We agree that anterior open bite is frequently accompanied by transverse and sagittal discrepancies. In our case report, the patient did in fact have a bilateral posterior crossbite, as can be observed in the initial dental casts and intraoral photographs. We failed to mention that the treatment plan presented to the patient included skeletal maxillary expansion using surgically assisted rapid palatal expansion. However, the patient “vehemently rejected surgery,” as we wrote in the article. Therefore, expansion was attempted through orthodontic means alone. Despite our efforts to dentally expand the maxillary posterior teeth, the occlusion ended with insufficient posterior overjet.
The statement made in the letter that the open-bite relapse occurred because the posterior teeth had insufficient overjet might have some merit because of the scissor effect. However, it has been documented that 1 main cause for open-bite relapse is failure of tongue rest posture adaptation. Tongue spurs were used during the first treatment, not just to close the open bite but also to establish a new engram correct tongue posture, precisely to prevent open-bite relapse. When one compares the huge magnitude of the initial open bite with the minimal one on the retreatment initial records, we considered that the open-bite relapse was minute but concede that it could have occurred because of an insufficient posterior overjet. However, the main reason for the need for retreatment was not the minimal open-bite relapse but the partial reopening of the extraction spaces in the area where the mandibular first molars were extracted. This occurred due to an inadequate retention protocol, which was the main reason that we decided to publish this case report; our objective was to alert colleagues that when extraction of first molars is considered, clinicians should implement the correct retention protocol to prevent these extraction spaces from reopening.
The answer to the question about how the diastema was closed with finger pressure is as follows: the procedure starts with etching the palatal surfaces of the 2 maxillary central incisors, followed by placing composite on both teeth and laying a small piece of retention wire (0.019 or 0.021 in, coaxial or gold chain flex retention) adapted to the palatal aspect of these teeth; the assistant should hold the polymerizing light beam while the clinician applies pressure with his or her thumbs, pushing 1 tooth against the other until polymerization of the adhesive occurs. This procedure might be painful for the practitioner’s fingers and the patient’s teeth, depending on the amount of space to be closed. For this procedure to be successful, the diastema should be very small (less than 0.5 mm). Otherwise, orthodontic movement can be accomplished by using a figure 8 ligature wire from canine to canine, tightening the wire weekly until the diastema is closed, and followed by bonding a palatal wire.