Опубликовано11.11.2018 в 02:32АвторZurisar

Anterior Openbite Braces

Progressive pictures of a patient showing treatment of an open bite due to tongue thrust. Note the dramatic reduction in the open bite simply by controlling the anterior posture of the tongue.

For mild open-bite malocclusions 1 to 3 mm , placing step bends and meticulous bracket positioning can help reduce the open bite without any significant side effects. In this patient, the anterior brackets were placed more gingivally as compared to the posterior brackets, to aid in correction of the open bite. Treatment is usually targeted at obtaining a positive overlap of the maxillary and mandibular incisors. There is no consensus as to the optimal therapy for AOB.

It can be treated by moving the teeth in the alveolar bone and soft tissue housing by employing interarch orthodontic mechanics. It can also be treated surgically by moving the skeletal bases. Behavior-modifying appliances might be indicated when digit sucking or interincisal tongue posture is identified. The patient shown in Figure 1 presented with the chief complaint of a gap between the upper and lower teeth and tongue thrust.

A tongue crib was placed to control the habit. After 6 months of active wear, the tongue thrust was sufficiently contained to begin fixed appliance orthodontic treatment. We strongly recommend tongue crib therapy before starting fixed appliance therapy.

We also recommend leaving it in the mouth during active orthodontic treatment as long as it does not interfere with treatment. Aesthetic diagnostic considerations also play a vital role in instituting the appropriate mechanics for open-bite correction.

Inadequate incisor display warrants extrusion of the anterior teeth for optimal smile aesthetics. However, if there is a gummy smile or excessive display of the incisors, we recommend intrusion of the posterior teeth using temporary anchorage devices. Box elastics extrude and tip the incisors back, as the force applied is usually anterior to the center of resistance Cr of the incisors.

This creates a clockwise moment, thereby limiting the amount of overbite or overcorrection that can be obtained.

A step bend, on the other hand, extrudes the anterior teeth but also creates a counterclockwise moment on the posterior segment that tends to worsen the existing open bite by tipping the posterior teeth forward6 Figure 3.

Although step bends have been shown to work efficiently in minor open bite cases less than 3 mm , severe cases might show worsening of the open bite with loss of torque control over the incisors. The step bend creates equal and opposite forces on the anterior and posterior segments green arrows.

However, the moments in blue are in the same direction, causing worsening of the open bite condition by canting the posterior occlusal plane. An extrusion arch in blue tied to a rigid anterior segment creates a one-couple force system that generates a single force F anteriorly in green.

The moments M generated in blue are counteracted by another set of moments in red using elastics yellow as shown. This example is assuming that the center of resistance of the posterior segment is between the roots of the premolars. Using a one-couple force system in the form of an extrusion arch7 can overcome the problems encountered with step bends or anterior vertical elastics.

Inserting the extrusion arch into the bracket slots of the anterior teeth, as is commonly done with continuous arch mechanics, creates statically indeterminate force systems.

A more viable option is to tie the extrusion arch over the anterior segment to create a single point of force application8 Figure 4. Once ligated, the extrusion arch delivers a single force at the anterior segment, which passes through the center of resistance of the anterior unit with no associated moment.

This causes rotation of the posterior occlusal plane that tends to open the bite further. This can be controlled by using seating elastics from the upper cuspids to the lower arch Figure 4.

The extrusive force of the elastics is anterior to the Cr of the upper posterior segment, creating a moment that negates the moment created by the extrusion arch. The sum of all forces and moments results in a pure intrusive force on the posterior segment and an opposite and an equal extrusive force on the anterior segment. The preferred archwire on the anterior and posterior segments is stainless steel,.

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The extrusion arch can be a. The magnitude of extrusive force used is around 40 g for the four incisors Figure 5. Retention The problem of retaining open bite corrections is one of the biggest challenges facing orthodontists. In our experience, relapse tendency can be minimized if a habit-breaking appliance or a tongue crib is used for at least 6 months prior to any incisor extrusion mechanics.

A silicone positioner is often helpful if used for 4 hours during the day and during sleep for at least 6 months. We suggest using lingual upper and lower fixed retainers.

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After the positioner use, a wraparound retainer for the upper arch is better than a conventional Hawley, as our objective should be to prevent wires between the occluding surfaces. A case report based on Figure 4 illustrating the application of elastics and an extrusion arch in the successful management of an open-bite malocclusion.

1 Jul Anterior open bite (AOB) is characterized by “insufficient overlap of the anterior open bite include employing anterior box elastics or placing a.

Note how the judicious application of elastics in combination with the extrusion arch results in the correction of the open bite and also provides the necessary overcorrection for long-term retention. Prevalence of malocclusion and orthodontic treatment need in the United States: Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia.

An epidemiological study related to different stages of dental development. Burford D, Noar JH. The causes, diagnosis and treatment of anterior open bite. Ngan P, Fields HW. Uribe F, Nanda R. Efficient mechanics and appliances to correct vertical excess and open bite. Nanda R, Kapila S, eds. Current Therapy in Orthodontics. Vertical-dimension control during en-masse retraction with mini-implant anchorage.

Am J Orthod Dentofacial Orthop. Force systems from an ideal arch. Management of open bite malocclusion. Biomechanics and Esthetic Strategies in Clinical Orthodontics. The Connecticut intrusion arch. Orthodontic treatment of anterior open bite. Int J Paediatr Dent.

Progressive pictures of a patient showing treatment of an open bite due to tongue thrust. Note the dramatic reduction in the open bite simply by controlling the anterior posture of the tongue.

26 Jul My treatment includes regular braces and elastics. My...
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25 Mar The first challenge is closing the open bite...
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Orthodontic Open bite Movie Collection

Orthodontic elastics, or rubber bands, are used along with braces...
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{REPLACEMENT-(Зайцев.нет)-(}Emergency Info Elastic Wear Rubber Bands Orthodontic elastics, or rubber bands, are used along with braces to add extra force to the braces to enhance orthodontic tooth movements. The most difficult part of wearing elastics is getting accustomed to them. The energy that the elastics provide can also create some temporary discomfort, and wearing them properly helps this to pass quickly, often in less than a week. Below are some important fun facts about the rubber bands:

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