Join me as I summarise Jay Park’s lecture looking at the anterior openbites and their management, with a focus on TADs, the good and the bad.

Part 1

Soft tissue aetiology and controversy

Dental-alveolar correction focus on posterior intrusion

Theories of tongue aetiology and AOB

· Tongue thrust = persistent visceral swallowing pattern for AOB Subtelny 1965

· Resting anterior tongue posture main factor Proffit 1993

Correct theory relates to resting tongue position:

· Anterior resting tongue position remains in between incisors many hours of the day, impedes incisor eruption and maintains AOB R.Juestus 2001

Anterior tongue posture correction

· Tongue anterior and high =  palatal crib.

· Tongue anterior in low = tongue spurs.

Indications for dental correction

1/ Posterior intrusion 2/ Intrusion of anterior teeth

· Intrusion posterior teeth

o Increased LAFH

o Excessive posterior gingiva

o Mild skeletal discrepancy

· Extrusion of anterior teeth

o Normal / decreased LAFH

o No excess gingival display

Posterior intrusion: Bite props as posterior bite plane affect

· 2-3mm of composite placed on the palatal cusp.

· Molar intrusion achieved =  1.5mm Hernandez 2017 17 months

TADS placed in the palate for intrusion

Jae Park combines bite plane effect with TADs

· RME bonded design acrylic capping on posterior teeth , 2 x TADs dento-alveolar region of the palate, between 5-6.

· Powerchain placed over the occlusal surface, from the palatal TAD to the buccal arm on the appliance

TADS with modified TPA

TPA placed with posterior hook for elastic traction

Position of TAD with modified TPA

Palatal dento-alveolar region of the 1st and 2ndmolars

· Ideal place for upper intrusion: Palatal U6-7, as intrusion vector ideal.

· Small interradicular space = challenge to place

· As molars intrude, space reduces in between molars Kuroda 2007

Palatal dento-alveolar region of the 2nd premolar / cuspid and 1st molar

· Easier location for placement

· However tipping of molars mesially occurs due to anterior vector from TAD

· Solution: Intrusion bend on 7s

Negative effects of palatal TADs and intrusion

Palatal cusp intrudes point of application, but buccal cusp doesn’t intrude / hangs down maintain occlusal vertical contact

Solution to negative effects

· Expand with QH and then palatal tad intrusion 2 stage approach, similar to QH, tipping movement then intrusion

· Approx. 300g per side for intrusion

Anterior extrusion

· Tads labially placed distal the upper and lower laterals with pt wearing elastics.