Anterior Open Bite Treatment With Bonded Spurs Associated With Build-ups Versus Conventional Bonded Spurs
Condition: Malocclusion; Open Bite
MeSH terms: Malocclusion; Open Bite
Study type: Interventional

Summary: 
      This study compares the dentoalveolar and skeletal effects of bonded spurs associated with
      build-ups versus conventional bonded spurs in the early treatment of anterior open bite
      patients. Half of participants will be treated with bonded spurs associated with build-ups,
      while the other half will be treated with conventional bonded spurs.

      The null hypothesis to be tested is that there are no differences for the dentoalveolar and
      skeletal effects between the two protocols.
    

Detailed description: 
      Anterior open bite is commonly related with lower anterior face height increase. Some early
      treatment protocols use appliances that control deleterious habits associated to appliances
      that produce control of the vertical dimension. Usually, these appliances (chincup, removable
      orthopedics) depend on patient's collaboration. Recently, the efficiency and stability of
      anterior open bite treatment with resin blocks bonded to the posterior teeth (build-ups)
      associated with fixed orthodontic appliances was described. They could be considered as a
      promissory alternative for vertical control during anterior open bite treatment. Then, it
      could be thought that the association of bonded spurs with posterior build-ups, instead of
      chincup, would produce vertical control during anterior open bite early treatment without the
      need of patient collaboration. Therefore, the aim of this study is to compare the
      dentoalveolar and skeletal effects of bonded spurs associated with build-ups versus
      conventional bonded spurs in the early treatment of anterior open bite patients.

      For this, patients will be recruited at the Orthodontic Clinic of Bauru Dental School,
      University of São Paulo, Brazil. Fifty patients between 7 and 11 years old diagnosed with
      anterior open bite greater than 1 mm will be prospective and randomly allocated in one of the
      two study group. The experimental group will consist of 25 patients treated with bonded spurs
      associated with build-ups. Control group will consist of 25 patients treated with
      conventional bonded spurs.

      Lateral radiographs and digital dental models will be obtained at the beginning (T1), 12
      months after treatment (T2), and 24 months after treatment (T3). Dentoalveolar and skeletal
      variables will be evaluated from the lateral radiographs in the Dolphin® software. Dental
      casts will be analyzed with the Orthoanalyzer® software to evaluate dentoalveolar anterior
      vertical development, posterior teeth inclinations and arch dimensions. Superimposition of
      digital dental models will be performed to evaluate the relative three-dimensional
      dentoalveolar changes on the maxillary and mandibular arches. Discomfort, pain and quality of
      life will be evaluated using questionnaires.

      After verifying the normal distribution, intergroup comparisons (T1 vs T2 and T1 vs T3) will
      be performed with t test and intragroup comparisons with dependent t test. Results will be
      considered statistically significant at P<0.05.

      The possible harms that could appear with these therapies are related to temporary tongue
      discomfort during the first days after the installation of the appliances. Patients and
      parents will be informed that is it normal. Although it has been reported that the discomfort
      is temporary and transitory and usually patients adapted to the treatment after 3-5 days,
      patients or parents will be able to stop the treatment at any moment.
    

Intervention name(s): Bonded Spurs associated with posterior build-ups; Conventional bonded spurs
Intervention type(s): Device; Device
Intervention description(s): Twenty-five patients will be treated with bonded spurs associated with posterior build-ups. The cervical portion of the palatal surfaces of the maxillary incisors and the incisal portion of the lingual surfaces of the mandibular incisors will be pumiced, rinsed, dried, and acid etched with 37% phosphoric acid. The etched surfaces will be subsequently rinsed and carefully dried. Then, the spurs will be bonded using Transbond primer/adhesive. The positions for the spurs will be chose to prevent possible future occlusal interferences The spurs will be sharpened with a carborundum disk before bonding. In addition, posterior build-ups (resin blocks) will be cemented on the functional cusps of all maxillary posterior teeth. The treatment time will be 12 months. After this time, the posterior build ups will be removed and the bonded spurs will be maintained for 12 months more, as active retention.; Twenty-five patients will be treated only with bonded spurs. The bonding of the spurs will follow the same protocol described for the experimental group. The treatment time will be 12 months. After this time, the bonded spurs will be maintained for 12 months more, as active retention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Open Bite; Orthodontic appliance; Cephalometry; Dental models