Comparison of orthodontic treatment outcomes in adults with skeletal open bite between conventional edgewise treatment and implant-anchored orthodontics.

摘要

INTRODUCTION: Open bites are known to be difficult malocclusions to treat. Generally, with conventional edgewise treatment, incisor extrusion rather than molar intrusion is observed. Recently, the use of miniscrews as anchorage has markedly increased. In this study, orthodontic treatment outcomes after conventional edgewise treatment and implant-anchored treatment were investigated by cephalometric analysis and several occlusal indexes. In addition, the stability of these patients 2 years after the retention phase was also analyzed. METHODS: Thirty adults (15 for nonimplant treatment [non-IA group] and 15 for implant-anchored treatment [IA group]) were our subjects. Cephalometric analysis, peer assessment rating, discrepancy index, and objective grading system were used. RESULTS: From the cephalometric values in the non-IA group, open-bite patients were generally treated by extrusion of the maxillary and mandibular incisors that resulted in clockwise rotation of the mandibular plane angle. In the IA group, intrusion of the maxillary and mandibular molars that resulted in counterclockwise rotation was noted. Furthermore, in the IA group, the soft-tissue analysis showed decreases in the facial convexity and the inferior labial sulcus angle that resulted in the disappearance of incompetent lips. In the retention phase, extrusion of the mandibular molars was observed in the IA group. From the objective grading system evaluation, significant reductions of overbite in canines and premolars were observed in both groups. Furthermore, less stability was observed in the IA group compared with the non-IA group according to the total objective grading system score. CONCLUSIONS: Ideal occlusion can be achieved in adults with severe open bite with both conventional edgewise and implant-anchored orthodontic treatment. However, absolute intrusion of the molars and improvement in esthetics might be achieved more effectively by using miniscrews as an anchorage device. In addition, since a significant amount of tooth movement occurs with miniscrews, careful attention is required during the retention phase.