SEMINAR REPORT ON

MANAGEMENT OF OPEN BITE

(By:SUNNY JANNU B.D.S 4th year

OPEN BITE :- According to Graber T.M. : Open bite is descriptive of a condition where a space exists between the occlusal or incisal surfaces of maxillary and mandibular teeth in the buccal or anterior segments, when the mandible is brought into habitual or centric occlusion.

CLASSIFICATION OF OPEN BITE :( Based on the location of open bite )

(1)

ANTERIOR OPEN BITE :-

(2) POSTERIOR OPEN BITE :-

ANTERIOR OPEN BITE *Anterior open bite is a condition where there is no vertical overlap between the upper and lower anteriors.

*Anterior open bite can be classified as; # Skeletal anterior open bite # Dental anterior open bite

ETIOLOGY OF ANTERIOR OPEN BITE:The etiology of anterior open bite is multifactorial

(a) Prolonged thumb-sucking habit

(b) Tongue thrusting

(c) nasopharyngeal airway obstruction and associated mouth breathing.

(d) Inherited factors such as increased tongue size, and abnormal skeletal growth pattern of the maxilla and mandible can also be responsible for open bite malocclusion.

FEATURES OF SKELETAL ANTERIOR OPEN BITE Extra-oral features:-

Intra-oral features :-

(A)

(B)

(C)

(D)

Skeletal anterior open bite:- (A) Due to counter-clockwise maxillary rotation. (B) Due to clockwise mandibular rotation. (C) Due to combination of A & B. (D) Due to vertical maxillary excess.

FEATURES OF DENTAL ANTERIOR OPEN BITE The following are the features of dental open bite:(a) Open bite limited to anterior segment often asymmet -rical. (b) Proclined upper anterior teeth.

(c) The upper and lower anteriors fail to overlap each other resulting in a space between the maxillary and mandibular anteriors. (d) The patient may have a narrow maxillary arch due to lowered tongue posture due to a habit. (e) Fish mouth appearance.

MANAGEMENT OF ANTERIOR OPEN BITE :( treatment of anterior open bite is done by : - Removal of cause - Myofunctional therapy - Orthodontic therapy - Surgical correction)

(A)

(B)

(C)

(D)

(E)

(F)

Anterior open bite treated with fixed appliance and extraction of upper and lower second premolars. (A)&(B) Pretreatment photographs, (C)&(D) Appliance in place, (E)&(F) Completion of treatment.

APPLIANCES USED TO REMOVE THE ETIOLOGY OF ANTERIOR OPEN BITE Etiology Age of patient Appliances used for Correction Tongue-thrust Preadolescent Fixed tongue crib/rake Tongue-thrust . Digit-sucking . . Digit-sucking . Mouthbreathing . . Mouthbreathing . . Adolescent or adult Preadolescent Fixed or removable tongue crib/rake Motivation & medicaments Acylic digit caps Fixed tongue crib/rake Fixed tongue crib/rake ENT check up followed by . Breathing exercises Mouth shield ENT check up followed by Breathing exercises . Orthodontic trainers.

Adolescent (rarely seen) Preadolescent

Adolescents & adults

(A
Habit breaker (A) Removable (B)Fixed

(B

POSTERIOR OPEN BITE

>Posterior open bite is a condition characterized by lack of contact between the posteriors when the teeth are in centric occlusion.

Causes of posterior open bite :There are two possible causes of posterior open bite:--Mechanical interference with eruption , either before or after the tooth emerges from the alveolar bone. --Failure of eruptive mechanism of the tooth so that the expected amount of eruption does not occur.

Posterior open bite in a patient having a lateral tongue thrust

Posterior open bite in a patient having an ankylosed upper left first permanent molar.

Radiographs showing failure of eruption of the upper left first permanent molar.

Radiograph showing arrest of eruption of the lower left first permanent molar.

TREATMENT

--Primary aim of treatment should be to remove the cause. --Lateral tongue spikes are a valuable aid in control of lateral tongue thrust.

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