ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Surgical Versus Non-Surgical (Skeletal Anchorage) Treatment of Adult Anterior Open Bite
Clinical Question In a middle-aged male patient with an anterior open bite and Class II malocclusion, how effective is orthodontic treatment combined with surgery compared to orthodontic treatment alone in correcting the open bite?
Clinical Bottom Line Skeletal anchorage and osteotomy appear to be equally effective methods in treating anterior open bites in young adults. However, the evidence available is weak. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18005833Kuroda/2007Adults treated with skeletal anchorage (n=10) or orthognathic surgery (n = 13)Non-Randomized Controlled Study
Key resultsPretreatment and post treatment lateral cephalograms suggest that subjects with overbites less than -3.0 mm treated with skeletal anchorage compared to LeFort I osteotomy combined with mandibular osteotmy achieved comparable results in terms of reducing facial heights (P = .4380) and increasing overbites (P = .9753) [i.e., not statistically significant]. The surgically treated subjects achieved significant incisor elongation (4.6 mm, P<.01).
#2) 15387036Kuroda/2004 1 (33 y.o. female)Case Study
Key resultsThe use of titanium screw anchorage and elastics successfully intruded this patient’s upper and lower first molars, improving her occlusion and rotating the mandible upward which improved her retrognathic chin and convex profile.
#3) 20397511Rachala/2010 1 (20 y.o. female)Case Study
Key resultsThe use of mini screws and coil springs in this patient successfully intruded her maxillary molars to produce good occlusion.
Evidence Search (("Open Bite"[Mesh] OR "Open Bite/surgery"[Mesh])) AND "Open Bite/therapy"[Mesh])) "middle aged"[MeSH Terms] OR ("middle aged"[MeSH Terms] OR "aged"[MeSH Terms]))
Comments on
The Evidence
Compliance and completion rate were adequate for all the studies. Follow-up was sufficient for the duration of the treatments, however, long-term success of the treatments was not monitored. The treatment groups were similar at start, however, the group sizes were very small (n=23 and two case study patients). Skeletal anchorage and surgical treatments used in these studies were very similar to each other; although not exactly the same. It is not clear if these studies were conducted using a double-blind method or if there were competing interests involved. Overall, the evidence available is weak.
Applicability This evidence applies to young adults with anterior open bites. Both non-surgical management using titanium screws and surgical treatments appear to be equally effective in treating anterior open bites in young adults. It is questionable as to how well the results from these studies apply to my patient because he is a male and is much older (51 y.o.) than the subjects who were studied.
Specialty/Discipline (Oral Surgery) (Orthodontics)
Keywords adults, anterior open bite, skeletal anchorage, orthognathic surgery
ID# 716
Date of submission: 09/20/2010spacer
E-mail tongkn@livemail.uthscsa.edu
Author Kimberly Tong
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Elan Lee, Brenna Sura, Allie Cearly (San Antonio, Texas) on 01/07/2014
Tong K presents a question between orthodontic and surgical dental work. Although no evidence was found contrary to the writers claim, additional information was discovered further supporting the use of oral surgery as a correctional procedure (Jensen U, 2010, 21130329 ). Data on successful orthodontic treatment for anterior open bite remains scant.
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