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When Is Two-phase Orthodontics Beneficial – Part 3

Open Bite MalocclusionMy patient R.S. first presented to our office for routine check-ups and evaluation of her thumb habit.  Here she is at age 7.  She is able to make her posterior teeth touch, but not her incisors.  Early phase orthodontics was indicated to help her with her thumb habit and correct her bite.

Open-bite Malocclusion As A Result Of Thumb/Tongue Habits

The open-bite malocclusion is another type of dento-facial anomaly that we, as orthodontist, recommend treating at a young age.  It is typically caused by extended thumb/digit sucking and/or pacifier use.  Many children can transition from these habits at a young age but a certain percentage become very attached to their thumb or pacifier.  As a result, the active suction of the lips and cheeks around the thumb or pacifier helps produce not only the open-bite, but also a narrowing of their palate.  As these patients enter the mixed dentition stage, most of these changes do not self-correct even if the child stops these habits on their own or with their parent’s encouragement.  This is because the tongue adapts to the anterior opening in order to help create a seal during swallowing.  This tongue thrust and/or posture, as it’s called, will then maintain the open-bite and prevent the incisors from growing to their ideal position.

Early phase orthodontics is usually indicated at around age 5 and up, to help re-establish normal swallowing, eliminate the habits, and position the teeth and jaws into their normal position.  The typical treatment involves the use of appliances that are placed in the upper or lower arch, which in turn make the thumb and/or tongue uncomfortable in their current state.  Braces are also used to help move the displaced teeth into their normal position.  Expansion of the palate is usually needed to help widen the palate too.  In some cases, like our child-patient above, the bite is also affected and this needs to be addressed also.  Waiting until these children are in their teens usually means that more extensive and surgical procedures may be needed, with guarded outcomes as a result of the continued dento-facial compensations that would continue to occur.  Our window of treatment is best during the growth years, when the teeth and especially the palate, responds the best.

Our patient R.S. was one of these children that needed our help.  She was an active thumb-sucker and for the longest time, wanted to stop.  But as a result of her habit, she had created the typical open-bite, maxillary constriction and protrusion.  She also showed a mentalis muscle strain, which is a strain of the muscles around the lip area and chin.  Her Phase I treatment involved a maxillary appliance that incorporated special extensions that reminded R.S. whenever she involuntarily placed her thumb in her mouth.  In essence, this made it uncomfortable to do so.  This appliance also helps to widen her palate into the normal size needed for her age.  Braces were also used to place these incisors in an ideal position.  We also treated her overjet-protrusion with the help of other appliances and elastics.  Overall, we were very successful in establishing the normal dimensions of the arch and a normal alignment.  Her habits were eliminated, and she now has a more harmonious facial balance as evident in her profile pictures. Her mentalis strain was eliminated too.

Here she is after Phase I treatment, at age 9. Treating patients like R.S. is a true joy in that we are able to help them withdraw from habits that are difficult to break, and at an age in which we can re-establish normal dento-facial growth.

Open Bite Malocclusion After

Dr. Surillo
Diplomate, American Board of Orthodontics
Children’s Braces & Dentistry