Oldies But Goldies: Correction of the Occlusal Plane Inclination of an Open Bite Case Using Occipital Headgear, a Thick Expansion Device and Posterior Bite Raisers

Abstract

Oldies But Goldies: Correction of the Occlusal Plane Inclination of an Open Bite Case Using Occipital Headgear, a Thick Expansion Device and Posterior Bite Raisers.AIM: This case report describes the treatment the open bite by correcting the occlusal plane inclination using occipital headgear, a thick acrylic cap expander and posterior bite raisers.SUBJECT: A patient aged of 13-year-6-month applied for treatment with the chief complaint of bite inability. The patient had a convex profile, increased vertical facial dimensions, severe anterior open bite, Class II molar and canine relationships, maxillary transverse deficiency. The cephalometric analysis revealed Class II relationship with high angle growth pattern (ANB: 4°, U1-SN°:107, IMPA:85°, GoGnSN:49.2°, overjet:4 mm, overbite: -6mm). We started the treatment with a thick McNamara type bonded rapid maxillary expansion device with additional Teuscher tubes at molar region. After we achieved the desired expansion amount, the occipital headgear was given for 18 hours a day with 450 gr of force. 8 months later, the RME device was removed because it was impinged in the mucosa. We fabricated another appliance with a vertical holding TPA and occlusal acrylic coverage from canines to second molars. We also placed occlusal composite bite blocks on lower 6 and 7s. The intrusion of the posterior teeth lasted 13 months. After debonding the appliance, upper and lower brackets were bonded. Intermaxillary elastics were given to improve the interdigitation. The total treatment time was 25 months.RESULTS: Class I molar and canine relations, well-aligned dental arches, ideal overbite, and overjet (2 mm) and aesthetic results were obtained. The smile aesthetic and soft tissue profile significantly improved because the mandible rotated counterclockwise as response to posterior intrusion. The final cephalometric analysis showed that the vertical dimensions decreased even though the patient was growing (ANB:3 ̊, UI-SN:101 ̊, IMPA:83 ̊ GoGN-SN:47 ̊).Conclusion: The correction of the occlusal plane inclination was achieved by the intrusion of the posterior teeth using occipital headgear and bite raisers. This method was proved to be a successful method.