Short and long term stability of open bite surgical treatment: a systemic review

Abstract

Introduction: The correction of anterior skeletal open bite is one of the most challenging deformities to treat in orthodontic practice, numerous surgical techniques have been suggested for the treatment of these types of deformities, either separately or both at the maxillary and the mandible. It is widely accepted that these procedures may present less predictable and stable short- and long-term results, manifested by a vertical relapse, which clinically results in reopening of the anterior joint. The aim of this review is to examine the stability of the skeletal open bite after maxillary osteotomy alone or combined with mandibular surgery, while studying the impact of associated malocclusions in the sagittal direction, as well as identifying therapeutic approaches eventually providing good short- and long-term stability. Materials and methods: The search strategy adopted in this research is based on the examination of three digital biographical databases: PubMed (MEDELINE), Science Direct, Cochrane library. The search was limited by using multiple keywords according to the following search equation: skeletal open bite and surgical treatment and stability or relapse.Only Studies that identify short-term and long-term changes in the following variables were evaluated: over-bite, PP-SN angle, PM.SN angle, anterior facial height and a follow-up period of at least one year. However, articles that did not meet the eligibility criteria and presented results with a follow-up of less than one year were excluded from this synthesis. Results: Initially, the search strategy resulted in 717 articles, then following the flowchart, only five retrospective studies were selected for the final analysis. Through this synthesis, the relapse seems to be more frequent after a bimaxillary surgery, while osteotomy and surgical closing rotation of the mandible with a rigid internal fixation can be considered as a therapeutic alternative proving a long and short term stability. Conclusion: Anterior open bite associated with a class II sagittal shift reports high rates of postoperative and long-term relapse, while anterior open bite associated with mandibular prognathism are generally more stable regardless of the type of surgery; however incoherent rates of relapse were reported in relation with the mandibular surgery and the severity of the initial shift.

Keywords

• Skeletal open bite and surgical treatment and stability or relapse