I hate open bites! I don’t understand their etiology, I don’t understand why they don’t self-correct, I don’t seem to be able to identify the diagnostic features that are really important, I really don’t know the best methods to treat them, and, even worse, I don’t know how to successfully retain the correction. Thank heaven that open bites are somewhat scarce. Over the past century, it appears that such frustrations have been shared by many practitioners; for example, the treatments used for open bites have included extractions, oral shields, tongue cribs, partial glossectomies, vertical pull chincups and other headgears, multilooped archwires for posterior intrusion, vertical elastics for anterior extrusion, implants for posterior intrusion, muscle exercises, tongue exercises, tooth positioners, surgery, and prayers. Not only have these treatments been used individually, but in many instances they have been used collectively, following the adage of throwing in “everything but the kitchen sink” with the hope that something will work. So, send me extremely crowded Class I malocclusions (they are easy to explain, patients readily accept the treatment, and they treat out rapidly) or send me Class II malocclusions involving prepubescent low-angle boys (growth gives you about 70% of the correction, but the orthodontist gets 100% of the credit), but don’t send me open bites. I hate open bites.
But there is hope just over the horizon. The American Association of Orthodontists has established the Practice-Based Research Network (AAO-PBRN) to foster orthodontic research in collaboration with the National Dental Practice-Based Research Network. Dr Vincent Kokich brought this effort to your attention in 2013 during the initial planning stage, and that phase is now concluded. The good news is that the first orthodontic network-based study has been launched, conducted by Dr Greg Huang, chair at the University of Washington Department of Orthodontics. It will potentially involve more than 250 practitioners from all over the United States who will follow about 1000 patients. The focus of this first effort will be the study of anterior open-bite treatment in adults. During this study, an attempt will be made to assess the effectiveness and stability of contemporary strategies for managing this type of malocclusion in adults. Hooray!
Resources to establish and run this network will come from the National Institute of Dental and Craniofacial Research (National Institutes of Health), and funds received will be used to create the network, train the participants, and administer a national network of practitioners in the conduct of practice-based research. If you sign up to participate in the network of providers, you will receive training on human subjects and research methods. Then you will merely agree to treat open-bite patients in your own office and report your observations to the director of the study. The director will not tell you how to treat patients, but when the study is concluded, samples will be constructed and articles will be written, and it is hoped, we will all know what works and what doesn’t. There are no costs involved in joining the network, and the practitioners and their participating patients will receive some compensation for their involvement.
If you would like to participate in this national effort to learn more about our patients and our treatments, please consider the information on the national network, which can be found at www.nationaldentalpbrn.org . Every orthodontist in the United States is qualified to participate in the practitioner network. Likewise, every orthodontic program is qualified and strongly encouraged to sign up.
Several other special challenges also seem worth mentioning now. If you, as a practitioner, know everything there is to know about open bites and you are successful in all your treatments, then I suppose you might think that there is no point in your participation, but that is exactly the opposite conclusion that you should draw. Show the world your successful strategies, and we will all learn from you. Beyond that, a special challenge goes out to all the speakers on the circuit. If you are going to talk the talk, maybe you also need to show what you can offer in terms of the treatment of anterior open-bite patients.
Finally, you should be aware that this network-based study is only the first of perhaps many to come. The near-term goal of the AAO-PBRN committee is to conduct several important and timely research projects on topics of great importance to orthodontists and the patients they treat. For example, such topics as treatment of Class II malocclusion, prevention and management of white spot lesions, and factors associated with root resorption have all been discussed as possible topics for network-based studies. In the end, keep in mind that the success of the anterior open-bite study, as well as other network-based studies that will follow, depends on you. We need the best evidence on which to base and improve our clinical practices; through your cooperation and collaboration, such evidence will be produced. Here is an opportunity for you to personally advance our specialty.
You can experience the thrill of discovery, the incredible, visceral feeling of doing something no one has ever done before, see things no one has ever seen before, know something no one has ever known before…. Welcome to science, you’re going to like it here.