ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Stability of Treating Open Bite with Maxillary Posterior Intrusion Using Absolute Anchorage Vs. Surgical Correction
Clinical Question What is the stability of intruding maxillary posterior teeth to correct an open bite when compared to surgical correction?
Clinical Bottom Line Research indicates that the most stable way to correct an anterior open bite is with surgery. The problem is that these various studies have different definitions of success and relapse. Therefore one should consider surgical correction vs. non-surgical correction on a case-by-case basis to determine which treatment is best. (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) 20889043Baek/20109 adults with anterior open biteCase series
Key resultsPrevious studies show that surgical treatment of open bites with a LeFort I osteotomy have a range of 7-21% relapse rate. Other studies show a 30% relapse rate for treatment of anterior open bites with intrusion of the mandibular posterior teeth. This study concentrated on intruding maxillary posterior teeth with mini-implants as anchorage. The maxillary posterior teeth were intruded by an average of 2.39 mm which allowed the mandible to rotate forward and a decrease in the ANB occurred (mean 0.66 degrees). An average of 0.99 mm reduction in overbite occurred during the first year. After 3 years the patients were recalled again and the average reduction in overbite from post-treatment to 3 years was 1.20 mm. This was an average of 17% relapse in overbite after 3 years.
#2) 10832998Proffit/200054 patients with >2mm open bite occlusionRetrospective Case Series
Key resultsThis study concluded that a >2 mm decrease in overbite rarely occurred beyond 1 year after surgical correction. The overall conclusion is that when the maxilla is moved superiorly in the treatment of anterior open bite there is a 10% chance of 2-4 mm relapse long term.
Evidence Search orthodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND anterior[All Fields] AND ("open bite"[MeSH Terms] OR ("open"[All Fields] AND "bite"[All Fields]) OR "open bite"[All Fields])
Comments on
The Evidence
The study by Baek was a retrospective study which only had 9 subjects. The lack of subjects makes it very difficult to determine the stability of this treatment. Any outliers would greatly affect the means of this study, making the results unreliable. The study by Proffit concluded that there was only a 10% relapse of 2-4mm after surgical correction. They do not indicate what the percentage of overall relapse was (<2mm), so it is difficult to compare the overall stability of surgery vs non surgery when correcting anterior open bites.
Applicability Many patients present with anterior open bites. It is important to know that there are other treatment options besides surgery to help correct these malocclusions.
Specialty/Discipline (Oral Surgery) (Orthodontics)
Keywords stability open bite, maxillary intrusion, absolute anchorage, surgical correction
ID# 731
Date of submission: 11/15/2010spacer
E-mail zirbel@uthscsa.edu
Author Cassandra Zirbel, DDS
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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?)
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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 Jaclyn Vu, Stephanie Lomeli, Ryan Chenausky (San Antonio, Texas) on 01/06/2014
A PubMed search on this topic was conducted on January 6, 2014 and found a more recent publication on the efficacy of implant-anchorage devices: Deguchi 2011, PubMed: 21435540 . The RCT included 30 individuals and concluded that implant-anchorage can achieve ideal occlusion in adults with severe open bite.
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