Early management of open bites

Patients who present with anterior open bites may benefit from an early phase of treatment. A number of treatment modalities have been suggested for this early management. The following possibilities can be considered, and are listed in order of ease of application and treatment:

• Finger and thumb appliances, which provide a barrier, can be used to correct minor problems. These appliances normally extend forward from the upper first molars, but are sometimes attached to the lower first molars.

• Palatal expansion in cases with narrow maxillas. This procedure provides space for eruption and retroclination of incisors. It also helps to open the airway and encourage nasal breathing, while providing more room for the tongue.

• Palatal bars and lingual arches can be placed on the molars. These appliances serve to reduce the vertical eruption of the molars.

• Posterior bite plates can be placed on the upper or lower posterior teeth. I lowever, if these only passively rotate the mandible open (especially in high-angle cases), their effect may be minimal, since little pressure seems to be exerted on the dentition.

• I ligh-pull facebows and vertical chin cups, when worn faithfully, can limit the vertical eruption of the upper molars and the upper and lower molars, respectively.

I lowever, cooperation is always the limiting factor with such appliances.

• Removal of deciduous canines and sometimes premolars in cases with significant crowding and/or protrusion allows for the eruption and retroclination of incisors.

• Myofunctional therapy may benefit more severe cases. It should be noted that a significant number of open-bite cases show improvement as the airway increases in size during orthodontics. Therefore, only a few patients require this service.

• If adenoids and tonsils are contributing factors to anterior open bites, their removal may aid in bite closure. Referral to an ear, nose and throat specialist is indicated in such cases.

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