Open Bite Treated with Extractions and Temporary Anchorage Devices

A 13-year-old female with a chief complaint of continuing treatment presented with Class I skeletal pattern and slight facial asymmetry. Intraorally, she had Class II molar relationship on the right side, class l on the left side and 3mm. of midline discrepancy. Her upper and lower incisors were proclined and slightly crowded. She had 1 mm. overbite and 5mm. overjet in initial mounted casts. Splint therapy was suggested to stabilize mandibular position. After splint wear, a new mounting was made, which resulted in an open bite from left second molars to right second molars. A visual treatment objective was prepared with four first bicuspid extractions. After 9 months, upper second molars were extracted and temporary anchorage devices (TADs) were placed in the upper arch for intrusion. Detailing strategies such as bracket repositioning, occlusal adjustment, and elastics were used. The role of segmented models, second molar extraction treatment, and superimposition analysis in patients with discrepancies in mandibular position is discussed. It is concluded that a thorough case workup is needed to provide patients with a successful treatment for open bite cases. This case was treated orthodontically in 2 years with four bicuspid and upper second molar extractions as well as vertical control with TADs.