Non-surgical orthodontic treatment of open bite in an adult patient

Signs Causes Types Complications Diagnostics Treatment Methods Prevention Doctors Work
Malocclusion occurs in different forms. One of them is an open bite. It is recorded quite rarely - up to 2% of patients have such an anomaly. In 12% of children under one year of age, improper closure is noted, by 6 years - 5.6%, and in adults the percentage is very small - 1.8 - 2%.

What is an open bite

Open bite - incomplete closure of the frontal row of teeth or lateral sections. A vertical gap is formed, which causes not only an aesthetic problem, but also functional disorders. Quite often, this type of pathology can be combined with another form of occlusion, and it is necessary to treat a distal or mesial open bite.

Diagnostic methods

The diagnosis is made based on complaints and examination of the oral cavity. To determine the form of the disease and the degree of occlusion, additional examination methods are used.

Orthopantomography is an informative diagnostic method. The picture shows not only the relative position of the teeth, but also the structure of the jaws. Additionally, X-ray cephalometric analysis is used. To determine treatment tactics, the orthodontist makes impressions of the jaws and creates an artificial model. It allows you to determine the exact parameters of the deviation of each tooth from its normal position.

If the disease is secondary and associated with chronic processes in the nasopharynx, an ENT consultation and treatment of the underlying disease are necessary. Only after this is orthodontic correction performed.

Signs

Visual signs of an open bite:

• a downwardly displaced chin and an enlarged lower part of the face;
• half-open mouth;
• the upper lip is narrow and tense at the moment of closure;
• the sky is shifted down and back;
• the nasolabial fold is smoothed.

Intraoral symptoms:

• vertical interdental gap;
• the first molars close in their normal position, but the incisors do not;
• trapezoidal shape of the lower jaw;
• the jaw arches narrow;
• crowding of the lower incisors due to lack of space;
• the height of the lateral parts of the jaw is greater than usual;
• the mucous membrane is often inflamed, the gingival papillae are deformed;
• macroglossia (enlarged tongue).

Lisp and slurred speech are also one of the signs of pathology. The patient breathes frequently through his mouth. Swallowing is infantile. It is difficult for him to bite off due to a violation of the closure of the teeth and chew food.

Symptoms and signs

Diagnostics:

1. Biting and normal chewing of food is difficult. The main role in this process shifts to the tongue, which helps form the food bolus. The whole process is characterized by specific hinge movements of the jaw.
2. Articulation is impaired and the pronunciation of some sounds is difficult.
3. The so-called infantile or infantile swallowing is observed.
4. Breathing occurs primarily through the mouth, so the mucous membrane is most often dry.
5. The lips are usually closed tightly to hide the defect. However, when the mouth is open, you can see the edges of the teeth and the tongue covering the gap.

The severity and degree of manifestation of symptoms directly depends on the distance between non-closing teeth. With an open bite of 1st degree it does not exceed 5 mm, 2nd degree - 9 mm, 3rd degree - more than 9 mm. The number of loose teeth is also a diagnostic sign.

When deformation occurs under the influence of childhood bad habits, the bite may be asymmetrical or crossbite. The latter, for example, is often a consequence of constant thumb sucking in infancy.

A regular pacifier can have a great influence on the formation of an open bite in a child under 2 years of age. The issue of its selection must be approached especially carefully.

Causes of open bite

An open lateral bite or improper closure of the front teeth can be a consequence of both acquired and genetic causes.

The occurrence of abnormal occlusion is influenced by the following points:

• heredity;
• abnormalities in intrauterine development (maternal illness, stress, medication);
• habits of sucking, chewing objects, or keeping the tongue half-protruded between the teeth;
• bone diseases;
• underdeveloped alveolar process;
• jaw injuries;
• ENT diseases and habit of mouth breathing;
• macroglossia;
• change of milk teeth early/late.

What it is

In dentistry, the concept of “bite” was introduced to describe the method of closure of the upper and lower dentition. Normally, by a certain age, a person should have formed a so-called physiological bite, which is characterized by a certain set of properties:

• each of the teeth must close with two antagonists in a certain order;
• the incisors of the upper jaw cover the incisors of the lower jaw;
• the upper canines slightly obscure the lower ones, and so on.

If any of the above conditions are not met, then we are talking about a certain developmental pathology.

An open bite is a disorder in which the upper and lower jaws do not meet completely.

In addition to the aesthetic aspect, such a complication can pose a potential health hazard, for example, provoke the appearance of ENT diseases and speech disorders. Loose teeth create difficulties when chewing food, which subsequently leads to severe disturbances in the functioning of the gastrointestinal tract.

The most common malocclusion is in the frontal region; less often, a similar pathology is recorded in the lateral rows of teeth.

Timely diagnosis can significantly simplify treatment, so it is extremely important not to miss a preventive visit to the dentist.

Types of open bite

Before an open bite is corrected, it is classified.

By etiology (causes of occurrence):

• false.
  A common cause is premature loss of baby teeth. And also bad habits. A false open bite is also called traumatic. The anomaly has the character of an increasing complication. And, if correction is not made at an early age when changing the primary bite, hardware treatment may be required.
• true.
  Treatment of open bite teeth of this type is more difficult. Since it is based on a bone disease, rickets. Patients have difficulty breathing, dry mucous membranes, more obvious speech defects and facial signs of the disease. Sometimes, to correct an open bite in an adult, it is necessary to involve not only an orthodontist, but also other specialists.

By location:

• lateral
  open bite. Non-occlusion of teeth in the lateral region. Occlusion can be unilateral or bilateral. There are 2 or several units in the problem area.
• anterior
  open bite. The most common type. 4-8 teeth of the frontal group are involved in the problem.

There are mandibular open bite, maxillary and combined. Symmetrical, asymmetrical.

Another classification:

• dentoalveolar
  open bite. The roots of the teeth are shortened;
• gnathic
  _ The disturbances occurred due to changes in the shape of the jaw.

The degree of occlusion pathology is noted based on the size of the vertical gap: up to 5 mm - I degree, up to 9 mm - II degree, more than 9 mm - III degree.

Prognosis and prevention

There are no clear opinions regarding the prognosis of treatment for open bite. It all depends on the nature of the pathology, as well as the therapy that is used. Often, with proper treatment, the patient can completely or partially get rid of the defect. Typically, doctors strive to eliminate functional malocclusions, restoring the patient’s ability to chew food and speak normally. After this, they begin to correct aesthetic defects. With a competent approach, it is possible to achieve high-quality results.

As for the prevention of open bite, it includes the following steps:

1. In the prenatal period – giving up bad habits, eating a balanced diet, monitoring test results, etc.
2. In the postnatal period - ensuring that the child does not suck his finger or other foreign objects, breathes through his nose and does not stick out his tongue.

It is also very important to regularly visit a dentist, who can always identify a malocclusion at an early stage and prescribe effective treatment.

Possible complications

Open vertical occlusion does not remain without consequences. The aesthetics of the face and smile suffer, difficulties develop in other functional departments:

• Digestion is disrupted due to problems with biting and chewing;
• the person has a lisp, and with a large gap, speech is slurred;
• The TMJ (temporomandibular joint) experiences difficulties, muscle tone decreases;
• the condition of the periodontium worsens (it experiences excessive load);
• the abrasion of the enamel of the teeth, on which all the work “falls”, increases, they are more loaded and experience increased pressure;
• Mouth breathing develops problems with the ENT organs and respiratory system.

Treatment in children and adults - a fundamental difference

No matter how scary and unpleasant a malocclusion may look, it can still be treated.

Of course, we are not talking about a magic pill that will solve all problems.

This is a long and painstaking path that the patient must go through under the clear guidance of a specialist.

It is advisable and correct to begin treatment in childhood, when the bite is at the stage of formation. In this case, a special set of myogymnastic exercises for the muscles of the face and tongue is prescribed. A correctly selected complex at the right age makes treatment of open bite in children as effective as possible. The orbicularis oris muscles become stronger and exert the necessary pressure on the bones of the jaw and teeth, forming the necessary bite.

It is advisable to do such exercises with a child who can repeat them and perform them correctly, without turning the procedure into pampering

It is not always possible to solve a problem with gymnastics. Then a whole arsenal of orthodontic devices comes to the rescue. At a young age, it is easiest for a child to suck on a special orthodontic pacifier. It is made from ordinary latex and differs from the usual one only in shape.

Starting from the age of 2, it makes sense if the pacifier is replaced by an elastic plate, which will allow you to give up not only the pacifier, but also a number of bad habits. Starting from the age of 4, vestibular plates have shown their effectiveness. At an older age, when a permanent bite begins to form, various orthodontic trainers are prescribed, which not only combat childhood habits, but also directly affect the formation of the facial skeleton.

Myogymnastics must be performed every day. You don’t have to set aside special time for this by doing a series of exercises while watching your favorite TV shows. You can increase the effectiveness of exercises using special devices. Rogers shock absorber, Friel interlabial disc, Dass activator - a whole “gym” for the muscles around the mouth.

The main goal, which is achieved through the use of these devices, is to change the tone of the masticatory muscles, return the growth of bone tissue to normal, normalize the function of the tongue, and improve the swallowing function.

There are also a number of systems and devices for permanent wear that correct the bite at the bone level:

• Klammt activator
• Frenkel apparatus
• Herbst apparatus
• Expansion plates on springs
• Vestibular arches, etc.

This is not the entire list of activators and devices used to correct bites. The specialist knows and makes a decision for each individual case. Sometimes you even have to resort to plastic surgery of the frenulum of the tongue to restore its mobility.

Although the problem of open bite is typical for children, adult patients often come to the clinic. Some, for unknown reasons, did not go to the dentist on time, and for some, the bite changed due to a number of traumatic factors.

Treatment in adults is a more complex and protracted process. The whole problem is that the dentition has already been formed, and jaw growth has stopped. But this does not mean that nothing can be done. There are many methods and devices for correcting an already formed bite in the later stages of development of the anomaly.

You can use removable aligners and devices, but they are significantly inferior to non-removable structures, such as braces or the Engle device. Treatment with braces is carried out in combination with the installation of special rubber rods.

But if after braces there is no visible result, and this happens, then you have to wear special crowns that change the height of the bite.

Good results are achieved using the Engle and Cojocaru apparatus. A special arc made of thin wire with special hooks for elastic shock absorbers (rods) is placed on the upper or lower, or both, with the help of which it is possible to achieve the necessary jaw traction.

The movement of the anterior teeth can be achieved not only through rods, but also using an expansive Angle arch. To do this, the target teeth are covered with crowns with hooks, the arch is bent in the direction of the required displacement and fixed in the hooks. A special metal with a memory effect strives to return to its original position and thus gradually pulls the teeth along with it to the level we need.

These methods still have a small drawback; they do not solve the aesthetic component of the problem. They don't change their face. And if the patient has a shortened lip, then after such traction, he simply will not close his lips and will be in a state of permanent smile, which is also not the best option.

Correction of the situation is achieved by using bite plates, which allow you to reduce the height of the bite to the required distance.

Their particular advantage is that they make it possible to reduce the height of the jaw on the sides and significantly improve the patient’s appearance.

And all this without the help of plastic surgeons and scalpels. But this is not always possible.

In some cases, radical surgical intervention cannot be avoided. This affects adult patients more than children due to stunted jaw growth. Then decortication is performed and the jaw bone is excised in the shape of a triangle to change the angle of its inclination.

The operation involves the removal of the first molars and filing of the cortical layer and is performed through the oral cavity under anesthesia. Before excising a section of the jaw, the orthodontist is faced with the task of preparing an apparatus for postoperative correction of the jaw. The strongest teeth – the last molars – are prepared for crowns. Special rubber rods will be attached to them, the other end of which is attached to the front teeth.

In the postoperative period, under the influence of traction, the jaw will gradually change its bend in the area of ​​decortication (where the tooth was removed).

A distraction device is used in a similar way. It requires activation and constant monitoring in the inpatient setting of the maxillofacial surgery department. The device is activated at 0.2 mm per day in the first week after surgery. Then it is necessary to correct the plastic part of the device so that it acts as a retention device for the next two months.

After any type of surgery, patients are advised to wear an external device, similar to a soft sling, on the chin and secured to the back of the head. Over the next 6-8 months, the patient will need to remove the permanent retainer and use the removable one only at night to allow the jaw to wean itself off the device.

Diagnostics

In addition to a visual examination, the orthodontist can measure the gap and assess the degree of open bite for further treatment. There is a possibility of direction for more in-depth research that will give a complete picture:

• teleroentgenogram;
• orthopantomogram;
• taking impressions.

Often a specialist sees the presence of a combination of disocclusions: distal open bite, mesial.

To collect information about the patient and the progress of the correction, before and after photos are taken.

Price

The table shows the approximate cost of correcting an open bite in a child.

Open bite correction is recommended during childhood. During this period, the jaws are actively forming. This is very difficult for adults to do; they have to remove teeth growing in the wrong place, followed by prosthetics.

Options and stages of treatment for open bite

In Moscow dental clinics, doctors offer various open bite treatment systems. But, as a rule, they are based on generally accepted correction principles.

Important!

The first stage of any treatment is to eliminate bad habits. This includes thumb sucking, the need to chew something and put the tongue back in its place so that it does not put pressure on the teeth. There is a special design for this with mini-spikes; when you try to push the tongue forward, the resulting discomfort teaches you not to do this.

Treatment of open bite in children

• myogymnastics.
  A set of selected exercises will allow you to correct the position of your teeth and train the muscles of the jaw apparatus. Gymnastics are done regularly, independently or with devices: Friel disk, Rogers shock absorber.
• activator.
  When changing the bite, the activators are fixed so that the front teeth do not exert pressure, everything is aimed at correcting those elements where the pathology is located. A tongue rest is provided. The designs come in different varieties and are supplemented with screws, etc., depending on the complexity of the pathology. Activators of Rogers, Klamt, Schwartz apparatus, etc.

Correction of occlusion in mixed dentition:

• myogymnastics;
• fixed systems;
• Engle's apparatus.

Plates with a vestibular arch, springs and a lock have proven themselves well. Metal hooks and rings are attached to the teeth that need to be moved. This happens due to tension.

Correction of open bite in adults

For patients with permanent dentition or at the end of the shift period, the emphasis is on jaw extension:

• orthodontic plates;
• braces with reversible arches;
• trainers, aligners.

A - braces, B - plates, C - trainers, D - mouthguards

Patients of the same age category may be prescribed different methods for treating occlusion disorders. It depends on the specific clinical picture, etiology, and degree of deviation from the norm.

Sometimes the only option left is surgical treatment. As a rule, the work of orthodontists comes first. With the help of a braces system, teeth are rotated into the correct position, if necessary, removal occurs. Then the maxillofacial surgeon begins. The jaw bone is dissected and returned to its normal position using plates and structures. After healing, braces are used again. The treatment is long, but this is the only way to achieve an excellent result and consolidate it with a strong degree of pathology and complicated accompanying deviations from the norm.

Causes

The causes of open bite can be divided into prenatal and postnatal. The first group includes the following:

• various unfavorable hereditary factors;
• infectious and somatic diseases suffered by the woman;
• bad habits and unbalanced diet of a pregnant woman;
• severe toxicosis.

All these factors can influence the process of bite formation in primary and permanent teeth. In this case, more serious concomitant pathologies may develop, such as cleft lip, deformation of the entire jaw, etc. Therefore, when identifying any malocclusion, it is important to conduct a comprehensive examination.

An open bite may develop in the postnatal period due to internal or external factors. In the first case, we are talking about a lack of certain microelements in the body, as well as a violation of metabolic processes.

Another common cause of malocclusion is that the child has problems with nasal breathing. In this regard, he begins to systematically breathe through his mouth, getting used to keeping it open. If parents notice such features, they should check the structure of the nasopharynx, especially the nasal septum, as soon as possible and begin treatment. Otherwise, the child may develop not only an open bite, but also other jaw pathologies.

The group of external factors includes the following:

• the child’s habit of biting nails or other foreign objects, for example, toys, pen caps, etc.;
• thumb sucking during the eruption of baby teeth;
• frequent protruding of the tongue between the teeth with the mouth open.

Often in these cases, the very form of the malocclusion begins to resemble the outline of the object that the child held in the mouth - a finger, a toy, etc.