Open Bite Diagnosis Treatment

This guide organises possible treatment options for a open bite diagnosis. The document is a treatment planning tool to assist you assist how to best treat patients. Treatments are graded by complexity, ranked by the orthodontic technique required, as a guide to the efficacy of treatment and enable providers to select cases that best matches their ability to apply advanced techniques. In this regard, it is particularly useful for dentists who are just beginning to provide clear aligner treatment.

Disclaimer

As doctors are solely responsible for the treatment they’re providing their patients, they should understand their limits and not hesitate to consult a specialist for further guidance when required. Note when applying this guide only general, high-level information on how each isolated condition might be treated is provided. The relationships between different conditions that exist in the majority of patients are not addressed. In this regard, always consider each patient’s individual dental and periodontal condition, restorative needs, facial proportions, and age when considering treatment options.

Open Bite

Open Bite

Open bite can be a dental or skeletal malocclusion. The clinician needs to pay attention to the patient’s soft tissue profile, maxillary archform, and mandibular angle (normally viewed in a lateral cephalometric radiograph). Certain traits of skeletal open bite can be present when looking at a patient’s photographs: a long, narrow face type (dolichofacial) with lower face height significantly increased and open mouth at repose.

The most predictable way to correct open bite with Proligner is by tipping back the incisors, thereby creating a relative extrusion effect to deepen the bite. In some cases, open bite can be caused by poor buccal-lingual coordination of the posterior segment and improving the coordination can reduce the vertical dimension of the patient. Long-term retention is especially important with open bite patients.

Skeletal open bites should be treated with skeletal solutions. This may require orthognathic surgery to address the skeletal component, with Proligner being used as the treatment of choice to address the dental component.

Dental

• Incisor Flared

Relative extrusion by retraction Novice (0-15 cases)

Anterior teeth can be “extruded” while being retracted (extruded relatively) to reduce open bite. If crowding is present, creating space using IPR and then retracting the teeth is another way to deepen the over bite.

• Incisor Upright

Absolute extrusion with auxiliaries Advanced (>50 cases)

Bonding buttons to teeth and extruding them with vertical elastics is a typical way to achieve absolute extrusion either prior to or during Proligner treatment. Be sure to allow adequate time for bone to develop around the teeth to avoid relapse.

Skeletal

Maintain open bite, aesthetic alignment Experienced (16-50 cases)

A treatment goal that aligns the teeth but maintains the open bite can be considered if skeletal open bite correction is not an option.

Pre-surgical Proligner alignment followed by surgery Advanced (>50 cases)

When treating a patient with skeletal open bite, the surgical plan has to be coordinated with an oral surgeon and a final discussion held with the patient to agree on the treatment goal. Once the goal is determined then the patient may start to wear pre-surgical aligners to align the teeth. After surgery, the patient can benefit from a brief phase of treatment to complete any remaining alignment needed.