Orthotown Jan/Feb 2016 - (Page 32)

case presentation // feature Treatment of Open-Bite with Mini-Screws and Segmental Mechanics by Edmund Khoo, BDSc (Hons), ABO, FICD Contributing authors: Tali Elfersi, Alejandro J. Lopez, Tatiya Ungphakorn, Justin Bair, Tom Lien Fig. 1 Introduction The open-bite patient often presents with one of the most difficult and challenging malocclusions for clinicians to treat. 1, 2 The American Board of Orthodontics Discrepancy Index denotes two points per millimeter, per tooth for open-bites and two points for an SN-MP plane greater than 38 degrees, with an additional two points per degree beyond that. It is not hard to see that open-bite patients typically score very high on the discrepancy index, which is a measurement of case complexity.3 The determination of whether an open-bite is truly skeletal or dental often requires analyses on multiple aspects. Skeletal profi le divergence and increased lower facial height typically correlate with skeletal components, whereas anterior teeth proclination and incisal display at rest and smiling are parameters used to determine dental components. Often the open-bite has a combination of both skeletal and dental components. The etiology of the open-bite is yet another area of contention, with a vast myriad of "culprits" ranging from genetics, mouth-breathing and weak musculature to tongue-thrusting and thumb-sucking habits.4, 5 Open-bites are treated using a variety of methods. Extraction of teeth (such as premolars) to reduce the so-called wedge effect and close open-bites has been touted, although research has shown that the wedge-effect phenomenon is questionable, at best.6 Orthognathic surgery is also another popular option, but it is 32 Fig. 2 not without associated risks and possible complications. Long-term studies have also shown significant relapse, even after orthognathic surgery.7, 8 In this case report, we will present and discuss the nonextraction treatment of a severe open-bite with the use of mini-screws and segmental mechanics. JANUARY/FEBRUARY 2016 // orthotown.com Clinical diagnosis An 11.5-year-old female patient presented to our clinic with the chief complaint of her front teeth not touching. Soft-tissue and facial analysis revealed a dolichofacial profile with a slight increase in anterior facial height-both lips were ahead of the E-line by about 2mm. Intraoral examination http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown Jan/Feb 2016

Orthotown.com Highlights
Embrace Progress: You Can’t Fight Mother Nature
Transfer Case: Can I Finish Without Surgery?
Best Direct Bonding Protocol
Class III Treatment in 15 Months
Go Beyond Accommodating: Working with Extra-Needs Patients
Treatment of Open-Bite with Mini-Screws and Segmental Mechanics
Cali Orthodontist an Engineer of New Smiles
Poll
Serendipity and the Right Technology: One Orthodontist’s Story
Townie Choice Awards 2015: Townies Have Spoken!
12 Marketing Tips for Orthodontists in 2016
Ad Index

Orthotown Jan/Feb 2016