Thank you for your interest in our article and for agreeing with the overall idea that the severity of the associated dentoskeletal discrepancies and the patient’s needs should be the primary factors for determining the need for surgical intervention.
The primary etiology of anterior open bite is usually untoward oral habits associated with a vertical growth pattern. Untoward oral habits can also cause maxillary transverse deficiency, and airway inadequacy can contribute to open-bite severity and maxillary transverse deficiency as well. Therefore, most likely, these were the primary etiologic factors of the open bites in our sample. However, it is difficult to determine the exact cause of the open bite in an adult because the etiologic factors such as vertical growth might have acted in the early ages, establishing the problem, but are not active any more. If the etiology is detected and the patient has an open bite associated with severe skeletal discrepancies, the orthodontic-surgical approach would be the best treatment to correct the morphologic problems. Additional treatment directed to the etiology should also be implemented to improve stability. Nevertheless, if the exact etiology cannot be identified in an open-bite patient with severe skeletal discrepancies, the best treatment would still be the orthodontic-surgical approach. In this case, probably the stability would be less because treatment of the causative factor could not be instituted. Evidently, this is not ideal, but in some instances that is the best option.
The basic objective of our study was to evaluate the stability of the orthodontic-surgical approach and not to evaluate whether the correct treatment approach was performed according to the etiology of the open bite. That is an interesting topic and should be studied in the future.