An evidence-based approach to treatment of open bite and deep bite: case reports

Evidence-based decision making is gaining increased emphasis in medicine and dentistry. Since orthodontics is both an art and a science, not all decisions can be based solely on scientific findings. However, to the extent that orthodontics is a science and is based on the principles of scientific method, the clinician can practice evidence-based decision making. This article summarizes the results of 6 case-controlled studies on treatment changes in deep bite or open bite.

All studies used the Bolton Brush Growth Study as a source for untreated controls. Strategies for correction of deep bite included cervical pull headgear, bionator therapy, and Tweed edgewise mechanotherapy. Open-bite strategies included 4 premolar extraction, 4 first molar extraction, and active vertical corrector therapy. The changes in 6 variables involved in overlap of the incisor teeth (changes in the maxilla and mandible, as well as tipping and bodily movements of the maxillary and mandibular incisors) were summed at the occlusal plane.

Extraction of permanent teeth influences vertical facial growth, growth of the mandible is a major factor in the correction of deep bite, and tipping of the incisor teeth is an important contributor to open-bite correction. Two clinical cases that demonstrate the application of this analysis are presented. The first case involves an open bite treated with extraction of 4 premolars, and the second is a nonextraction deep-bite case treated with a Herbst appliance, followed by fixed appliances.

Case-controlled studies can help practitioners decide among various treatment strategies for vertical overbite problems.