5mm. Orthodontic-related treatment included four premolars extraction and intrusion of bilateral maxillary molars using four miniscrews. Finally, this treatment achieved a clinically centred chin with two gonial angles at the same level. Post-condylectomy, the large AOB was resolved, together with a bilateral neutral molar relationship and alignment of the incisor midlines. Besides, the resected right condyle was covered by a continuous cortex bone and returned to the glenoid fossa. In sum, a high-challenging combined-type CH case was accomplished with impressive improvement in facial and occlusal symmetry, thanks to condylectomy and post-surgery miniscrew-assisted orthodontics.
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Affiliation(s)
- Guanjie Yuan
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei province, China
| | - Yue Zhang
- Department of Orthodontics, Shenzhen Children's Hospital, Shenzhen, China
| | - Qinggong Meng
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei province, China; Department of Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei province, China
| | - Yingjie Li
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei province, China; Department of Trauma and Temporomandibular Joint Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei province, China.
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Kuharattanachai K, Jotikasthira D, Rangsri W, Tripuwabhrut K. Effect of occlusal hypofunction on centre of resistance in maxillary central incisor using the finite element method. J Orthod 2024; 51:19-27. [PMID: 37269106 DOI: 10.1177/14653125231176575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine differences in the location of centre of resistance (Cres) between functional and hypofunctional teeth and to evaluate the relationship between the pulp cavity volume and locations of the Cres, using the finite element (FE) method. DESIGN Retrospective cohort study. PARTICIPANTS FE models of right maxillary central incisor, derived from cone-beam computed tomography (CBCT) images of 46 participants, were divided into normal function (n = 23) and hypofunction (n = 23) groups using anterior overbite and cephalometric measurements. METHODS Measurements of the tooth and pulp cavity volume were made from the CBCT. Cres levels were presented as percentages of the root length from the root's apex. All data were analysed and compared using the independent t-test (P < 0.05). The relationship between the location of Cres and volume ratios were evaluated statistically. RESULTS The means of the pulp cavity/tooth volume and root canal/ root volume ratio of the maxillary central incisor in the anterior open bite group were significantly greater than those in the normal group. The average location of Cres in the anterior open bite group was 0.6 mm (3.7%) apically from the normal group, measured from root apex. The difference was statistically significant (P < 0.01). There was a significant correlation between root canal/root volume ratio and locations of Cres (r = -0.780, P < 0.001). CONCLUSIONS The Cres in the hypofunctional group was located more apical than the functional group. As the pulp cavity volume increased, the level of Cres shifted apically.
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Affiliation(s)
- Kachaphol Kuharattanachai
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Dhirawat Jotikasthira
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Wetchayan Rangsri
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
| | - Kanich Tripuwabhrut
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Elshal NS, Mohammad MH, Tawfik MA, Fouda MAES. Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial. Dental Press J Orthod 2024; 28:e2323110. [PMID: 38198349 PMCID: PMC10768647 DOI: 10.1590/2177-6709.28.6.e2323110.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB). MATERIAL AND METHODS Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used. RESULTS AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed. CONCLUSION The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.
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Affiliation(s)
- Noheir Samir Elshal
- Mansoura University, Faculty of Dentistry, Department of Orthodontics (Mansoura, Egypt)
| | | | - Marwa Ali Tawfik
- Mansoura University, Faculty of Dentistry, Department of Orthodontics (Mansoura, Egypt)
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Martinelli F. Class II and anterior open bite malocclusion treated with mini-implants, intermaxillary elastics, speech therapy, and retained with a night-wear palatal crib wraparound. APOS TRENDS IN ORTHODONTICS 2023. [DOI: 10.25259/apos_196_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
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.
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Affiliation(s)
- Fernando Martinelli
- Department of Orthodontics, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Private practice in Porto Alegre, RS, Brazil,
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Siddhartha R, Sudhakar SS, Rai K, Rai S, Rai S. Innovative Technique for Correction of Open Bite - A Case Report. Contemp Clin Dent 2023; 14:87-90. [PMID: 37249995 PMCID: PMC10209768 DOI: 10.4103/ccd.ccd_241_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 09/30/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- R Siddhartha
- Department of Orthodontics, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | | | - Kripal Rai
- Department of Public Health Dentistry, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Shreyas Rai
- Department of Conservative Dentistry, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Shivprasad Rai
- Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, Karnataka, India
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Hammad T, Moussa H, Marzouk W, Ismail HA. Effect of maxillary and mandibular extrusion arches on dentoskeletal changes in adults with anterior open bite: a quantitative analysis. Angle Orthod 2023; 93:26-32. [PMID: 36066246 DOI: 10.2319/021922-155.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To quantify dentoskeletal changes accompanying the use of extrusion arches during the treatment of anterior open bite (AOB) in adults. MATERIALS AND METHODS A total of 23 adult patients with an AOB of -3.05 mm ± 1.27 mm were treated with upper and lower extrusion arches after the alignment phase. Lateral cephalograms were taken before placement of the extrusion arch, immediately after closure of the open bite (T2), and at the end of orthodontic treatment (T3). Data were statistically analyzed using repeated-measures analysis of variance and the Bonferroni post hoc test for pairwise comparisons (α = 0.05). RESULTS Successful closure of AOB, with an overall change in overbite of 4.73 ± 1.93 mm, was achieved in an average of 3.8 months and remained stable at T3. Upper and lower incisors were significantly extruded by 2.05 mm ± 0.72 mm and 2.54 mm ± 1.63 mm, respectively, and significantly retroclined by 6.36° ± 1.63° and 8.45° ± 3.83°, respectively, with a resultant increase in the interincisal angle of 12.80° ± 2.09°. Statistically significant intrusion and mesial tipping (P < .001) of the maxillary and mandibular first molars were observed at T2. Dentoskeletal changes remained stable at T3, except for a significant reduction of the mesial tipping of the maxillary and mandibular first molars. CONCLUSIONS The combined use of maxillary and mandibular extrusion arches resulted in significant favorable dentoskeletal changes that led to the successful closure of AOB during a short duration of treatment.
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Nonsurgical Orthodontic Treatment of a Severe Open Bite Case Using Miniscrews with Modified Multiloop Edgewise Arch Wire Technique. Case Rep Dent 2022; 2022:1844167. [PMID: 36157202 PMCID: PMC9499781 DOI: 10.1155/2022/1844167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022] Open
Abstract
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.
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Effect of piezocision on molar intrusion in open-bite treatment using a modified MEAW technique. J Orofac Orthop 2020; 82:163-174. [PMID: 33237371 DOI: 10.1007/s00056-020-00261-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/17/2020] [Indexed: 01/17/2023]
Abstract
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.
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