Open Bite Closure with

Mandibular OsteotomyMandibular Osteotomy

Dale Bloomquist

Dilemmas of Surgical Treatment

of Open Bite

• Are surgical treatments stable?

• How do you decide which surgical

treatment is going to be best?

Long-term stability of anterior open bite therapy: A review

Huang, G

Semin Orthod 8:162-172, 2002Semin Orthod 8:162-172, 2002

A review of the orthodontic literature with

respect to long-term stability after orthodontic

or combined orthodontic-surgical treatment

of anterior open bite

Long-term stability of anterior open bite therapy: A review

Huang, GSemin Orthod ;, 2002

• “In summary, the orthodontic therapies do not always result in positive overlap of the incisors at the always result in positive overlap of the incisors at the end of treatment.”

• “The existing literature suggests that approximately 80% of anterior open-bite subjects will have positive overlap at the latest follow-up, whether they undergo only orthodontic therapy or a combination of orthodontic-surgical therapy.”

Surgical Alternatives for Anterior Open Bite

Maxillary Osteotomies

Combined Maxillary and Maxillary OsteotomiesCombined Maxillary and

Mandibular Osteotomies

Mandibular Osteotomy

Maxillary Osteotomies

Surgical Management of Anterior Open bite

Effects of “counterclockwise” rotation of the Maxilla

Maintains or decreases facial height

Changes maxillary occlusal planeChanges maxillary occlusal plane

Uprights maxillary incisors

Increases lateral nasal soft tissue fullness

Widens alar base and alar cartilage

Flattens upper lip

Brief bibliography of Maxillary Osteotomies

for the treatment of Open bites

• Denison TF, Kokich VG, Shapiro PA; Stability of

maxillary surgery in openbite versus nonopenbite

malocclusions. Angle Orthod 1989 Spring;59(1):5-10

• Kahnberg KE, Zouloumis L, Widmark G;

Correction of open bite by maxillary

21.4% relapse to open bite

42.9% significant increase in facial height

Correction of open bite by maxillary

osteotomy. A comparison between bone plate

and wire fixation. J Craniomaxillofac Surg

1994 Aug;22(4):250-5

• Proffit WR, Bailey LJ, Phillips C, Turvey T;

Long-Term Stability of Surgical Open-Bite Correcton

by LeFort I Osteotomy. Angle Orthod 2000; 70(2):

112-117

No difference between rigid (plates and

screws) and wire ossseous fixation

OB decreased 2-4 mm in 7%

Lower face height increased >2 mm in 32%

pretreatment

presurgery

Maxillary Osteotomies

Combined Maxillary and

Surgical Alternatives for Anterior Open Bite

Combined Maxillary Combined Maxillary and

Mandibular Osteotomies

Mandibular Osteotomy

Combined Maxillary

and Mandibular

Osteotomies

Brief bibliography of combined osteotomies

for the

Treatment of anterior open bite

• Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, Tuinzing DB, van't

• Haymond CS, Stoelinga PJ, Blijdorp PA, Leenen RJ, Merkens NM;

Surgical orthodontic treatment of anterior skeletal open bite using

small plate internal fixation. One to five year follow-up. Int J Oral

Maxillofac Surg 1991 Aug;20(4):223-7

16 % relapse to no overbite

Mean of 1.9mm increase in facial height

• Hoppenreijs TJ, Freihofer HP, Stoelinga PJ, Tuinzing DB, van't

Hof MA, van der Linden FP, Nottet SJ; Skeletal and dento-

alveolar stability of Le Fort I intrusion osteotomies and

bimaxillary osteotomies in anterior open bite deformities. A

retrospective three-centre study. Int J Oral Maxillofac Surg 1997

Jun;26(3):161-75

• Proffit WR, Bailey LJ, Phillips C, Turvey T;

Long-Term Stability of Surgical Open-Bite Correction

by LeFort I Osteotomy. Angle Orthod 2000; 70(2):

112-117

Relapse to open bite in 19%

Significant increase in palatal plane to

occlusal plane angle

Overbite decrease 2-4mm in 12%

Facial height increased >2mm in 40%

Maxillary Osteotomies

Combined Maxillary and

Surgical Alternatives for Anterior Open Bite

Mandibular OsteotomyCombined Maxillary and

Mandibular Osteotomies

Mandibular Osteotomy

Mandibular Osteotomy

Brief bibliography of mandibular surgery for

the

treatment of anterior open bite

• Kahnberg KE, Widmark G; Surgical treatment of the open bite deformity. Surgical correction of combined mandibular prognathism and open bite by oblique sliding osteotomy of the mandibular rami. IntJ Oral Maxillofac Surg 1988 Feb;17(1):45-8

7.5% relapse of overbite correction

Slight increase in mandibular plane

• Reitzik M, Barer PG, Wainwright WM, Lim B; The surgical treatment of skeletal anterior open-bite deformities with rigid internal fixation in the mandible. Am J Orthod Dentofacial Orthop1990 Jan;97(1):52-7

• Oliveira JA, Bloomquist DS; The stability of the use of bilateral sagittal split osteotomy in the closure of anterior open bite. Int J Adult Orthodon Orthognath Surg 1997;12(2):101-8

3.3% relapse of gonial

angle

No statistically significant linear

changes

Gonial angle relapsed 33.4%

Long Term Stability of Open Bite

Closure with

BSSO and Mandibular

Counterclockwise RotationCounterclockwise Rotation

Heidi K. Horwitz, D.D.S.

University of Washington, School of Dentistry

Department of Orthodontics, November 2, 2001

Summary:

33 open bite subjects had BSSO with

counterclockwise rotation for correction.

Subjects were followed for an average of 5yr Subjects were followed for an average of 5yr

2mo post surgery; T3 to T5.

22 same or increase T3 - T5 66.7%66.7%

+ 9 decrease T3 - T5 27.0%27.0%

What happened to overbite T3 What happened to overbite T3 -- T5 ?T5 ?

31 positive at T5 93.9%93.9%

+ 2 relapse to open bite at T5 6.1%6.1%

33 subjects 100%100%

Predictors of stability?

Tested Correlations:

1. Initial characteristicse.g. Mp-SN, Overbite

2. Dental changes T1-T2

None were found

2. Dental changes T1-T2

3. Skeletal correction T2-T3

• 50% (10 of 20) overbite with incisor contact

• 40% (8 of 20) incisor overlap but no contact

4 yrs., 6 mos. posttreatment

• 40% (8 of 20) incisor overlap but no contact

• 10% (2 of 20) no incisor overlap

Closure of the anterior open bite using mandibular sagittal split osteotomy.

Bisase B, Johnson P, Stacey M

Br J Oral Maxillofac Surg. 2010 Jul;48(5):352-5

Stability of open bite correction with sagittal

split osteotomy and closing rotation of the

mandible.Stansbury CD, Evans CA, Miloro M, BeGole EA, Morris

DE

J Oral Maxillofac Surg. 2010 Jan;68(1):149-59.

Treated with deprogramming splint

Discrepancy between CR & CO

Initial contact right second molars

37-

0

Mandibular midline osteotomyfor constriction

BSSO with mandibularcounterclockwise rotation

Treatment time 21 months

38-9

Final 38-9

37-0 38-9

37-0 38-9

Surgical Management of

Anterior Open Bite

Combined Osteotomies

Initial

Initial record

Initial

Initial

Initial

Following surgically assisted RPE and alignment

Presurgical record 30-4

Presurgical facial photos

Final records

Cephalometrics

Final photographs

2 years postoperative

2 years postoperative

2 years postoperative

Dilemmas of Surgical Treatment

of Open Bite

• Are surgical treatments stable?Generally – yes, but the causes of relapse are unclear

• How do you decide which surgical

treatment is going to be best? Esthetics, esthetics, esthetics