Simplifying the approach of open bite treatment with aligners and selective micro-osteoperforations: An adult case report

• Published in: International orthodontics Vol. 19; no. 1; pp. 159 - 169
• Main Authors: Greco, Mario, Rossini, Giulia, Rombolà, Andrea
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.03.2021
• Subjects: Clear Aligners; Corticotomy; Micro-osteoperforation; Open Bite; Tooth Movement Techniques; Open Bite; Tooth Movement Techniques; Micro-osteoperforation; Corticotomy; Clear Aligners
• ISSN: 1761-7227; 1879-680X
• DOI: 10.1016/j.ortho.2020.11.005

Open bite treatment represents one of the most challenging malocclusions because it has a multifactorial aetiology and in particular because its dental correction strongly depends on the possibility to manage the posterior intrusion with a reliable system controlling the vertical position of upper and lower molars. Clear Aligner system proved to be an efficient way to control the hyper divergent patients performing posterior intrusion and managing the counterclockwise rotation of the mandible. This technique has shown to be predictable for molar intrusion up to 1mm. This case report shows a successful open bite orthodontic treatment in which the molar intrusion effect has been amplified in the digital setup and facilitated by means of micro-osteo perforations (MOPs) performed selectively only in the molar areas in order to stimulate the bone in a specific movement direction. The digital setup was set to create molar intrusion in upper and lower molars up to 3mm and thus favouring a counterclockwise mandible rotation, supported and controlled by elastics. The posterior intrusion was combined with an anterior extrusion following smile arc exposure and the treatment was completed in 16 months overall. The final cephalometric analysis showed a significant reduction of SN/Go-Gn angle of 4° with consequent counterclockwise rotation of the mandible. The mandibular superimposition showed a 2.5mm molar intrusion without root resorption and with a controlled incisor proclination. A solid Class I bilateral occlusion was achieved with normal overjet and overbite, the dental arches were well aligned and levelled with good intra-arch symmetry and regular arch form. The frontal aesthetic analysis showed an improvement of the dental exposure with a normalized smile arc due to a combination of relative and pure extrusion. The present alternative approach to treat severe open bite combining selective MOPs in the posterior and lateral sectors and clear aligners could predictably control molar vertical position avoiding the use of auxiliary and eliminating the risk of root resorption. Arch development, molar intrusion, and overbite correction with counterclockwise mandible rotation could be predictably achieved respecting digital setup and creating proper Class I bilateral occlusion.