The patient I treated has both skeletal and dental component to his open bite, but it was argued that molar intrusion is far more stable than anterior teeth extrusion . As far as I know is that the elimination of the causative factor of the open bite is what makes the best results in terms of stability .
The full details of the case are listed in my questions.
Thanks for your help
The abnormal tongue thrusting and thumb or finger suching, must stop before or during intermaxillary anterior bite closing mechanics. I found the palatal toungue retracting appliances in both causative factors not effective. Motivation helps better. As far as the stability of molar intrusion versus anterior extrusion, I think molar intrusion is more stable, simply because the causing habits will reverse the anterior extrusion after closing the open bite, plus there is no habit to reverse molar intrusion.
One risk with extrusion would be if the alveolar bone does not follow the teeth in the extrusive process - such as a case where the extrusion is done too rapidly.
But, even if molar intrusion or anterior extrusion is performed if the cause of the open bite is not addressed will not the pathology return?
Therefore, you might consider the causative factors first.
The important issue here is that we could not generalized the way of treatment for all open bite cases,either by extrusion of anteriors or intrusion of posteriors or may be both as combination..there are several factors which make the decision of treatment.and i think that the most important one is the incisor show at rest and smile,in which if there was a good or enough incisor show,so we cant do further extrusion of anterios at all , in addition to the compromized alveolar bone height as Dr.Jenkins mention3d in the previous comment ..
Regarding to stability in the available evidence. i think there is no evidence to prefer extrusion or intrusion in the literatue ..
Thank you .
Thanks Dr Suhail Khori for your answer, I agree that anterior extrusion would be faster to relapse especially if adequate overbite was not acheived during treatment .One thing to consider is that the low muscle tonus of the long faces patients may be responsible for posterior teeth relapse .
One important issue is muscle tonus . If you have a good muscle tonus without contraction and good lip seal in your patient, so extrusion will be stable. Otherwise, you should intrude molars to make up a good facial and muscular balance .
Hi Dr. Alyan, This is a great question! I did not find the details of your patient information, however.
It is very difficult to intrude molars and the literature has more information on extrusion than intrusion. I also know this from personal experience as my orthodontist tried to intrude my molars to close my anterior open bite. I believe, your best possibility of success is with implant anchorage for intrusion. He used implants on my palate and I ended up tearing up my tongue due to limited space, strong muscle developed over time etc... and loosening the implants so if you do use implants, place them to the buccal.
As far as stability, I agree with all of the others, we must recognize causative factors and be sure these have been addressed.
Also, esthetics of lower anteriors is super important and often overlooked.
Good luck!
Lisa
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