Use of A Posterior Bite Block Modified With TPA and Palatal Crib For Treating Openbite in Growing Individual A Case Report

Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Use of a Posterior Bite Block Modified with TPA and

Palatal Crib for Treating Openbite in Growing
Individual: A Case Report
Dr. Jibin Joy Daniel1, Dr. Asjad Nizar2, Dr. K. Nillan Shetty3, Dr. Anil Kumar4
1.
Assistant Professor, Pushpagiri college of Dental sciences, Kerala
2.
Post graduate student, AJ Institute of Dental sciences, Mangalore
3.
Professor & HOD, Department of Orthodontics, AJIDS, Mangalore
4.
Reader, Department of Orthodontics, AJIDS, Mangalore
Corresponding author- Dr.Asjad Nizar, Post graduate student, AJIDS, Mangalore
Abstract:- more susceptible to dental extrusion and further bite opening

Background The aim of this paper is to illustrate the use during conventional biomechanical therapy, several authors
of a Posterior biteblock modified with TPA and Palatal have proposed intraoral devices, similar to vertical holding
crib to obtain the vertical control of maxillary molars, appliances used during orthodontic treatment, to inhibit the
restrict tongue pressure as well as Intruding posterior maxillary molar over-extrusion and to promote a more
molars thereby autorotating mandible. favourable mandibular counter clockwise rotation
4,5
Case report Use of posterior biteblock modified with TPA [Bascifici and Karaman, 2002; De Berardinis et al., 2000;
and Palatal crib for correcting Anterior Openbite in Gracco and Spena, 2008; Wise et al., 1994; Linder Aronson
growing individual is illustrated. Patient was successfully et al., 1993; Shpak et al., 2006; Cerruto et al., 2018].
treated, and the open bite was fully corrected thanks to
molar intrusion, following counter clockwise rotation of II. MATERIALS AND METHODS
the mandible and tongue correction. Finishing of
alignment was performed in phase II of the treatment A posterior biteblock is made with a clear acrylic on a
with conventional appliances. working model which is modified with TPA made of 0.9mm
Conclusion Posterior biteblock modified with TPA and stainless steel wire where U loop is made in a direction
Palatal crib proved to be effective in controlling the opposite to conventional TPA and It should be 2mm away
vertical position of maxillary molars promoting the from the tissue surface and a Palatal crib is made to restrict
counter-clockwise rotation of the mandible and tongue pressure.
stimulating a different tongue posture.
Keywords:- Openbite, Openbite Correction, Growing

Individuals, Tongue Pressure.
I. INTRODUCTION
Anterior open bite is a challenging malocclusion

characterised by a deficiency in the normal vertical overlap
between anterior incisors edges when the posterior teeth are
in occlusion1. The prevalence of anterior open bite ranges
from 1.5% to 11% among different age and ethnic groups
[Pisani et al., 2016; Harvold et al., 1981. Di Ventura et al.,
2019; Nota et al., 2019; Carvalho et al., 2011]
The aetiological features of open bite can generally be

grouped under three headings as follows2: 1. Disturbances in
the eruption of the teeth and alveolar growth (e.g., ankylosed
primary molar). 2. Mechanical interference with eruption and
alveolar growth (e.g., finger-sucking habit). 3. Vertical
skeletal dysplasia.
According to Proffit and Fields3 [1983], the ideal timing

to start interceptive treatment is during the mixed dentition
because every modification in deciduous dentition has the Fig 1:- Posterior Bite Plane With Modified Tpa And Tongue
potential to relapse due to ongoing growth-related Crib
changes. Since patients with this type of vertical growth are
IJISRT22NOV048 www.ijisrt.com 111

ISSN No:-2456-2165
III. A CASE REPORT
A 16 yrs old female patient came to our department with

a chief complaint of forwardly placed upper teeth. On extra
oral examination she has convex profile, posterior
divergence, mesomorphic build with athletic body type and
mesocephalic head with incompetent lips.
On Intraoral examination, Patient presented with class I

molar relation, anterior openbite, Proclined upper and lower
incisors with midline diastema, lower arch crowding and
tongue thrusting habit.
After examination she was diagnosed as Skeletal Class

II base, with underlying Angle’s Class I malocclusion with
anterior open bite and Proclined upper and lower anteriors,
spacing in upper and crowding in lower anteriors and a
vertical growth pattern.
 Treatment Objectives
1. Correction of tongue thrusting habit.
2. Correction of open bite.
3. Correction of proclined upper and lower anteriors.
4. Correction of spacing in upper anteriors.
5. Correction of crowding in lower anterior region.
 Treatment plan
Non-extraction treatment plan is finalised and Fig 3:- Posterior Bite Block Modified With Tpa And
correction of anterior openbite by Intruding upper posteriors Palatal Crib
thereby autorotating mandible with the use of posterior
biteblock modified with TPA and Palatal crib. So that we can
achieve vertical control over upper molars at the same time
intrusion of upper molars as well as we can restrict tongue
pressure. After that, phase II with Conventional fixed
appliance therapy. The appliance used is PEA MBT
mechanotherapy in 0.022 SLOT.
Fig 4:- After 6 Months Of Treatment, Anterior Openbite

Is Corrected And Strap Up With 0.014 Niti On Both
Fig 2:- Pre-Treatment Intra Oral Photographs Arches

ISSN No:-2456-2165
IV. DISCUSSION [9]. Wise J, Magness WB, Powers J. Maxillary molar
vertical control with the use of transpalatal arches. Am
Open bite malocclusion is a difficult to treat in J Orthod Dentofacial Orthop 1994; 106:403-8.
orthodontic practice. Treatment modalities include functional
appliances in growing children and surgeries in adults. Minor
cases can be treated by fixed orthodontics along with some
habit breaking appliances. Relapse rates are highest in this
type of malocclusion. Functional efficiency of the
stomatological system is undermined in such cases. Extra
care should be taken while diagnosing and planning treatment
for such these cases as any error in identifying the etiology
may lead to a poor end result.
In this case Posterior biteblock modified with TPA and

Palatal crib proved to be effective in controlling the vertical
position of maxillary molars promoting the counter-
clockwise rotation of the mandible and stimulating a different
tongue posture.
V. CONCLUSION
Open-bite malocclusion is the one in treatment group,

which has the most possibility of relapse. The most important
feature for dental treatment is the stability of treatment. The
functional treatment methods, when applied in early and
active stages of growth and development, provide positive
stable results by turning vertical development towards
horizontal development.
REFERENCES
[1]. Bascifici FA, Karaman. Effects of a modified acrylic

bonded rapid maxillary expansion appliance and
vertical chin cap on dentofacial structures. Angle
Orthod 2002; 72:61-71.
[2]. Burke M, Jacobson A. Vertical changes in high-angle
Class II division 1 patients treated with cervical or
occipital pull headgear. Am J Orthod Dentofacial
Orthop 1992; 102:501-508.
[3]. Cangialosi TJ. Skeletal morphologic features of anterior
open bite. Am J Orthod Dentofacial Orthop 2003;
85:28–36.
[4]. Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM,
Ferreira FM, Pordeus AI. Prevalence of malocclusion in
primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatric Dent
2011; 12 (2): 107-111.
[5]. Cerruto C, Cozzani P, Cozzani M. Compliance-free and
non-invasive treatment of an anterior open bite in a 11-
year-old girl. Eur J Paediatric Dent 2018; 19(4): 282-
286.
[6]. Gracco A, Spena R. Vertical control in nonextraction
treatment of growing patients with anterior skeletal open
bite. J Clin Orthod 2008;42(8):443-9.
[7]. Proffit WR, Fields HW. Occlusal forces in normal and
long face children. J Dental Res 1983;62(5):571-4.
[8]. Urzal V, Braga AC, Ferreira AP. Oral habits as risk
factors for anterior open bite in the deciduous and mixed
dentition – cross-sectional study. Eur J Paediatric Dent
2013; 14 (4): 299-302.

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Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology

Use of a Posterior Bite Block Modified with TPA and

Abstract:- more susceptible to dental extrusion and further bite opening

Keywords:- Openbite, Openbite Correction, Growing

Anterior open bite is a challenging malocclusion

The aetiological features of open bite can generally be

According to Proffit and Fields3 [1983], the ideal timing

IJISRT22NOV048 www.ijisrt.com 111

A 16 yrs old female patient came to our department with

On Intraoral examination, Patient presented with class I

After examination she was diagnosed as Skeletal Class

Fig 4:- After 6 Months Of Treatment, Anterior Openbite

IJISRT22NOV048 www.ijisrt.com 112

In this case Posterior biteblock modified with TPA and

Open-bite malocclusion is the one in treatment group,

[1]. Bascifici FA, Karaman. Effects of a modified acrylic

IJISRT22NOV048 www.ijisrt.com 113

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