Lateral open bite. The consequences of deformation of the occlusion of the dentition. Surgical treatment of open bite

Anomalies in the development of the jaw and facial bones are rare, but are among the pathologies that are difficult to correct. Open bite occurs in less than 5% of the population. It has a characteristic severe symptoms and develops in infancy and adulthood. Treatment of open bite in children and adults has a very good prognosis. The sooner signs of an open bite are detected, 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, give a list of signs of the disease for self-identification, and 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 of the doctors treat 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 anterior and lateral 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 ajar. The anomaly affects not only the appearance of a person, but also his health. Improper development of the jaw and intermaxillary bones affects the quality of breathing, chewing food and swallowing.

Photo 1. Open not correct bite.

There is an open bite in adults and children, but only 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:

The table shows various classifications malocclusion of the open type and their brief descriptions.

The main signs of an open bite

The most noticeable signs include severe deformation of facial features, asymmetry of the jaws, articulated movements, chewing disorders. Sometimes, in an effort to hide defects, patients tightly close their lips, but even despite these actions, upper edge teeth. The dental arches themselves narrow, making the face oval, 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 done by the tongue, which contributes to the swallowing of chewed food, since the jaws themselves, especially with insufficient closure, are not able to chop food well. Swallowing also changes, becoming abnormal - infantile or infantile.

Sound pronunciation is disturbed, especially for deaf and hissing consonants, lip and lingo-labial sounds. In addition to speech disorders, there may also be respiratory disorders, which become oral. This causes irritation and dryness of the mucous membranes, and also contributes to the penetration of viruses and bacteria into the body.

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

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

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Reasons for the formation of an open bite

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

External causes

• constant same-type movements of the tongue, laying the tongue between the rows of front teeth;
• jaw trauma;
• thumb sucking and pacifiers that press on the oaks, deforming them and the jaw bones;
• irregular shape of the nipple;
• early loss of front or side teeth (less often - loss of teeth in adulthood);
• chronic mouth breathing.

Photo 4. The formation of bite and its correction makes sense to start in childhood.

Internal causes

• hereditary factors (if the family had cases of the formation of an open bite in parents, then this increases the chances of developing an anomaly in a child);
• maternal illness during pregnancy can adversely affect the formation of the fetus;
• atypical arrangement of the rudiments of the anterior or lateral teeth, which, growing, put pressure on the jaw bones and bend them;
• metabolic disorders, pathologies of the hormonal system;
• underdevelopment of the intermaxillary bone due to rickets (it is this open bite that is called true);
• a cleft in the alveolar process of the palate, distorting the upper jaw and interfering normal growth teeth.;
• macroglossia (abnormal enlargement of the tongue that presses on the bones and teeth).

Open bite treatment methods

Correction of 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 combined treatment.

Photo 5. Bracket systems are effectively used in the treatment of open bite.

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Conservative treatment of open bite

The best thing conservative methods open bite treated early stages development and in childhood. So to get rid of bad habits, children are prescribed to wear special removable mouth guards, trainers and devices that help to correctly position the tongue in oral cavity. These pads also help adult patients with the initial stage of open bite development.

Photo 6. Removable devices can be chosen for the treatment of malocclusion.

Mimic exercises stimulate the development of facial muscles and allow for short term eliminate most functional disorders. Myogymnastics is also used in the recovery period, after the completion of bite correction. Exercise helps you get used to new form oral cavity, develop proper breathing and speech. And eating a large number solid foods that put stress on the jaw, increase muscle strength and form a correct bite.

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

Also, electrical muscle stimulation is often used both during and after treatment to correct facial signs of open bite.

Open bite correction in adults

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

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

Surgical treatment of open bite

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

Photo 8. Correction of an open bite by surgery requires careful preparation.

First, orthodontists align the bite (install special plates that eventually turn the teeth in the right direction), cut the frenulum and remove extra teeth. After removing the braces, the result is fixed, and a compact osteotomy is also performed - a small surgical procedure to violate the integrity of the alveolar processes of the teeth. This is necessary in order to weaken the resistance of the bone and simplify the procedure.

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

Malocclusion is a common occurrence that goes unnoticed. Children with pathology do not understand the extent of the consequences without therapy, and parents, for various reasons, do not turn to orthodontic specialists to correct the anomaly, but even an imperceptible deviation can disrupt the functioning of the body. One of the most difficult types of occlusion is the open bite type. With it, there is a vertical gap between the teeth in a closed state.

The concept of open bite

An open bite is a change in the position of the teeth, in which there is no tight connection of two opposite bone structures. The problem concerns children, with age the risk of pathology decreases. Open bite is not a disease, it is a dysfunction dental system.

With an anomaly, there is no tight connection on the lateral bone organs or in the smile zone. A gap is formed between the rows of units, its width depends on the severity of the defect. The deformity is diagnosed in 4% of patients and requires long-term correction. What the pathology looks like can be seen in the photo.

Characteristic features

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An open bite is detected when there is a gap when the jaws are closed. The open type is characterized by distinctive manifestations that can be observed visually:

• the third part of the face (from below) is extended;
• the chin fold is almost invisible;
• the chin is shifted to one side;
• lips do not close;
• the upper lip appears to be shortened;
• teeth and the tip of the tongue peep out from under the lip, covering the gap;
• noticeably muscle tension because of the desire of a person to hide the gap by a tight connection of the lips.

In the mouth, deviations from the norm look like this:

Functional disorders are identified on the basis of:

• difficulty biting food and then swallowing;
• develop anomalies of the temporomandibular joint and periodontal disease;
• the surface of the sky from above and the nasal cavity are changed;
• failures in breathing through the mouth, problems with speech;
• the oral mucosa dries up when inhaled;
• interdental sigmatism;
• underdevelopment of the paranasal sinuses.

Causes of pathology

There are a number of factors that can provoke the occurrence of anomalies of the dentoalveolar system. These include:

An ailment in a child can appear for a number of reasons:

• congenital pathologies due to a mother who suffered various diseases during gestation (infections, viral diseases, intoxication);
• bite inheritance from close relatives;
• jaw injury;
• developmental pathology endocrine system;
• rickets;
• bad habits of the baby (lip biting, thumb sucking);
• chronic ENT diseases with nasal breathing disorder;
• incorrect position of the head during sleep;
• unbalanced and incorrect nutrition and multiple caries;
• diseases of the genitourinary system;
• early loss of milk teeth.

In adults, the problem can be exacerbated by improper orthodontic treatment. After implantation of units or installation of bridges, the bite can be noticeably deformed.

Why is such a bite dangerous for a child?

Without quality treatment of an open bite, it can become the main cause of serious deviations: improper chewing of food, breathing difficulties, speech defects. Anomalies are characteristic of childhood Therefore, it is desirable to carry out therapy for babies.

With a frontal open bite, the organs of the smile zone do not grind food, which increases the load on other units. The child’s language is also involved in this process, which in the future will cause him overdevelopment and increase in size. The appearance of defects in the front teeth is associated with improper swallowing: the bone organs are open, the tongue is repelled from the cheeks, due to which the facial facial muscles are overstressed. When talking, the tongue gets into the front gap, due to which some sounds are not pronounced clearly.

An open bite is almost always accompanied by mouth breathing. The consequences of jaw deformity are as follows:

• an increase in carbon dioxide and a decrease in oxygen;
• is changing biochemical composition blood;
• there is a deterioration in the outflow of blood from the veins, which contributes to stagnation in the lungs;
• CNS dysfunction.

When the upper jaw of a person narrows in the lateral sections, this leads to protrusion of the teeth. Bottom part the face is lengthened, the chin looks massive. The problem is that the pathology can progress, in adults contributing factor may be the wrong way of life.

Open bite classification

The severity of the anomaly of bite is distinguished by the height of the formed lumen and the number of teeth that do not have contact. Conventionally, there are three degrees of deformation:

• I - characterized by the presence of a gap of 5 mm, located vertically. Connection of lateral and medial incisors, as well as eye teeth missing.
• II - the height of the clearance is 1 cm. Non-closure is localized not only on the frontal, but also on the chewing units.
• III - the gap reaches a height of more than 1 cm. The contact of the anterior part of the rows of bone organs is completely absent.

Rachitic and traumatic

Traumatic open bite is a pathology that most often affects children 4-8 years old. It appears in the presence of the following habits:

• protruding tongue and clamping it with teeth;
• sucking various improvised objects and fingers;
• biting and chewing cubes, pens, etc.

It is necessary to wean a child from addictions until the milk units begin to fall out. In the absence of measures to prevent them, the deformation is fixed, it becomes more difficult to get rid of it. The pathology is due to external influence- the person is healthy, but the growth of the teeth needs to be corrected.

Open rachitic bite is a complex form of occlusion disorder. The defect appears when the jaw bones are formed incorrectly. Most often it develops in an infant or child at 2-3 years of age. What to do will be decided by the doctor together with the parents, but in most cases, the intervention of a surgeon is required, followed by the use of orthodontic appliances.

Front and side

In an anterior open bite, the absence of occlusion is observed on the anterior teeth. Pathology is characterized by difficulty in speech, atypical swallowing, problems with chewing. Sometimes incomplete connection of the lips is noticeable.

For a lateral open bite, the hallmark is the absence of occlusion of the lateral units. In pathology, the most significant violations are problems with chewing, swallowing, dysfunction of the mandibular joint is often observed.

Treatment

Correction of an open bite is not performed by specialists according to one scheme. The algorithm of actions for each person who applied for help is developed individually, based on the degree of neglect of the deformity and age. Photos before and after the intervention of specialists will help to assess the quality of the therapeutic effect and the changes that have occurred to the patient.

The use of orthodontic structures

For children 3-14 years old, the use of removable structures is required. They expand the dental arch, normalize the position of the tongue, increase the tone of the masticatory muscles. These are plates with an emphasis for the tongue, silicone trainers, as well as devices:

• Andresen-Goipl activator;
• Herbst's design;
• Klammt's activator;
• Frenkel apparatus.

It is almost impossible to force a baby at 2-3 years old to wear regularly removable plates, therefore, parents are obliged to make efforts for effective treatment of open bite. At the second stage, the treatment is accompanied by the wearing of non-removable devices. During the change of dairy units, special products with a screw are relevant.

Pathological changes in the presence of molars, they can be corrected solely under the influence of plates that move the bone organs mechanically, with the help of levers and special arches for dentoalveolar lengthening. Angle apparatus is often used for teeth that require movement, the Herbst-Cojocaru design to eliminate the defect of the lateral units.

When the open bite is corrected, the use of retention mechanisms is not required. The period of fixing the result lasts as long as the main therapy (sometimes longer). For adult patients, only braces are suitable. They need to be worn for about 2 years, you can choose aesthetic, lingual or metal designs.

Myogymnastics

With milk bite in children, the main method of correction is myogymnastics. It is prescribed to restore the functioning of the muscles of the mouth and tongue. Regular exercise prevents the progression of the deformity. With a formed temporary bite, impressive results can be achieved, since the child understands the need for treatment and adheres to the recommendations of a specialist. In parallel, other events may be assigned:

• the use of solid foods that increase the load on the jaw;
• electrical stimulation;
• work with a speech pathologist.

Orthognathic surgery

In the most severe cases, an open bite is treated with surgery. The operation is planned and carried out jointly by the maxillofacial surgeon and the orthodontist. This is a radical method, which is applied only when conservative therapy does not give the desired result. Treatment options include:

1. removal of supernumerary bone organs;
2. performing compact osteotomy;
3. pulling out the extreme molars, after which the cortical layer is removed to the lower edge.

Often, crowns are shortened that interfere with the closing of the jaws. The treated teeth are completely depulped. With severe deformities, a specialist prescribes a correction of dyslalia with a constant consultation with a speech therapist. Next, prosthetics are performed to eliminate defects in the crowns so that the contact of the teeth becomes tight.

The anomaly causes severe psychological discomfort and can provoke serious illness some body systems. Correcting an overbite can take years and require large financial investments.

Preventive actions

Preventive measures to prevent the development of an open bite should be carried out in childhood, when it is possible to prevent displacement. In order not to resort to orthodontic methods for the baby, mothers can start prophylaxis during pregnancy, carefully monitoring its course.

You can prevent deformity in a child in simple ways:

• Eliminate harmful habits of children (chewing pens, sucking fingers);
• from the third year of a baby’s life, you need to wean him from a pacifier;
• teach nasal breathing;
• treat ENT diseases and caries in time;
• prevent the development of rickets;
• follow the diet and a sufficient amount of vitamins entering the body;
• a short lingual frenulum must be corrected at an early age;
• with incorrect teething, it is important to do gymnastics;
• if milk units began to fall out early, it is worth using the prosthetics service.

​​All existing variations in the placement of teeth in rows in humans are divided by dentists into two groups: physiological (correct) and pathological (with various anomalies). In this article, we will talk in detail about the causes and treatment of open bite in adults and children.

Physiological bite is the correct position of the upper and lower row of teeth with central occlusion relative to each other. The normal position is when the upper and lower teeth of the closed jaw are tightly compressed together. In this case, the incisors of the upper row protrude no more than a third above the lower row of incisors, while the upper molars merge with the lower row of molars.

• With a closed jaw, there are no gaps or gaps between the teeth.
• The junction line of the central incisors of both rows runs strictly along the midline of the face.
• In the lateral region, the teeth are compressed in one line, without overlapping one row on the other.
• Chewing food does not cause any inconvenience or pain.
• The oval of the face with a physiological bite has an impeccable shape, and the teeth themselves are arranged in even, beautiful rows.

Varieties of bite anomalies

One of the most common types of malocclusion is the open bite. If, during occlusion of the jaw, individual teeth or a group of teeth in the upper and lower rows do not contact each other, this indicates a occlusion pathology. The gap between the teeth in an open bite can be in the lateral or anterior areas. Open lateral bite implies non-closure of chewing molars, while one or more pairs of teeth may not contact each other. This kind of pathology often leads to a speech defect and can be associated with various ENT diseases. In addition, due to a violation of the chewing function, diseases of the digestive system and the gastrointestinal tract can occur.

If the incisors of the upper row are more than half on the lower row of incisors, this indicates a type of pathology such as deep bite. The cause of a deep bite is most often insufficient face height. Due to the disproportion of the face, a deep bite can be present not only on the front, but also in the region of the lateral teeth. After the treatment, the person acquires correct form, the lips cease to turn outward, the habit of pursing the lips is gradually eradicated.

With a clenched jaw, the incisors of the upper and lower rows do not touch, as a result of which a cleft is formed between them - this pathology is called anterior open bite (front bite). The external manifestation of the anterior open bite is a constantly ajar mouth. Anterior open bite is considered by orthodontists to be the most complex form of malocclusion. Correction of the anterior bite is carried out with the help of mechanical action and the use of non-removable bracket systems.

In case of defective development of one of the sides of the jaw, crossbite. This pathology leads to a violation of the chewing function (due to loose closure of the teeth on one side, a person is forced to chew food on one side). This leads to the development of pathology of the temporal and jaw joints, facial asymmetry, pain when opening the mouth. Correction crossbite It is performed using removable devices or a bracket system in combination with mechanisms for the full expansion of the jaws. However, structures often have to be reinstalled due to the impossibility of reliable fastening.

The reasons

The most common causes of open bite are:

• Maxillofacial injuries;
• Heredity;
• Illness of the mother during the period of bearing a child;
• Incorrect arrangement of teeth;
• Violation metabolic processes organism;
• Work failures endocrine gland;
• Rickets;
• In children - sucking fingers and other objects, using a pacifier for more than a year and a half;
• Violation of the swallowing function (at the time of swallowing, the tongue is between the teeth);
• Tumor of the palate or tongue.

Open bite symptoms

The main symptom of malocclusion is the gap between the teeth with a tightly clenched jaw. Depending on the vertical length of the gap, open bite is divided into three types:

• the gap between the teeth is less than 2 mm;
• slot width 2-5 mm;
• a gap of 5 mm or more.

Depending on the length, the open bite has three dividing groups:

• front teeth partially or completely do not touch;
• frontal teeth and premolars do not touch;
• with a clenched jaw, only the second molars are in contact.

The above bite pathologies lead to the impossibility of complete closure of the lips, which is why the patient's mouth is constantly ajar. The sharp sides of the anterior teeth are concave, and the concavity can be either one side of the upper or lower jaw, or both. The separation of the anterior teeth can reach 1.5 mm or more. The patient has to make efforts to keep the lips closed, thus covering the bite defect, as a result, the upper lip is extended, and the fold lower lip smoothed out.

Treatment

To determine how to treat an open bite , needs to be accurate diagnosis, as a result of which concomitant jaw diseases are also detected. Only a detailed diagnosis will help the doctor prescribe a productive treatment for open bite.

Depending on the age of the patient and the degree of bite deformation, he is prescribed orthodontic, surgical or combined treatment.

For example, to correct a milk bite, treatment occurs with the help of prevention, which can lead to a decrease in pathogenetic factors (sucking fingers, nipples, normalizing the position of the tongue when swallowing, rickets, etc.). Treatment is carried out in a complex - therapeutic effect and special myogymnastics.

Before correcting an open bite in a child, some steps should be taken. preventive measures:

1. normalize the position of the tongue in the mouth;
2. eliminate bad habits;
3. make sure that breathing is nasal;
4. timely carry out preventive measures for rickets.

Eliminate bad habits

To help the child wean from thumb sucking, you can use special cardboard sleeves that are worn on the elbow bends, fixing the baby’s handle in upright position. The child does not have the ability to put fingers in his mouth.

If the child bites his nails, you should persistently and gently remove his hand every time. This habit can signal a nervous breakdown or tension in the baby. Therefore it is better to visit the neuropathologist. For some girls, a manicure serves as a psychological barrier. If you make up a 5-8-year-old baby's nails, she will simply be afraid to spoil her beautiful varnish, thereby overcoming the pathological reflex.

Nasal breathing. An open malocclusion may be due to a lack of nasal breathing. Recovery correct breathing, the patient should visit an ENT doctor to determine the presence of inflammation of the adenoids or tonsils. If necessary, they are removed, after which the child will have to learn to breathe through the nose again.

Breathing exercises to stabilize nasal breathing, which can be done with a child at home:

• During morning hygiene, you need to take water into your mouth and push it out with force with a trickle. Repeat several times.
• The child takes a mouthful of water and holds it behind his cheeks for a while. This procedure does not allow the child to breathe through the mouth, gradually accustoming to nasal breathing.
• The training of the circular muscles is carried out alternately by stretching the lips into a tube, and then into a wide smile. Besides bubble- excellent gymnastics for circular muscles.
• Learning to whistle. The child stretches his lips, trying to reproduce the whistle.
• The child tries to hold a plastic spoon or ruler with his lips for several minutes.

To get the result, the exercises should be performed systematically, preferably several times a day.

Correction of bite during the period of changing teeth in a child

To correct an open bite in the transitional period (the period of replacement of milk teeth by molars), biological and hardware methods, crowns or mouth guards that increase the bite are added to the main methods of treatment and myogymnastics. At the beginning of the shift period, fixed preparations are used to move the teeth. If it is necessary to move the teeth of one jaw, a vestibular arch can be used, which is attached to the supporting milk or first permanent teeth with the help of special rings.

An open malocclusion in the second period of mixed dentition can be corrected using a plate with a special stop under the tongue. The presence of a screw on the plate provides uniform pressure on the dental arches, thereby contributing to their expansion. Also, Angle's apparatus can be used to expand the dental arches. To reduce the effect of the Angle apparatus on the region of the posterior teeth, it is better to use it alternately with extraoral traction.

For the treatment of permanent occlusion, plates with a tongue rest on one jaw can also be used. But more effective for this period is the use of non-removable devices. For example, the Angle apparatus with a shaped arch, rings and hooks specially designed for this purpose, which help move the teeth with the help of rubber traction.

If simultaneous dentolvelar shortening of the posterior teeth and lengthening of the anterior teeth is required, the Hurst-Cojacaru apparatus is used. Its main function is to guide the teeth in the right direction and mechanically influence the correction of the open bite.

The most successful open deep bite is corrected using the following devices:

1. Andresen-Goypl apparatus.
2. Plate with tongue support.
3. The fourth type of the Frenkel apparatus.
4. In the last period of mixed dentition - braces.

Open bite is an orthodontic anomaly characterized by the absence of occlusion between the dentition. Violation of respiratory, speech and chewing functions, along with an unpresentable appearance, is a consequence of the diagnosis. Pathology deals a “crushing blow” to the image in physiological and psychological terms. What is an open bite and why does it arise from an orthodontic point of view?

Open bite is a vertical anomaly of occlusion (closure), the origins of which lie in genetics, intrauterine maturation and formation at all stages of life. The main causes of occurrence are distinguished:

• genetic predisposition;
• diseases of a woman during gestation;
• defects of the lips, palate and alveolar process;
• language parafunction;
• rickets;
• metabolic disorder;
• defects of the nasal septum;
• ENT diseases;
• sucking foreign objects;
• untimely eruption and loss of teeth;
• maxillofacial injuries;
• wrong position during sleep;

Anna Losyakova

Dentist-orthodontist

Note! Since the reasons are not only dental in nature, the correction of an open bite, in addition to orthodontists, requires the involvement of dental surgeons, otolaryngologists, and speech therapists.

Kinds

The classification of bite anomalies is subdivided depending on the etiology, severity, location and type of deformity.

In accordance with the causes that caused the bite is divided into:

Nameopen bite	Characteristic	Causedthe reasons
		Congenital	Acquired
Rachitic (true)	Dysfunction of the bones of the jaw system.	Violation of the structure of bones caused by genetics, abnormalities in the process of intrauterine development.	Rickets, injuries of the jaw bones received during life.
Traumatic (false)	Dysfunction of the dentition.	Intrauterine defects of the dentition, lips, palate, nasal septum, parafunction of the tongue.	Sucking foreign objects, untimely growth and loss of teeth, ENT diseases, incorrect position in a dream.

The rachitic form is the most severe, requiring long-term treatment up to surgical intervention. For the treatment of a false form, it is enough to wear devices and myogymnastics.

By location:

• anterior open bite - lack of occlusion between the front teeth;
• lateral open bite - unilateral or bilateral absence of occlusion of the posterior teeth.

By severity (the distance at which the teeth do not close):

• 1st - up to 0.5 cm;
• 2nd - from 0.5 cm to 0.9 cm;
• 3rd - over 0.9 cm.

Anna Losyakova

Dentist-orthodontist

Important! Depending on the species, symptoms are traced; complex diagnostics are required for treatment.

Symptoms

Pathology does not have a latent form, but is clearly expressed by three groups of signs - facial, intraoral and functional. Hardware diagnostics is carried out in order to identify the causes, severity for the development of further treatment.

Facial signs

The face should ideally have the equality of three parts: upper, middle and lower. In case of pathology, the lower part during visual inspection will be proportionally superior to the rest of the sections. Manifestation of facial features:

• muscle tension or spasm in the mouth area;
• deformation of the nasolabial fold;
• inability to close lips;
• chin displacement;
• visual visibility of the tongue and teeth due to the inability to close the mouth;
• lengthening the bottom.

Intraoral signs

Intraoral symptoms include:

• the gap between the dentition of various sizes;
• lack of contact with antagonist teeth in the anterior or lateral part;
• underdevelopment of dental tissues;
• irregularities of the tooth cutting part;
• plaque on the surface of the teeth, leading to the formation of calculus;
• redness and bleeding of the gums;
• rapidly progressive;
• hypertrophic.

Diseases of the teeth and gums are caused by the constant ingestion of pathogenic microbes into the mouth and overdrying of the oral mucosa, which saliva cannot cope with, since the mouth is constantly in the open position.

Functional features

Symptoms are due to the unnatural position of the dentition due to malocclusion, which contributes to the impossibility of performing natural functions. Main features:

• difficulty in the process of biting off food;
• chewing and swallowing dysfunction;
• predominance of mouth breathing;
• violation of diction;
• symbiosis of hissing sounds;
• underdevelopment of the lower jaw.

Anna Losyakova

Dentist-orthodontist

Important! Pronounced symptoms have a triple effect on the patient's body. Facial features give an unaesthetic appearance often developing an inferiority complex. Intraoral symptoms contribute to the occurrence of diseases of the oral cavity, functional - to diseases of the digestive and respiratory systems.

Diagnostics

Primary diagnosis is based on visual inspection and analysis of signs, study of the anamnesis and complaints of the patient. A specific treatment regimen is developed taking into account accurate research methods that establish the severity and cause of the occurrence. Diagnostic methods include:

1. Orthopantomogram is an x-ray that allows you to evaluate complete picture anomalies: the presence of incipient caries, the correctness of root canal filling, the condition of bone and soft tissues.
2. Teleroentgenography - panoramic shot skull in the anterior or lateral projection, which makes it possible to make an accurate diagnosis due to the maximum approximation in size to natural.
3. Photometric examination of the jaws is a method that allows you to observe the pathology in statics and dynamics, to evaluate the process of progression over time based on images obtained in different periods.

Anna Losyakova

Dentist-orthodontist

Important! After evaluating complex diagnostic data, dentists, orthodontists and oral surgeons select the optimal treatment for open bite. Additionally, patients with speech and respiratory disorders consultations of a speech therapist and an otolaryngologist are appointed.

Treatment

How to fix an open bite? Is it possible to get rid of the pathology completely, and in what time frame? - the first questions of patients after the diagnosis. Open bite involves treatment with a conservative, surgical and combined method. The choice depends on the diagnostic data and the age of the patient.

Treatment in children

Treatment of open bite in children is technically easier and less time-consuming than in adults. Between the age of the child and the period of treatment there is a directly proportional relationship: than younger child the more gentle treatment is recommended. This fact is explained by the unformed bite and skeletal system.

During the period of temporary and early mixed dentition (up to 6 years of age), myotherapy is recommended with a selected set of exercises and an increase in the consumption of hard foods that require tension in the masticatory muscles. At the stage of bite formation, in order to wean the child from bad habits (sucking foreign objects), special plates are used.

An open bite in a child is effectively treated with the following structures:

1. The Herbst apparatus is a non-removable orthopedic product that restructures the work of the joints and muscles of the lower jaw. The constant action of the device leads to stretching of the ligaments and the habit of the muscles to work in an updated mode, eliminating the pathology.
2. The Schwartz apparatus is a removable structure with sliding screws that expands and lengthens the dentition. Wire and spring elements in the form of a vestibular arch provide a moving force.
3. The Klammt Activator is a multifunctional device where the plastic in the area of ​​the incisors is replaced by wire arcs, which allowed for more space for the tongue and provided comfort without the feeling of a foreign body.
4. Chin sling - a device for supporting the chin, connected to a cap, designed to be worn during the period of the formed temporary bite and its change. It is recommended to wear at night.

At the age of 15 years, therapy is similar to that of adults, which is due to the completion of the structure of the formation of a permanent occlusion and bones of the maxillofacial system.

Treatment in adults

Diagnosis: open bite hardware treatment in adults occurs using the following systems:

1. Bracket systems - orthodontic structures attached to the teeth with metal wires. The principle of operation is based on the fact that each tooth has its own hole in which it is held with the help of connective tissue. constant pressure in one direction causes the tooth to change position, making the correction of the dentition.
2. Angle's apparatus is a springy archwire, with the help of traction, aligning the row or changing the position of the teeth required for correction.

Sometimes, to restore contact of teeth with antagonists and an aesthetic appearance, metal-ceramic prosthetics. In difficult cases, a combined method is used: surgical intervention and device therapy.

Anna Losyakova

Dentist-orthodontist

Important! The healing process does not happen instantly. Therapy takes months and years. However, pathology is completely curable, regardless of the causes, type and age category. The patient needs to be patient, strictly follow medical recommendations in order to avoid negative consequences upon refusal of treatment.

Consequences if left untreated

There is a category of people who make the mistake of applying for medical care at the moment when the problem has gone too far or ignoring it altogether. Incorrect bite will not go away by itself, but will negatively affect the work of all organs and systems of the body. First of all, they will suffer:

• oral cavity, contributing to premature caries and inflammation of the mucous membrane;
• ration provision future mother products rich in calcium, responsible for the formation of the skeletal system of the fetus;
• proper organization of the chest or artificial feeding baby in the first period of life in order to prevent rickets;
• ridding the child of the habit of sucking on foreign objects, which contributes to the curvature of an unerupted dentition;
• control over free nasal breathing, especially during sleep, since an imbalance between oral and nasal breathing leads to a violation of the maxillofacial bones;
• control over the growth of teeth and fixation of premature loss, minimizing the occurrence of traumatic bite;
• timely treatment of caries and gum disease for yourself and your child, timely replacement of missing teeth.

Regardless of the causes, type of pathology and age of the patient, open bite is subject to complete cure. To minimize the loss of time and simplify treatment, it is necessary to urgently undergo a diagnosis and proceed to the prescribed therapy when symptoms appear. This will help not only maintain a presentable appearance, but also preserve the health of organs and body systems.

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

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

L.S. Persin believes that “occlusion cannot be open, because. no closure of teeth” (1996). He calls this condition disocclusion.

Etiology and pathogenesis of open bite.

Causes of open bite are:

Heredity,
- diseases of the mother during pregnancy (toxicoses, infectious, viral diseases, diseases of the endocrine system, of cardio-vascular system and etc.),
- atypical position of the rudiments of the teeth,
- 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 (thrown head),
- bad habits (sucking fingers, tongue, biting nails, pencils and various objects, laying the tongue between the dentition in the defect area after the early loss of temporary or permanent teeth, etc.),
- traumatic injury jaws,
- cleft alveolar process and palate.

True is called an open bite that arose in children who had rickets.

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

Etiology of rickets.

Causal and predisposing factors to the occurrence of rickets are the following:

1. Lack of solar radiation and exposure to fresh air.
2. Nutritional factors: a) not adapted for INFANT CHILDREN mixtures (to which, in particular, vitamin D3 is not added, b) long-term milk-fed; c) late introduction of complementary foods and complementary foods; d) receiving predominantly vegetarian complementary foods (cereals, vegetables).
3. Perinatal factors. a) prematurity (at 26 weeks, the increase in Ca in the fetal body is 100-120 mg / kg / day, P - 60 mg / kg / day, and at 36 weeks Ca-120-150 mg / kg / day, and P-85 mg / day kg / gestation) and a child of less than 30 weeks of gestation often has osteopenia already at birth. b) placental insufficiency (activation of parathyroid hormone secretion to maintain calcium balance)
4. Insufficient motor 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 dysbacteriosis with diarrhea.
6. Long-term anticonvulsant therapy (phenobarbital, difenin, etc.) promotes accelerated metabolism of metabolic active forms vitamin D.
7. Malabsorption syndromes (celiac disease, cystic fibrosis, etc.), chronic diseases liver and kidneys, leading to disruption of the formation of metabolically active forms of vitamin D.
8. Hereditary anomalies of vit. 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 the bones.

Violation of ossification in rickets occurs in the epiphyses - resorption of epiphyseal cartilage, violation of epiphyseal bone growth, metaphyseal proliferation of non-mineralized osteoid. However, in the pathogenesis of the development of rickets, not only parathyroid hormone plays a role, but also C-cells. thyroid gland that produce Calcitonin, and it inhibits the resorption of the organic matrix of the bone, 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 the biological inferiority of the jaw bones and dental tissues. Bones that give in 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 (rachitic) bite (as opposed to a false - traumatic) (Fig. 122).

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

The angle of the mandible is farther than usual, so only back teeth contact, an open bite is obtained. 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 amenable to pressure and stretching forces.

The lower dentition loses its parabolic shape: the anterior portion of the dental arch loses its roundness and flattens, which in turn leads to crowding of the lower anterior 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 front teeth, which stand in a straight line, the sides - chewing teeth, located with pronounced deformation also in a straight line. This jaw shape is a sign of rickets. If the mandible is so deformed that the mandibular molars are tilted towards the tongue by the action of the maxillofacial muscle, then such a rachitic mandible indicates late rickets.

Rickets also causes an unfavorable effect of the chewing muscles on the development of the upper jaw: the muscles attached in the area of ​​the temporal bone, jaw 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 a palatal shift of the premolars.

The upper jaw is elongated in the area of ​​the frontal teeth, increases in length, and the palate takes the form of a lyre. The lower jaw shortens in the sagittal direction, the arch flattens in the area of ​​the anterior teeth and branches out in the area of ​​the canines.

Traumatic (false) open bite occurs as a result of chronic or acute trauma. Chronic trauma occurs as a result of the action of bad habits (sucking fingers, lips, cheeks, tongue, biting nails, pencils, sleeping with the head thrown back). The gap between the teeth usually corresponds to the shape of the "object" that the child sucked.

An open bite can result from misalignment of fragments in the treatment of jaw fractures.

Classification

There are two main forms of open bite according to its localization: open bite in the area of ​​the front teeth and open bite in the area of ​​the lateral teeth (one-sided, two-sided). There is also a symmetrical or asymmetrical open bite. It is advisable to single out the open bite of the maxillary, mandibular and combined forms.

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

True (rachitic);
- false (traumatic).

It is advisable to determine the severity of 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 etiological factor and forms of open bite are divided into degrees of severity (Vasilevskaya ZF): I - only the central incisors, lateral incisors, 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 (often the anterior upper teeth), in the overwhelming majority of cases, dentoalveolar lengthening is observed in the lateral sections of the upper jaw; the mandibular angles often increase (greater than 135°).

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

Open Bite Clinic.

The dentoalveolar form of open traumatic occlusion develops mainly as a result of the bad habits mentioned above. The gap between the teeth usually corresponds to the shape of the object that the child sucks. With a pronounced open bite, when a significant distance is formed between the front teeth (0.5 ÷ 1.0 cm and more), a typical violation of the relationship between the individual parts of the face is outwardly determined. lower division faces are usually excessively large in relation to upper section(Fig. 126).

When examining the profile, the lowering of the chin is noted in comparison with the level of standing of the angle of the lower jaw. Upper lip shortened or stretched, nasolabial and chin folds are smoothed out, the mouth is always somewhat ajar, lips close with difficulty. The 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 found, 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 anterior teeth are closely spaced, on hard tissues teeth are hypoplastic. The cutting edges of the anterior teeth often follow a concave curve. The tongue is usually enlarged, it has longitudinal and transverse furrows, the papillae are smoothed, sometimes there are pinpoint hemorrhages at the tip. In the region of the upper and sometimes lower anterior teeth, the gingival papillae are hypertrophied, edematous, bleeding, and deposits of tartar are often observed. In many cases, generalized carious disease develops.

With age in antagonistic groups chewing teeth are significantly erased chewing surfaces. As a rule, with an open bite, there is a compensatory macroglossia. An open bite can result from a deformity in one or both jaws.

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

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

Open bite in rickets is characterized by:

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

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 proper. The dentoalveolar height in the anterior region is less, and in the lateral region 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 jaw height and the height of the nasal part with an open bite is disturbed as a result of an increase in the height of the jaws (3:2 compared to 5:4 in the norm). The anterior height of the jaws is greater than the posterior height, sometimes 2 times or more. The anterior teeth are often deviated vestibularly, the inter-incisal angle is reduced (ii<1400).

Functional disorders.

Open bite leads to significant functional disorders (difficulty biting food, chewing, improper swallowing, impaired speech, change in breathing).

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

With an open bite, there is an incorrect swallowing (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 incorrect, the teeth are open, and the tip of the tongue is repelled when swallowing from the lips and cheeks. This can lead to separation of the front teeth.

There is an indistinct pronunciation of lingual-dental and labial hissing sounds "p", "b", "c", "m", "f", "s", "sh", "h", "r".

The tongue during a conversation, as a rule, slips into the existing gap (vague speech, lisp). When speaking, children tend to compensate for the lack of articulation of sounds by narrowing the oral fissure or approaching the tip of the tongue to the lower dentition, which explains the peculiar facial expressions during conversation.

Breathing with an open bite is predominantly oral, which is due to the constant gaping of the oral fissure. The muscles of the oral and oral region are usually inactive, this is due to a conditioned reflex reaction to the gaping of the oral fissure, the desire to hide the defect by stretching the lips. Constant lip tightening makes breathing easier and leads to less drying of the oral mucosa. With oral breathing, there are violations of a general nature. 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 releases 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 intermittent oral breathing, the blood loses half of its oxidative capacity. Biochemical changes in plasma also relate to an increase in the content of glucose and calcium. A clinical blood test shows in such cases a decrease in hemoglobin, leukocytosis with a shift to the left, and an unstable ESR. Mouth breathing leads to a deterioration in the outflow of venous blood and disruption of the central nervous system. Breathing is superficial. Congestion in the lungs.

Establishing diagnosis.

When diagnosing an open bite, it is necessary to establish 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 the diagnosis is the ratio of the posterior teeth. So, if the closure of the lateral teeth is correct (Angle class I), the diagnosis is "open bite". If the contact of the lateral teeth corresponds to the picture of the distal occlusion (class II according to Angle) and there is no closure of the anterior teeth, a distal occlusion complicated by open is diagnosed.

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

Prevention. In the prevention of open bite, the main attention should be paid to improving the health of a pregnant woman, maintaining a healthy lifestyle, preventing rickets and other diseases of the child, preventing the emergence and elimination of bad habits, normalizing nasal breathing, articulating the tongue when speaking and swallowing. With a short frenulum of the tongue, it is necessary to carry out its plastic surgery.

Basic principles of open bite treatment.

Treatment of open bite must be differentiated: depending on its variety, severity and age of the patient.
A very effective and necessary method of treatment for temporary and early removable dentition is myogymnastics of the muscles of the tongue and the circular muscles of the mouth. With the help of special gymnastics, the restoration of muscle function is achieved and the development of malocclusion is prevented.

Gymnastics can achieve positive results in the treatment of anomalies in children during the period of the formed milk occlusion. The most suitable age for this treatment method is between 4 and 7 years of age, 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 circular muscle of the mouth. The child closes his lips and puffs out his cheeks, after which he presses his fists to his cheeks and slowly squeezes the air out through pursed lips. To develop the circular muscle of the mouth, 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 lay a strip of paper folded in half between the lips and squeeze the lips. The paper is held with lips for 30-50 minutes. While doing homework or when the child is watching TV. The exercise is performed daily.

Of the exercises with resistance, the following are most often used.

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

Table 5
Muscles of the mouth

The action of the Rogers shock absorber is based on the same principle. It is a mouth expander, on which a rubber ring is put on. The force of contraction of the circular muscle of the mouth must overcome the force of contraction of the rubber ring.

Friel's Interlabial Disk Exercise. The disc is placed between the lips and held by them first for 1 minute, and then 3-5 minutes.

Dass activator exercise

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. From self-hardening plastic, platforms are modeled according to the shape of the lips. The child holds the activator with his lips, pulling it with his thumb by the ring. Exercise is done 2 times a day for 5-20 times. With temporary and early removable dentition, orthodontic treatment is most often combined with preventive measures. For treatment, expanding plates with screws, springs, vestibular arches for the upper jaw (with its narrowing) are used, sometimes in combination with an emphasis for the tongue in the anterior region 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 released from the apparatus. On the oral side there is an emphasis for the tongue. Activators are combined with screws, springs, vestibular arches.

AND I. Katz recommends that after the eruption of the first permanent molars, they are covered with crowns that separate the bite. After 10 - 20 days, the crowns are removed, temporary teeth are ground down until the first permanent molars come into contact, and then these crowns are fixed again 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 conducting, if necessary, anti-rachitic treatment or eliminating possible causes for the development of an open bite: eliminating bad habits, normalizing the position of the tongue, normalizing nasal breathing, swallowing, and sound production. Very effective in terms of eliminating bad habits are vestibular plates of various designs and positioners.

During the period of temporary occlusion, various removable devices 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, Mühlemann propulsor, etc. The designs of these devices depend on the concomitant sagittal and transversal pathology of occlusion.

Klamt open activator(Fig. 130) is a single basis for the upper and lower jaws. In the anterior section, it is open, but four V-shaped processes welded into the base prevent the impact of the tongue on the frontal teeth. The apparatus is equipped with two arcs: 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 sagittally to widen the jaws.

Schwartz apparatus for the treatment of an 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 displaced. The plate covers the mucous membrane of the alveolar process and is adjacent to the last two molars in the region of the necks, it should not be adjacent to the rest of the teeth. From the plate on both sides of it, behind the last molars, a metal springy vestibular arch departs, which in the region of the molars has the shape of a loop, and its middle part is located in the beds of the rings fixed on the teeth, which serve as a support and are subject to displacement. The principle of operation of the device is based on the use of mechanical force developed by a springy arc. The arc is periodically activated in the vertical direction.

The Herbst apparatus is also used to treat open bite. For the first permanent molars of the upper and lower jaws, rings with hooks open distally are prepared. On the frontal teeth of the upper and lower jaws, rings with hooks are prepared, open on the upper jaw up and on the lower jaw down. Having fixed the rubber traction 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 cross.
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, which provide dentoalveolar lengthening (or shortening) and elimination of sagittal and transversal occlusion anomalies.

In the period of late removable and permanent occlusion with a significant divergence of the anterior teeth, intermaxillary traction is used. Depending on which jaw is to be treated, one or two Angle devices, the Cojocaru device, are used.

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

With the help of an expansive Angle arch, it is possible to move the anterior 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 arc, by virtue of its elasticity, tends to return to its original position and pulls the teeth along with it.

And yet, the 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 parts of the jaw. To do this, use plates with bite pads on the lateral teeth.

In this case, the 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 mixed dentition period and in the permanent dentition, non-removable arc devices are used, with sufficiently stable teeth, reverse arcs can be used (Fig. 135).

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

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

The wire arc for this purpose is bent so that its front part is located at the level of the cutting edges of the teeth. With ligatures, the arc 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).

Pulling the alveolar process should be done slowly to avoid rupture of the periodontal and neurovascular bundle of the tooth. It usually takes at least a year to eliminate a significant gap between the teeth. Instead of ligature tying the arch to the teeth, rings with hooks can be applied to the teeth to be moved, for which a stretched 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 for each jaw. It should be emphasized that 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 be displaced, and not the teeth to be moved.

Using orthodontic archwires 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 ratio of the dentition.

Elongation of the alveolar process to eliminate the gap between the teeth can be achieved by placing a support arch on one jaw and crowns with hooks on the teeth to be moved in the opposite jaw. Rubber traction is installed on the support arc and crowns.

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

Combined (hardware-surgical) method of open bite treatment. Elimination of an open bite by orthodontic methods after the end of jaw growth is ineffective. In severe cases, restoring occlusal contact between teeth can be achieved by shortening the teeth in occlusal contact by such an amount until all or most of the teeth are in contact. If necessary, depulpation of shortened teeth is indicated.

The elimination of an open bite after the end of the growth of the jaws can be achieved by a surgical method. Of the proposed operations, decortication and excision of triangular sections of the bone deserve attention (Fig. 137 a, b, c).

Decortication proposed by A.Ya. Katz, consists in the removal of the first molars and the removal of the cortical layer with a burr, if possible, to the lower edge of the jaw.

Before the operation, an apparatus with intermaxillary traction is prepared and fixed on the teeth. The apparatus is as follows: crowns are placed on the second and third molars and rings with hooks are placed on the groups of frontal teeth of both jaws. After the operation, a rubber band is placed on the hooks. Under the influence of rubber traction, a slow bending of the jaw occurs in places where teeth have been removed and decortication has been performed (Fig. 137, a). This operation is performed intraorally. If an open bite was formed as a result of underdevelopment of the frontal section of the upper jaw, then its elimination can be achieved by the operation shown in Fig. 137b. The elimination of an open bite can also be obtained by dissection of the branches of the lower jaw (Fig. 137, c).

At the Department of Pediatric Dentistry, Pediatric Maxillofacial Surgery and Implantology of KhSMU, a method for treating open bite with a combined method has been developed and introduced into healthcare practice. The scheme of treatment of patients with an open bite by the distraction method is as follows: 1. Examination, diagnosis, preparation of a treatment plan; 2. Making an individual distraction apparatus and fixing it on the teeth of the lower jaw; 3. Conducting surgery; 4. Postoperative treatment; 5. Activation of the device by 0.2 mm, daily, 7-8 days after the operation; 6. In the process of displacement of the jaw fragment, correction of the plastic part of the apparatus; 7. After achieving the necessary 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. The use of a soft chin sling during the entire period of treatment.

During the prehospital period, the patient is examined on an outpatient basis. They take impressions from the upper and lower jaws, cast models (working and control). According to working models, an orthodontic device is made (Fig. 16). The distraction apparatus consists of two metal mouthguards, in the lateral sections, threaded rods are soldered to the contacting teeth from the vestibular side, bent in the front section vertically upwards on the right and left at the edge of the frontal mouthguard, and rigidly connected with the help of screw pairs to the front metal-plastic mouthguard on the teeth having vertical slot (Fig. 139). In the event that the movement of a fragment of the body of the lower jaw upwards is more than 1 cm, then in the first 5-7 days, vertical distraction is supplemented with intermaxillary rubber traction.

To do this, hooks for intermaxillary rubber traction are additionally welded into the front mouthguard of the apparatus. The orthodontic device is fitted on the teeth and fixed with phosphate cement. The patient is sent to the hospital for surgery. The distraction method of treating patients with an open bite consists in partial osteotomy of the body of the lower jaw and subsequent dosed exposure to the distraction apparatus in the vertical direction.

The operation proposed by V.I. Kutsevlyak, Yu.A. Litovchenko, consists in 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 the open bite (Fig. 18). In the interdental space, a fissure burr cuts the alveolar process from top to bottom for 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 dissected, connecting the two previous cuts. The bridge-like area 1.0-1.2 cm in size is kept intact, which includes a spongy substance and a compact plate on the lingual side; neurovascular bundle with spongy substance on the vestibular side. The wound is sutured. A similar operation is carried out on the opposite side.

After the wound has healed (in 7-8 days), the activation of the screw pairs on the orthodontic device begins, two turns of the screw daily (the rate of distraction is 0.2 mm per day). As a result of the activation of the orthodontic device due to the plasticity of the bone tissue, there is a gradual stretching and bending of the preserved bridge-like section of the jaw 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 upwards, with the help of nuts, the frontal mouthguard is corrected until the fragment is established in orthognathic occlusion. Then the vertical hinge is fixed with quick-hardening plastic. The retention period lasts 60 days. The orthodontic device is removed after the control radiographs.

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

Prosthetics in open bite.

Open bite is often accompanied by enamel hypoplasia. With a 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 is not always possible to restore. It is restored with oncoming crowns with a small gap between the teeth. If it is necessary to dramatically increase the length of the crowns to restore occlusal contact, it is advisable to make the crowns of an acceptable size and not put them into occlusal contact.

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

Orthodontics
Under the editorship of prof. IN AND. Kutsevlyak