Vertical Dimension

The management of the interim phase of a complete oral rehabilitation in patients with severely worn dentition is often challenging due to loss of occlusal vertical dimension, loss of tooth structure, uneven wear of teeth creating an uneven plane of occlusion, and para-functional habits. This paper will demonstrate how a clear thermo-forming matrix fabricated from the diagnostic wax-up can be used as a guide to facilitate treatment.

In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach. The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach. Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been en...

The aim of this study was to investigate the effectiveness of a quad-helix/crib (Q-H/C) appliance in a group of growing subjects with thumb-sucking habits and both dental and skeletal open bites. Methods: The records of 23 subjects treated with Q-H/C appliances were compared with a control group of 23 untreated subjects with similar vertical relationships. Lateral cephalograms were analyzed before treatment (T1; mean age, 8.4 Ϯ 1.4 years) and immediately after treatment (T2; mean age, 9.9 Ϯ 1.5 years). Mean duration of treatment was 1.5 Ϯ 7 months. The T2-T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test). Results: The average increase in overbite during Q-H/C therapy (3.6 mm more than the control group) overcorrected the amount of anterior open bite at T2. However, 4 of 23 subjects did not show positive overbites at T2. Both the maxillary and mandibular incisors had significantly greater lingual inclinations (about 4.0°) associated with greater extrusion (1.4 and 1.0 mm, respectively) in the Q-H/C group than in the control group. In addition, the treated group showed a greater downward rotation (1.2°) of the palatal plane than did the control group. This change was associated with a greater increase in upper anterior facial height (0.7 mm) and a clinically significant reduction in the palatal plane-mandibular plane angle (Ϫ1.7°) in the Q-H/C group with respect to the controls. The upper and lower lips showed significant tendencies toward retraction relative to the E-plane in the treated group (2.6 and 2.9 mm, respectively) compared with the controls. Conclusions: The Q-H/C appliance was effective in correcting the dental open bite in 90% of growing subjects with thumb-sucking habits and dentoskeletal open bites. The Q-H/C protocol produced a clinically significant improvement in the vertical skeletal relationships because of downward rotation of the palatal plane.

In 32 Caucasian adult males serial MRI scans of the jaw muscles were taken approximately perpendicular to the mean fibre direction of the jaw muscles to determine their cross-sectional areas. These areas are proportional to the maximal isometric strength of a muscle. To describe facial skeletal variation, nine angular and 21 linear cephalometric measurements were recorded, and statistically reduced by means of multiple regression and principal component analysis. Six components were extracted, rotated, and subsequently correlated with the maximal cross-sectional areas of the jaw elevators and anterior digastric muscle. Positive significant correlations were found between a linear combination of several transversal skull dimensions on the one hand, and the maximal temporalis and masseter cross-sections on the other. A negative significant correlation was found between the flexure of the cranial base and the temporalis cross-section. Surprisingly, no significant correlations were found between either anterior facial height or posterior facial height and any of the jaw muscles cross-sections. It was concluded that, in adult males with normal skull shape, relationships exist to a limited extent between craniofacial morphology and the cross-sectional areas of the jaw muscles.

The Class III malocclusion is a most common skeletal malocclusion in Japan, with a prevalence of 4% to 5% in the general population. 1,2 Approximately one third of orthodontic patients exhibit a Class III malocclusion. The morphologic condition of the mandible in persons with Class III malocclusions is different from that found in normal Class I subjects, 5 and most skeletal characteristics of Class III patients with a permanent dentition are already present in the deciduous dentition 6-9 (ie, in Class III malocclusion during primary dentition, mandibular lengths are significantly greater and the mandible is situated more anteriorly than it is in Class I subjects . The position of the maxilla, meanwhile, is slightly retrusive, in association with a smaller-than-normal maxilla. Regarding the growth and development of the craniofacial skeleton in individuals with Class III malocclusion, Guyer et al, 7 using cross-sectional cephalometric records from persons ranging in age from 5 to 15 years old, indicated that Class III malocclusion

A vertical analysis involving ten linear measurements was developed to localize skeletal and dentoalveolar dysplasias. The measurements are of biologic relevance, reflecting the amount of growth harmony or disharmony to the examination and record-taking time. The vertical dimensional analysis uses the age- and sex-related University of Michigan mean values for comparative data for each measurement. Ratios were computed for a five-unit proportional analysis. Both analyses were applied to assess the vertical problems of three female patients. The analyses detected specific areas of dysplasia for each patient.

This study assessed masticatory efficiency and duration of the masticatory cycle in 14 asymptomatic patients with severe bone resorption. All patients had worn complete dentures for over 10 years. Recall visits were scheduled at 5 months and 1 year after receiving new dentures. Fourteen patients were evaluated in this study. The Research Diagnostic Criteria questionnaire and tests of the efficiency and duration of the masticatory cycle were performed with artificial food before, 5 months after, and 1 year after new dentures were delivered. Masticatory efficiency was assessed using a sieve system; artificial food was ground for 35 masticatory cycles and monitored by the operator. Masticatory efficiency at 5 months was significantly improved for the 0.42-mm mesh. An improvement in masticatory efficiency and a reduction in mastication time were observed with the new dentures after 1 year. The results of this study indicated that 5 months did not allow enough time to demonstrate improved muscular capacity and ability after receiving new dentures. After 1 year, the duration of the masticatory cycle was reduced, and masticatory efficiency was significantly improved.

Vertical control is one of the primary objectives sought by orthodontists when treating malocclusions in hyperdivergent individuals. This investigation aimed at assessing vertical control, by cephalometric measurements, during the treatment of Angle Class II Division 1 malocclusion. Thirty cases, selected from the files of the São Leopoldo Mandic Dental Research Center, Brazil, of subjects with Angle Class II Division 1 malocclusion and facial hyperdivergence, were used in this study. The patients were treated using a combined extraoral appliance during a mean treatment time of 1.1 years. Pre-and posttreatment cephalometric measurements were compared to assess vertical control. The results were submitted to ANOVA (p = 5%). The ANOVA test revealed no statistically significant difference between the pretreatment and posttreatment values of OP (Occlusal plane angle) and SN.MP. While there was a decrease in Y-axis, FMA, and PP.MP, there was an increase in SN.PP, Co-Go, AFH, PFH, and FHI. It was concluded that the divergence in the facial lower third of the patients did not increase, suggesting that the combined extraoral appliance with the line of force application directed to the resistance center of the maxilla was effective in treating Angle Class II malocclusion in hyperdivergent subjects.

Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years, such as the use of short implants or tilted implants (including zygoma implants), with the aim of avoiding maxillary sinus floor elevation. Both of these techniques have advantages and disadvantages that should be evaluated carefully to choose the most appropriate treatment. Zygoma implants or short/tilted implants are not a panacea for the treatment of patients with inadequate posterior maxillary bone stock. Instead, treatment should be based on the characterization of resorption patterns of the posterior maxilla, and may include the need for sinus grafting or other grafting procedures to reestablish not only adequate bone volume for implant placement, but also a favorable intermaxillary relationship, to optimize the functional and esthetic outcome of the final prosthetic rehabilitation. The authors discuss the indications, advantages, and disadvantages of sinus-grafting procedures in association with or without other reconstructive procedures.

It is widely accepted that the orthodontist should have a thorough understanding of the craniofacial musculature and its association with the growth and development of the dentofacial complex. There is still much controversy regarding the influence of the mandibular muscles on normal growth and development, and on orthodontic treatment and stability. This review presents an outline of the mandibular muscles and the vertical facial pattern. The different methods by which the mandibular muscles have been investigated are discussed. The potential influence of these muscles on normal morphologic variation in different people is also discussed, along with the implications for contemporary orthodontic treatment and stability.

The orthodontic treatment of an adult patient with a skeletal Class III malocclusion, increased anterior facial height, negative overjet, and bilateral posterior crossbite is presented. Treatment options included mandibular first premolar or third molar extractions with dentoalveolar compensation or combined surgicalorthodontic treatment. Mandibular third molar extraction with dentoalveolar compensation was the treatment choice. Biofunctional brackets, with accentuated lingual crown torque on the maxillary incisors and accentuated buccal crown torque on the mandibular incisors, were used. The anterior crossbite was corrected with intermaxillary elastics from the palatal aspect of the maxillary incisors to the labial aspect of the mandibular incisors. Class III elastics moved the maxillary teeth mesially and assisted in retruding the mandibular teeth. Patient compliance with the elastics was excellent, and satisfactory dentofacial esthetics were achieved. This treatment protocol has rigorous indications, and it is not a routine plan. The mechanotherapy and the pros and cons of this approach are discussed. (Am J Orthod Dentofacial Orthop 2005;128:787-94)

Amelogenesis imperfecta is a hereditary disease that causes structural anomalies in dental enamel of both the primary and permanent dentition. The anomaly may present a variety of clinical forms and appearances, with its main characteristics being the loss of tooth structure, compromised esthetic appearance, and dental sensitivity. The aim of this study was to present the clinical report of a 16-year-old patient with severely compromised esthetics as a result of amelogenesis imperfecta of the hypocalcified type who was rehabilitated with composite resin and ceramic crowns.

Prolonged tooth maintenance by a more aged population considerably increases the probability of dentists having to treat patients with high levels of tooth wear. Pathological tooth wear, caused primarily by parafunction, seems to be a growing problem that affects a large number of adult patients. The clinical report presents a case of a partially edentulous patient with an elevated degree of wear in the upper jaw caused by attrition and erosion, rehabilitated with a maxillary overlay removable partial denture (ORPD) consisting of a chrome-cobalt (Cr-Co) framework with anterior acrylic resin veneers, posterior cast overlays, and acrylic resin denture bases. Removable partial prosthesis is a treatment alternative when teeth are found to be severely worn or when the patient needs a simple and economical option. Because economics is a conditional factor of the treatment, the clinician should present different treatment alternatives to the patient, in which the overlay prosthesis can be ...

Objectives: The aim of this study was to histologically assess whether elevation of partial-thickness flaps results in reduced bone alterations, as compared with fullthickness flap preparations. Material and Methods: In five beagle dogs, both mandibular second premolars (split-mouth design) were subjected to one of the following treatments: Tx1: elevation of a partial-thickness flap over the mesial root of P 2 and performing a notch at the height of the bone. Tx2: elevation of a full-thickness flap over the mesial root of P 2 and performing a notch at the height of the bone. After 4 months, sections were evaluated for: (i) vertical bone loss and (ii) osteoclastic activity using histometry. Results: Elevation of both full-and partial-thickness flaps results in bone loss and elevated osteoclastic activity. Partial-thickness flaps can result in less bone loss than full-thickness flaps, but are subject to some variability. Conclusion: Use of partial-thickness flaps does not prevent from all bone loss. The procedure may result most of the times in less bone loss than the elevation of fullthickness flaps. Further research has to evaluate the determinants of effective outcomes of partial-thickness flap procedures.

This prospective study was designed to establish how the positions of the molars and the condyles are related to incisor position in the mandibular rest position and how their positions are altered by changing head posture. Measurements of the mandibular rest position were taken on 24 men (age range, 23 to 35) with normal Class I occlusion, skeletal patterns, and temporomandibular joint function. The movements of 5 landmarks (lower incisor, and condyles and molars bilaterally) were tracked from maximum intercuspation into 4 independent rest positions (upright supported, upright unsupported, supine supported, and supine unsupported) using an optoelectric (Optotrak; Northern Digital, Waterloo, Ontario, Canada) computer system. The positions were based on minimal electromyographic and verbal instructions to swallow, lick the lips, and say "Mississippi." The results showed significant (P < .01) movements of the incisors, the molars, and the condyles into each of the 4 rest positions. Movements of the molars and the condyles into the supported upright posture and the unsupported upright posture differed slightly but significantly because of greater movement into the supported posture. Patterns of mandibular movement were entirely different between the upright and the supine rest positions; the mandible rotated anteriorly in the supine position and posteriorly in the upright position. We concluded that movement into the mandibular rest position from the intercuspal position is not a simple opening rotation of the mandible, and that the pattern of movement is influenced by head support and body postures. (Am J Orthod Dentofacial Orthop 2001;120:614-22)

Within the limitations of this clinical study, average closest speaking space values of 1 to 3 mm can be used in the clinical determination of the occusal vertical dimension of prosthetic restorations, regardless of dental and skeletal classified occlusions; no correlation was found between the amount of vertical overlap and closest speaking space. The use of the Turkish word seyis was appropriate for registering the closest speaking space in native Turkish speakers.

Although many complete denture patients are elderly and may suffer from a variety of medical or mentally compromising conditions, these factors together with patient gender are not frequently related to ongoing denture difficulties. The clinician is advised to carefully determine the adequacy of the patient's dentures before suspecting another patient-related cause.

Introduction: The postretention stability of open-bite treatment is a controversial topic in orthodontics. Methods: In this study, the lateral cephalometric radiographs of 64 patients treated with orthodontics alone were evaluated to determine the amount of postretention change. The mean postretention interval was 14 years. The sample was divided into 3 groups based on the amounts of pretreatment overbite: (1) the contact group (n 5 24), incisal overlap and incisal contact; (2) the overlap group (n 5 25), incisal overlap and no incisal contact; and (3) the open-bite group (n 5 15), no incisal overlap. The headfilms were digitized, and the values were analyzed. Results: The 3 groups reacted differently. During the postretention period, mean overbite deepened in all groups, with the contact group deepening significantly more than the open-bite group. Overjet increased significantly more in the open-bite group than in the contact group. Pretreatment overjet correlated mildly with postretention overjet relapse in the open-bite group. Conclusions: All 64 subjects had positive incisal overlap at the postretention recall. (Am J Orthod Dentofacial Orthop 2010;137:302.e1-302.e8)

This case report discusses the management of bilaterally labially impacted maxillary canines and a deepbite Class II malocclusion in a 21-year-old woman. An interdisciplinary approach to treatment with different mechanical strategies led to the achievement of the desired esthetic, functional, and occlusal treatment goals. The problems associated with impacted maxillary canines and the biomechanical interventions used for this patient are discussed. (Am J Orthod Dentofacial Orthop 2002;429:429-37)

PURPOSE: To compare the effect of implant abutment modification on the amount of cement extruded at the crown-abutment margin and to evaluate the vertical discrepancy after cementation.MATERIALS AND METHODS: Access openings of titanium abutments were modified with an opening (open) and placement of two vent holes 3 mm from the occlusal edge and 180 degrees apart (internal vent). Access openings were filled with resin material (closed) and used as controls. Each abutment was secured to an implant analog. Eugenol-free zinc oxide cement (TempBond NE) was selected to cement the cast crowns (n = 9) onto test abutments. The amount of cement extruded out of the margin was calculated, and vertical seating discrepancies were determined with a linear transducer device before and after cementation. Differences among groups were analyzed statistically.RESULTS: The mean amount of extruded cement ranged from 36% to 90% of the total cement placed within the crowns. The order, from least to greatest amount of excess cement extrusion at the margins, was internal vent, open, and closed; significant differences were observed between test groups. The net vertical discrepancies of tested specimens ranged from -7 μm to +6 μm (mean, 0 μm). No statistically significant differences in vertical discrepancy were found between the groups.CONCLUSIONS: Venting the hollow abutment resulted in the least amount of cement extrusion when compared to closing off the screw access channel or leaving it open. Within the limitations of this study, it may be concluded that the use of two, 0.75-mm radius vent holes placed 3 mm apical to the occlusal area of the abutment and 180 degrees apart will limit the amount of cement extruded into the gingival sulcus of implant-retained crowns.

This case report describes the nonsurgical, nonextraction therapy of a 16-year-old boy with a skeletal Class III malocclusion, a prognathic mandible, and a retrusive maxilla. He was initially classified as needing orthognathic surgery, but he and his parents wanted to avoid that. The Class III malocclusion was corrected with a rapid palatal expander and a maxillary protraction mask followed by nonextraction orthodontic treatment with fixed appliances, combined with short Class III and vertical elastics in the anterior area. The height of the maxillary alveolar process and the vertical face height were slightly increased with treatment. Class I molar and canine relationships were achieved, and the facial profile improved substantially. (Am J Orthod Dentofacial Orthop 2009;136:736-45)

The purpose of this study was to evaluate the cephalometric and occlusal changes, the functional occlusion, and the dentinal sensitivity of anterior open-bite treatment with occlusal adjustment. Methods: The sample comprised 20 patients who experienced relapse of the anterior open bite (mean, -1.06 mm). Occlusal adjustment was performed until a positive overbite was established. Cephalometric changes were evaluated on lateral cephalograms taken before and after the occlusal adjustment. The functional occlusion analysis consisted of evaluating immediate anterior and canine guidance and the number of teeth in contact before and after the procedure. Dentinal sensitivity was evaluated before, shortly after, and 4.61 months after the occlusal adjustment. Pretreatment and posttreatment cephalometric changes and the number of teeth in contact were compared with dependent t tests. Percentages of anterior and canine guidance before and after the adjustment procedure were compared with the McNemar test. To compare dentinal sensitivity at several stages, the nonparametric Friedman test was used, followed by the Wilcoxon test. Results: Significant increases in overbite and mandibular protrusion were seen, as were significant decreases in apical base discrepancy, facial convexity, and growth pattern angles. The percentages of immediate anterior and canine guidance increased significantly, as did the number of teeth with occlusal contacts. Dentinal sensitivity increased immediately after the adjustment but decreased to normal levels after 4.61 months. Conclusions: Occlusal adjustment is a viable treatment alternative for some open-bite patients; it establishes positive vertical overbite and improves the functional occlusion with only transient dentinal sensitivity. (Am J Orthod

Purpose: The purpose of this study was to evaluate the effectiveness of using titanium screws in combination with particulate human mineralized allograft, in a "tenting" fashion, to augment large vertical alveolar ridge defects for implant placement. Materials and Methods: This prospective case study evaluated augmentation in consecutive patients with large (Ͼ7 mm) vertical alveolar ridge defects. Vertical ridge augmentation was performed using mineralized allograft placed around titanium screws to tent out the soft tissue matrix. The ridges were clinically evaluated 4 to 5 months after augmentation, and implants were placed at that time. Bone cores were harvested from all patients for histologic evaluations. Results: Fifteen patients were treated in this prospective case study, and the mean vertical augmentation was 9.7 mm. Two patients had wound dehiscence resulting in loss of graft and requiring secondary grafting before implant placement. Five patients required 2-stage grafting procedures to achieve ideal ridge height before implant placement. Clinical evaluation of the grafted sites upon re-entry revealed uniform ridge anatomy. Histomorphometric analysis of 7 specimens revealed a mean bone content of 43%. A total of 32 implants were placed into grafted sites in 15 patients. All implants were integrated and successfully restored. Mean follow-up was 16.8 months after implant placement. Conclusions: Tenting of the periosteum and soft tissue matrix with titanium screws maintains space and minimizes resorption of mineralized particulate allograft. This technique offers predictable functional and esthetic reconstruction of large vertical defects without the use of autogenous bone and is capable of osseointegration. More studies are needed to evaluate the stability of vertically grafted bone after long-term loading.

An adolescent girl with an Angle Class III malocclusion, excessive lower facial height, and anterior open bite sought nonsurgical treatment. She was treated with a multiloop edgewise archwire (MEAW). In association with a chincup, MEAW mechanics allowed the successful correction of the anterior open bite and the molar relationship, without major alterations of the patient's profile. Combined orthodontic and surgical treatment should be considered for patients with skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, MEAW treatment is an alternative that can have excellent results. (Am J Orthod Dentofacial Orthop 2010;138:89-95) a Adjunct professor, Graduate Dentistry Program in orthodontics, Federal

Prolonged tooth maintenance by a more aged population considerably increases the probability of dentists having to treat patients with high levels of tooth wear. Pathological tooth wear, caused primarily by parafunction, seems to be a growing problem that affects a large number of adult patients. The clinical report presents a case of a partially edentulous patient with an elevated degree of wear in the upper jaw caused by attrition and erosion, rehabilitated with a maxillary overlay removable partial denture (ORPD) consisting of a chrome-cobalt (Cr-Co) framework with anterior acrylic resin veneers, posterior cast overlays, and acrylic resin denture bases. Removable partial prosthesis is a treatment alternative when teeth are found to be severely worn or when the patient needs a simple and economical option. Because economics is a conditional factor of the treatment, the clinician should present different treatment alternatives to the patient, in which the overlay prosthesis can be ...

Objective: To identify the skeletal, dentoalveolar, and soft tissue changes that occur during Class II correction with the Cantilever Bite Jumper (CBJ). Materials and Methods: This prospective cephalometric study was conducted on 26 subjects with Class II division 1 malocclusion treated with the CBJ appliance. A comparison was made with 26 untreated subjects with Class II malocclusion. Lateral head films from before and after CBJ therapy were analyzed through conventional cephalometric and Johnston analyses. Results: Class II correction was accomplished by means of 2.9 mm apical base change, 1.5 mm distal movement of the maxillary molars, and 1.1 mm mesial movement of the mandibular molars. The CBJ exhibited good control of the vertical dimension. The main side effect of the CBJ is that the vertical force vectors of the telescope act as lever arms and can produce mesial tipping of the mandibular molars. Conclusions: The Cantilever Bite Jumper corrects Class II malocclusions with similar percentages of skeletal and dentoalveolar effects. (Angle Orthod. 2009:79; )

Maxillary molar distalization is an increasingly popular option for the resolution of Class II malocclusions. This communication describes the effects of one particular molar distalizing appliance, the distal jet, in a sample of 20 consecutively treated and growing subjects (11 females, nine males; mean starting age of 13) and compares these effects with those of similar devices. Pre- and postdistalization cephalometric radiographs and dental models were analyzed to determine the dental and skeletal effects. The distal jet appliances were constructed using a biomechanical couple to direct the distalizing force to the level of the maxillary first molar&#39;s center of resistance. The distal jet was the only appliance used during the distalization phase of treatment. Examination of the cephalometric tracings demonstrated that the crowns of the maxillary first molars were distalized an average of 3.2 mm into a Class I molar relationship. In the process, the first molars were tipped dis...

Large areas of mucogingival alterations may result from advanced regenerative procedures. This prospective case series study was performed to introduce and evaluate a surgical approach that combines the strip gingival graft technique with the use of a xenogeneic collagen matrix. The primary outcome measurement was the increase in keratinized tissue width from baseline to 12 months postprocedure. Twenty patients were enrolled, and they all completed the 12-month evaluation. All treated sites exhibited a significant gain in keratinized tissue at 12 months, with a mean width of 6.33 mm (SD: 2.16), while there was a 43% contraction of the grafted area at 6 months. Tissue dimensions remained stable between 6 and 12 months. The use of the combination graft was well accepted by the patients, with minimal morbidity according to the patients&#39; low self-reported pain and the low utilization of pain medication.

The present study aimed to compare the treatment outcomes of a fixed-functional appliance (Twin-Force Bite Corrector - TFBC) and a conventional removable functional appliance (Activator) in the treatment of skeletal Class II malocclusions. The TFBC and Activator Groups each included 10 young adults possessing a skeletal Class II malocclusion, and the treatment outcomes of both groups were quantified and compared, using lateral cephalometric radiographs, with an untreated skeletal Class II Control Group. A skeletal Class I relationship and a marked reduction in overjet were achieved in both treatment groups; however, the duration of treatment was significantly shorter in the TFBC Group (0.45 years) when compared with the Activator Group (1.37 years) (p &lt; 0.001). Effective length and sagittal positioning of the mandible underwent significant changes in the TFBC and Activator Groups. Vertical facial dimensions increased in each group; however, these increases were significantly grea...

Tooth loss, alterations on tooth structure, and reduced vertical dimension are known to severely compromise the stomatognathic system. This case report describes the treatment of a patient who presented with an extremely worn maxillary anterior dentition with a loss of posterior support owing to the loss of almost all the posterior teeth, except the mandibular premolars. Provisional removable partial dentures were used to create an optimum maxillomandibular relationship and to provide restorative space prior to the restoration of the remaining teeth. This restoration was accomplished with a combination of layered hybrid and microfilled composite materials, which restored the maxillary anterior teeth to optimum esthetics and function.

Introduction: Anterior open-bite (AOB) treatment is considered challenging because of difficulties in determining and addressing etiologic factors and the potential for relapse in the vertical dimension after treatment. In this review, we compiled evidence on the long-term stability of the major therapeutic interventions for correcting AOB. Our objective was to review and compile evidence for the stability of surgical and nonsurgical therapies for AOB malocclusion. Our data sources were PubMed, EMBASE, Cochrane Library, limited gray literature search, and hand searching. Methods: A search was performed of the electronic health literature on the stability of AOB after treatment. Hand searching of major orthodontic journals and limited gray literature searching was also performed, and all pertinent abstracts were reviewed for inclusion. Full articles were retrieved for abstracts or titles that met the initial inclusion criteria or lacked sufficient detail for immediate exclusion. Studies accepted for analysis were reviewed and their relevant data retrieved for pooling. The long-term stability estimates were pooled into nonsurgical and surgical groups, and summary statistics were generated. Results: One hundred five abstracts met the initial search criteria, and 21 articles were included in final analyses. Rejected articles failed to exhibit follow-up times of 12 months or more, did not include measurements of overbite (OB), or did not meet inclusion criteria. All included articles were divided into a surgical group (SX) with a mean age of 23.3 years and a nonsurgical group (NSX) with a mean age of 16.4 years. All studies were case series. Random-effects statistical models were used to pool the mean OB measures before and after treatment and also at the long-term follow-up. The pretreatment adjusted means of OB were -2.8 mm for the SX and -2.5 mm for the NSX. AOB closures up to 11.6 mm (SX) and 11.4 mm (NSX) were achieved. Relapse in the SX group during the mean 3.5 years of follow-up reduced the OB to 11.3 mm; the NSX group relapsed to 10.8 mm in the mean 3.2 years of follow-up. Pooled results indicated reasonable stability of both the SX (82%) and NSX (75%) treatments of AOB measured by positive OB at 12 or more months after the treatment interventions. Conclusions: In the included case series publications, success of both the SX and NSX treatments of AOB appeared to be greater than 75%. Because the SX and the NSX were examined in different studies and applied to different clinical populations, no direct assessment of comparative effectiveness was possible. The pooled results should be viewed with caution because of the lack of within-study control groups and the variability among studies. (Am J Orthod Dentofacial Orthop 2011;139:154-69)