Orthodontic management of habit-related anterior open bite with a modified tongue crib: a case report

Abstract

This case report presents the treatment outcomes achieved with a modified transpalatal arch, an acrylic button, an anterior tongue crib, and extraction fixed orthodontic treatment in a female patient aged 13 years and 2 months presenting with an anterior open bite secondary to thumb sucking and infantile swallowing/tongue thrusting habits. Initially, an anterior open bite, an overjet of 3.6 mm, an Angle Class I molar relationship, a Class II canine relationship, proclined incisors, and a skeletal Class II relationship accompanied by a mandibular retrusion tendency were detected. In the first stage, a modified fixed habit-breaking appliance was utilized to physically obstruct the thumb sucking habit, prevent the anterior interposition of the tongue, and redirect tongue posture. Significant clinical improvement was observed in the open bite within approximately six months. Subsequently, fixed orthodontic treatment was initiated following the extraction of teeth 14 and 24. At the end of the treatment, the anterior open bite was closed, the overjet-overbite relationship was improved, and a Class I canine relationship along with adequate occlusal interdigitation was achieved. Cephalometrically, the ANB angle decreased from 4.9° to 3.8°, the Wits appraisal decreased from 4.5 mm to 2.8 mm, the IMPA decreased to 91°, and the interincisal angle increased to 141.6°. This case demonstrates that the elimination of etiological factors, vertical control, and long-term functional follow-up are of critical importance in the treatment of habit-related open bites.

Keywords

• Anterior open bite
• thumb sucking
• tongue thrusting
• tongue crib
• orthodontic treatment

Abstract

Bu olgu sunumunda, parmak emme ve infantil yutkunma/dil itimi alışkanlıklarına sekonder gelişen anterior açık kapanışa sahip 13 yıl 2 aylık adölesan kız hastada; modifiye transpalatal ark, akrilik buton, anterior dil önleyici aparey ve çekimli sabit ortodontik tedavi ile elde edilen tedavi sonuçları sunulmaktadır. Başlangıç değerlendirmesinde anterior açık kapanış, 3,6 mm overjet, Angle Sınıf I molar ilişki, Sınıf II kanin ilişki, prokline keserler ve mandibular retrüzyon eğiliminin eşlik ettiği iskeletsel Sınıf II ilişki saptanmıştır. İlk aşamada, parmak emme alışkanlığını fiziksel olarak engellemek, dilin anterior bölgede konumlanmasını önlemek ve dil postürünü yeniden yönlendirmek amacıyla modifiye sabit alışkanlık kırıcı aparey kullanılmıştır. Bu aparey ile yaklaşık altı ay içinde anterior açık kapanışta belirgin klinik iyileşme gözlenmiştir. Ardından, 14 ve 24 numaralı dişlerin çekimini takiben sabit ortodontik tedaviye başlanmıştır. Tedavi sonunda anterior açık kapanış kapatılmış, overjet-overbite ilişkisi iyileştirilmiş ve yeterli oklüzal interdigitasyon ile birlikte Sınıf I kanin ilişki elde edilmiştir. Sefalometrik olarak ANB açısı 4,9°’den 3,8°’ye, Wits değeri 4,5 mm’den 2,8 mm’ye düşmüş; IMPA değeri 91°’ye gerilemiş ve interinsizal açı 141,6°’ye yükselmiştir. Bu olgu, alışkanlık kaynaklı açık kapanışların tedavisinde etiyolojik faktörlerin ortadan kaldırılmasının, vertikal kontrolün sağlanmasının ve uzun dönem fonksiyonel takibin kritik öneme sahip olduğunu göstermektedir.

Keywords

• Anterior açık kapanış
• parmak emme
• dil itimi
• dil paravanı
• ortodontik tedavi

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