Informed consent and open-bite correction

The online article, “Long-term stability of surgical-orthodontic open-bite correction” (Maia FA, Janson G, Barros SE, Maia NG, Chiqueto K, Nakamura AY. Am J Orthod Dentofacial Orthop 2010;138:254.e1-10), and the associated Editor’s Comment allowed the authors and the editor to make an important point with implications for informed consent regarding open-bite correction: “every orthodontist should realize that the severity of the associated dentoskeletal discrepancies and the patient’s needs should be the primary factors for requiring surgical intervention and not closure of the open bite per se, intending a more stable occlusal result” (Turpin DL. Editor’s comment. Am J Orthod Dentofacial Orthop 2010;138:254-6).

The point is well taken that open-bite correction—after correction by way of upper jaw surgery or after lower jaw surgery or after both upper and lower jaw surgeries and after all patients had orthodontic care—can relapse in a clinically significant manner. Accordingly, the patient’s expected improvements in facial proportions, postsurgery, might be the better prime mover for proposed treatment rather than open-bite correction, based on this research.

Many warts were forgiven to bring to light the positive benefit of this research. The editor was well aware of this and suggested numerous design improvements for future study.

Keeping future study in mind, the authors should discuss more adequately the purported cause(s) of open bite for each patient or cohort. Was the etiology (1) genetically based, (2) an airway inadequacy, (3) a maxillary transverse deficiency, (4) the result of untoward oral habits, (5) idiopathic or unknown, (6) all of the above, or (7) other? The authors did note that, for 25 patients, “Maxillary transverse deficiency was corrected by rapid maxillary expansion.” More details would have been appreciated.

Diagnosis and treatment of the cause of a diagnosed problem should be the cornerstone of scientific care and are needed for evidential conclusions. “Open bite” should not be considered a diagnosis with enough depth to allow one to propose surgery without further in-depth investigation. If the open bite were secondary to a thumb or tongue habit, surgery would not be the treatment of first choice. If the cause of a condition is unstated and treatment proceeds without adequately stating the diagnosis, then it might appear to a reader that the cause of the problem is unknown and random treatment is being undertaken to see whether it happens to work. That approach is not recommended too often.

The cause(s) or possible causes of the anterior open bites for the 39 patients in the study should have been discussed, speculated upon, and possibly controlled for in the research design. Older patients with an open bite were younger at 1 time. The process of disproportionate growth likely started at a young age. Although we cannot turn back time to fix something that eventually contributed to a poor pattern as an adult, the root cause(s) of the open bite might still reside within the patient, and, if that were true, the original etiology, if fixable, might improve the postsurgical relapse prognosis.

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Apr 13, 2017 | Posted by in Orthodontics | Comments Off on Informed consent and open-bite correction
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