Korean J Orthod.  2022 May;52(3):210-219. 10.4041/kjod21.180.

Treatment of anterior open bites using nonextraction clear aligner therapy in adult patients

• Suh H
• Garnett BS
• Mahood K
• Mahjoub N
• Boyd RL
• Oh H

• KMID: 2529944
• DOI: http://doi.org/10.4041/kjod21.180

Abstract

Objective
The purpose of this study was to examine the effectiveness and mechanism of clear aligner therapy for the correction of anterior open bite in adult nonextraction cases.
Methods
Sixty-nine adult patients with anterior open bite were enrolled and classified into Angle’s Class I, II, and III groups. Fifty patients presented with skeletal open bite (mandibular plane angle [MPA] ≥ 38°), whereas 19 presented with dental open bite. Fifteen cephalometric landmarks were identified before (T1) and after (T2) treatment. The magnitudes of planned and actual movements of the incisors and molars were calculated.
Results
Positive overbite was achieved in 94% patients, with a mean final overbite of 1.1 ± 0.8 mm. The mean change in overbite was 3.3 ± 1.4 mm. With clear aligners alone, 0.36 ± 0.58 mm of maxillary molar intrusion was achieved. Compared with the Class I group, the Class II group showed greater maxillary molar intrusion and MPA reduction. The Class III group showed greater mandibular incisor extrusion with no significant vertical skeletal changes.
Conclusions
Clear aligners can be effective in controlling the vertical dimension and correcting mild to moderate anterior open bite in adult nonextraction cases. The treatment mechanism for Class III patients significantly differed from that for Class I and Class II patients. Maxillary incisor extrusion in patients with dental open bite and MPA reduction with mandibular incisor extrusion in patients with skeletal open bite are the most significant contributing factors for open bite closure.

Keyword

Clear aligner; Orthodontic treatment; Tooth movement; Anterior open bite

Figure

• 

  Figure 1 Cephalometric landmarks, reference planes, and dentoalveolar linear measurements used in this study. Measurements were measured using the same reference planes at T1 and T2 tracings. a (U6-PP), perpendicular distance between mesiobuccal cusp of maxillary 1st molar and palatal plane (ANS-PNS) (mm); b (U1-PP), perpendicular distance between incisal edge of maxillary central incisor and palatal plane (mm); c (L6-MP), perpendicular distance between mesiobuccal cusp of mandibular 1st molar and mandibular plane (Go-Me) (mm); d (L1-MP), perpendicular distance between incisal edge of mandibular central incisor and mandibular plane (mm). T1, before treatment; T2, after treatment; S, sella; N, nasion; A, A point; B, B point; Pog, pogonion; Go, gonion; Me, menton; ANS, anterior nasal spine; PNS, posterior nasal spine.

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  Figure 2 Vertical changes by Angle class groups. A, U6-PP change; B, L6-MP change; C, lower facial height change; D, L1-MP change. Dental intrusion presented as negative value; dental extrusion presented as positive value. NS, not significant. * Represents significant difference between the groups. Statistical significance set at p < 0.05. See Figure 1 for definitions of each measurement.

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