We appreciate Dr Karthickeyan’s interest in our article, and we want to clarify some of his concerns with the methodology and conclusions.
Although other factors might play roles in the etiology of anterior open bite at an early age, thumb- and dummy-sucking are the primary etiologic agents of anterior open bite at this stage. Anterior tongue thrusting and anterior tongue-rest posture are always present, in varying degrees, with an anterior open bite. A vertical growth pattern is associated with an anterior open bite. Tongue spurs are effective in eliminating the deleterious sucking habits, tongue thrusting, and anterior tongue posture. Therefore, although the specific etiologic factor was not determined for each patient, the tongue spurs would act on the most important causative factors of the open bite, and the high-pull chincup would control the vertical growth tendency.
Yes, having 4 groups—a control group, a group treated with bonded spurs only, another with high-pull chincup therapy only, and a fourth with both appliances—would be an interesting way to evaluate the isolated effects of the appliances. The variation in the design with 3 groups would be interesting as well. However, our intention was to investigate only the effects of the associated appliances. A follow-up study with the suggested designs might be conducted in the future.
The question of how much high-pull chincup therapy and bonded spurs individually contributed to increasing the overbite of the treated patients would be answered by the suggested study designs.
Evidently, the results in the experimental group consisted of an association of spontaneous correction with the effects of the appliances. The conclusion that there was open-bite correction in 86.7% of the treated patients is the actual result, considering this group alone. However, since the control group showed spontaneous correction in 13.3% of the subjects, the net effect is represented by the difference between the percentages of improvement in the treated patients and the control subjects. Although this is mentioned in the discussion, it was not stated in the conclusions. Perhaps the first conclusion should have been stated in relation to the control group, as the second, for clarity.