An American Board of Orthodontics case report Treatment of an open bite malocclusion Stella Stathls Efstratiadis, DDS* New York, N.Y.
The patient had a Class I (Angle) malocclusion characterized by an anterior open bite, bimaxillary dental protrusion, posterior and anterior crossbites, and mandibular midline deviation. A nonextraction treatment was followed for this patient. A Begg appliance (0.020 inch) and a posterior high-pull headgear were used. The prognosis was good because of the rather favorable skeletal pattern of the patient. The active treatment lasted 12 months. The patient was retained with a positioner. The occlusion was stable at 2 years posttreatment. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.] (AM J ORTHOD OENTOFACORTHOP 1990;98:94-102.)
The open bite malocclusion is a complex clinical entity. It can be associated with an aberrant skeletal growth pattern or with an oral habit such as thumb sucking or tongue thmstingY -'s The open bite malocclusion that is associated with vertical skeletal excess, commonly known as "the long face syndrome," is difficult to treat with conventional orthodontic treatment alone, particularly when the patient's facial growth has been completed. Indeed, the severe, vertical skeletal dentofacial deformities of adults are best treated with orthognathic surgical procedures combined with orthodontic therapyJ 921 In the less severe form of open bite malocclusion in which the patient presents with a relatively normal skeletal pattern, treatment with conventional orthodontic appliances usually suffices. Various appliances and techniques have been used for the treatment of patients with an open bite malocclusion. The treatment plan and mechanotherapy aim to correct the vertical discrepancy and the sagittal and transverse malrelations that usually coexist in the same dentition. 22-29 This article describes the clinical diagnosis, treatment, and results o f a patient with a Class I (Angle) malocclusion characterized by an anterior open bite, bimaxillary dental protrusion, anterior and posterior crossbites, and mandibular midline deviation. This patient was treated with the Begg appliance (0.020 inch) supplemented with a posterior high-pull headgear.
*Assistant Professor of Dentistry, Division of Orthodontics, Columbia University. School of Dental and Oral Surgery. 81411O427
94
CASE REPORT CLINICAL DIAGNOSIS The patient was a postpubertal girl, 13 years 4 months of age, of endomorphic stature. The texture, tonicity, and color of the oral soft tissues were normal. Oral hygiene and dental health were good (Fig. 1). The past medical history was noncontributory. The patient exhibited a large tongue with low posture and tongue thrusting during swallowing. Slight lisping was evident during speech. She had a permanent dentition with the maxillary canines partially erupted and the second molars in occlusion. There was a Class I (Angle) malocclusion characterized by an anterior open bite and bimaxillary dental protrusion. The fight first and second premolars, and the fight lateral incisors, and the mandibular fight canine were in crossbite. The mandibular midline was deviated toward the fight side. There was approximately 2 nun of crowding in the maxillary arch and 2.5 mm of spacing in the mandibular arch. The Bolton analysis showed an 0.8 mm excess of maxillary tooth structure (Fig. 2). The patient had a rounded, fairly symmetric face with competent lips. The lower facial height appeared somewhat long in relation to the total facial height. The profile was relatively straight, characterized by an obtuse nasolabial angle and protruding lower lip (Fig. 3). The cephalometrie analysis indicated a Class I skeletal pattem (ANB = 1°). The mandibular and occlusal plane angles were normal (SN-MP = 32 °, SN-OP = 14°). The mandibular and maxillary incisors were protrusive (T-APo = 6.5 mm, T-NB at 7.5 mm/33 °, I-NA at 8 mm/28.5°). The antefior lower facial height was somewhat long in relation to the total height (ANS-GN to N-GN = 57.61%). The facial soft-tissue profile was relatively straight. The Holdaway angle was 6.5 °. The nasolabial angle was obtuse and the lower lip was protruding (Fig. 4, Table I).
Volume 98 Number 2
Case report
Fig. 1. Pretreatment intraoral photographs.
Fig. 2. Pretreatment study models.
95
96
Am. J. Orthod. Dent*fat. Orthop. Augttst 1990
Efstratiadis
Fig. 3. Pretroatment facial photographs.
T a b l e I. S u m m a r y o f c e p h a l o m e t r i e m e a s u r e m e n t s
Measurement SNA SNB ANB SN-MP SN-OP NPo-FH IMPA FMA T-APo T-NA I-NA T-NB
T-NB 1
I
Norm 82° 80° 2° 32° 14° 87.8 ° 90° 25* 0 nun 22° 4 mm 25* 4 mm
13 years 4 months (A) 82o 81 °
14 years 5 months (B) 83° 81.5 °
l°
32 ° 14°
1.5 °
I
I
16 years 4 months (C) 820 81 ° 10
1000
31 ° 13° 89 ° 91 °
31.5* 13.5" 89° 93*
24 ° 6.5 mm
24 ° 5 mm
24 ° 5 nun
29.5 ° 8mm 33* 7.5mm
27° 7.5mm 24 ° 6 mm
29 ° 8mm 26° 6mm
89 °
- interincisal angle
131"
116°
128"
123.5 °
NB-Po Holdway ratio ANS-GN to N-GN (Lower anterior facial height to total facial height) Holdaway angle
4 mm 1 55%
0mm 7.5•0 57.61%
0ram 6/0 57.85
0mm 6/0 57.72%
8.5*
7°
1
8*
The dental radiographs showed all permanent teeth present including the third molars. The mandibular first molars exhibited shallow occlusal restorations. Root formation was complete for all o f the teeth except the third molars. According to the lateral jaw radiographs, the crowns o f the maxillary third molars were calcified but root formation had not started. The eruption pattern o f the mandibular third molars appeared unfavorable. The cause o f this malocclusion was both genetic and environmental in nature. The tongue posture might have contributed to the severity o f the malocclusion.
6.5 °
PLAN OF TREATMENT A nonextraction procedure was followed. This was indicated because o f the available space in the mandibular arch (2.5 mm) and the tongue posture. In addition, with extraetion of teeth, a concave soft-tissue profile could develop. The objectives of treatment were to align the maxillary canines, establish normal overjet and overbite relationships, retract the mandibular incisors and upright the maxillary incisors as much as the available space permitted, correct the erossbite of the right premolars, and correct the lower midline. A Begg appliance (0.020-inch slo0 and a posterior high-pull headgear
Volume 98 Number 2
Case report
u,,"
Fig. 4. Pretreatment cephalometric tracing.
Fig. 5. Posttreatment photographs.
97
98
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
1
Fig. 6. Post-treatmentstudy models.
k
z,: ,~ -',
j...
® Fig. 7, A and B. Cephalometricsuperimposition at pretreatment(sofid lines) and posttreatment(dotted
lines).
were used. The prognosis was good because of the rather favorable skeletal pattern. PROGRESS OF TREATMENT The fight second premolars were banded first and crosselastics were worn to correct the crossbite. Subsequently, the maxillary first molars were banded and a high-pull headgear was fitted. It was used to provide anchorage against the light
Class III elastics (2 oz), which were worn to retract the mandibular incisors and canines. The maxillary incisors and canines were aligned with 0.014-inch and 0.016-inch arch wires with molar stops. Light vertical elastics (I oz) were worn to bring the maxillary canines into occlusion and a light anterior box elastic was worn to close the anterior open bite. When all teeth were aligned, 0.018 and 0.020-inch arch wires were inserted for finishing procedures. Uprighting springs were
Volume 98
Case report
Number 2
99
Fig. 8. Posttreatment facial photographs.
Fig. 9. Postretention intraoral photographs.
placed to correct the axial inclinations of incisors, canines, and premolars. The response to treatment was excellent and cooperation was good. RESULTS ACHIEVED
The anterior open bite and crossbite were corrected. The maxillary canines were aligned and brought into occlusion.
The crossbite of the right premolars was corrected. The mandibular midline was corrected to coincide with the maxillary midline. The second molars were erupted into a better occlusion. The Class I molar occlusion was maintained and positive overjet and overbite relationships were achieved. The mandibular intercanine distance did not change (Figs. 5 and 6).
100
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
Fig. 10. Postretention intraoral study models.
q •
\
.:
°
® Fig. 11, A and B. Postretention cephalometric superimposition at posttreatment (sofid lines) and postretention (dotted lines)•
The posttreatment dental radiographs showed a healthy dentition with no evidence of decay or root resorption. The inclination of all roots was satisfactory. The third molars had not yet erupted. According to the lateral jaw radiographs, the mandibular third molars exhibited an unfavorable eruption pattern and were extracted 1 year later.
Cephalometric superimposition showed that the patient did not grow during treatment (Fig. 7, A). The first molars and maxillary incisors maintained their initial positions. The anterior open bite and edge-to-edge sagittal relationship were corrected by retraction and extrusion of the mandibular incisors (I-NB at 6 mm/24 °) (Fig. 7, B). The lips also were
Volume 98 Number 2
C a s e report
101
i,
i, i;
Fig. 12. Postretontion facial photographs. retracted after the retraction of the anterior teeth; the mentolabial sulcus was better defined after the completion of treatment. The facial photographs showed improvement of the softtissue profile. The lower lip had been retracted and the profile was orthognathic and harmonious (Fig. 8).
SECONDARY TREATMENT (RETENTION) The patient was retained with a positioner. It was worn 4 hours a day and at night for 3 months. After 3 months, it was worn only at night. The total retention time was 2 years. During that period the patient was examined every 3 to 6 months. The main function of the positioner was to maintain the positive overjet and overbite relationships achieved during treatment.
FINAL EVALUATION The occlusion was stable 2 years after treatment (Figs. 9 and 10). Apparently the establishment of positive overjet and overbite relationships prevented any relapse of the mandibular incisors in spite of the tongue interposition. The third molars exhibited an unfavorable eruption pattern and were extracted 1 year after the completion of treatment. Cephalometrie superimposition indicated that during retention the mandible moved slightly downward (1.5 nun) (Fig. I 1, A). The maxillary and mandibular incisors did not change (Fig. 11, B). The lips were retracted further and the mentolabial sulcus was better defined during retention. The facial photographs showed that the profile had maintained its harmony 2 years after the completion of active treatment (Fig. 12). REFERENCES 1. Hellman M. Open-bite. Ira" J ORTHOD1931;17:421-44. 2. Swinehart EW. Clinical study of open-bite. Art J ORTHODORAL Sting 1942;28:18-34. 3. Straub WJ. Malfunction of the tongue. Part 1. The abnormal swallowing habit: its causes, effects, and results in relation to orthodontic treatment and speech therapy. AM J ORTHOO 1960;46:404-24.
4. Hapak FN. Cephalometric appraisal of the open bite case. Angle Orthod 1964;34:65-72. 5. Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod 1964;34:75-93. 6. Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. AM J ORrHOO 1964;50:337-57. 7. Richardson AR. Skeletal factors in anterior open-bite and deep overbite. AM I OR'rrtOD I969;56:114-27. 8. Richardson AR. Dentoalveolar factors in anterior open bite and deep overbite. Dent Rec 1970;21:53-7. 9. Linder-Aronson S. Adenoids: their effect on mode of breathing and nasal air flow and their relationship to characteristics of the facial skeleton and the dentition. Aeta Otolaryngol 1970:Suppl 265. 10. Worms FM, Meskin LH, Isaaeson. Open-bite. AM J ORTHOD 1971 ;59:589-95. 1I. Moss ML, Salentijn L. Differences between the functional matrices in anterior open-bite and deep overbite. AM J OR'I-HOD 1971 ;60:264-80. 12. Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme variation in vertical facial growth and associated variations in skeletal and dental relations. Angle Orthod 1971;41:219-29. 13. Bj6rk A, Skieller V. Facial development and tooth eruption. AM J ORTHOO1972;62:339-83. 14. Speidel TM, lsaacson RJ, Worms b'W. Tongue-thrust therapy and anterior dental open bite. AM J ORTHOD1972;62:287-95. 15. Nahoum HI. Anterior open-bite: a cephalometrie analysis and suggested treatment procedures. AM J ORTHOO1975;67:513-21. 16. Nahoum HI. Vertical proportions: a guide for prognosis and treatment in anterior open-bite. AM J ORTHOD1977;72:128-46. 17. Trouten JC, Eniow DH, Rabine M, Phelps AE, Swedlow D. Morphologie factors in open bite and deep bite. Angle Orthod 1983;53:192-211. 18. Cangialosi TJ. Skeletal morphologic features of anterior open bite. AM J ORTnOD 1984;85:28-36. 19. Proffit WR, Gamble JW, Christiansen RL. Generalized muscular weakness with severe anterior open-bite. A case report. AM J ORrttOD 1968;54:104-10. 20. Bell WH, Proffit WR, White RP. Surgical correction of dentofacial deformities. Philadelphia: WB Saunders, 1980. 21. Thomas PM, Proffit WR. Combined surgical and orthodontic treatment. In: Proffit WR, et al., eds. Contemporary orthodontics. St. Louis: CV Mosby, 1986:519-57. 22. Creekmore TM. Inhibition or stimulation of the vertical growth
102
23. 24. 25.
26. 27.
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
of the facial complex, its significance to treatment. Angle Orthod 1967;37:285-97. Kuhn RJ. Control of anterior vertical dimension and proper selection of extra-oral anchorage. Angle Orthod 1968;38:340-9. Graber TM. Orthodontics: principles and practice. Philadelphia: WB Saunders, 1972. Pearson LE. Vertical control in treatment of patients having backward-rotational growth tendencies. Angle Orthod 1978;48: 132-40. Pearson LE. Vertical control in fully banded orthodontic treatment. Angle Orthod 1986;56:205-24. Pfeiffer JP, GrobEty DA. A philosophy of combined orthopedicorthodontic treatment. A~,fJ ORTHOD 1982;81:185-201.
28. Dellinger EL. A clinical assessment of the Active Vertical Corrector, a nonsurgical alternative for skeletal open bite treatment. AM J OR'rHOD 1986;89:428-36. 29. Kim YH. Anterior open bite and its treatment with multiloop edgewise archwire. Angle Orthod 1987;57:290-321. Reprint requests to" Dr. Stella Efstratiadis School of Dental and Oral Surgery Columbia University 630 W. 168th St. New York, NY 10032
The patient had a Class I (Angle) malocclusion characterized by an anterior open bite, bimaxillary dental protrusion, posterior and anterior crossbites, and mandibular midline deviation. A nonextraction treatment was followed for this patient. A Begg appliance (0.020 inch) and a posterior high-pull headgear were used. The prognosis was good because of the rather favorable skeletal pattern of the patient. The active treatment lasted 12 months. The patient was retained with a positioner. The occlusion was stable at 2 years posttreatment. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.] (AM J ORTHOD OENTOFACORTHOP 1990;98:94-102.)
The open bite malocclusion is a complex clinical entity. It can be associated with an aberrant skeletal growth pattern or with an oral habit such as thumb sucking or tongue thmstingY -'s The open bite malocclusion that is associated with vertical skeletal excess, commonly known as "the long face syndrome," is difficult to treat with conventional orthodontic treatment alone, particularly when the patient's facial growth has been completed. Indeed, the severe, vertical skeletal dentofacial deformities of adults are best treated with orthognathic surgical procedures combined with orthodontic therapyJ 921 In the less severe form of open bite malocclusion in which the patient presents with a relatively normal skeletal pattern, treatment with conventional orthodontic appliances usually suffices. Various appliances and techniques have been used for the treatment of patients with an open bite malocclusion. The treatment plan and mechanotherapy aim to correct the vertical discrepancy and the sagittal and transverse malrelations that usually coexist in the same dentition. 22-29 This article describes the clinical diagnosis, treatment, and results o f a patient with a Class I (Angle) malocclusion characterized by an anterior open bite, bimaxillary dental protrusion, anterior and posterior crossbites, and mandibular midline deviation. This patient was treated with the Begg appliance (0.020 inch) supplemented with a posterior high-pull headgear.
*Assistant Professor of Dentistry, Division of Orthodontics, Columbia University. School of Dental and Oral Surgery. 81411O427
94
CASE REPORT CLINICAL DIAGNOSIS The patient was a postpubertal girl, 13 years 4 months of age, of endomorphic stature. The texture, tonicity, and color of the oral soft tissues were normal. Oral hygiene and dental health were good (Fig. 1). The past medical history was noncontributory. The patient exhibited a large tongue with low posture and tongue thrusting during swallowing. Slight lisping was evident during speech. She had a permanent dentition with the maxillary canines partially erupted and the second molars in occlusion. There was a Class I (Angle) malocclusion characterized by an anterior open bite and bimaxillary dental protrusion. The fight first and second premolars, and the fight lateral incisors, and the mandibular fight canine were in crossbite. The mandibular midline was deviated toward the fight side. There was approximately 2 nun of crowding in the maxillary arch and 2.5 mm of spacing in the mandibular arch. The Bolton analysis showed an 0.8 mm excess of maxillary tooth structure (Fig. 2). The patient had a rounded, fairly symmetric face with competent lips. The lower facial height appeared somewhat long in relation to the total facial height. The profile was relatively straight, characterized by an obtuse nasolabial angle and protruding lower lip (Fig. 3). The cephalometrie analysis indicated a Class I skeletal pattem (ANB = 1°). The mandibular and occlusal plane angles were normal (SN-MP = 32 °, SN-OP = 14°). The mandibular and maxillary incisors were protrusive (T-APo = 6.5 mm, T-NB at 7.5 mm/33 °, I-NA at 8 mm/28.5°). The antefior lower facial height was somewhat long in relation to the total height (ANS-GN to N-GN = 57.61%). The facial soft-tissue profile was relatively straight. The Holdaway angle was 6.5 °. The nasolabial angle was obtuse and the lower lip was protruding (Fig. 4, Table I).
Volume 98 Number 2
Case report
Fig. 1. Pretreatment intraoral photographs.
Fig. 2. Pretreatment study models.
95
96
Am. J. Orthod. Dent*fat. Orthop. Augttst 1990
Efstratiadis
Fig. 3. Pretroatment facial photographs.
T a b l e I. S u m m a r y o f c e p h a l o m e t r i e m e a s u r e m e n t s
Measurement SNA SNB ANB SN-MP SN-OP NPo-FH IMPA FMA T-APo T-NA I-NA T-NB
T-NB 1
I
Norm 82° 80° 2° 32° 14° 87.8 ° 90° 25* 0 nun 22° 4 mm 25* 4 mm
13 years 4 months (A) 82o 81 °
14 years 5 months (B) 83° 81.5 °
l°
32 ° 14°
1.5 °
I
I
16 years 4 months (C) 820 81 ° 10
1000
31 ° 13° 89 ° 91 °
31.5* 13.5" 89° 93*
24 ° 6.5 mm
24 ° 5 mm
24 ° 5 nun
29.5 ° 8mm 33* 7.5mm
27° 7.5mm 24 ° 6 mm
29 ° 8mm 26° 6mm
89 °
- interincisal angle
131"
116°
128"
123.5 °
NB-Po Holdway ratio ANS-GN to N-GN (Lower anterior facial height to total facial height) Holdaway angle
4 mm 1 55%
0mm 7.5•0 57.61%
0ram 6/0 57.85
0mm 6/0 57.72%
8.5*
7°
1
8*
The dental radiographs showed all permanent teeth present including the third molars. The mandibular first molars exhibited shallow occlusal restorations. Root formation was complete for all o f the teeth except the third molars. According to the lateral jaw radiographs, the crowns o f the maxillary third molars were calcified but root formation had not started. The eruption pattern o f the mandibular third molars appeared unfavorable. The cause o f this malocclusion was both genetic and environmental in nature. The tongue posture might have contributed to the severity o f the malocclusion.
6.5 °
PLAN OF TREATMENT A nonextraction procedure was followed. This was indicated because o f the available space in the mandibular arch (2.5 mm) and the tongue posture. In addition, with extraetion of teeth, a concave soft-tissue profile could develop. The objectives of treatment were to align the maxillary canines, establish normal overjet and overbite relationships, retract the mandibular incisors and upright the maxillary incisors as much as the available space permitted, correct the erossbite of the right premolars, and correct the lower midline. A Begg appliance (0.020-inch slo0 and a posterior high-pull headgear
Volume 98 Number 2
Case report
u,,"
Fig. 4. Pretreatment cephalometric tracing.
Fig. 5. Posttreatment photographs.
97
98
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
1
Fig. 6. Post-treatmentstudy models.
k
z,: ,~ -',
j...
® Fig. 7, A and B. Cephalometricsuperimposition at pretreatment(sofid lines) and posttreatment(dotted
lines).
were used. The prognosis was good because of the rather favorable skeletal pattern. PROGRESS OF TREATMENT The fight second premolars were banded first and crosselastics were worn to correct the crossbite. Subsequently, the maxillary first molars were banded and a high-pull headgear was fitted. It was used to provide anchorage against the light
Class III elastics (2 oz), which were worn to retract the mandibular incisors and canines. The maxillary incisors and canines were aligned with 0.014-inch and 0.016-inch arch wires with molar stops. Light vertical elastics (I oz) were worn to bring the maxillary canines into occlusion and a light anterior box elastic was worn to close the anterior open bite. When all teeth were aligned, 0.018 and 0.020-inch arch wires were inserted for finishing procedures. Uprighting springs were
Volume 98
Case report
Number 2
99
Fig. 8. Posttreatment facial photographs.
Fig. 9. Postretention intraoral photographs.
placed to correct the axial inclinations of incisors, canines, and premolars. The response to treatment was excellent and cooperation was good. RESULTS ACHIEVED
The anterior open bite and crossbite were corrected. The maxillary canines were aligned and brought into occlusion.
The crossbite of the right premolars was corrected. The mandibular midline was corrected to coincide with the maxillary midline. The second molars were erupted into a better occlusion. The Class I molar occlusion was maintained and positive overjet and overbite relationships were achieved. The mandibular intercanine distance did not change (Figs. 5 and 6).
100
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
Fig. 10. Postretention intraoral study models.
q •
\
.:
°
® Fig. 11, A and B. Postretention cephalometric superimposition at posttreatment (sofid lines) and postretention (dotted lines)•
The posttreatment dental radiographs showed a healthy dentition with no evidence of decay or root resorption. The inclination of all roots was satisfactory. The third molars had not yet erupted. According to the lateral jaw radiographs, the mandibular third molars exhibited an unfavorable eruption pattern and were extracted 1 year later.
Cephalometric superimposition showed that the patient did not grow during treatment (Fig. 7, A). The first molars and maxillary incisors maintained their initial positions. The anterior open bite and edge-to-edge sagittal relationship were corrected by retraction and extrusion of the mandibular incisors (I-NB at 6 mm/24 °) (Fig. 7, B). The lips also were
Volume 98 Number 2
C a s e report
101
i,
i, i;
Fig. 12. Postretontion facial photographs. retracted after the retraction of the anterior teeth; the mentolabial sulcus was better defined after the completion of treatment. The facial photographs showed improvement of the softtissue profile. The lower lip had been retracted and the profile was orthognathic and harmonious (Fig. 8).
SECONDARY TREATMENT (RETENTION) The patient was retained with a positioner. It was worn 4 hours a day and at night for 3 months. After 3 months, it was worn only at night. The total retention time was 2 years. During that period the patient was examined every 3 to 6 months. The main function of the positioner was to maintain the positive overjet and overbite relationships achieved during treatment.
FINAL EVALUATION The occlusion was stable 2 years after treatment (Figs. 9 and 10). Apparently the establishment of positive overjet and overbite relationships prevented any relapse of the mandibular incisors in spite of the tongue interposition. The third molars exhibited an unfavorable eruption pattern and were extracted 1 year after the completion of treatment. Cephalometrie superimposition indicated that during retention the mandible moved slightly downward (1.5 nun) (Fig. I 1, A). The maxillary and mandibular incisors did not change (Fig. 11, B). The lips were retracted further and the mentolabial sulcus was better defined during retention. The facial photographs showed that the profile had maintained its harmony 2 years after the completion of active treatment (Fig. 12). REFERENCES 1. Hellman M. Open-bite. Ira" J ORTHOD1931;17:421-44. 2. Swinehart EW. Clinical study of open-bite. Art J ORTHODORAL Sting 1942;28:18-34. 3. Straub WJ. Malfunction of the tongue. Part 1. The abnormal swallowing habit: its causes, effects, and results in relation to orthodontic treatment and speech therapy. AM J ORTHOO 1960;46:404-24.
4. Hapak FN. Cephalometric appraisal of the open bite case. Angle Orthod 1964;34:65-72. 5. Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod 1964;34:75-93. 6. Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. AM J ORrHOO 1964;50:337-57. 7. Richardson AR. Skeletal factors in anterior open-bite and deep overbite. AM I OR'rrtOD I969;56:114-27. 8. Richardson AR. Dentoalveolar factors in anterior open bite and deep overbite. Dent Rec 1970;21:53-7. 9. Linder-Aronson S. Adenoids: their effect on mode of breathing and nasal air flow and their relationship to characteristics of the facial skeleton and the dentition. Aeta Otolaryngol 1970:Suppl 265. 10. Worms FM, Meskin LH, Isaaeson. Open-bite. AM J ORTHOD 1971 ;59:589-95. 1I. Moss ML, Salentijn L. Differences between the functional matrices in anterior open-bite and deep overbite. AM J OR'I-HOD 1971 ;60:264-80. 12. Isaacson JR, Isaacson RJ, Speidel TM, Worms FW. Extreme variation in vertical facial growth and associated variations in skeletal and dental relations. Angle Orthod 1971;41:219-29. 13. Bj6rk A, Skieller V. Facial development and tooth eruption. AM J ORTHOO1972;62:339-83. 14. Speidel TM, lsaacson RJ, Worms b'W. Tongue-thrust therapy and anterior dental open bite. AM J ORTHOD1972;62:287-95. 15. Nahoum HI. Anterior open-bite: a cephalometrie analysis and suggested treatment procedures. AM J ORTHOO1975;67:513-21. 16. Nahoum HI. Vertical proportions: a guide for prognosis and treatment in anterior open-bite. AM J ORTHOD1977;72:128-46. 17. Trouten JC, Eniow DH, Rabine M, Phelps AE, Swedlow D. Morphologie factors in open bite and deep bite. Angle Orthod 1983;53:192-211. 18. Cangialosi TJ. Skeletal morphologic features of anterior open bite. AM J ORTnOD 1984;85:28-36. 19. Proffit WR, Gamble JW, Christiansen RL. Generalized muscular weakness with severe anterior open-bite. A case report. AM J ORrttOD 1968;54:104-10. 20. Bell WH, Proffit WR, White RP. Surgical correction of dentofacial deformities. Philadelphia: WB Saunders, 1980. 21. Thomas PM, Proffit WR. Combined surgical and orthodontic treatment. In: Proffit WR, et al., eds. Contemporary orthodontics. St. Louis: CV Mosby, 1986:519-57. 22. Creekmore TM. Inhibition or stimulation of the vertical growth
102
23. 24. 25.
26. 27.
Am. J. Orthod. Dentofac. Orthop. August 1990
Efstratiadis
of the facial complex, its significance to treatment. Angle Orthod 1967;37:285-97. Kuhn RJ. Control of anterior vertical dimension and proper selection of extra-oral anchorage. Angle Orthod 1968;38:340-9. Graber TM. Orthodontics: principles and practice. Philadelphia: WB Saunders, 1972. Pearson LE. Vertical control in treatment of patients having backward-rotational growth tendencies. Angle Orthod 1978;48: 132-40. Pearson LE. Vertical control in fully banded orthodontic treatment. Angle Orthod 1986;56:205-24. Pfeiffer JP, GrobEty DA. A philosophy of combined orthopedicorthodontic treatment. A~,fJ ORTHOD 1982;81:185-201.
28. Dellinger EL. A clinical assessment of the Active Vertical Corrector, a nonsurgical alternative for skeletal open bite treatment. AM J OR'rHOD 1986;89:428-36. 29. Kim YH. Anterior open bite and its treatment with multiloop edgewise archwire. Angle Orthod 1987;57:290-321. Reprint requests to" Dr. Stella Efstratiadis School of Dental and Oral Surgery Columbia University 630 W. 168th St. New York, NY 10032
