Anterior open bite with temporomandibular disorder treated with titanium screw anchorage: evaluation of morphological and functional improvement

Abstract

Skeletal anterior open bite is one of the most challenging malocclusions to correct because it is difficult to establish absolute anchorage for molar intrusion with traditional orthodontic mechanics. In addition, patients with anterior open bite sometimes have signs and symptoms of temporomandibular disorders (TMD). In this article, we report the successful treatment of a patient with severe skeletal anterior open bite and TMD; we used titanium screw anchorage. The patient, a woman, age 19 years 11 months, had an open bite of -4.0 mm and increased anterior lower facial height. The titanium screws were implanted in the mandible, and intrusion force was provided with elastic chains for 6 months. After active treatment for 36 months, her mandibular first molars were intruded about 3.0 mm, and good occlusion was achieved. Her retrognathic chin and convex profile were improved both by upward rotation of the mandible and advancement genioplasty with vertical reduction. After treatment, the TMD signs and symptoms were reduced, and improvements of both function and occlusion were achieved. Molar intrusion with titanium screw anchorage might be a useful treatment option to improve function, occlusion, and facial esthetics in patients with severe anterior open bite and TMD.