Evaluation Treatment Outcomes of Anterior Open Bite Treated With Maxillary Intrusive Force by Temporary Anchorage Devices
Phase: NA
Conditions: Anterior Openbite Malocclusion
Sponsor: Faculty of Dental Medicine for Girls

 
 
 
Evaluation Treatment Outcomes of Anterior Open Bite 
Treated with Maxillary Intrusive Force by Temporary 
Anchorage Devices. 
 
A proposal 
Submitted to the Faculty of Dental Medicine for Girls, Al- Azhar University 
 In Partial Fulfillment of the Requirement for Master Degree 
 
In 
 Orthodontics  
 
By 
Baian Mohammed Saaid Saaidi 
BDS (2009), Faculty of Dental Medicine misr university for science and 
technology(MUST) 
 
Orthodontic Department 
Faculty of Dental Medicine for Girls 
Al-Azhar University 
16 August  2021
Code  
ORTHO-109-2-G 

 
 
 
Supervisors  
 
Prof. Dr. Samir Abdo Ibrahim 
Professor of Orthodontics  
Faculty of Dental Medicine for Girls  
 Al-Azhar University 
 
 
 
Dr. Amany mohammed Ibrahim Diab 
Lecturer of Orthodontics 
Faculty of Dental Medicine for Girls  
 Al-Azhar University 
 
 
 
 
 
 
 
 
 
 
 

1 
 
Introduction 
 
           Anterior open bite may be defined as: That condition where the upper 
incisor crowns fail to overlap the incisal third of the lower incisor crowns when the 
mandible is brought into full occlusion. Within the limits of this definition, the 
degree or severity of malocclusion may vary from a mild edge to edge relationship 
of the incisor teeth to a severe and handicapping malocclusion(1). 
 
            This type of malocclusion like any other malocclusion is the result of 
certain causes either of hereditary or non-hereditary origin that act pre- or post-
natally on the tissues of the orofacial region. Few malocclusions have a single 
specific cause. more often they are the result of a combination of many factors 
operating within the inherent predetermined growth potential of each individual 
patient(2). 
 
             Morphology of Dental Open Bite: the shape of the maxillary arch will 
show characteristic features related to the etiology. If the malocclusion is due to a 
foreign body (pencil, pipe) being held passively between the incisor teeth, then the 
open bite is localized to the particular teeth involved; they will fail to erupt to the 
occlusal level of the other teeth in the arch. 
 
               The same clinical appearance is evident in cases having ankylosed upper 
or lower incisor teeth. When the malocclusion is as a result of a thumb sucking 
habit, then the upper incisor teeth may be proclined resulting in a V-shaped upper 

2 
 
arch. Due to the increased buccal pressure exerted on the molar teeth by the cheeks 
during sucking, there is a narrowing of the arch in the molar region (3). 
 
            The mandibular incisor teeth are slightly depressed and lingually inclined. 
In occlusion, the anterior open bite has a characteristic appearance. The opposing 
molars and Premolars are in contact, the canines may or may not be in contact, the 
lateral and central incisors are in frank open bite,the mouth has the appearance of a 
'fish mouth(4). 
 
             Cephalometric characteristics as this malocclusion is a dental condition 
rather than a skeletal problem, there are no special skeletal features evident, in the 
maxilla there is no increase in height from the cusp’s tips of the molars to the 
palatal plane, but there may be a decrease in the vertical height measured from the 
mesial edge of the upper incisors to the palatal plan(5). 
 
                In the presence of an increased overjet, the cephalometric analysis will 
show both angular and linear evidence of proclined upper incisor teeth. The 
mandible may show retroclined and crowded lower incisors may result from a 
thumb sucking habit. The alveolar height in this region is not increased(6). 
 
                It is well recognized that anterior open bite malocclusion is one of the 
most difficult orthodontic problems with regard to treatment and stability , they 
recognized that a 'dental malocclusion' has a better prognosis than a 'dento-skeletal 
malocclusion'(7). 

3 
 
 
               The conventional orthodontic treatments for the correction of an anterior 
open bite include bite blocks,high-pull headgear, and new facemask designs. to 
achieve dentoalveolar intrusion of the maxillary posterior segments. Fixed 
mechanics, multiloop edgewise archwires, extraction therapy, intermaxillary 
vertical elastics, and inhibition of molar eruption during growth have also been 
used to treat the anterior open bite. (8-10). 
 
                These modalities have been recommended for intrusion of the maxillary 
posterior segment and anterior dentoalveolar extrusion. However, none of these 
treatment approaches are satisfactory because of negative effects on the skeletal 
and/or esthetic pattern and a serious tendency for relapse (11). 
             
                Recently, dental implants, miniplates, and miniscrews have been used as 
anchorage units in orthodontic treatments. These techniques can supply the 
anchorage that is needed for specific dental movements, regardless of patient 
cooperation. Changes in dentofacial structures resulting from molar and buccal 
segment intrusion with miniplates placed in the zygoma have been shown in many 
studies and case reports, and successful molar intrusion and open bite treatments 
have been reported with miniscrews anchorage(12-13). 
 
                   In this study for management of anterior open bite, temporary 
anchorage devices (TADs) will be use to intrude the maxillary posterior teeth to 
allow auto rotation of the mandible to close an anterior open bite 
 

4 
 
Aim of the study 
 
The present study will be performed to: 
              Evaluate the treatment outcome of anterior open bite by temporary 
anchorage device TADs ( buccal and palatal miniscrows ). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5 
 
Subjects and Methods 
 
Sample size calculation : 
To assess the treatment outcome of anterior open bite through a temporary 
anchorage devices TADs , paired t-test to will be used. A minimum total sample 
size of 10 participants will be sufficient to detect the effect size of 0.9 a power (1-
β=0.80) of 80% at a significance probability level of p<0.05. The sample size was 
calculated according to G*Power software version 3.1.9.3. 
 
Figure1. Paired T-test- total sample size calculations 
 

6 
 
 
             The sample of open bite patients will be taken from the Orthodontic Clinic 
Faculty of Dental Medicine for Girls, Al-Azhar University. 
          The steps of the procedure will be explained to the patients / parents and an 
informed consent will be signed. 
Inclusion criteria: (14) 
1. Patients age range 13-18 years old. 
2. Patients have anterior open bite. 
3. Normal healthy patient. 
4. Patient have healthy oral tissues. 
5. Patient have class I or II jaw relationship. 
6. Patient have complete set of permanent teeth except the wisdom tooth. 
Exclusion criteria :(15) 
1. Uncooperative patient and parents. 
2. patient who had undergo previous orthodontic treatment. 
3. Patient with class III jaw relationship. 
Appliances: 
Maxillary Temporary anchorage devices (TADs) and direct bounded 
attachment buccal and palatal on maxillary posterior teeth. 
Methodology  
− Open bite patient will be collected from Orthodontic Clinic, Treatment 
Center, Faculty of Dental Medicine, Girls, Al-Azhar University. 

7 
 
1) The following record will be taken for each patient before delivery appliance 
and after the appliance removal to detect amount closing of bite achieved: 
− Panoramic and cephalometric X-ray :cephalometric analysis will do 
before and after treatment to detect :ANB Angel , anterior facial hight 
, posterior facial hight, upper incisor inclination , SN line ,FH line . 
− Upper and lower orthodontic cast  
− Extraoral and intraoral photograph 
 
2) Treatment plan: 
-eliminate causative habit by proper selected appliance. 
- dental correction of the open bite problem: 
• Correct the open bite by intrusion posterior teeth with temporary 
anchorage device, miniscrows on buccal and palatal side and intrusive 
force. 
• Smile analysis will do after correction the open bite to evaluate effect 
of intrusion . 
 
 
 
 
 
 
 

8 
 
 
 
 
Statistical analysis: 
 
 
Data will be collected and the amount closing of bite achieved will be 
tabulated and statistical analysis. 
 
Ethical consideration: 
 
 
The research protocol approved by ethical committee of Faculty of Dental 
Medicine, girls, Al-Azhar University, (P-OR-21-05). The steps of the procedure 
will be explained to the patients / parents and an informed consent will be signed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

9 
 
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