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170]

ORIGINAL ARTICLE

The effect of posterior bite-plane on

dentoskeletal changes in skeletal open-bite
malocclusion
Emami Meibodi S1, Fatahi Meybodi SAR2,
Abstract
Samadi AH3
With regard to the vertical problem of skeletal open-bite
1
Associate Professor, Department of Orthodontics, Islamic Azad
University, Tehran, Iran; 2Postgraduate student, Department of
malocclusion, this study was undertaken to evaluate the effect Orthodontics, Tehran University of Medical Sciences, Tehran,
of upper posterior bite-plane on the dentoskeletal changes Iran; 3Private Practice, Tehran, Iran
of skeletal open-bite malocclusion. The material consisted
of 23 patients, with skeletal open-bite in mixed dentition Correspondence:
period. The patients were treated by upper removable Dr. Seyed Amir Reza Fatahi Meybodi, Apartment 8, No.5,
Jalinus Alley, Yarmohammadi Alley, Kolahdouz St., Shariati
posterior bite plane appliance. Before and after treatment Ave., Tehran, Iran. E-mail: [email protected]
lateral cephalogram were obtained. Certain angular and
linear variables were measured. The pre-treatment and post-
treatment measurements were compared using paired t-test to
an investigation it was shown that among patients
evaluate the significance of the results. There were significant
suffering from skeletal open-bite, 41% had a Cl II Div
changes in vertical incisor overlap following treatment with
upper posterior bite plane. Increase of PFH, Jaraback index,
1 malocclusion[5] which was created due to improper
UAFH/LAFH ratio were significant .There was significant growth pattern, inheritance or oral habits. [6,7] If
decrease in SN-MP angle. The dentoalveolar heights of the left untreated, several unfavorable sequela would be
upper and lower anterior segment were increased as well as encountered such as posterior cross-bite, anterior
the distance of the lower molars to mandibular plan. Only the facial height excess and facial disproportion, and lip
maxillary first molar height did not change. incompetency[8-15] and orthodontic treatment could
become so difficult that orthognathic surgery would
Key words be inevitable.
Mixed dentition period, posterior bite-plane, skeletal open-bite
Vertical chin-cup, high pull head-gear, vertical elastics,
DOI: ********** PMID: *********** functional appliances and skeletal anchorage have been
proposed for treatment.[8-12] Among the treatment
protocols is growth modification, recruitment of
growth remained, which consists of early treatment
Introduction of vertical dimension during mixed dentition period
by restraining vertical alveolar growth with a
Skeletal open-bite is one of the most difficult functional appliance. Posterior bite plane, which could
malocclusions to treat. The morphologic pattern usually be considered a simple functional appliance, could be
consists of excessive vertical height in maxillary used for this purpose. Some believe that forward and
dentoalveolar portion,[1] and the absence of over- upward rotation of mandible achieved by this appliance
bite in anterior segment of dental arches. [2] Kelly et is beyond that of fixed orthodontic appliances.[16-18]
al have reported the prevalence of this malocclusion Regarding controversies existing about this appliance,
in 3.5% of white American children and 16.5% of this study was undertaken to evaluate the effect of
African-Americans,[3] while a prevalence of 3.5% in posterior bite plane on dentoskeletal characteristics in
patients aged 8 to 17 is reported by Proffit et al.[4] In skeletal open-bite.

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Emami Meibodi, et al.: Posterior bite plane and open-bite

Materials and Methods Regarding vertical dimension of dentition, all the

measurements increased significantly unless those
Twenty three patients (13 girls and 10 boys), aged related to upper molar (6-PP) where the changes were
9.5 ± 1 years, who were referred to an academic center insignificant [Table 2].
and a private clinic in Tehran were selected based on
the following criteria: mixed dentition period, vertical Discussion
growth pattern with SN-MP > 36°, anterior open-bite
> 1 mm, lack of history of orthodontic treatment, This study showed that the posterior bite plane as a
trauma and dentofacial syndromes. All the patients were removable appliance caused the SN-MP to decrease
treated with a posterior bite plane, which consisted of significantly; since AFH had not changed while PFH
a simple removable maxillary Hawley appliance with increased, it seems that the appliance made the soft
occlusal acrylic plate from distal of first permanent tissue and muscles to stretch, induced the growth in
molar to mesial of first deciduous molar that vertically posterior region and mandibular rotation upwardly.
exceeded the freeway space by 2 mm. The minimum Significant increase in UAFH/LAFH confirms anterior
treatment period was 8 months. The pre- and post- rotation of mandible and decrease of LAFH.
treatment lateral cephalograms were obtained, traced
and the following measurements were done with an
accuracy of 0.5 mm for linear measurements or 0.5°
for angular measurements [Figure 1]: SN-MP, AFH,
PFH, Jaraback index, UAFH/LAFH. In order to
evaluate the vertical position of dentition, the distance
of central incisor edge (1 for upper incisor, /1 for lower
incisor) and mesial cusp of first permanent molar (6
for upper molar, /6 for lower molar) to palatal plan
(PP) or mandibular plan (MP) for respective jaw were
measured. All the parameters were re-measured for
the 10 randomly selected cases; since the difference
between 2 was not significant, the first measurements
were considered for statistical analysis by paired t-test.

Results
SN-MP was significantly decreased, where as PFH,
Jaraback index and UAFH/LAFH were significantly Figure 1: Dental and skeletal parameters used. a, SN-MP; b, AFH; c,
increased; change in AFH was insignificant [Table 1]. PFH; d, UAFH; e, LAFH; f, /6-MP; g, 6-PP; h, /1-MP; I, 1-PP.

Table 1: Comparison of pre-treatment and post-treatment skeletal changes with posterior-bite plane therapy
Pretreatment Postreatment Differences Paired T-test
SN-MP 41.5 ± 4.5 40.5 ± 4.3 -1 ± 1.2 P < 0.01
Jaraback index 57.4 ± 3.1 60.3 ± 5.2 2.9 ± 1.8 P < 0.001
AFH* 114.7 ± 4.3 115.2 ± 7.03 0.5 ± 2.02 P < 0.8
PFH† 65.7 ± 4.1 70.4 ± 4.2 4.7 ± 2.5 P < 0.00001
UAFH‡/LAFH§ 73.7 ± 8.6 75.9 ± 7.4 2.2 ± 1.3 P < 0.00001
*AFH (Anterior Facial Height), †PFH (Posterior Facial height), ‡UAFH (Upper Anterior Facial Height), §LAFH (Lower Anterior Facial Height).

Table 2: Comparison of pre-treatment and post-treatment dental changes with posterior-bite plane therapy
Pretreatment Postreatment Differences Paired t-test
1*-PP|| 26.8 ± 1.9 28.2 ± 5.2 1.4 ± 1.5 P < 0.01
/1†-MP¶ 38.1 ± 2.1 40 ± 2.8 1.9 ± 2.3 P< 0.02
6 -PP
‡
19.7 ± 3.1 19.3 ± 2.1 - 0.5 ± 1.1 P < 0.2
/6§-MP 28.8 ± 1.6 30.2 ± 3.3 1.4 ± 1.6 P < 0.05
*1 (incisal edge of upper central incisor), †/1 (incisal edge of lower central incisor), ‡6 (mesial cusp of upper first molar), §/6 (mesial cusp of lower first molar), ||PP (Palatal Plan), ¶MP (Mandibular Plan).

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Emami Meibodi, et al.: Posterior bite plane and open-bite

Significant increase in mandibular and maxillary patient from future complex orthodontic treatment or
anterior dentoalveolar height indicates that one of even orthognathic surgery.
the reasons that caused the open-bite to close was the
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Source of Support: Nil, Conflict of Interest: Nil
posterior face, disharmony would be relieved, saving

204 J INDIAN SOC PEDOD PREVENT DENT | Oct - Dec 2009 | Issue 4 | Vol 27 |