Orthotown April 2020 - 20

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High Angle Open Bite, Crowding,
TMJ and Perio Issues
A case involving a patient with multiple issues has Townies discussing myofunctional therapy and its efficacy

NyceBiteR
Member Since: 10/21/08
Post: 1 of 29

Just saw this case for a consultation and am debating where to start. Chief complaint:
Crowding, bite on left doesn't feel right.
She clearly has thin soft-tissue biotype, attachment loss. TMJ symptoms are intermittent
soreness in the jaw muscles, grinding and clenching; however, they are not enough to interfere
with normal activity. She's never been treated for TMD. Condyles appear asymmetric on the
pan, but she had no clicking or limited ROM on examination. Did the tongue push out U3-3?
Is the fi xed retainer no longer passive? Should I refer her to a periodontist first? Myofunctional
therapy? Is this a surgery-or-nothing case? ■

2/12/2020

Fenrisúlfr
Member Since: 02/25/09
Post: 2 of 29

Myofunctional therapy is a scam. That fi xed retainer is what is causing the issue, because of
distortion. I'd remove the retainer ASAP, have her see a periodontist regarding prognosis of the
lower 3-3. She is likely to need SARPE and some combo of upper and lower extractions to get
the teeth to fit, or just SARPE. ■
2/12/2020

justinudm
Member Since: 09/29/14
Post: 3 of 29

20

I agree with Fen. The upper fi xed retainer is active or was active and caused the UL3 to
tipple buccally. This is a high-angle Class 2 skeleton with a somewhat steep occlusal plane. If the
TMD issue is treated with a splint, my guess is she would drop back into a significant Class 2
position. She may have an undiagnosed functional shift and be functioning with her condyles
in a forward position?
If you give a split, warn and get informed consent about the bite changing and the possible
resultant need for jaw surgery to correct the issue if this happens. A SARPE is likely needed to

APRIL 2020 // orthotown.com

OT0420_MB1_Open-Bite_AG.indd 20

3/26/20 12:38 PM


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Orthotown April 2020

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