Join me for a topic summary looking at anterior openbites from the AAO. This summary looks at the differences in key diagnostic criteria, the options for treatment planning, and the evidence to support time. The summary is taken from Roberto Carrillo, Flavia Artese and Ravi Nanda’s lectures.

Separate treatment plan:

· treatment of the aetiology

· Treatment of mechanics

Aetiology

Tongue posture / thrust or mouth breathing, alter equilibrium of AP and vertical tooth position.

· Tongue posture / thrust

o Forwards position, not thrust / swallowing, as low intensity and duration

o Different positions of tongue being forwards, results in different presentations of AOB, high = proclined uppers, horizontal bi-proclination, low procline lowers

o See previous podcast on Flavia Artese in her Power2Reason lecture

· Mouth breathing

o Mouth breathing in itself is not considered factor for Tonsillectomy AAO-HNS guideline

Treatment

Extend of AOB does not determine treatment, Facial type and extent of AOB poor correlation r=0.2 Duplat 2016

o

· Habit dissuader crib or spurs:

o High tongue block tongue

o Low tongue block and redirect

o Removable – Aligner with lingual attachments, poke probe through and becomes uncomfortable

· Adults like as removable, bonded is difficult to accept Voudouris 2022

o Cribs and spurs- relapse 17%  Huang 1990

§ Effective reduction in tongue forces and position at 1 year Taslan 2010

· Myofunctional therapy

o Speech and language therapy – relapse 4% Smithpeter 2010

· Dental:

o Incisor extrusion - relapse 38% Janson 2003

o Molar intrusion - relapse 27% Espinosa 2020

o Extractions – relapse 25% Janson 2006

· Skeletal:

o Surgery – relapse 25% Greenlee 2011

Posterior intrusion

· Screws / plates = depends on anatomical limitations

Skeletal anchorage with aligners

· Ct approach = C cuts and T-triangular elastics

· C-cuts – through OCCLUSAL and buccal surface to prevent deflection premolar to molar

· Pre-load elastics and then insert into the patients mouth

· Posterior intrusion

Lecture titles from AAO 2022

Key factors for vertical control with clear aligners Roberto Carrillo

Game changers in open bite treatment – Dr Flavia Artese

Biomechanic & Esthethic based management of open bite - Dr Ravi Nanda