Open Bite, are we treating the right causes. Power2Reason. Flavia Artese. Brazil. Episode 18 July 7th 2020

Flavia Artese presents on one of the main causes of anterior open bites, tongue position, and described the use of tongue cribs and spurs.

Conclusion:

Use of palatal cribs and tongue spurs are effective at managing AOBs, where the aetiology is anterior tongue position. however stability is related to resting tongue position long term.

Aetiology

• Anterior tongue position at rest, not in swallowing, as low intensity and duration.

What is normal tongue posture?

• The tongue should be behind the upper incisors, in both a AP and vertical plane.

Treatment for anterior tongue position involves changing the AP and vertical position

•  Correct tongue position: Proffit equilibrium theory, form follows function of resting tissues.  

4 Vertical tongue positions:

1.  High: Protrude upper incisors
2. Horizonal tongue ideal vertical but anterior. Procline upper and lower incisors
3. Low tongue. Not maintain transverse palate = constriction. Proclined lower incisors
4. Very low tongue. Severe AOB. Lowers retroclined and 2 occlusal planes

2 Treatment types based on altering posture of tongue, both retract the anterior tongue (considered myofunctional appliances)

1. Cribs (LOWER TONGUE and AP RETRACT):
   1. Upper arch appliance with loops
   2. Type of tongue position correction: high and horizontal
2. Spurs (RAISE TONGUE and AP RETRACT):
   1.  Lower arch appliance with spikes

Changes in tongue position with cribs / spurs  

·      Less AP movement of the tongue (AP retraction),

·      Raises tongue (for spurs) Schwestka 1995

·      Reflex arc –  Contact = pain =  retract tongue AP

Does it hurt?

• VAS 0-10 = very low = 0-2 Pts had spurs upper and lower

Protocol

1.     High or horizontal  tongue position:

• Use fixed palatal cribs, used through mixed dentition

2.     Low or very low tongue:

•  RPE (tongue raises following RPE Ozbek 2009)
•  Spurs lower arch, used through mixed dentition

Stability protocol:

• 2 stage approach – assess in interval between myofunctional appliance and fixed appliances

Retention protocol:

Stable

• Bonded retainers

Unstable

• Bonded retainers + spurs lower arch

Treatment stability relapse

• 25% orthodontics only Greenlee
• 18% orthodontics and surgical treatment Greenlee
• 0-17% Myofunctional Huang 1990

Quality of Life

•  OHR QOL AOB management with palatal cribs correction = positive change more than 10 points: Pithon 2019

References

Stability of AOB treatment, surgical Vs non-surgical

Greenlee, G.M., Huang, G.J., Chen, S.S.H., Chen, J., Koepsell, T. and Hujoel, P., 2011. Stability of treatment for anterior open-bite malocclusion: a meta-analysis. American journal of orthodontics and dentofacial orthopedics, 139(2), pp.154-169.

Quality of life and AOB

Pithon, M.M., Magno, M.B., da Silva Coqueiro, R., de Paiva, S.M., Marques, L.S., Paranhus, L.R., Tanaka, O.M. and Maia, L.C., 2019. Oral health–related quality of life of children before, during, and after anterior open bite correction: A single-blinded randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics, 156(3), pp.303-311.

Diagnosis and treatment Dr Artese paper

Artese, A., Drummond, S., Nascimento, J. and Artese, F., 2011. Criteria for diagnosing and treating anterior open bite with stability. Dental Press J Orthod, 16(3), pp.136-61