Open bite: a review of etiology and management

Diagnosis and treatment of open bite malocclusion challenges pediatric dentists who attempt to intercept this malocclusion at an early age. This article updates clinicians on the causes and cures of anterior open bite based on clinical data. Patients with open bite malocclusion can be diagnosed clinically and cephalometrically, however, diagnosis should be viewed in the context of the skeletal and dental structure. Accurate classification of this malocclusion requires experience and training. Simple open bite during the exchange of primary to permanent dentition usually resolves without treatment. Complex open bites that extend farther into the premolar and molar regions, and those that do not resolve by the end of the mixed dentition years may require orthodontic and/or surgical intervention. Vertical malocclusion develops as a result of the interaction of many different etiologic factors including thumb and finger sucking, lip and tongue habits, airway obstruction, and true skeletal growth abnormalities. Treatment for open bite ranges from observation or simple habit control to complex surgical procedures. Successful identification of the etiology improves the chances of treatment success. Vertical growth is the last dimension to be completed, therefore treatment may appear to be successful at one point and fail later. Some treatment may be prolonged, if begun early. Long-term clinical outcomes are needed to determine treatment effectiveness and clinicians should consider the cost-effectiveness of these early initiated and protracted plans.