Anterior Açık Kapanış: Etiyoloji, Tedavi Yaklaşımları ve Uzun Dönem Stabilite
Synopsis
Anterior open bite is one of the most challenging malocclusions in orthodontics due to its multifactorial etiology, diverse dentoalveolar and skeletal characteristics, and susceptibility to posttreatment relapse. This chapter reviews the definition, classification, prevalence, etiological factors, contemporary treatment approaches, and long-term stability of anterior open bite based on the available scientific literature. The roles of genetic predisposition, vertical growth patterns, orofacial dysfunction, oral habits, and respiratory factors are discussed. Treatment modalities, including preventive and interceptive approaches, growth modification, orthodontic camouflage, extraction and nonextraction fixed orthodontic treatment, skeletal anchorage-assisted molar intrusion, and orthognathic surgery, are examined. Particular emphasis is placed on the long-term maintenance of treatment outcomes, relapse-related factors, and retention strategies, with reference to findings from systematic reviews and meta-analyses. Current evidence indicates that successful correction of anterior open bite can be achieved through various treatment modalities; however, long-term stability varies according to the treatment approach and individual patient characteristics. In conclusion, comprehensive etiological assessment, individualized treatment planning, and long-term follow-up are essential for achieving and maintaining stable orthodontic outcomes.
References
Nanda R. Management of Open Bite Malocclusion. In: Rudolph P, Pendill J (eds.) Biomechanics and Esthetic Strategies in Clinical Orthodontics. [Basım yeri belirtilmemiş]: Elsevier Health Sciences; 2005. p. 156–176.
Proffit WR, Fields HW, Larson BE, Sarver DM. Güncel Ortodonti. 6. baskı. (Darendeliler N, Çev. Ed.). Ankara: Nobel Tıp Kitabevleri; 2020.
Lopez-Gavito G, Wallen TR, Little RM, et al. Anterior openbite malocclusion: a longitudinal 10-year postretention evaluation of orthodontically treated patients. American Journal of Orthodontics. 1985;87(3): 175–186. doi:10.1016/0002-9416(85)90038-7
Mizrahi E. A review of anterior open bite. British Journal of Orthodontics. 1978;5(1): 21–27. doi:10.1179/bjo.5.1.21
Nielsen IL. Vertical malocclusions: etiology, development, diagnosis and some aspects of treatment. The Angle Orthodontist. 1991;61(4): 247–260. doi:10.1043/0003-3219(1991)061%3C0247:vmedda%3E2.0.co;2
Ngan P, Fields HW. Open bite: a review of etiology and management. Pediatric Dentistry. 1997;19(2): 91–98.
Burford D, Noar JH. The causes, diagnosis and treatment of anterior open bite. Dental Update. 2003;30(5): 235–241. doi:10.12968/denu.2003.30.5.235
Proffit WR, Fields HW Jr, Moray L. Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. The International Journal of Adult Orthodontics and Orthognathic Surgery. 1998;13(2): 97–106. doi:10.3126/ojn.v8i1.21335
Avrella MT, Zimmermann DR, Andriani JSP, et al. Prevalence of anterior open bite in children and adolescents: a systematic review and meta-analysis. European Archives of Paediatric Dentistry. 2022;23(3): 355–364. doi:10.1007/s40368-021-00683-6
Londono J, et al. Prevalence of malocclusion in Turkish children and adolescents: A systematic review and meta-analysis. Clinical and Experimental Dental Research. 2023;9(4): 689–700. doi:10.1002/cre2.771
Cangialosi TJ. Skeletal morphologic features of anterior open bite. American Journal of Othodontics. 1984;85(1): 28–36. doi:10.1016/0002-9416(84)90120-9
Kim YH. Anterior openbite and its treatment with multiloop edgewise archwire. The Angle Orthodontist. 1987;57(4): 290–321. doi:10.1043/0003-3219(1987)057%3C0290:aoaitw%3E2.0.co;2
Hartsfield JK Jr. Development of the vertical dimension: nature and nurture. Seminars in Orthodontics. 2002;8(3): 113–119. doi:10.1053/sodo.2002.125430
Rijpstra C, Lisson JA. Etiology of anterior open bite: a review. Journal of Orofacial Orthopedics. 2016;77(4): 281–286. doi:10.1007/s00056-016-0029-1
Midtbø M, Halse A. Occlusal morphology in Turner syndrome. The European Journal of Orthodontics. 1996;18(1): 103–109. doi:10.1093/ejo/18.2.103
López-Pérez R, Borges-Yáñez SA, López-Morales P. Anterior open bite and speech disorders in children with Down syndrome. The Angle Orthodontist. 2008;78(2): 221–227. doi:10.2319/092006-379rr.1
Gershater M. The proper perspective of open bite. The Angle Orthodontist. 1972;42(3): 263–272. doi:10.1043/0003-3219(1972)042%3C0263:tppoob%3E2.0.co;2
Shetty YR, Keshan A, Hegde AM, et al. Skeletal open‐bite treatment with zygomatic anchorage for a child with mental retardation: A new modality. Special Care in Dentistry. 2017;37(6): 299–303. doi:10.1111/scd.12254
Björk A. Prediction of mandibular growth rotation. American Journal of Orthodontics. 1969;55(6): 585–599. doi:10.1016/s0002-9416(72)90277-1
Arat M, İşeri H. Orthodontic and orthopaedic approach in the treatment of skeletal open bite. The European Journal of Orthodontics. 1992;14(3): 207–215. doi:10.1093/ejo/14.3.207
Enlow DH, Kuroda T, Lewis AB. Intrinsic craniofacial compensations. The Angle Orthodontist. 1971;41(4): 271–285. doi:10.1043/0003-3219(1971)041%3C0271:icc%3E2.0.co;2
Sassouni V, Nanda S. Analysis of dentofacial vertical proportions. American Journal of Orthodontics. 1964;50(11): 801–823. doi:10.1016/0002-9416(64)90039-9
Schudy FF. The rotation of the mandible resulting from growth: its implications in orthodontic treatment. The Angle Orthodontist. 1965;35(1): 36–50. doi:10.1043/0003-3219(1965)035%3C0036:trotmr%3E2.0.co;2
Pearson LE. Vertical control in treatment of patients having backwardrotational growth tendencies. The Angle Orthodontist. 1978;48(2): 132–140. doi:10.1043/0003-3219(1978)048%3C0132:vcitop%3E2.0.co;2
Fields HW, Proffit WR, Nixon W, et al. Facial pattern differences in long-faced children and adults. American Journal of Orthodontics. 1984;85(3): 217–223. doi:10.1016/0002-9416(84)90061-7
Björk A, Skieller V. Facial development and tooth eruption: an implant study at the age of puberty. American Journal of Orthodontics. 1972;62(4): 339–383. doi:10.1016/S1073-8746(99)80021-8
Kim YH. Overbite depth indicator with particular reference to anterior openbite. American Journal of Orthodontics. 1974;65(6): 586–611. doi:10.1016/0002-9416(74)90255-3
Harvold EP, Vargervik K, Chierici G. Primate experiments on oral sensation and dental malocclusions. American Journal of Orthodontics. 1973;63(5): 494–508. doi:10.1016/0002-9416(73)90162-0
Graber TM. The “three M's”: Muscles, malformation, and malocclusion. American Journal of Orthodontics. 1963;49(6): 418–450. doi:10.1016/0002-9416(63)90167-2
Akın E, Sayin MÖ, Karaçay Ş, et al. Real-time balanced turbo field echo cine-magnetic resonance imaging evaluation of tongue movements during deglutition in subjects with anterior open bite. American Journal of Orthodontics and Dentofacial Orthopedics. 2006;129(1): 24–28. doi:10.1016/j.ajodo.2005.10.002
Fujiki T, Takano-Yamamoto T, Noguchi H, et al. A cineradiographic study of deglutitive tongue movement and nasopharyngeal closure in patients with anterior open bite. The Angle Orthodontist. 2000;70(4): 284–289. doi:10.1043/0003-3219(2000)070%3C0284:acsodt%3E2.0.co;2
Bunta O, et al. Tongue Behavior in Anterior Open Bite—A Narrative Review. Diagnostics. 2025;15(6): 724. doi:10.3390/diagnostics15060724
Gao C, Wang M, He H, et al. Association between non-nutritive sucking habits and anterior open bite: A systematic review and meta-analysis. BMC Oral Health. 2025;25: 1124. doi:10.1186/s12903-025-06040-z
Larsson E. Treatment of children with a prolonged dummy or finger-sucking habit. The European Journal of Orthodontics. 1988;10(1): 244–248. doi:10.1093/ejo/10.3.244
Popovich F, Thompson GW. Thumb-and finger-sucking: Its relation to malocclusion. American Journal of Orthodontics. 1973;63(2): 148–155. doi:10.1016/0002-9416(73)90069-9
Klein ET. Pressure habits, etiological factors in malocclusion. American Journal of Orthodontics. 1952;38(8): 569–587. doi:10.1016/0002-9416(52)90025-0
Wolford LM, Cottrell DA. Diagnosis of macroglossia and indications for reduction glossectomy. American Journal of Orthodontics and Dentofacial Orthopedics. 1996;110(2): 170–177. doi:10.1016/s0889-5406(96)70105-1
Linder-Aronson S, Woodside D, Lundströ A. Mandibular growth direction following adenoidectomy. American Journal of Orthodontics. 1986;89(4): 273–284. doi:10.1016/0002-9416(86)90049-7
McNamara Jr JA. Influence of respiratory pattern on craniofacial growth. The Angle Orthodontist. 1981;51(4): 269–300. doi:10.1043/0003-3219(1981)051%3C0269:iorpoc%3E2.0.co;2
Zhao Z, Zheng L, Huang X, et al. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021;21: 108. doi:10.1186/s12903-021-01458-7
Proffit WR. Equilibrium theory revisited: factors influencing position of the teeth. The Angle Orthodontist. 1978;48(3): 175–186. doi:10.1043/0003-3219(1978)048%3C0175:etrfip%3E2.0.co;2
Proffit W, Fields HW, Nixon W. Occlusal forces in normal-and long-face adults. Journal of Dental Research. 1983;62(5): 566–570. doi:10.1177/00220345830620051201
Engel MB, Richmond J, Brodie AG. Mandibular growth disturbance in rheumatoid arthritis of childhood. American Journal of Diseases of Children. 1949;78(5): 728–743. doi:10.1001/archpedi.1949.02030050745010
Proffit WR, Vig KW. Primary failure of eruption: a possible cause of posterior open-bite. American Journal of Orthodontics. 1981;80(2): 173–190. doi:10.1016/0002-9416(81)90217-7
Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. American Journal of Orthodontics. 1964;50(5): 337–358. doi:10.1016/0002-9416(64)90175-7
Nahoum HI. Anterior open-bite: a cephalometric analysis and suggested treatment procedures. American Journal of Orthodontics. 1975;67(5): 523–531. doi:10.1016/0002-9416(75)90297-3
Epker BN, Fish L. Surgical-orthodontic correction of open-bite deformity. American Journal of Orthodontics. 1977;71(3): 278–299. doi:10.1016/0002-9416(77)90188-9
Ng CST, Wong WKR, Hagg U. Orthodontic treatment of anterior open bite. International Journal of Paediatric Dentistry. 2008;18(2): 78–83. doi:10.1111/j.1365-263x.2007.00877.x
Nshimiyimana E, Ubuzima P, Mukeshimana C, et al. Skeletal and dental open bite treatment using clear aligners and orthodontic miniscrew-anchored fixed appliances in permanent dentition: A systematic review. Journal of the World Federation of Orthodontists. 2025;14(1): 46–63. doi:10.1016/j.ejwf.2024.09.003
Worms FW, Meskin LH, Isaacson RJ. Open-bite. American Journal of Orthodontics. 1971;59(6): 589–595. doi:10.1016/0002-9416(71)90005-4
Adriano LZ, et al. Anterior open bite self-correction after cessation of non-nutritive sucking habits: a systematic review. European Journal of Orthodontics. 2023;45(3): 235–243. doi:10.1093/ejo/cjac054
Andersen WS. The relationship of the tongue-thrust syndrome to maturation and other factors. American Journal of Orthodontics. 1963;49(4): 264–275. doi:10.1016/0002-9416(63)90003-4
Haryett R, Hansen F, Davidson P, et al. Chronic thumbsucking: the psychologic effects and the relative effectiveness of various methods of treatment. American Journal of Orthodontics. 1967;53(8): 569–585. doi:10.1016/0002-9416(67)90069-3
Meng M, Xie Y, Cao J, et al. Effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite: A systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2023;163: 298–310. doi:10.1016/j.ajodo.2022.10.017
Watson WG. A computerized appraisal of the high-pull face-bow. American Journal of Orthodontics. 1972;62(6): 561–579. doi:10.1016/0002-9416(72)90001-2
Haas AJ. A biological approach to diagnosis, mechanics and treatment of vertical dysplasia. The Angle Orthodontist. 1980;50(4): 279–300. doi:10.1043/0003-3219(1980)050%3C0279:abatdm%3E2.0.co;2
İşcan HN, Dinçer M, Gültan A, et al. Effects of vertical chincap therapy on the mandibular morphology in open-bite patients. American Journal of Orthodontics and Dentofacial Orthopedics. 2002;122(5): 506–511. doi:10.1067/mod.2002.128643
Fränkel R, Fränkel C. A functional approach to treatment of skeletal open bite. American Journal of Orthodontics. 1983;84(1): 54–68. doi:10.1016/0002-9416(83)90148-3
Erbay E, Ugur T, Ülgen M. The effects of Frankel's function regulator (FR4) therapy on the treatment of Angle Class I skeletal anterior open bite malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics. 1995;108(1): 9–21. doi:10.1016/s0889-5406(95)70061-7
Denny JM, Weiskircher MA, Dorminey JC. Anterior open bite and overjet treated with camouflage therapy. American Journal of Orthodontics and Dentofacial Orthopedics. 2007;131(5): 670–678. doi:10.1016/j.ajodo.2004.11.041
Matsumoto MAN, Romano FL, Ferreira JTL, et al. Open bite: diagnosis, treatment and stability. Brazilian Dental Journal. 2012;23: 768–778. doi:10.1590/s0103-64402012000600024
Chang YI, Moon SC. Cephalometric evaluation of the anterior open bite treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 1999;115(1): 29–38. doi:10.1016/s0889-5406(99)70313-6
Küçükkeles N, Acar A, Demirkaya AA, et al. Cephalometric evaluation of open bite treatment with NiTi arch wires and anterior elastics. American Journal of Orthodontics and Dentofacial Orthopedics. 1999;116(5): 555–562. doi:10.1016/s0889-5406(99)70189-7
Hammad T, Elraggal A, Moussa H, et al. Stability of anterior open bite cases treated with upper and lower extrusion arches in adults: a follow-up study. The Angle Orthodontist. 2023;93: 659–666. doi:10.2319/030623-155.1
Isaacson RJ, Lindauer SJ. Closing anterior open bites: the extrusion arch. Seminars in Orthodontics. 2001;7(1): 34–41. doi:10.1053/sodo.2001.21064
Aras A. Vertical changes following orthodontic extraction treatment in skeletal open bite subjects. The European Journal of Orthodontics. 2002;24(4): 407–416. doi:10.1093/ejo/24.4.407
Arvystas MG. Treatment of anterior skeletal open-bite deformity. American Journal of Orthodontics. 1977;72(2): 147–164. doi:10.1016/0002-9416(77)90056-2
Kocadereli I. The effect of first premolar extraction on vertical dimension. American Journal of Orthodontics and Dentofacial Orthopedics. 1999;116(1): 41–45. doi:10.1016/s0889-5406(99)70301-x
Staggers JA. Vertical changes following first premolar extractions. American Journal of Orthodontics and Dentofacial Orthopedics. 1994;105(1): 19–24. doi:10.1016/s0889-5406(94)70095-8
Greenlee GM, Collins JL, Leroux B, et al. Treatment outcomes and short-term stability in adult anterior openbite patients treated with or without extractions: a National Dental Practice-Based Research Network study. The Angle Orthodontist. 2025;95: 149–156. doi:10.2319/070224-518.1
Carano A, Siciliani G, Bowman SJ. Treatment of skeletal open bite with a device for rapid molar intrusion: a preliminary report. The Angle Orthodontist. 2005;75(5): 736–746. doi:10.1043/0003-3219(2005)75[736:tosobw]2.0.co;2
Çinsar A, Alagha AR, Akyalçın S. Skeletal open bite correction with rapid molar intruder appliance in growing individuals. The Angle Orthodontist. 2007;77(4): 632–639. doi:10.2319/071406-292
Sherwood KH, Burch JG, Thompson WJ. Closing anterior open bites by intruding molars with titanium miniplate anchorage. American Journal of Orthodontics and Dentofacial Orthopedics. 2002;122(6): 593–600. doi:10.1067/mod.2002.128641
Umemori M, Sugawara J, Mitani H, et al. Skeletal anchorage system for open-bite correction. American Journal of Orthodontics and Dentofacial Orthopedics. 1999;115(2): 166–174. doi:10.1016/s0889-5406(99)70345-8
Park H, Jang B, Kyung H. Maxillary molar intrusion with microimplant anchorage (MIA). Australasian Orthodontic Journal. 2005;21(2): 129–135. doi:10.2478/aoj-2005-0016
Kuroda S, Sakai Y, Tamamura N, et al. Treatment of severe anterior open bite with skeletal anchorage in adults: comparison with orthognathic surgery outcomes. American Journal of Orthodontics and Dentofacial Orthopedics. 2007;132(5): 599–605. doi:10.1016/j.ajodo.2005.11.046
Kwon TG, Elnagar MH, Shirazi S, et al. Orthodontic correction of anterior open bite using skeletal anchorage: systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery. 2024;53(5): 393–404. doi:10.1016/j.ijom.2023.10.031
Erverdi N, Keles A, Nanda R. The use of skeletal anchorage in open bite treatment: a cephalometric evaluation. The Angle Orthodontist. 2004;74(3): 381–390. doi:10.1043/0003-3219(2004)074%3C0381:tuosai%3E2.0.co;2
Erverdi N, Usumez S, Solak A. New generation open-bite treatment with zygomatic anchorage. The Angle Orthodontist. 2006;76(3): 519–526. doi:10.1043/0003-3219(2006)076[0519:ngotwz]2.0.co;2
Seres L, Kocsis A. Closure of severe skeletal anterior open bite with zygomatic anchorage. Journal of Craniofacial Surgery. 2009;20(2): 478–482.
Epker BN, Schendel SA. Total maxillary surgery. International Journal of Oral Surgery. 1980;9(1): 1–24. doi:10.1016/s0300-9785(80)80002-0
Stansbury CD, Evans CA, Miloro M, et al. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. Journal of Oral and Maxillofacial Surgery. 2010;68(1): 149–159. doi:10.1016/j.joms.2009.07.105
Jung MH, Baik UB, Ahn SJ. Treatment of anterior open bite and multiple missing teeth with lingual fixed appliances, double jaw surgery, and dental implants. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143(4): S125-S136. doi:10.1016/j.ajodo.2011.11.022
Taylor RG, Mills PB, Brenner LD. Maxillary and mandibular subapical osteotomies for the correction of anterior open-bite. Oral Surgery, Oral Medicine, Oral Pathology. 1967;23(2): 141–147. doi:10.1016/0030-4220(67)90086-2
Ayliffe P, Bamber MA, Colan KM, et al. Ortognatik Cerrahinin Temelleri. 1. baskı. (Apaydın A, Çev. Ed.). İstanbul: İstanbul Tıp Kitabevi; 2009.
Wang M, Zhang B, Li L, et al. Vertical stability of different orthognathic treatments for correcting skeletal anterior open bite: a systematic review and meta-analysis. European Journal of Orthodontics. 2022;44(1): 1–10. doi:10.1093/ejo/cjab011
Kim YH, Han UK, Lim DD, et al. Stability of anterior openbite correction with multiloop edgewise archwire therapy: a cephalometric follow-up study. American Journal of Orthodontics and Dentofacial Orthopedics. 2000;118(1): 43–54. doi:10.1067/mod.2000.104830
Janson G, Valarelli FP, Henriques JFC, et al. Stability of anterior open bite nonextraction treatment in the permanent dentition. American Journal of Orthodontics and Dentofacial Orthopedics. 2003;124(3): 265–276. doi:10.1016/s0889-5406(03)00449-9
Freitas MR, Beltrão RTS, Janson G, et al. Long-term stability of anterior open bite extraction treatment in the permanent dentition. American Journal of Orthodontics and Dentofacial Orthopedics. 2004;125(1): 78–87. doi:10.1016/j.ajodo.2003.01.006
González Espinosa D, de Oliveira Moreira PE, Silva da Sousa A, Flores-Mir C, Normando D. Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis. Progress in Orthodontics. 2020;21: 35. doi:10.1186/s40510-020-00328-2
