We thank Drs Jose Bosio and Roberto Justus for their wonderful case report (Bosio JA, Justus R. Treatment and retreatment of a patient with a severe anterior open bite. Am J Orthod Dentofacial Orthop 2013;144:594-606) in which a remarkable improvement was achieved in a patient with a severe anterior open bite treated with mandibular soldered tongue spurs.
A severe anterior open bite is a quite difficult problem to deal with. The approach provided by the authors gives us another effective option to avoid many unpredictable risks during orthognathic surgery.
Nevertheless, there are several problems that confused us, and we need your help to understand.
First, an anterior open bite is a malformation always connected with not only vertical but also sagittal and transverse anomalies. This patient showed a severe anterior open bite along with a posterior crossbite before treatment. Although the first stage of treatment had corrected the severe anterior open bite and the posterior crossbite, the overjet of the posterior teeth was too small. In a 6-month period, the open bite recurred and was attributed to inappropriate retention protocol. After retreatment, the relapsed anterior open bite was corrected once again. However, the overjet of the posterior teeth was still small, and we can see that the right third molar had been in an open bite after 1.5 years despite the efforts to keep it closed, such as removing the acrylic on the tooth’s lingual side and placing pressure on the wire from the buccal side. Because the small size of the overjet prevented the posterior teeth from achieving the biggest intercuspal occlusion, the posterior teeth were not stable and could easily relapse. The relapse of the posterior occlusion would unavoidably cause the occlusal vertical rising; the anterior bite rose 3 times owing to the scissor effect. Was the unstable posterior occlusion 1 reason for the relapse? Moreover, the maxillary arch was narrow relative to the mandibular arch; therefore, we are curious about whether the authors considered horizontally expanding the maxillary arch to increase the overjet of the posterior teeth and the stability of the occlusion to prevent relapse.
Second, the 1-mm space opened between the maxillary central incisors in the 1.5-year posttreatment pictures was closed immediately by pushing the teeth together with finger pressure; this interested us very much. We have a few patients with some space relapsed between the maxillary central incisors during the retention period, and we will be very honored if the authors could show the details about the treatment procedures with it.