Correction of open bite in children and adults. Open bite teeth

Problems with bite occur in many children and adults, but, unfortunately, many do not pay attention to this disorder and do not take the necessary measures to eliminate it. As a result, other internal organs may also suffer. In orthodontics, a complex and common pathology of occlusion is distinguished - open bite. This disorder occurs in most cases in children. Open bite is a complex pathology that must be treated at an early stage, that is, from childhood.

In the dental field, the word "occlusion" is used to describe the method of closing and opening the upper and lower arches of teeth. Usually, by the time a person reaches a certain age, a complete formation of a physiological bite occurs, which is accompanied by certain qualities:

Each of the units of the dentition must close with two antagonists in a certain position;
The upper incisors provide overlap with the lower incisors;
There is slight obstruction of the lower canines by the upper ones.

If any symptom is not fulfilled, then in this case it is worth talking about the development of a pathological process.
An open bite is a pathological disorder during which complete closure is not observed in the upper and lower dentition.

An open bite is an anomaly in the development of the dentition. It is characterized by a pronounced defect - incomplete closure of the jaws. Correcting such a bite is quite difficult.

This pathology not only spoils the appearance, but can also cause serious harm to health.

Important! An open bite can cause a variety of ENT diseases and can also be a major factor in speech problems. Loose teeth can cause great difficulty in chewing food, which can result in disruption of the digestive tract.

An open bite is often observed in the anterior part of the dentition. Sometimes this pathology occurs in the lateral rows of teeth.
Many dentists advise regularly visiting the dental office. Upon examination, pathologies can be identified at an early stage of development and can be easily eliminated. Otherwise, delay can lead to serious disorders in the body and severe, long-term treatment.

Why does an open bite occur?

Before starting treatment for this pathology, it is worth finding out what factors provoke its appearance. There are many reasons for the appearance of open occlusion, among which it is worth highlighting the most important:

It is also worth highlighting the main causes of congenital nature:

Presence of a genetic predisposition;
If before this there were serious illnesses of a somatic and infectious nature;
If toxicosis occurs with pronounced symptoms;
Impact of exogenous factors;
Incorrect location of the primordia;
The presence of placental type insufficiency.

Acquired appearance factors:

The presence of rickets in childhood;
Disorder of normal metabolism of mineral components;
Endocrinopathy;
The presence of hypovitaminosis with pronounced severity;
Impaired respiratory functions in the upper section;
If there is untimely appearance of tooth buds and their late eruption;
Macroglossia;
If there is a short frenulum of the tongue;
Early eruption of teeth, which causes early tooth loss;
Presence of tumors in the oral cavity;
Traumatic injuries of the jaw apparatus;
Disorder of the activity of the organs of the endocrine system;
The presence of a pathological structure of the jaw bones;
If you sleep in an incorrect and uncomfortable position;
The presence of certain ailments of the circulatory system and urinary system.

Varieties

Open bite is divided into two types. To understand how each of these types manifests itself, it is worth carefully considering the characteristics of each.

There are two types of open bite: traumatic - usually acquired as a result of mechanical impact from hard objects, rachitic - as a result of a violation of the jaw bone.

Traumatic. Open occlusion of this type usually appears in children, because it is provoked by various bad habits. If this disorder appeared before the molars erupted, then it is quite easy to get rid of it; for this you need to wean the child from gnawing hard objects and from other bad habits. If you delay and do nothing, this process will only worsen and it will be much more difficult to get rid of this violation. Therefore, it is important to begin correction at an early stage. Often this disorder occurs on the front part of the dentition;
Rachitic. This type of violation is quite difficult to correct. The thing is that when the bite is broken, deformation occurs not only of the teeth, but also of the jaw bone itself. Therefore, during treatment it is necessary to return the correct shape to the jaw bones. This requires quite a long exposure, and sometimes surgical intervention is required. However, dental abnormalities can worsen over time, so it is important to see a doctor as early as possible at the earliest stage of this disorder. It is also worth paying attention to the symptoms of this type of open bite - problems with nasal breathing, speech impairment and difficulty chewing food. A rachitic malocclusion does not allow for normal chewing of food, therefore, with this disorder, there is a lack of full contact between the teeth.

Depending on location

Also, varieties of this disorder are distinguished depending on the area where the disorder is present.

There are two types of open occlusions: frontal - characterized by non-closing of the front incisors, lips, problems with biting, lateral - non-closing of molars, as a result of problems with chewing and swallowing.

The following types of localized open occlusions are distinguished:

Frontal bite. This pathology is observed in the area of the frontal dental units. With this type of bite, there is a disorder of diction, poor closing of the lips, problems when biting off food;
Side. In the presence of this disorder, there is a loose closure of the lateral teeth. During this type of bite, poor chewing of food, improper swallowing occurs, and some symptoms of the lower jaw joint may also be observed.

It is worth noting that a lateral or frontal malocclusion can be on one side or on both sides at the same time.

Degrees

Depending on the height of the lumen, the number of crowns of the same type that do not have contact, several degrees of severity of open bite pathology are distinguished:

First degree. During this degree there is a gap in the vertical position and its size is 5 mm. There is no contact at the site of the canines and incisors;
Second degree. The area of non-closure is present not only in the area of the frontal dental units, but also in the area of the premolars. The size of this area can reach up to 9 mm;
Third degree. At this degree, there is a complete absence of contact between the incisors, canines, premolars and extreme molars. The height of the gap can be from 9 mm or more.

Symptoms

The pathological process of this type is usually accompanied by signs that are divided into several groups - facial, intraoral, functional type.

Lengthening of the lower facial part is observed. In these cases, the changes involve no more than a third of the facial area;
Sometimes it may be observed that the chin is slightly sloping to the side;
Slightly or strongly open mouth;
The nasolabial fold has a smoothed structure;
The upper lip cannot fully close with the lower lip or causes an increased level of tension when closed. This is due to the fact that the upper lip has a flaccid structure;
From the oral cavity you can see the cutting part of the incisors and the tip of the tongue.

The presented image shows symptoms of a facial type disorder: confusion of the dentition, non-occlusion of teeth, protrusion of the chin, deformation of the aesthetic appearance of the face.

Intraoral symptoms:

With this pathology, there may be a lack of closure between the dentition of the upper jaw and the dentition of the lower jaw;
There is a gap of varying sizes between the dental rows;
There may be crowding of the frontal dental units;
Sometimes there is extensive damage to caries and the formation of tartar;
The occurrence of hypoplasia of tooth enamel;
The contour of the cutting part acquires a ribbed structure;
The appearance of gingivitis in a hypertrophic form;
Increased bleeding and swelling of the gums may occur;
Changes in the symmetry and size of the width of the jaw arches and the shape of the palate;
Increased degree of dryness of the oral mucosa;
The occurrence of diseases in the nasal cavity and paranasal sinuses.

Functional symptoms:

Having problems when biting;
Problems chewing food;
Improper swallowing;
Mechanical speech disorder or interdental sigmatism;
Mouth breathing;
The occurrence of dysfunction of the temporomandibular joint.

How is the examination carried out?

Diagnosis of an open bite should be carried out by an appropriate specialist - an orthodontist. First of all, a visual examination of the patient should be performed. During this examination, the mouth and teeth are examined. Also at this stage of the examination, signs of a facial, intraoral and functional nature are revealed.
An instrumental examination is also carried out, which reveals the severity of the pathological process. During this diagnosis, the gap between the rows is measured.
Additionally, in order to make an accurate diagnosis, other examination methods are used:

Orthopantomography;
Application of photometric survey;
Use of X-ray cephalometric type analysis;
Teleradiogram.

If there is an advanced form of open bite, then additional consultations with other third-party specialists may be used.

Orthopantomography is an x-ray diagnostic method in which a panoramic photograph of the teeth is taken. Thanks to this x-ray, a single image shows the image of both curved lower and upper jaws together, which allows you to compare the condition of the bone tissue of the masticatory apparatus.

How to treat

If you find similar signs that there is an open malocclusion, you should immediately contact a specialist - a dentist. During the examination, the doctor will be able to determine whether there is a malocclusion or not. In addition, he will be able to prescribe effective treatment that will help eliminate the pathological process and straighten all the teeth in a short time. The choice of treatment for this disease depends on the age category of the patient and the degree of neglect of this pathological process.

Features of treatment of open bite in primary teeth

In order to correct the occlusion of primary teeth, methods are first used, the direction of which is to restore the equilibrium working process of the myodynamic system of the jaw:

The use of myogymnastics. This procedure is indicated for children under 7 years of age. This therapeutic therapy can be carried out independently or with the help of special equipment - activators;
Use of electromyostimulation;
Increasing the load during chewing due to the consumption of solid food.

In pediatric orthodontics, myogymnastics is used to treat malocclusions. A specially designed series of exercises will allow you to develop the main muscles of the oral cavity. This procedure helps to painlessly cope with various malocclusions.

In advanced cases, methods are used that involve the use of orthodontic devices with a non-removable system. They provide a change in muscle tone, help normalize swallowing, and also cause the attachment of bone tissue of alveolar-type processes. These systems include the following systems:

The use of persistent vestibular plates is often prescribed, which ensure that the child is quickly weaned from bad habits;
The use of special occlusive overlays that are installed on the area of premolars and molars;
It is often prescribed to use Klammt or Andresen-Goipl activators during treatment;
Using a chin sling;
Treatment using Frenkel and Herbst or Schwartz devices;
To correct the growth of jaw bone tissue, wearing orthodontic type trainers or aligners is prescribed;
Additionally, expansion-type plates can be installed, which may have springs or screws;
If a child has a narrowing of the fixed part of the jaw, then wearing a vestibular type arch is mandatory.

Features of treatment of open bite of permanent teeth

If open occlusion has already appeared with a formed bite or at a late stage of a replacement bite, then removable and fixed-type systems can be used.
Effective treatment systems:

Wearing a mouthguard. This is required for maximum alignment of the dentition;
Using braces. Different braces can be used, it all depends on the degree of pathological disorder. They can also be made of different materials - metal, sapphire, ceramics, plastic;
The use of crowns, with the help of which the bite changes the height;
Engel apparatus;
The use of special crowns that provide separation of the occlusion.

The braces system is the most effective means of correcting teeth and bite. Braces are a non-removable device that is fixed to the teeth with a special glue for the entire course of treatment, which is convenient and effective, and corrects the dentition by tensioning the metal arch.

In order to correct the bite of molars, it is recommended to use fixed systems. These structures best help straighten crooked teeth and jaw bones.
If the open bite is at an advanced stage, then orthodontic systems are used in conjunction with surgical treatment methods. Additionally, the following treatment methods may be prescribed:

Compactosteotomy;
Carrying out removal of dental units that are of the supernumerary type;
Application of decortication. This method consists of removing the outermost molars and removing the cortical layer with a bur to the very bottom edge.

Sometimes crowns can be shortened, which cause difficulties in tightly closing the jaw arches. During this process, complete depulpation of the treated dental units is performed.
If there are pronounced problems with speech functions, then in these cases correction of dyslalia with the help of a speech therapist is prescribed. At the final stage, prosthetics are carried out, during which the visible defect in the surface of the crowns is eliminated and a tight occlusal contact is ensured.

What could be the consequences?

If treatment is not provided in a timely manner or is completely absent, serious complications in various systems of the human body may result. First of all, there will be a pronounced violation of diction, which will require the help of a speech therapist to eliminate.
This type of pathology often causes serious disorders of the respiratory system. These disorders in children usually become chronic. Impaired chewing and improper swallowing result in serious problems and pathologies of the digestive system.

Attention! When an open bite is incorrect, a serious pathology of the tongue occurs - tongue hypertrophy, which is accompanied by an increase in the size of the tongue. This violation can cause not only problems with internal organs, but also seriously spoil the appearance.

Due to the fact that with an open bite there is a constant overstrain of the facial muscles, the face acquires an unnatural expression over time. Breathing usually occurs through the mouth, which ultimately leads to an increase in carbon dioxide levels in the blood. An increase in carbon dioxide affects the outflow of blood and causes stagnation in the respiratory system. All this can negatively affect the state of the central nervous system.

How to prevent it?

Basically, an open bite appears as a result of the influence of various external factors. Therefore, to prevent this from happening, you need to observe a number of factors that will prevent the occurrence of this pathology.

One of the methods for preventing the formation of a bite is plastic surgery of the frenulum of the tongue. It involves surgery to reduce improper attachment of the frenulum. In its normal position, the frenulum of the tongue does not cause any discomfort and is completely invisible.

These factors are especially relevant for children:

First of all, it is important to eliminate all bad habits in children that cause crooked teeth;
It is imperative to get rid of pathological movements of the tongue;
The baby must be taught to breathe through the nose from birth;
If the need arises, the hyoid frenulum needs to be adjusted;
It is important to regularly check the body for the presence of rickets.

Important! The most difficult stage is unlearning bad habits. The most dangerous habit is considered to be chewing and biting nails, pencils, and pens. How to eliminate this bad habit? The most difficult thing is to stop a child from biting his nails. But if you constantly cut his nails and remove hangnails, then the need for this process will disappear by itself. Girls can have their nails painted.

If finger sucking and nail biting occurs in an infant, then in this case you can use other methods. To do this, your child can wear special elbow pads that will prevent the arms from bending.
Be sure to monitor the child's breathing. Try to teach him to breathe only through his nose. If you suddenly notice that the baby is breathing through his mouth, then you can use persuasion. Be sure to praise him when he breathes through his nose. You can also take a beautiful photograph of the baby and hang it in a visible place so that the correct facial expression is before the baby’s eyes.

Preventive measures

It is imperative to follow preventative measures that will help protect you or your child from bite problems. It is best to prevent this pathology than to treat it for a long period. In addition, even the most effective treatment does not always provide 100% results.
Preventive treatment for the development of open bite should begin right from the period of pregnancy and continue from the moment the child’s first baby tooth emerges. In order for prevention to be effective, the following important measures and recommendations should be followed:

During pregnancy, you should avoid contact with infected people. This will help avoid contracting various infections;
It is worth avoiding the influence of harmful factors;
You definitely need to watch your diet. It must be correct and ensure normal metabolism;
It is necessary to wean a child from bad habits right from the first days;
It is not recommended for a child to suck on a pacifier for a long period, up to a maximum of 3 years;
Watch the child's breathing, it should be through the nose;
It is recommended to promptly treat various dental diseases of the teeth;
It is necessary to regularly take the necessary measures to prevent rickets;
If there is a short frenulum of the tongue, then surgery should be performed to correct it;
Regular visits to the dentist;
If suddenly there are slight signs of improper teething, it is recommended to use special gymnastics.

It is important to visit the dentist's office regularly. This needs to be done once every six months. At the appointment, the doctor will conduct a dental examination, during which he can find pathological processes at their earliest stages. At an early stage of pathology, bites are easiest to eliminate than in advanced stages. Therefore, you must carefully monitor the health of your teeth and oral cavity.

Correct bite is very important for a person, because with pathology, the load on the most “loaded” teeth increases significantly, which is fraught with tooth loss. In addition, a pathological bite changes the appearance of the face, it can even interfere with the child’s ability to chew and speak normally. It is worth understanding in more detail the methods of correcting the wrong taste in a child.

Periods of development

Pathology does not develop immediately; it develops in several stages:

Newborn. This period of time is characterized by a complete absence of teeth in the baby, but an experienced orthodontist is already able to determine how the incisors and molars will be positioned. The lower jaw of a newborn is located slightly back, and this is quite normal.
The appearance of the first milk teeth. As soon as the baby's first teeth begin to appear, the lower jaw noticeably straightens. A little later, the teeth on top (most often the incisors) begin to cover the lower teeth almost halfway.
Alignment of baby teeth. At this stage, it is considered quite normal if the baby develops gaps between the non-permanent teeth and the tubercles wear away. This process is smooth and gradual and is usually considered complete by age six. By this age, the bite becomes almost straight (the upper teeth no longer cover the lower jaw).
Changing dairy products to indigenous ones. This process occurs with varying intensity in all children, but usually it lasts up to 11-12 years. During this time, baby teeth fall out and permanent molars grow in their place. Normally, the upper teeth begin to cover the lower ones, but no more than one-third the size of the crown. Clefts and gaps between the teeth should not normally be observed.

Reasons for violations

The formation of a pathological bite is usually a whole set of reasons for which there was no correct development. Most often, experts talk about a hereditary factor - if one of the parents has a bite that is far from ideal, then the child has every chance of encountering the same problem.

An incorrect bite can occur due to the fact that baby teeth for some reason (for example, due to a dental disease) were removed ahead of schedule. Delayed, late teething is also a cause for concern. It may well cause the formation of a pathological bite.

An incorrect bite can occur in a child who is fed pureed soft food for too long, or in a child suffering from frequent diseases of the ENT organs (for example, with adenoids, the bite changes significantly). The cause may be sucking on a pacifier for too long. The cause of the pathology can also be a bad habit of sucking fingers.

Many orthodontic specialists are inclined to believe that problems with a child’s bite begin in the womb, because the formation of the jaw and all its components occurs long before birth. It is believed that anemia of the expectant mother, metabolic disorders in her body, acute viral infections during the first trimester of pregnancy are considered factors that negatively affect the formation of the fetal jaw bone frame.

The role of proper nutrition should not be underestimated.- if the body of a newborn or infant lacks calcium and fluoride, then the risk of developing bite pathologies increases tenfold.

The condition of the oral cavity also affects the bite - in a child who regularly suffers from inflammation of the gums, stomatitis and other inflammatory problems in the mouth, the risk of developing a malocclusion is much higher.

Consequences

A cosmetic defect, which to one degree or another becomes noticeable if a child has an incorrect bite, is just the tip of the iceberg. More serious consequences of the pathology lie in the fact that the basic function of the teeth is disrupted. The child begins to chew food incorrectly, which quite often leads to diseases of the stomach, liver, pancreas, and intestines at a very early age.

The bite affects the clarity and quality of speech. With pathology, the child may begin to suffer from speech defects, and this will prevent him from communicating normally with peers. This is where the roots of severe psychological problems in primary school or older school age grow.

Children with malocclusion have an increased risk of developing periodontal disease, their teeth are more vulnerable, and children lose many units very early due to excessive wear and improper load - implantation is required.

The most serious consequences concern changes in the temporomandibular joints. Such pathologies can cause constant painful headaches, hearing loss, and breathing problems (especially at night).

Norms and deviations

It is customary to assess the final state of the bite after changing non-permanent milk teeth to molars. Normally, the upper jaw protrudes slightly forward (by one third of the length of the crown, no more), the teeth on top have close contact with the lower ones. There are no large gaps or clefts between the teeth, and there should not be any extra or unpaired teeth.

A correct and healthy bite has several varieties, all of which are considered normal variants. Malocclusion has more varied manifestations:

Distal. This is the most common malocclusion, which is diagnosed in both children with unstable teeth and children with molars. The upper jaw protrudes significantly forward, the relationship of all teeth is disturbed. In this case, the upper jaw itself can often be developed to a greater extent than the lower jaw.
Mesial. With this pathology, the lower jaw moves forward. It is usually more developed than the upper one. A child with such an overbite looks somewhat belligerent - the chin is pushed forward, the upper lip drops slightly.
Open. With such a pathological bite, the teeth close completely. This is considered the most complex pathology.
Deep. Due to the development of this pathology, the upper incisors cover the lower teeth by more than a third of the crown size. This is a very common type of pathological bite among children.
Cross. This type of bite is said to occur when the upper and lower jaws are displaced horizontally relative to each other. A child’s face with this pathology looks asymmetrical; the problem requires long-term correction from a very early age.

Diagnostics

An experienced orthodontist can even tell you whether there is a risk of developing malocclusion and check the condition of the upper and lower jaws in newborns. However, in practice this is usually not strictly necessary. Therefore, many parents turn to this specialist on the referral of a dentist, who, during a scheduled or unscheduled examination, discovers one or another bite pathology in the child.

The orthodontist conducts an anthropometric study and finds out whether there is facial asymmetry. After this, the doctor makes impressions of each jaw, and plaster models are cast from them in the laboratory. Using them, the doctor can tell with great accuracy (up to a millimeter) which teeth are displaced and how, whether there is twisting, and where the most problematic areas are located.

An x-ray makes it possible to find out what is inside the gums - how the teeth are formed, how the root canals are located. Only then does the doctor check how chewing is developed in the little patient, how the pathology affects speech, and whether the bite interferes with free breathing.

The question of at what age a child should be taken to see an orthodontist is worthy of separate discussion. Some say that it is better to do this at 5-6 years old, when the teeth begin to change into permanent ones. However, experts warn that noticeable malocclusion in a younger child is not a reason not to go to the doctor. The sooner the correction begins, the better: while there is active growth, the problem is corrected much faster and more effectively.

Methods

Correcting a bite is usually a rather lengthy and labor-intensive task. Modern medicine uses several basic methods to cope with the problem:

hardware treatment;
Maxillofacial Surgery;
myotherapy;
combined methods (using several methods at once - for example, the use of devices after surgery);
non-equipment treatment.

The orthodontist decides which method to choose (based on the results of the examination). It is worth talking about the essence of these methods in more detail:

Hardware treatment

Special devices are good at helping to cope with malocclusion in childhood. Such devices can be removable and non-removable, as well as mechanical, guiding and operating. Mechanical - this is the Angle apparatus and any bracket system. Guide devices are mouthguards and linings through which biting occurs. The existing devices use artificial obstacles to protect the teeth from pressure from the cheek muscles. These include Schoncher records.

Removable plates are usually used to make teeth grow straighter under the pressure of the arches, but we are only talking about correcting the position of the jaws in relation to each other. The plates do not have a pronounced effect on the inclination of the teeth.

When a toddler’s teeth are crooked, the orthodontist will suggest installing a brace system instead of plates. If pain or changes occur in the temporomandibular joint, a special silicone splint is recommended for the baby, which fits tightly onto the teeth and fixes them in a more or less normal position from a physiological point of view. The splint allows all nearby muscles and ligaments to “rest” and relaxes them. From the point of view of modern medicine, these are the most effective dental trainers (silicone removable devices).

Whatever device is prescribed to the child, parents should prepare for the fact that the treatment will be lengthy. For example, braces systems are worn for at least 1.5-2 years, and removable plates and aligners need to be worn not only during the day for a couple of hours, as many do. You will have to wear them almost constantly. Only such a responsible and consistent approach to therapy (as well as a patient attitude towards the treatment process) will help cope with the problem of malocclusion once and for all.

Myotherapy

This is a very popular method of correcting pathological occlusion in orthodontic practice. It is a technique of specific gymnastics, which is aimed at the activation and development of certain maxillofacial muscles and muscle groups involved in articulation, chewing, and facial movements.

This method is usually used for children with unstable teeth - from 3 to 6 years. At older ages, myotherapy does not show the desired effectiveness as an independent method.

If it is prescribed, it is only as an auxiliary method - when wearing the device or after surgery.

The orthodontist prescribes an individual set of exercises for each small patient, which directly depends on the type and degree of pathology. The most commonly practiced exercises are clenching the teeth in turn (the upper jaw forward, the lower jaw back, then vice versa), strong squeezing of two jaws, tightly clenching the lips, holding a light flat object with the lips - a ruler or a sheet of paper. There is also a set of exercises for the tongue and cheeks.

Myotherapy will also require enormous patience and hard work from parents and the child, because the exercises will need to be performed systematically, as the muscles get used to the load, increasing this load and the duration of such “charging” until a feeling of muscle fatigue in the masticatory and facial muscles.

Surgical correction

Surgical intervention to correct the bite in children is not required so often, but sometimes (especially in cases of complex congenital anomalies) one cannot do without a surgeon’s scalpel. The operations are aimed at shortening or lengthening the arches, and sometimes even changing the size of the chin.

Surgery is usually only indicated for adolescents who have not been helped by other methods (braces, plates, mouth guards). They try not to perform surgery on children aged 2-3 years - such an intervention can cause injuries.

Rehabilitation after such an operation is long and quite painful for the child, the risk of infection is high, which is why they try to abandon surgical correction in favor of longer, but more gentle correction methods.

After surgery, the patient goes back under the control of the orthopedist, who will help straighten the bite for quite a long time through the use of devices.

Correction of distal bite

Correcting a distal bite takes a very long time. It may take several years. Moreover, this pathology is often complicated - signs of a deep bite are added to it. The good news is that treatment started in childhood usually proceeds faster and brings the desired effect. The most common method is the installation of removable devices and simultaneous myotherapy.

Correction of deep bite

To correct this pathology, large amounts of solid food are prescribed in children under 6 years of age. It is hard green apples and crackers that help teeth get closer to normal. No other treatment is provided until the age of six.

When the child turns six, if crackers and dryers do not help, the doctor selects the necessary device for the child (removable mouth guards, hard or soft plates, silicone trainers).

After 12 years, if the problem is not solved, the doctor puts permanent devices on the child. Simultaneously with treatment, a visit to a speech therapist and the use of myotherapeutic gymnastics techniques are recommended for all age categories.

Correction of mesial occlusion

If such a pathological bite is detected in childhood, the child is prescribed to wear a mouthguard or silicone trainer. If the degree of pathology is significant, then the child may be prescribed to wear special orthodontic caps with support for the chin. If these methods are unsuccessful, the baby may have several lower teeth removed.

In the same way as with other pathologies of the maxillofacial apparatus, myotherapeutic gymnastics are prescribed.

To make the exercises easier for the child, dentists come to the rescue and polish the prominent cusps of the fangs.

The devices are usually worn until 12-13 years of age. After this age, the orthodontist evaluates the result and decides on the need for further treatment. If there is such a need, you can wear non-removable devices.

Prevention

Even if the child has no visible dental problems It is advisable to visit the dentist at least once a year, starting from one year of age. This will help not only to eliminate all emerging inflammatory foci in a timely manner, but also to promptly identify incipient malocclusions and begin to correct them. The sooner this happens, the more effective the treatment will be.
All respiratory diseases should be treated promptly that lead to impaired nasal breathing - treat or remove adenoids, avoid chronic rhinitis. The habit of breathing through the mouth not only contributes to acute respiratory viral infections, but also leads to the formation of a pathological bite.
Small children, as directed by a doctor, must give vitamin D, since rickets, which can develop due to a lack of this vitamin in the body, affects the condition of the maxillofacial bones.
Needed in a timely manner Avoid pacifiers and bottle feeding. If the baby already has milk teeth, he does not need a pacifier. Ideally, after one year the child should drink from a cup, and at one and a half years he should completely give up the pacifier. This will significantly reduce the risk of developing malocclusion.
It is important to ensure that the child has sufficient level of calcium in the body. If there is a deficiency, you should definitely consult a pediatrician and start taking calcium supplements.
To learn how to correct a malocclusion, watch the following video.

An open bite is a type of dental anomaly, which is characterized by the formation of a gap when the upper and lower jaws close. This condition is also called disocclusion, that is, translated from Latin, “opening.” Open bite can be both anterior and lateral, one- and two-sided, as well as true and false. False curvature has two forms: dentoalveolar and - more complex - gnathic, when the bite is formed due to improper development of the jaws. As for the true anomaly, it is formed only at the gnathic level.

Why does open bite occur?

The reasons for the development of this anomaly may be different. Thus, a “false” anterior, or, as it is also called, frontal, open bite appears due to prolonged thumb sucking or irregularly shaped bottles and pacifiers. Mouth breathing, infantile type of swallowing, short frenulum of the tongue and absence of anterior teeth also cause open disocclusion. Due to the above disorders, the tongue moves forward and either rests on the upper teeth or lies between them. As a result, the teeth move out or become shorter, and the child develops sigmatism, that is, a lisp. Lateral open bite is formed mainly due to untimely loss or absence of chewing teeth. Children often stick their tongue into the gaps that have formed in the dentition, which is why they become separated.

The formation of open disocclusion is also influenced by macroglossia - an increase in the size of the tongue, congenital disorders, heredity, as well as diseases of the mother during pregnancy.

A true open bite is a consequence of rickets, which is why it is also called “rickets.” As mentioned earlier, true disocclusion is formed due to underdevelopment of the jaw bones and is more difficult to correct.

How to correct an open bite?

Both false and true open bite can be corrected; you just need to choose the right treatment and start it on time. Better yet, do everything possible to avoid the development of an anomaly.

Open bite in a child - what to do?

Comprehensive treatment will help eliminate an open bite in a child. The first step is to wean children from bad habits that contribute to its formation, as well as to establish the processes of breathing and swallowing and, if we are talking about true curvature, to cure rickets. It is also necessary to carefully take care of the baby’s oral hygiene and be sure to replace lost teeth, including milk teeth, with hypoallergenic dentures.

Physiotherapeutic treatment and myogymnastics help cure open bite in children under seven years of age. The program is developed individually, based on the characteristics of each patient.

However, exercise alone is not enough. During treatment, the child must wear orthodontic appliances that normalize the bite. The palatal expander helps correct the anomaly caused by mismatched jaw sizes. The chin sling and structures with intermaxillary traction push back an overly protruding jaw, and activators and bite plates normalize the position of the tongue and muscle function, and also minimize the pressure of the cheeks and lips on the dentition. In certain cases, some designs must be worn at the same time.

In addition, there are situations when the closure can be normalized by changing the height of the back teeth. In this case, they are reduced with the help of devices that inhibit their eruption, or, if teeth have already appeared, by grinding down some of them. The above treatment option is most often used for lateral curvatures.

Attention!

In patients with an open bite, the upper lip is located too high, from under which the front teeth will always be visible even after treatment. Wearing bite blocks will help you avoid the “ever smiling man” effect.

After the eruption of all permanent teeth, that is, around the age of 12-13, patients are fitted with braces to normalize the position of the teeth and dentition. Children cannot take them off, which has a positive effect on the treatment process and makes it possible to determine the timing of wearing them with almost one hundred percent accuracy. For more conscious patients, install. However, braces solve the problem only at the level of the dentition. In the case of more serious anomalies, additional equipment is installed simultaneously with bracket systems.

How to eliminate an open bite in adults

Adults also have their bite corrected using braces and aligners, and in more complex cases, their teeth are ground down and crowns are placed on them, or even some of them are removed. However, to eliminate particularly severe curvatures, specialists often resort to orthognathic surgery - jaw surgery.

During the operation, patients’ lower jaw is sawed almost completely in the area of the first molars or “eights,” and sometimes part of the upper jaw in the frontal region is removed. Not all Moscow dentists can offer such operations, since orthognathic surgery in private clinics is poorly developed. However, surgery is only one of the stages of treatment and will not be effective without wearing braces or aligners.

Consequences of an open bite

People who refuse treatment face very unpleasant consequences. Due to open disocclusion, the symmetry of the face, the functioning of the muscles and the temporomandibular joint are disrupted. Moreover, the owner of an open bite cannot breathe normally, swallow, close his mouth and chew food, and also clearly pronounce words with a large number of hissing and voiceless consonants. Leaving everything as it is in this situation would be a big mistake; an open bite can and should be corrected!

Open bite refers to vertical anomalies and is characterized by the presence of a vertical gap when the dentitions close in the anterior or lateral areas.

The population frequency of open bite is low and is 1.9% between the ages of 3 and 27 years. The highest incidence of open bite was found in children aged 7-11 months. - 18.51%. The bite in children of this period is in the initial period of formation; the first milk teeth, which have not yet come into contact, are erupting. In children during the period of temporary occlusion, the prevalence of this anomaly ranges from 2.3% to 5.6%. In children 6-12 years old (changeable dentition), its prevalence is 1.6%, and in children 13-14 years old and adolescents (16-18 years old) - 1.3%. The frequency of open bite in schoolchildren aged 7 - 16 years is 1.12%, in the structure of dental anomalies - 2.37%.

L.S. Persin believes that “there cannot be an open bite, because there is no closure of teeth" (1996). He calls this condition disocclusion.

Etiology and pathogenesis of open bite.

The causes of open bite are:

Heredity,
- illnesses of the mother during pregnancy (toxicosis, infectious, viral diseases, diseases of the endocrine system, cardiovascular system, etc.),
- atypical position of the tooth buds,
- diseases of early childhood (especially rickets),
- dysfunction of the endocrine glands, mineral metabolism,
- nasal breathing, function and size of the tongue,
- incorrect position of the child during sleep (head thrown back),
- bad habits (sucking fingers, tongue, biting nails, pencils and various objects, inserting the tongue between the dentition in the area of the defect after early loss of temporary or permanent teeth, etc.),
- traumatic damage to the jaws,
- cleft of the alveolar process and palate.

A true open bite is an open bite that occurs in children who have suffered from rickets.

Vitamin D regulates the phosphorus-calcium balance, so even introducing a sufficient amount of phosphorus and calcium into the child’s body does not save him from rickets if D-hypovitaminosis is not eliminated.

Etiology of rickets.

The causative and predisposing factors to the occurrence of rickets are the following:

1. Lack of sun exposure and exposure to fresh air.
2. Nutritional factors: a) formulas not adapted for INFANTS (to which, in particular, vitamin D3 is not added, b) milk-fed for a long time; c) later by introducing supplementary feeding and complementary foods; d) receiving predominantly vegetarian complementary foods (porridge, vegetables).
3. Perinatal factors. a) prematurity (at 26 weeks the increase in Ca in the fetal body is 100-120 mg/kg/day, P is 60 mg/kg/day, and at 36 weeks Ca is 120-150 mg/kg/day, and P is 85 mg/day kg/day) and a child less than 30 weeks of gestation often has osteopenia at birth. b) placental insufficiency (activation of parathyroid hormone secretion to maintain calcium balance)
4. Insufficient physical activity (lack of elements of physical education in the family (massage and gymnastics, etc.), because the blood supply to the bone increases significantly with muscle activity
5. Intestinal dysbiosis with diarrhea.
6. Anticonvulsant therapy prescribed long-term (phenobarbital, diphenine, etc.) promotes accelerated metabolization of metabolically active forms of vitamin D.
7. Syndromes of impaired absorption (celiac disease, cystic fibrosis, etc.), chronic diseases of the liver and kidneys, leading to impaired formation of metabolically active forms of vitamin D.
8. Hereditary abnormalities of vit metabolism. D and calcium-phosphorus metabolism.
9. Environmental factors. Excess in soil and water, products of strontium, lead, zinc, etc. leading to partial replacement of calcium in bones.

Impaired ossification in rickets occurs in the epiphyses - resorption of epiphyseal cartilage, disruption of epiphyseal bone growth, metaphyseal growth of non-mineralized osteoid. However, in the pathogenesis of the development of rickets, not only parathyroid hormone plays a role, but also the C-cells of the thyroid gland, which produce Calcitonin, which inhibits the resorption of the organic bone matrix and stimulates the incorporation of calcium into the bone. Thus, it determines the concentration of calcium and phosphorus in the blood of individual patients.

Signs of late rickets are manifested by biological inferiority of the jaw bones and dental tissues. Bones that are subject to continuous traction and pressure during the functional activity of the masticatory muscles and are pliable due to insufficient mineralization are easily deformed.

Rickets is manifested by the formation of a true open (rickets) bite (as opposed to a false - traumatic) (Fig. 122).

Externally, such a patient has a discrepancy in the relationship between the facial and cranial bones. The face is small in comparison with the skull and looks infantile. The lower third of the face is enlarged (Fig. 123).

The angle of the lower jaw is set further than usual, so that only the back teeth contact, resulting in an open bite. The action of the chewing muscles is more reflected in the lower jaw, which is the supporting bone for the entire chewing muscles and is susceptible to pressure and stretching forces.

The lower dentition loses its parabolic shape: the frontal portion of the dental arch loses its roundness and becomes flattened, which in turn leads to a crowded arrangement of the lower frontal teeth.

According to N.I. Agapov, the rachitic lower jaw is characterized by a trapezoidal shape of the alveolar arch (Fig. 124).

The short side of the trapezoid is the frontal teeth, which stand in a straight line, the sides are the chewing teeth, which, with severe deformation, are also located in a straight line. This jaw shape is a sign of rickets. If the lower jaw is so deformed that the lower molars become tilted towards the tongue under the action of the mylohyoid muscle, then such a rachitic lower jaw indicates late rickets.

Rickets also causes an unfavorable effect of the masticatory muscles on the development of the upper jaw: the muscles attached to the area of the temporal bone, maxillary tubercle and pterygoid process pull down the alveolar processes and adjacent tissues and indirectly affect the area of the upper premolars and molars.

The buccal musculature also constricts these areas, resulting in compression of the jaw and displacement of the premolars palatally.

The upper jaw elongates in the area of the front teeth, increases in length, and the palate takes on the shape of a lyre. The lower jaw is shortened in the sagittal direction, the arch is flattened in the area of the frontal teeth and branches in the area of the fangs.

Traumatic (false) open bite occurs as a result of chronic or acute trauma. Chronic injury occurs as a result of bad habits (sucking fingers, lips, cheeks, tongue, biting nails, pencils, sleeping with your head thrown back). The space between the teeth usually corresponds to the shape of the “object” that the baby was sucking on.

An open bite can occur as a result of improper alignment of fragments during the treatment of jaw fractures.

Classification

There are two main forms of open bite based on its location: open bite in the area of the anterior teeth and open bite in the area of the lateral teeth (unilateral, bilateral). There are also symmetrical and asymmetrical open bites. It is advisable to distinguish open bite of the maxillary, mandibular and combined forms.

Depending on the etiology and pathogenesis of D.A. Kalvelis distinguishes two main forms of open bite:

True (rachitic);
- false (traumatic).

It is advisable to determine the degree of severity of an open bite by the size of the vertical gap (Bogatsky V.A.): I degree - up to 5 mm, II degree - from 5 to 9 mm, III degree - more than 9 mm.
Regardless of the etiological factor and form, open bite is divided into degrees of severity (Vasilevskaya Z.F.): I - only the central incisors, lateral incisors, and canines do not close; II - the central incisors, lateral incisors, canines, first and second premolars do not close, III - only the last molars close.

In addition to dentoalveolar shortening (usually the upper anterior teeth), in the vast majority of cases dentoalveolar lengthening is observed in the lateral areas of the upper jaw; The mandibular angles often increase (more than 135°).

Schwartz divides open bite into two forms: dentoalveolar and gnathic. The dentoalveolar form is characterized by shortening of the roots of the teeth and alveolar parts. In the gnathic form, a sharp curvature of the body of the lower jaw is detected (convex in the lateral areas and concave in the anterior) with a deployed angle of the lower jaw. Branches may be shortened. In many cases, however, there is a high position of the joints in the skull without shortening of the branches of the lower jaw.

Open bite clinic.

The dentoalveolar form of open traumatic bite develops mainly as a result of the bad habits mentioned above. The space between the teeth usually matches the shape of the object the baby is sucking on. With a pronounced open bite, when a significant distance (0.5÷1.0 cm or more) is formed between the front teeth, a typical violation of the relationships between individual parts of the face is externally determined. The lower part of the face is usually excessively large in relation to the upper part (Fig. 126).

When examining the profile, a lowering of the chin is noted in comparison with the level of the angle of the lower jaw. The upper lip is shortened or tense, the nasolabial and chin folds are smoothed, the mouth is always slightly open, the lips close with difficulty. Intraoral signs of an open bite include a vertical gap between the front teeth. When examining the dentition and their relationships, other complications are often discovered, such as: lateral compression, abnormal arrangement of teeth, deformation of the shape of the crowns of the teeth. The dental arches are narrowed, especially the upper one, the front teeth are closely spaced, and hypoplasia is detected on the hard tissues of the teeth. The cutting edges of the anterior teeth often follow a concave curve. The tongue is usually enlarged, it has longitudinal and transverse grooves, the papillae are smoothed, and sometimes pinpoint hemorrhages are noticeable at the tip. In the area of the upper and sometimes lower front teeth, the gingival papillae are hypertrophied, swollen, bleeding, and tartar deposits are often observed. In many cases, generalized carious disease develops.

With age, the chewing surfaces of the opposing groups of chewing teeth wear down significantly. As a rule, with an open bite, compensatory macroglossia occurs. An open bite can be caused by deformation of one or both jaws.

An open bite is often accompanied by dentoalveolar lengthening in the lateral areas of the upper jaw and an increase in the mandibular angles. Analysis of diagnostic models of jaws with an open bite shows that the dentition of the upper and lower jaws, as a rule, is deformed with insufficient development of their apical bases.
With the dentoalveolar form of open bite, the upper incisors often deviate vestibularly, and the angle of inclination of their axes relative to the plane of the base of the upper jaw (SpP) decreases. The growth of the frontal portion of the upper jaw is inhibited. The value of the basal angle is within average values (B=200). The prognosis for the treatment of such malocclusion is favorable.

An open bite due to rickets can be of a dentoalveolar or gnathic form. The dentoalveolar form of open bite is often combined with a distal bite, narrowing of the upper dentition and protrusion of the upper anterior teeth.

An open bite with rickets is characterized by:

An increase in the basal angle (B>200) and dentoalveolar shortening in the area of both upper and lower frontal teeth;
- curvature of the roots of the incisors and their shortening, as a result of which the ratio of the heights of 1:6 and 1:6 teeth is disrupted.

The gnathic form of open bite is characterized by changes in the shape of the lower jaw. There is a depression on its lower edge in front of the place of attachment of the masticatory muscles themselves. The dentoalveolar height in the anterior area is less, and in the lateral areas it is usually greater than normal. The lower part of the face is elongated, the basal angle B is increased (B>200), the angles of the lower jaw are increased (Go>1230), the direction of the posterior contours of the branches is sometimes normal. The edge of the lower jaw has an almost vertical direction. The temporomandibular joints are located high. The ratio of the anterior height of the jaws and the height of the nasal part in an open bite is disturbed as a result of an increase in the height of the jaws (3:2 compared to 5:4 normally). The anterior height of the jaws is sometimes 2 times or more greater than the posterior one. The anterior teeth are often deviated vestibularly, the interincisal angle is reduced (ii<1400).

Functional disorders.

An open bite leads to significant functional impairment (difficulty biting food, chewing, improper swallowing, speech impairment, changes in breathing).

With an anterior open bite, biting food is impaired because the frontal group of teeth is excluded from contact. This leads to overload of the remaining teeth and a decrease in chewing efficiency. In children with a small number of pairs of antagonizing teeth, the tongue takes part in kneading food, as a result of which its muscles become overdeveloped and strong, and the tongue is increased in volume (tongue hypertrophy).

With an open bite, improper swallowing occurs (V.P. Okushko). In the normal way of swallowing, the lips are calmly folded, the teeth are clenched, and the tip of the tongue rests on the hard palate behind the upper incisors; if it is incorrect, the teeth are open, and the tip of the tongue pushes away from the lips and cheeks when swallowing. This can lead to separation of the front teeth.

There is an unclear pronunciation of lingual-dental and labial hissing sounds “p”, “b”, “v”, “m”, “f”, “s”, “sh”, “ch”, “r”.

During a conversation, the tongue, as a rule, slips into the existing gap (unclear speech, lisp). When speaking, children tend to compensate for the lack of articulation of sounds by narrowing the mouth opening or by moving the tip of the tongue closer to the lower dentition; this explains the peculiar facial expressions when speaking.

Breathing with an open bite is predominantly oral, which is caused by the constant gaping of the mouth. The muscles of the oral and perioral area are usually inactive, this is explained by a conditioned reflex reaction to the gaping of the oral slit, the desire to hide the defect by stretching the lips. Constant tension on the lips makes breathing easier and leads to less drying of the oral mucosa. When mouth breathing occurs, there are general disturbances. In this case, there is no sufficient mixing of residual air with tidal air, which is very important for normal ventilation of the lungs. In addition, the passage of air through the nose stimulates the respiratory muscles. Mouth breathing produces significantly less carbon dioxide than nasal breathing. With oral hyperventilation, the carbon dioxide content in the blood increases and the oxygen content decreases. Even with inconsistent mouth breathing, the blood loses half its oxidative capacity. Biochemical changes in plasma also include an increase in the content of glucose and calcium. A clinical blood test shows in such cases a decrease in hemoglobin content, leukocytosis with a shift to the left, and inconsistent ROE. Mouth breathing leads to a deterioration in the outflow of venous blood and disruption of the central nervous system. Breathing is shallow. Congestion in the lungs.

Establishing diagnosis.

When diagnosing an open bite, it is necessary to determine whether this pathology is independent or combined with other anomalies. Since open bite as an independent form of anomaly is observed very rarely.

Decisive for diagnosis is the relationship of the lateral teeth. So, if the closure of the lateral teeth is correct (Class I according to Angle), an “open bite” diagnosis is made. If the contact of the lateral teeth corresponds to the picture of the distal bite (Class II according to Angle) and there is no closure of the anterior teeth, a distal bite complicated by an open bite is diagnosed.

The diagnosis is made on the basis of a clinical examination, photometric examination of the face, study of diagnostic models of the jaws, orthopantomograms of the jaws, lateral TRGs of the head. Based on the results of a tele-radiological examination of the head, the dentoalveolar and gnathic forms of open bite are determined.

Prevention. In the prevention of open bite, the main attention should be paid to the health of the pregnant woman, her adherence to a healthy lifestyle, the prevention of rickets and other diseases of the child, the prevention and elimination of bad habits, the normalization of nasal breathing, tongue articulation when speaking and swallowing. If there is a short frenulum of the tongue, it is necessary to perform its plastic surgery.

Basic principles of open bite treatment.

Treatment of open bite must be differentiated depending on its type, severity and age of the patient.
A very effective and necessary method of treatment for temporary and early mixed dentition is myogymnastics of the muscles of the tongue and the orbicularis oris muscle. With the help of special gymnastics, muscle function is restored and the development of malocclusion is prevented.

Gymnastics can achieve positive results in the treatment of anomalies in children during the period of formed primary occlusion. The most suitable age for using this treatment method is from 4 to 7 years, when the child can understand what is required of him and perform the exercises. Gymnastic exercises are prescribed without apparatus or with special apparatus.

Exercises for the orbicularis oris muscle. The child closes his lips and puffs out his cheeks, after which he presses his fists to his cheeks and slowly squeezes out air through his clenched lips. To develop the orbicularis oris muscle, you can whistle, blow on an easily moving object, for example, a suspended piece of cotton wool, a feather, etc. It is also recommended to place a folded strip of paper between your lips and purse your lips. Hold the paper with your lips for 30-50 minutes. While doing homework or while the child is watching TV. The exercise is performed daily.

The most commonly used resistance exercises are the following.

The child places his bent little fingers in the corners of his mouth and stretches them slightly, squeezing his lips and making sure that they do not turn out.

Table 5.
Muscles of the mouth circumference

The Rogers shock absorber operates on the same principle. It is a mouth dilator onto which a rubber ring is placed. The contraction force of the orbicularis oris muscle must overcome the contraction force of the rubber ring.

Exercise with Friel's interlabial disc. The disc is placed between the lips and held there first for 1 minute, and then for 3-5 minutes.

Exercise with Dass activator

The activator is made of orthodontic wire with a diameter of 1-1.2 mm and plastic. A piece of wire 25 cm long in the middle is bent in the form of a ring, and at the ends in the form of triangles perpendicular to the plane of the ring. The pads are modeled from self-hardening plastic according to the shape of the lips. The child holds the activator with his lips, pulling it by the ring with his thumb. The exercise is done 2 times a day, 5-20 times. In case of temporary and early mixed dentition, orthodontic treatment is most often combined with preventive measures. For treatment, expansion plates with screws, springs, vestibular arches are used for the upper jaw (if it is narrowed), sometimes in combination with a tongue rest in the anterior area or bite pads on the lateral teeth. The action of these devices is designed to change the tone of the masticatory muscles and the restructuring of the bone tissue of the alveolar processes in the lateral areas, as well as to normalize the function of the tongue, especially during swallowing. It is advisable to combine such devices with an extraoral bandage and a chin sling with a vertical rubber rod.

It is also possible to use activators. They should be designed so that the lateral teeth of both jaws rest on the bite pad. The front ones, on the contrary, are freed from the apparatus. On the oral side there is a tongue rest. Activators are combined with screws, springs, and vestibular arches.

AND I. After the first permanent molars have erupted, Katz recommends covering them with bite-release crowns. After 10 - 20 days, the crowns are removed, the temporary teeth are ground down until the first permanent molars contact, and then these crowns are again fixed on the first permanent molars. Such manipulations are repeated several times. After the eruption of the second permanent molars and front teeth, this method has no effect.

During the period of temporary occlusion, treatment, first of all, should be aimed at carrying out, if necessary, antirachitic treatment or eliminating possible causes of the development of open bite: eliminating bad habits, normalizing the position of the tongue, normalizing nasal breathing, swallowing, sound production. Vestibular plates of various designs and positioners are very effective in eliminating bad habits.

During the period of temporary occlusion, a variety of removable appliances are used with the addition of wire or plastic elements to their design, which remove the tip of the tongue from the dentition and prevent the bad habit of pressing the tongue on the front teeth (open Klamt activator, Balters bionator), as well as the Andresen-Goipl activator, Muehlemann propulsor, etc. The designs of these devices depend on the concomitant sagittal and transversal pathology of occlusion.

Open Klamt activator(Fig. 130) is a single basis for the upper and lower jaws. In the anterior section it is open, but the influence of the tongue on the front teeth is prevented by four V-shaped processes welded into the base. The device is equipped with two arches: a vestibular one, which moves the lower frontal teeth distally, and an oral one, which moves the upper frontal teeth mesially. The activator can be sawn along the sagittal to expand the jaws.

Schwartz apparatus for the treatment of open bite, it is a removable plastic plate located on the upper or lower jaw, or two plates for both jaws, depending on which teeth need to be moved. The plate covers the mucous membrane of the alveolar process and is adjacent to the last two molars in the cervical area; it should not be adjacent to the remaining teeth. A metal springy vestibular arch extends from the plate on both sides behind the last molars, which in the area of the molars has the shape of a loop, and its middle part is located in the beds of the rings, mounted on the teeth, serving as a support and subject to displacement. The operating principle of the device is based on the use of mechanical force developed by a spring arc. The arc is periodically activated in the vertical direction.

The Herbst apparatus is also used to treat open bite. Rings with hooks open distally are prepared for the first permanent molars of the upper and lower jaw. Rings with hooks are prepared for the front teeth of the upper and lower jaws, open on the upper jaw upward and on the lower jaw downward. Having secured the rubber rod on the hooks soldered to the rings on the 1st permanent molars, the rubber is thrown over the hooks soldered to the rings on the front teeth of the opposite jaw. Thus, the thrust goes crosswise.
In the initial period of mixed dentition, the same treatment methods are used as in the period of temporary dentition. Springs, levers, lingual or vestibular arches are mounted in various plate devices, providing dentoalveolar lengthening (or shortening) and eliminating sagittal and transversal anomalies of occlusion.

During the period of late mixed and permanent dentition, with significant divergence of the anterior teeth, intermaxillary traction is used. Depending on which jaw is to be treated, one or two Angle apparatuses and a Cojocaru apparatus are used.

If the upper and lower front teeth are to be moved, two Angle arches are used, which have the appropriate number of hooks, and intermaxillary traction is carried out using a rubber traction. Intermaxillary traction can also be carried out as follows. The upper and lower front teeth are covered with plastic mouthguards, stamped metal crowns, or soldered rings are put on the teeth - at the same time, all the cutting edges, which have hooks for rubber traction, are released according to the number of teeth being moved.

Using the expansive Angle arch, you can move the front teeth vertically without intermaxillary traction. To do this, the teeth to be moved are covered with crowns or rings with hooks bent towards the mucosa. The arc is bent in the direction of the intended displacement and then put on the hooks with force. The arch, due to its elasticity, tends to return to its original position and pulls the teeth along with it.

And yet, treatment of an open bite with intermaxillary traction, even with a favorable outcome, does not eliminate the aesthetic defect, since the height of the lower third of the face does not change. If the upper lip is shortened and the front teeth are visible from under it, then intermaxillary traction is not indicated, because after treatment the upper dentition will not be covered by the lip, and the patient will give the impression of always smiling. In such cases, plates with bite pads should be used on the lateral teeth to reduce the height of the alveolar processes in the lateral areas of the jaw. For this purpose, plates with bite pads are used on the lateral teeth.

In this case, a restructuring of the bone tissue of the alveolar processes occurs, the height of the lateral sections of the jaws decreases, the vertical gap disappears, the height of the lower third of the face decreases and the patient’s appearance improves.

Lateral open bite is eliminated mainly by intermaxillary traction or prosthetics.

At the end of the period of mixed dentition and in permanent dentition, fixed arch devices are used; with sufficiently stable teeth, it is possible to use reversible arches (Fig. 135).

These devices can be combined with a vertical extraoral traction (chin sling with head cap).

When there is a pronounced open bite and a curved jaw in the frontal area, treatment consists of applying an extraoral bandage consisting of a chin sling, a head cap and a vertical rubber band. With lateral compression of the jaw, it is expanded with a sliding plate. Traction of the alveolar processes to eliminate the gap between the teeth is achieved by applying an intermaxillary rubber traction on the orthodontic arches.

For this purpose, the wire arch is bent so that its front part is located at the level of the cutting edges of the teeth. Using ligatures, the arch is pulled to the necks of the teeth, while it tends to return to its original position and pulls the teeth tied to it and accordingly stretches the tissues surrounding the tooth (Fig. 136).

Extraction of the alveolar process should be done slowly to avoid rupture of the periodontium and neurovascular bundle of the tooth. It usually takes at least a year to correct a significant gap between teeth. Instead of ligating the arch to the teeth, rings with hooks can be placed on the teeth to be moved, behind which a tense orthodontic arch is placed.

If it is necessary to correct an open bite due to the dentition of both jaws, orthodontic arches are installed separately on each jaw. It should be emphasized that in order to support the arch, it is necessary to install rings on the first and second molars, and these rings should be soldered together, otherwise the supporting teeth will shift, and not the teeth to be moved.

By using orthodontic arches simultaneously with the elimination of an open bite, it is possible to expand or narrow the dentition, correct the position of individual teeth and normalize the relationship of the dentition.

Traction of the alveolar process to eliminate gaps between teeth can be achieved by applying a supporting arch to one jaw and crowns with hooks to the teeth to be moved in the opposite jaw. A rubber rod is installed on the supporting arch and crowns.

If it is necessary to stretch the alveolar processes, crowns or rings with hooks are strengthened on the front teeth of both jaws and a rubber rod is installed.

Combined (hardware-surgical) method of treating open bite. Eliminating an open bite using orthodontic methods after jaw growth has stopped is ineffective. In severe cases, restoration of occlusal contact between teeth can be achieved by shortening the teeth in occlusal contact by such an amount until contact is formed on all or most of the teeth. If necessary, depulpation of shortened teeth is indicated.

Elimination of an open bite after the jaws have finished growing can be achieved surgically. Of the proposed operations, decortication and excision of triangular sections of bone deserve attention (Fig. 137 a, b, c).

Decortication proposed by A.Ya. Katz, consists of removing the first molars and removing the cortical layer with a bur, as far as possible to the lower edge of the jaw.

Before the operation, an apparatus with intermaxillary traction is prepared and secured to the teeth. The device is as follows: crowns are placed on the second and third molars and rings with hooks are installed on the groups of front teeth of both jaws. After the operation, a rubber rod is installed on the hooks. Under the influence of rubber traction, a slow bending of the jaw occurs in the places where teeth were removed and decortication was performed (Fig. 137, a). This operation is performed intraorally. If an open bite is formed as a result of underdevelopment of the frontal part of the upper jaw, then its elimination can be achieved by the operation shown in Fig. 137, b. Elimination of an open bite can also be achieved by dissecting the branch of the lower jaw (Fig. 137, c).

At the Department of Pediatric Dentistry, Pediatric Maxillofacial Surgery and Implantology of Kharkiv State Medical University, a method of treating open bite using a combined method has been developed and introduced into healthcare practice. The treatment regimen for patients with open bite using the distraction method is as follows: 1. Examination, diagnosis, drawing up a treatment plan; 2. Manufacturing an individual distraction device and fixing it on the teeth of the lower jaw; 3. Carrying out surgery; 4. Postoperative treatment; 5. Activation of the device by 0.2 mm, daily, 7-8 days after surgery; 6. In the process of displacement of a fragment of the jaw, correction of the plastic part of the apparatus is carried out; 7. After achieving the required change in the shape of the body of the lower jaw, the apparatus was fixed in this position, and it played the role of a retention apparatus for 60 days; 8. After X-ray control - removal of the device; 9. Orthodontic and orthopedic treatment according to indications; 10. Use of a soft chin sling during the entire treatment period.

During the prehospital period, the patient is examined on an outpatient basis. Impressions are taken from the upper and lower jaws, and models are cast (working and control). An orthodontic device is made using working models (Fig. 16). The distraction device consists of two metal mouthguards; in the lateral sections, threaded rods are soldered onto the contacted teeth from the vestibular side; they are bent in the anterior section vertically upward on the right and left at the edge of the frontal mouthguard, and are rigidly connected using screw pairs to the anterior metal-plastic mouthguard on the teeth with vertical slot (Fig. 139). If the upward movement of a fragment of the body of the lower jaw is more than 1 cm, then in the first 5-7 days vertical distraction is supplemented with an intermaxillary rubber rod.

To do this, hooks for intermaxillary rubber traction are additionally welded into the frontal mouth guard of the device. The orthodontic device is adjusted to the teeth and secured with phosphate cement. The patient is sent to the hospital for surgery. The distraction method of treating patients with open bite consists of partial osteotomy of the body of the lower jaw and subsequent, dosed exposure to a distraction device in the vertical direction.

The operation proposed by V.I. Kutsevlyak, Yu.A. Litovchenko, consists of skeletonizing the body of the lower jaw from the vestibular side of the alveolar process with a semi-oval incision at the level that caused an open bite (Fig. 18). In the interdental space, a fissure bur is used to dissect the alveolar process from top to bottom to its entire thickness (5) and from bottom to top - the body of the lower jaw to the projection of the neurovascular bundle. In the projection of the neurovascular bundle, only the compact layer is cut, connecting the two previous cuts. The bridge-like area, 1.0-1.2 cm in size, is preserved intact, including spongy substance and a compact plate on the lingual side; neurovascular bundle with spongy substance on the vestibular side. The wound is stitched up. A similar operation is carried out on the opposite side.

After the wound has healed (after 7 - 8 days), the activation of screw pairs on the orthodontic device begins, two turns of the screw daily (distraction rate 0.2 mm per day). As a result of activation of the orthodontic device due to the plasticity of the bone tissue, a gradual stretching and bending of the preserved bridge-like portion of the jaw occurs along with the neurovascular bundle, the teeth of the lower jaw come into contact with the teeth of the upper jaw. As the fragment moves upward, with the help of nuts, the frontal mouth guard is corrected until the fragment is established in an orthognathic bite. The vertical hinge is then secured with quick-hardening plastic. The retention period lasts 60 days. The orthodontic device is removed after control radiographs.

The length of the retention period depends in part on the method of treatment. After correcting the bite with functionally functioning devices (vestibular plate, Mühlemann propulsor, Andresen-Heupl activator, open Klammt activator, Balters bionator, etc.) and eliminating functional disorders of the retention apparatus, they are not required. After using mechanically-acting devices with single-maxillary or intermaxillary traction, the retention period is equal to the average treatment period or longer by 6-8 months. The patient should gradually wean himself from dentoalveolar traction and use traction only during sleep.

Prosthetics for open bite.

An open bite is often accompanied by enamel hypoplasia. If there is significant deformation of the crowns of the teeth and a pronounced cosmetic defect, their correction with artificial crowns made of plastic or porcelain is indicated. However, occlusal contact cannot always be restored. It is restored with counter crowns when there is a small gap between the teeth. If to restore occlusal contact it is necessary to sharply increase the length of the crowns, it is advisable to make the crowns of an acceptable size and not introduce them into occlusal contact.

Prosthetics using crowns of various designs should be considered only an auxiliary method.

Orthodontics
Edited by prof. IN AND. Kutsevlyak

Anomalies in the development of the jaw and facial bones are rare, but they are among the pathologies that are difficult to correct. Open bite occurs in less than 5% of the population. It has characteristically severe symptoms and develops in both infancy and adulthood. Treatment of open bite in children and adults has a very good prognosis. The sooner the signs of an open bite are identified, the easier and faster the treatment of this disease will be.

The article will tell you how the anomaly is classified, what are the causes of its occurrence, will give a list of signs of the disease for self-identification, and will also tell you whether it is possible to correct an open bite in children and older patients. You will receive an answer to the question - how long will it take, which doctor treats open bite and how to effectively prevent the development of pathology and avoid serious complications.

What is an open bite?

An open bite is a vertical pathology of the development of the dentition, in which the jaw does not close completely in the area of the front and side teeth. This type of bite interferes with the closing of the lips, which is why the mouth of a person with such an anomaly is always slightly open. The anomaly affects not only a person’s appearance, but also his health. Improper development of the jaw and premaxillary bones affects the quality of breathing, chewing and swallowing.

Photo 1. Open malocclusion.

Open bite occurs in adults and children, but only the one that occurs due to rickets suffered in childhood is called true. All others are considered false or traumatic.

Open bite is classified according to several parameters:

According to the degree of development of the anomaly	According to the form of open bite formation	According to the type of symmetry of the jaw bones
Stage I - a gap of no more than 5 mm, no contact of the upper and lower incisors, sometimes fangs; Stage II - the gap between the teeth reaches 9 mm, there is no contact between the front teeth and premolars. Stage III - a vertical gap more than 9 mm long, there is no contact between the front teeth, premolars and molars.	Maxillary - deformation runs along the upper jaw and can be caused by both pathological changes in the shape of the palate, and improper development of the dental alveoli or abnormal location of the tooth buds in the jaw. Mandibular - often occurs due to deformation of the bones of the lower jaw or pathologies of the lower row of teeth (congenital or acquired). Combined or mixed form - combines both types.	Asymmetrical - the curvature of the dental plate develops only on one side, in the lateral part of the jaw, sometimes does not affect the front teeth (incisors and canines). Symmetrical - a vertical gap occurs due to deformation of the front teeth, or bilateral pathology on the part of the premolars.

The table presents various classifications of open malocclusion and their brief descriptions.

The main signs of an open bite

The most noticeable signs include severe deformation of facial features, jaw asymmetry, articulated movements, and chewing disorders. Sometimes, in an effort to hide defects, patients close their lips tightly, but even despite these actions, the upper edge of the teeth can be seen through the gap. The dental arches themselves narrow, making the face oval and elongated, especially in its lower third. Tooth enamel is often affected by caries.

Photo 2. Open bite compared to a physiologically correct bite.

When chewing food, the main work is performed by the tongue, which facilitates the swallowing of chewed food, since the jaws themselves, especially if they are not closed sufficiently, are not able to grind food well. Swallowing also changes, becoming abnormal - infantile or infantile.

Sound pronunciation is impaired, especially for deaf and hissing consonants, labial and lingual sounds. In addition to speech disorders, breathing disorders may also be present, which becomes oral. This causes irritation and dryness of the mucous membranes, and also facilitates the penetration of viruses and bacteria into the body.

Photo 3. Contacting an orthodontist will help diagnose an open bite in time and begin its treatment.

Only specialists - an orthodontist and a dentist - can correctly identify a developmental anomaly and make a diagnosis of “open bite” as a result of X-ray cephalometric analysis and orthopantomography. Doctors take pictures of the jaws and damaged soft tissues of the face, after studying which they make a final verdict.

Reasons for the formation of an open bite

Jaw deformities can occur for many reasons. It can be either congenital or acquired. Be the result of injury or illness. The reasons for the formation of an open bite include external (exogenous) and internal (endogenous).

External reasons

constant similar movements of the tongue, placing the tongue between the rows of front teeth;
jaw injury;
thumb sucking and pacifiers, which put pressure on oak trees, deforming them and jaw bones;
irregular nipple shape;
early loss of front or side teeth (less commonly, loss of teeth in adulthood);
chronic mouth breathing.

Photo 4. It makes sense to begin the formation of the bite and its correction in childhood.

Internal reasons

hereditary factors (if there were cases of open bite formation in the parents in the family, this increases the chances of developing an anomaly in the child);
maternal illnesses during pregnancy can negatively affect the development of the fetus;
atypical location of the rudiments of the front or lateral teeth, which, as they grow, put pressure on the jaw bones and bend them;
metabolic disorders, pathologies of the hormonal system;
underdevelopment of the premaxillary bone due to rickets (it is this open bite that is called true);
a cleft in the alveolar process of the palate, curving the upper jaw and interfering with the normal growth of teeth.;
macroglossia (abnormal enlargement of the tongue, which presses on bones and teeth).

Treatment methods for open bite

Correcting an open bite takes place in several stages and can take more than one year. Therefore, doctors strongly recommend preventing the formation of this anomaly, as well as conducting regular examinations and preventive measures in patients at risk. There are two methods: conservative therapy and surgical intervention. However, doctors make their choice in favor of combination treatment.

Photo 5. Braces are effectively used in the treatment of open bites.

Conservative treatment of open bite

Open bite is best treated with conservative methods in the early stages of development and in childhood. So, to get rid of bad habits, children are prescribed to wear special removable mouthguards, trainers and devices that help to correctly position the tongue in the oral cavity. Such onlays also help adult patients with the initial stage of open bite development.

Photo 6. To treat malocclusion, you can choose removable appliances.

Facial exercises stimulate the development of facial muscles and make it possible to eliminate most functional disorders in a short period of time. Myogymnastics is also used during the recovery period, after the completion of bite correction. Exercises help you get used to the new shape of your mouth and develop proper breathing and speech. And eating a large amount of hard foods, which put stress on the jaws, increases muscle strength and forms a correct bite.

Photo 7. There are various myotherapy exercises aimed at correcting an open bite.

Electrical muscle stimulation is also often used both during and after treatment to correct facial signs of an open bite.

Correction of open bite in adults

Previously, treatment of open bite in older patients required mandatory surgical intervention. Nowadays, correction of this pathology does not always lead to surgical intervention. For the treatment of adult patients, non-removable devices are used, such as bracket systems, plates with shutters for teeth, Andresen-Goipl and Frenkel devices.

People who refuse treatment face very unpleasant consequences. Due to open disocclusion, the symmetry of the face, the functioning of the muscles and the temporomandibular joint are disrupted. Moreover, the owner of an open bite cannot breathe normally, swallow, close his mouth and chew food, and also clearly pronounce words with a large number of hissing and voiceless consonants. Leaving everything as is in this situation would be a big mistake; an open bite can and should be corrected!

Surgical treatment of open bite

Surgical intervention is used only in cases of serious injuries to the jaws and facial bones, complex pathologies and pronounced facial asymmetry.

Photo 8. Correcting an open bite surgically requires careful preparation.

First, orthodontists straighten the bite (install special plates that eventually turn the teeth in the right direction), trim the frenulum and remove excess teeth. After removing the braces, the result is fixed, and a compactosteotomy is also performed - a small surgical procedure to disrupt the integrity of the alveolar processes of the teeth. This is necessary in order to reduce the resistance of the bone and simplify the procedure.

After surgical correction and complete healing, the patient undergoes a rehabilitation period, which includes: speech therapy correction, restoration of functions of the masticatory muscles, development and training of the jaw ligaments.