J Korean Assoc Oral Maxillofac Surg.  2012 Oct;38(5):284-294. 10.5125/jkaoms.2012.38.5.284.

Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system

• Kim HS
• Lee SH
• Youn T
• Kim HG
• Huh JK

• KMID: 1434330
• DOI: http://doi.org/10.5125/jkaoms.2012.38.5.284

Abstract

OBJECTIVES
The anterior open bite with temporomandibular disorders (TMD) is one of the most challenging cases both orthodontically and surgically. We introduce an intermaxillary traction treatment for patients with anterior open bite and TMD using a skeletal anchorage system (SAS).
MATERIALS AND METHODS
This study was comprised of 52 patients with anterior open bite and TMD. A total of four mini-screws were inserted, two screws each into the maxilla and mandible, to obtain a class II pattern of elastic application with 120-200 g force. Adjunctive muscle relaxation treatments, such as splint therapy, medication, and botulinum toxin injection were applied during or before intermaxillary traction. At least one treatment among adjunctive muscle relaxation treatment, mentioned above, was applied to 96.2% of patients. We evaluated the clinical characteristics of patients, TMD symptom changes, amount of open bite improved. The degree of open bite improvement was compared between the open bite-reduced group (21 patients) and not-reduced group (5 patients).
RESULTS
TMD symptoms (muscle/joint pain, joint sound, mouth opening) remained or improved in most patients, and worsened in about 10% of patients for each items. Anterior open bite was improved by a mean of 1.75 mm (P<0.01) during treatment. The open bite-reduced group exhibited a significant open bite improvement compared to the not-reduced group (P<0.05), with 37% of open bite improvement occurring during the first 3 months of treatment.
CONCLUSION
The intermaxillary traction technique using SAS is a valid modality for correction of anterior open bite and improvement of TMD symptoms.

Keyword

Open bite; Malocclusion; Temporomandibular disorders; Intermaxillary traction

MeSH Terms

Arthralgia
Botulinum Toxins
Gravitation
Humans
Malocclusion
Mandible
Maxilla
Mouth
Muscle Relaxation
Open Bite
Phenothiazines
Splints
Temporomandibular Joint Disorders
Traction
Botulinum Toxins
Phenothiazines

Figure

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  Fig. 1 Open bite reduced group when forced on chin top. A. Not forced on chin top. B. Forced on chin top.

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  Fig. 2 Adjunctive treatment for muscle relaxation. (BTI: botulinum toxin A injection)

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  Fig. 3 Symptom changes of temporomandibular disorders between before and after treatment of intermaxillary traction using skeletal anchorage system. (MMO: maximum mouth opening, Y: symptoms exist, N: symptoms not exist)

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  Fig. 4 Intraoral photographs during intermaxillary traction treatment using skeletal anchorage system. A. Start of traction. B. 3 months later. C. 9 months later. D. 1 year 3 months later.

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  Fig. 5 A. Lateral cephalometric radiographs. Left: pretreatment, middle: anterior open bite closed, right: the most posterior teeth extruded for occlusion seating. B. Superimposition of cephalometric tracings before (black line) and after (gray line) intermaxillary traction treatment using skeletal anchorage system. Left: superimposed on sella-nasion plane at sella, middle: superimposed on palatal plane at anterior nasal spine, right: superimposed on mandibular plane at menton.

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