ONLINE ONLY

Stability of anterior open-bite treatment with

occlusal adjustment
Guilherme Janson,a Marcus Vinicius Crepaldi,b Karina Maria Salvatore Freitas,b Marcos Roberto de Freitas,c
and Waldyr Jansonc
Bauru, Brazil
Introduction: In this study, we aimed to evaluate the long-term stability of anterior open-bite treatment with
occlusal adjustment and the dentinal sensitivity caused by this procedure in the long term. Methods: The sample comprised 17 open-bite patients who experienced relapse of the negative vertical overbite after
orthodontic treatment and were retreated with occlusal adjustment. The cephalometric changes were
evaluated on lateral cephalograms obtained before and after the occlusal adjustment and in the long term
(mean, 3.4 years after occlusal adjustment). Dentinal sensitivity was also evaluated before the occlusal
adjustment, and 1.35 months, 4.61 months, and 3.4 years later. The cephalometric statuses between the 3
evaluations were compared with analysis of variance (ANOVA) and Tukey tests. The percentages of
clinically significant relapse were calculated. To compare dentinal sensitivity at the several stages,
nonparametric Friedman and Wilcoxon tests were performed. Results: Statistically significant relapse of anterior open bite occurred in 33.3% of the patients. Those who had the procedure before 21 years of age were
most likely to experience relapse. Dentinal sensitivity remained within the normal range in the long term.
Conclusions: Despite the statistically significant relapse of anterior open bite, clinically significant stability
was found in 66.7% of the patients. (Am J Orthod Dentofacial Orthop 2010;138:14.e1-14.e7)

n open-bite malocclusion in the permanent dentition is difficult to treat and often has significant relapse after orthodontic correction.1
Stability of anterior open-bite correction in extraction
patients is greater than in nonextraction patients.2-4
Some patients with relapse of anterior open bite can
be retreated with occlusal adjustment.5-7 The occlusal
adjustment procedure to correct open bite in relapsed
orthodontic patients produces counterclockwise rotation
of the mandible, improvement in the maxillomandibular
relationship, increased overbite, and reduced facial
convexity.7
Because no orthodontic tooth movement is required
to close the bite, it is speculated that this unusual treatment alternative can provide more stable results than orthodontic treatment, although this has not been
systematically investigated.1,7 Therefore, the objective
From Bauru Dental School, University of Sao Paulo, Bauru, Sao Paulo, Brazil.
a
Professor and Head, Department of Orthodontics.
b
Graduate student, Department of Orthodontics.
c
Professor, Department of Orthodontics.
Based on research by the second author in partial fulfillment of the requirements
for the PhD degree in orthodontics.
The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.
Reprint requests to: Guilherme Janson, Department of Orthodontics, Bauru
Dental School, University of Sao Paulo, Al. Octavio Pinheiro Brisolla, 9-75,
Bauru, SP, 17012-901, Brazil; e-mail, jansong@travelnet.com.br.
Submitted, September 2009; revised and accepted, January 2010.
0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.01.023

of this study was to evaluate the long-term stability of

anterior open-bite treatment with occlusal adjustment
and the dentinal sensitivity in the long term.
MATERIAL AND METHODS

The sample consisted of 17 patients (7 male, 10 female), obtained from the files of the Department of Orthodontics at Bauru Dental School, University of Sao
Paulo, Bauru, Sao Paulo, Brazil. All patients originally
had an anterior open-bite malocclusion, had undergone
orthodontic treatment with fixed appliances, had anterior open-bite relapse after a mean posttreatment period
of 4.15 years (range, 1-6 years), and were retreated with
the occlusal adjustment procedure. The patients mean
age when the procedure was performed was 21.53 years
(SD, 4.19 years; range, 17.58-31.50 years). After the occlusal adjustment, their mean age was 21.67 years (SD,
4.19; range, 17.66-31.58 years); in the long term, the
mean age was 25.07 years (SD, 4.15; range, 21.0035.00 years). The mean time of long-term evaluation
was 3.40 years (SD, 0.17; range, 3.16-3.91 years). The
occlusal adjustment procedure was performed in centric
relation, according to the method of Okeson.8
This study was approved by the Ethics in Research
Committee of the University of Sao Paulo, Bauru, Sao
Paulo, Brazil, and all subjects signed informed consent.
The cephalometric changes were evaluated on
lateral cephalograms obtained before and after the
14.e1

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Janson et al

occlusal adjustment and in the long term. The cephalometric tracings and landmark identifications were made
on acetate paper by 1 investigator (M.V.C.) and then
digitized with a digitizer (Numonics Accugrid XNT,
Houston Instruments, Austin, Tex). These data were
stored in a computer and analyzed with Dentofacial
Planner (version 7.02, Dentofacial Planner Software,
Toronto, Ontario, Canada), which corrected the image
magnification factors of the lateral cephalograms that
were between 6% and 9.8%.
All cephalometric measurements were described in
our previous article.7
Dentinal sensitivity was evaluated before the adjustment, after 1.35 months (SD, 0.45; range, 0.432.30 months), after 4.61 months (SD, 0.60; range,
2.63-5.20 months), and in the long term (3.4 years after
the occlusal adjustment; SD, 0.17; range, 3.16-3.91),
with the sensitivity test of Price et al.9 This test consists of a questionnaire used in the various stages to
evaluate dentinal sensitivity of the equilibrated teeth.
The level of sensitivity was evaluated in relation to
mastication, heat, cold, citrus fruits, and percussion.10
The patients answered each question on a visual analog
scale (0-10; 0 5 no pain and 10 5 the worst pain
imaginable).9
A month after the first measurements, 15 randomly
selected cephalograms were retraced and remeasured by
the same examiner (M.V.C.). Casual errors were calculated according to Dahlbergs formula11 (Se2 5 Sd2/
2n), where Se2 is the error variance and d is the difference between 2 determinations of the same variable.
Systematic errors were evaluated with dependent t tests
at P \0.05.12
Statistical analysis

Because the sample included some patients who

were still growing, it was divided into 2 subgroups to investigate growth influence in the results. One subgroup
consisted of patients under 21 years of age, and the other
of patients over that age when the occlusal adjustment
was performed. The 3 evaluation stages were compared
with dependent analysis of variance (ANOVA) followed
by Tukey tests in the whole sample and the subgroups.
A clinically significant relapse of anterior open bite
was defined as a negative overbite between the maxillary and mandibular incisors at the long-term evaluation. Therefore, to establish a clinical parameter as to
the probability of open-bite correction stability with occlusal adjustment, the percentages of patients with and
without clinically significant relapse were calculated
from the number of patients who had positive overbites
after the procedure.

American Journal of Orthodontics and Dentofacial Orthopedics

July 2010

To compare dentinal sensitivity at the 3 stages, nonparametric Friedman and Wilcoxon tests were performed. The level of significance used was 5%. These
analyses were performed with Statistica software (version 6.0, Statistica for Windows, Statsoft, Tulsa, Okla).
RESULTS

The error study showed that only variables

SN.GoGn, GPrnPog and LL-E had systematic errors,
and casual errors varied from zero (S-Go/LAFH) to
1.28 (Md1.NB).
Although treatment changes were also included, the
emphasis in this evaluation was on the posttreatment
changes. Therefore, the results demonstrated that
some changes after the occlusal adjustment, such as
decreased lower anterior face height (LAFH) and the
increased overbite had significant relapses at the longterm posttreatment stage, although not with values similar to the initial stage. Only FMA and posterior molar
height (PMH) relapsed significantly toward similar initial values in the long term (Table I).
Patients whose occlusal adjustment was performed
before age 21 years had similar results to the whole sample, except that LAFH relapsed toward similar initial
values (Table II).
Patients whose occlusal adjustment was performed
after 21 years of age had significant relapses of PMH
and LAFH toward similar values of the initial stage
(Table III).
Of the 15 patients who had positive overbite after
the occlusal adjustment, 5 had a negative overbite or
a clinically significant relapse of the open bite at the
long-term evaluation. Thus, there were clinically significant relapses in 33.3% of the patients, but 66.7%
had clinically significant stability of the anterior
open-bite correction with occlusal adjustment in the
long term.
There were significant increases in dentinal sensitivity to mastication, heat, cold, and percussion immediately after the occlusal adjustment, but sensitivity
returned to the initial conditions after 4.61 months.
This remained stable in the long term (Table IV).
DISCUSSION

Our sample consisted of patients who were previously evaluated regarding occlusal adjustment as a retreatment procedure of relapsed open bite, except for
1 patient who had moved abroad and 2 others who
moved to other towns and could not come for the postadjustment follow-up.7 The initial selection of the sample included 20 open-bite subjects who had been
orthodontically treated with clinically significant

Janson et al

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 138, Number 1

14.e3

Table I. Means and standards deviations of cephalometric variables before and after occlusal adjustment (OA) and in
the long term (n 5 17) and results of dependent ANOVA and Tukey tests

Variable
Mandibular components
P-NB (mm)
P-Nperp (mm)
SNB ( )
Maxillomandibular relationships
Wits (mm)
ANB ( )
NAP ( )
Facial patterns
FMA ( )
SN.GoGn ( )
NSGn ( )
Vertical components
S-Go (mm)
PMH (mm)
LAFH (mm)
S-Go/LAFH
Dentoalveolar components
Overjet (mm)
Overbite (mm)
Md1-AP (mm)
Md1.NB ( )
Md1-NB (mm)
Soft-tissue components
GPrnPog ( )
GSnPog ( )
Sn-Me (mm)
Interlabial gap (mm)
LL-E (mm)
LL-SnPog (mm)

Before OA

After OA

Long term

Mean (SD)

Mean (SD)

Mean (SD)

1.16 (1.52)A
8.46 (9.71)A
78.35 (4.64)A

1.55 (1.59)B
7.44 (9.85)A
78.64 (4.40)A

1.27 (1.42)AB
8.53 (10.15)A
78.61 (4.43)A

0.035*
0.055
0.513

1.02 (2.25)A
3.77 (2.32)B
6.25 (5.39)B

0.516
0.012*
0.006*

0.77 (1.70)A
4.36 (2.45)A
7.41 (5.78)A

0.63 (2.08)A
3.95 (2.33)AB
6.38 (5.50)B

33.08 (7.84)A
37.94 (8.35)A
70.41 (4.86)A

32.15 (7.63)B
36.97 (8.30)B
69.65 (4.74)B

32.91 (7.79)A
36.91 (8.01)B
69.69 (4.45)B

0.000*
0.001*
0.010*

74.81 (6.70)A
54.59 (4.57)A
74.41 (5.40)A
1.01 (0.12)A

74.72 (7.02)A
53.25 (4.41)B
72.25 (4.73)B
1.03 (0.12)B

75.17 (6.86)A
54.36 (4.29)A
73.74 (4.89)C
1.02 (0.12)B

0.342
0.000*
0.000*
0.000*

2.77 (1.31)A
1.11 (0.85)A
5.10 (1.81)A
32.38 (6.61)A
8.10 (2.25)A

2.68 (0.82)A
1.17 (0.89)B
4.97 (1.81)A
31.62 (6.29)A
7.95 (2.38)A

3.09 (1.34)A
0.41 (0.77)C
5.14 (1.84)A
33.12 (5.12)A
7.86 (2.37)A

0.091
0.000*
0.504
0.083
0.221

137.96 (5.08)A
162.98 (6.57)A
73.57 (4.51)A
2.78 (3.01)A
0.60 (1.92)A
4.87 (1.60)A

139.24 (4.63)B
164.10 (6.60)B
73.15 (4.55)A
1.34 (2.02)B
0.07 (2.20)AB
4.47 (2.00)AB

139.75 (4.94)B
163.96 (7.61)B
73.20 (4.05)A
1.10 (1.12)B
0.34 (2.93)B
3.95 (2.46)B

0.000*
0.041*
0.502
0.014*
0.039*
0.046*

Different letters indicate statistically significant differences.

*Statistically significant at P \0.05.

relapse of the anterior open bite and who were willing to

have their malocclusion retreated. Although a sample of
17 subjects might not be statistically ideal, it can be considered satisfactory because of the unusual procedure
used to correct the open bite and because the patients
were prospectively treated and followed.
Because the primary focus of this study was anterior
open-bite relapse, the discussion will initially concentrate on overbite and other changes in variables during
the posttreatment period. Changes immediately after
the procedure were previously addressed.7 The small
differences in the changes with the occlusal adjustment
in the previous study were because of the 3 patients lost
to the long-term stability evaluation, as explained, and
the different statistical analyses used.
There was a mean increase in overbite after the occlusal adjustment of 2.28 mm, correcting the open bite
of 1.11 to 1.17 mm on average, but there was a significant relapse of 0.76 mm, decreasing the overbite from

1.17 to 0.41 mm on average (Table I). Despite the significant overbite decrease, anterior open-bite correction
was reasonably stable because the overbite did not return to the initial values. The only other similar longitudinal study, including 18 adults with anterior open bite
treated with occlusal adjustment, demonstrated that
the 10-year long-term evaluation showed stable and
physiologic occlusions.5 However, the authors did not
quantify the open bite (overbite) in any of the stages
studied; their evaluations were subjective. These factors
impair comparison of their results with the long-term
results of our study.
FMA, PMH, and LAFH, which had significantly decreased with the occlusal adjustment procedure, showed
significant increases in the long term (Table I). These increases might be consequent to residual growth in some
patients and also to tooth extrusion because of muscular
imbalance after the procedure; this will be discussed below.13-15 The sample was divided into 2 subgroups of

14.e4

Janson et al

American Journal of Orthodontics and Dentofacial Orthopedics

July 2010

Means and standards deviations of cephalometric variables before and after occlusal adjustment (OA) and in
the long term for patients under 21 years of age after OA (n 5 9) and results of dependent ANOVA and Tukey tests

Table II.

Variable
Mandibular components
P-NB (mm)
P-Nperp (mm)
SNB ( )
Maxillomandibular relationships
Wits (mm)
ANB ( )
NAP ( )
Facial patterns
FMA ( )
SN.GoGn ( )
NSGn ( )
Vertical components
S-Go (mm)
PMH (mm)
LAFH (mm)
S-Go/LAFH
Dentoalveolar components
Overjet (mm)
Overbite (mm)
Md1-AP (mm)
Md1.NB ( )
Md1-NB (mm)
Soft-tissue components
GPrnPog ( )
GSnPog ( )
Sn-Me (mm)
Interlabial gap (mm)
LL-E (mm)
LL-SnPog (mm)

Before OA

After OA

Long term

Mean (SD)

Mean (SD)

Mean (SD)

0.96 (1.65)A
7.24 (10.92)A
77.58 (4.61)A

1.43 (1.53)A
6.12 (11.21)A
77.75 (4.39)A

1.27 (1.44)A
6.93 (11.42)A
77.85 (4.53)A

0.088
0.236
0.724

0.58 (1.95)A
5.55 (2.42)A
9.84 (5.83)A

0.00 (2.48)A
5.14 (2.32)A
8.85 (5.63)A

0.06 (2.48)A
5.05 (1.89)A
8.73 (4.72)A

0.174
0.133
0.075

33.91 (9.83)A
40.36 (9.66)A
71.21 (4.89)A

32.84 (9.85)B
39.48 (9.62)AB
70.51 (4.60)B

33.67 (9.92)A
39.35 (9.49)B
70.52 (4.41)B

0.007*
0.032*
0.022*

71.80 (7.31)A
52.96 (4.29)A
73.69 (4.46)A
0.97 (0.14)A

71.78 (8.09)A
51.59 (4.31)B
71.42 (3.79)B
1.00 (0.14)B

72.42 (7.89)A
52.80 (3.85)A
73.23 (3.78)A
0.99 (0.14)AB

0.288
0.000*
0.000*
0.032*

2.91 (1.20)A
1.01 (0.52)A
4.74 (2.06)A
32.22 (6.75)A
8.36 (2.70)A

2.73 (0.90)A
1.43 (0.97)B
4.66 (2.07)A
31.91 (6.28)A
8.37 (2.80)A

3.22 (1.43)A
0.48 (0.93)C
4.93 (2.22)A
32.82 (4.64)A
8.51 (2.83)A

0.184
0.000*
0.365
0.575
0.529

137.33 (6.00)A
160.94 (6.66)A
73.45 (2.44)A
3.43 (3.72)A
1.24 (2.44)A
4.95 (1.93)A

138.56 (5.12)AB
162.17 (6.86)A
73.11 (2.66)A
1.28 (2.09)A
0.53 (2.85)A
4.44 (2.69)A

139.05 (5.58)B
161.81 (8.16)A
73.01 (3.22)A
1.38 (1.50)A
0.55 (3.63)A
4.33 (3.30)A

0.042*
0.310
0.525
0.060
0.356
0.525

Different letters indicate statistically significant differences.

*Statistically significant at P \0.05.

patients under and over 21 years of age to evaluate the

percentages of these changes from growth. All other
significant dentoskeletal and tegumental changes after
the procedure had no significance in the long term
(Table I).
Obviously, with such reduced observations in each
group, these evaluations should be more appropriately
considered a pilot study.16-19 By comparing the
changes in both subgroups, it can be seen that the
younger subgroup had similar changes as the whole
sample, whereas the older subgroup had significant
increases only in PMH and LAFH in the
posttreatment period (Tables II and III). Therefore, it
seems that the remaining growth of patients of the
younger subgroup largely contributed to the
significant overbite decrease in the whole sample and
in this subgroup. However, what explains the
significant increases in PMH and LAFH of the older
subgroup? Probably, it is the muscle imbalance

created by the occlusal adjustment. As the teeth were

ground, freeway space increased, but there were no
changes in tongue volume, muscle length, and
masticatory force. Consequently, this allowed the
teeth to erupt up to a point where the original balance
between the eruptive and masticatory forces was
reestablished.14,20-24 This mechanism also contributed
to a decrease in overbite that can be seen even in the
older subgroup, although it was not statistically
significant (Table III). Similarly to the whole sample,
no other significant dentoskeletal and tegumental
changes after the procedure were significant in the
long term in the subgroups (Tables II and III).
A clinically significant relapse means a negative
overbite in the long-term observation stage and better
represents the overbite status that is important to the patient.2,4,13,25 Therefore, the percentages of patients with
clinically significant relapse and stability were
calculated in the sample.

Janson et al

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 138, Number 1

14.e5

Means and standards deviations of cephalometric variables before and after occlusal adjustment (OA) and in
the long term for patients over 21 years of age at the OA (n 5 8) and results of dependent ANOVA and Tukey tests

Table III.

Variable
Mandibular components
P-NB (mm)
P-Nperp (mm)
SNB ( )
Maxillomandibular relationships
Wits (mm)
ANB ( )
NAP ( )
Facial patterns
FMA ( )
SN.GoGn ( )
NSGn ( )
Vertical components
S-Go (mm)
PMH (mm)
LAFH (mm)
S-Go/LAFH
Dentoalveolar components
Overjet (mm)
Overbite (mm)
Md1-AP (mm)
Md1.NB ( )
Md1-NB (mm)
Soft-tissue components
GPrnPog ( )
GSnPog ( )
Sn-Me (mm)
Interlabial gap (mm)
LL-E (mm)
LL-SnPog (mm)

Before OA

After OA

Long term

Mean (SD)

Mean (SD)

Mean (SD)

1.38 (1.44)A
9.83 (8.67)A
79.22 (4.83)A

1.68 (1.75)A
8.92 (8.55)A
79.65 (4.47)A

1.27 (1.50)A
10.33 (8.91)A
79.46 (4.45)A

0.178
0.203
0.654

0.97 (1.49)A
3.02 (1.78)A
4.67 (4.63)A

1.35 (1.32)A
2.62 (1.56)A
3.61 (4.03)A

2.26 (1.11)A
2.33 (1.93)A
3.46 (4.90)A

0.065
0.112
0.118

32.16 (5.32)A
35.21 (6.06)A
69.51 (5.00)A

31.37 (4.56)A
34.15 (5.87)A
68.70 (5.03)A

32.06 (4.97)A
34.17 (5.24)A
68.76 (4.61)A

0.087
0.062
0.223

78.20 (4.10)A
56.42 (4.41)A
75.22 (6.52)A
1.04 (0.11)A

78.02 (3.79)A
55.12 (3.95)B
73.19 (5.74)B
1.06 (0.10)B

78.27 (3.94)A
56.12 (4.30)A
74.31 (6.13)A
1.06 (0.10)AB

0.874
0.002*
0.000*
0.007*

2.61 (1.49)A
1.23 (1.15)A
5.51 (1.50)A
32.57 (6.90)A
7.80 (1.76)A

2.63 (0.77)A
0.88 (0.74)B
5.32 (1.53)A
31.30 (6.72)A
7.48 (1.87)AB

2.95 (1.31)A
0.32 (0.60)B
5.38 (1.42)A
33.47 (5.92)A
7.13 (1.59)B

0.465
0.000*
0.747
0.131
0.012*

138.67 (4.11)A
165.27 (6.05)A
73.70 (6.29)A
2.06 (1.93)A
0.11 (0.70)A
4.78 (1.26)A

140.00 (4.22)AB
166.27 (5.96)A
73.21 (6.26)A
1.40 (2.09)A
0.43 (1.10)AB
4.50 (0.93)AB

140.55 (4.34)B
166.38 (6.60)A
73.42 (5.06)A
0.78 (0.26)A
1.36 (1.51)B
3.53 (0.99)B

0.010*
0.051
0.786
0.211
0.038*
0.017*

Different letters indicate statistically significant differences.

*Statistically significant at P \0.05.

Of the 17 patients, 2 (1 from each subgroup) did

not have a positive overbite after the occlusal adjustment because their dentinal sensitivity limited the
amount of grinding.7 They ended with a negative overbite of 0.2 mm that remained stable in the long term.
Therefore, they were excluded from this evaluation.
Consequently, of the 15 patients evaluated, 5 (3 from
the younger subgroup and 2 from the older subgroup)
had negative overbite or a clinically significant relapse
of the open bite at the long-term evaluation. Thus,
33.3% of the patients had a clinically significant relapse, but 66.7% had clinically significant stability of
the anterior open-bite correction with occlusal adjustment in the long-term (Figs 1-3). This percentage
was greater than26 and similar to25 stability studies
combining extraction and nonextraction patients,
greater than a study of nonextraction patients only,4
and less than another study of extraction patients
only,2 all treated in the permanent dentition. This

Table IV. Results of comparisons of dentinal sensitivity

(Friedman ANOVA and Wilcoxon tests) before and
after occlusal adjustment (OA) and in the long term
Factor
Mastication
Heat
Cold
Citrus fruits
Percussion

Before
OA
A

0
0A
0A
0A
0A

1.35 months
after OA
B

3.44
2.00B
0.88B
0.38A
0.23B

4.61 months
after OA
A

0.64
0.11A
0.17A
0.00A
0.01A

Long
term
A

0.97
0.41A
0.12A
0.13A
0.02A

P
0.000*
0.002*
0.000*
0.129
0.012*

Different letters indicate statistically significant differences.

*Statistically significant for P \0.05.

shows that this malocclusion has great relapse potential independent of the type of treatment. The relapse
mechanism in nonextraction patients is primarily due
to the smaller vertical development of the maxillary
and mandibular incisors in the posttreatment period

14.e6

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American Journal of Orthodontics and Dentofacial Orthopedics

July 2010

Fig 1. Intraoral photographs taken before the occlusal adjustment show the anterior open bite.

Fig 2. Intraoral photographs taken after the occlusal adjustment show correction of the anterior open
bite, with a positive overbite.

Fig 3. Intraoral photographs taken in the long term after the occlusal adjustment show clinical
stability of the open-bite correction with the occlusal adjustment. However, a slight reduction in
the overbite is obvious.

and the tendency of the extruded anterior teeth to intrude back to their original positions.1,4,15 The
relapse potential in extraction patients is smaller
because much of the open bite is closed through the
drawbridge principle and therefore requires less
extrusion of the anterior teeth.2,3,25,27,28 In patients
corrected with occlusal adjustment, the relapse is
primarily consequent to extrusion of the posterior
teeth in an attempt to reestablish the physiologic
balance, as explained. In addition to these
mechanisms, muscular habits might contribute to the
relapse; that should be also investigated.
There was a significant increase in dentinal sensitivity after 1.35 months of the occlusal adjustment for mastication, heat, cold, and percussion (Table IV).
However, 4.61 months after the procedure, sensitivity

had already returned to the initial levels, and this remained stable in the long term, demonstrating that,
once the sensitivity caused by the procedure has subsided, it will not return.7
Our results demonstrate the great resiliency of openbite malocclusions and also suggest an additional mechanism for its relapse. In developing patients, growth
changes also play a role in the relapse of the open bite
as shown by the greater changes in the younger subgroup of patients. However, even in patients whose occlusal adjustment was performed after 21 years of age,
there was relapse potential, as demonstrated by significant increases in PMH and LAFH in the long-term posttreatment period. Although there was not a significant
overbite decrease, it decreased slightly. Therefore, there
seems to be a mechanism to correct the physiologic

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 138, Number 1

imbalance produced by the procedure with eruption of

the posterior teeth until it is reestablished.
This information might frustrate the clinician who
might have thought that occlusal adjustment would be
a definite solution for specific patients with open-bite malocclusion, such as some relapsed open bites from previous
orthodontic or orthodontic-surgical treatment. It seems
then that open-bite malocclusions are destined to relapse
in many patients. How can this clinically significant relapse percentage be reduced? An interesting approach
would be to associate the procedures to reduce the clinically significant relapse. For example, nonextraction
and extraction orthodontic treatments have 38.1% and
25.8% of clinically significant relapses, respectively.2,4
If these relapsed patients can be retreated with occlusal
adjustment, and, knowing that this procedure has
a clinically significant relapse rate of 33.3%, after the
2 procedures, the numbers of clinically significant
relapsed patients would be significantly reduced.
CONCLUSIONS

1.

2.

3.
4.

There was a statistically significant relapse of anterior open bite in the whole sample; growth seemed
to have contributed to a significant amount of the
relapse.
The primary factor that contributed to the relapse
was the increase in posterior molar height, consequent to compensatory posterior tooth eruption.
There was clinically significant stability in 66.7%
of the patients.
Dentinal sensitivity remained within the normal
range in the long term.

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