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Morphology of open bite

Zur Morphologie des offenen Bisses

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this work was to define and illustrate the skeletal morphology of open-bite patients against the background of sagittal jaw relationships on the basis of lateral cephalograms.

Materials and methods

Lateral cephalograms of 197 untreated adults were analyzed in dental imaging software (Onyx Ceph 3™; Image Instruments, Chemnitz, Germany). Four groups were formed based on vertical (Index scores) and sagittal (individualized ANB values) parameters. Ninety-nine patients were defined as the control group due to their neutral sagittal and vertical relationships. The remaining patients were found by their vertical relationships to represent open-bite cases and were divided by their sagittal relationships into three study groups: neutral (Class I, n = 34), distal (Class II, n = 26), and mesial (Class III, n = 38). A geometric morphometric approach was used to analyze the x,y-coordinates of 28 skeletal landmarks on each cephalogram. Relative size was captured based on centroid size (CS). The shape-determining factors in the groups were compared by permutation testing after Procrustes transformation, and intergroup differences were visualized in the form of thin-plate splines.

Results

While size (CS) was significantly increased in the Class III group, the other two groups were not different from the control group. After Procrustes transformation, characteristic and invariably significant (p < 0.001) differences in shape were detected. Neutral (Class I) open bite involved compression in the mandibular ramus and the upper anterior facial third, including vertical expansion in the lower molar and anterior nasal spine areas. Mesial (Class III) open bite was associated with pronounced vertical and sagittal size reductions in the upper posterior segments and reduced lengths of the mandibular ramus. Distal (Class II) open bite involved expansion in the pterygoid area and compression in the mandibular ramus.

Conclusion

Open bite is not a homogeneous group. Our geometric techniques of morphometric analysis revealed typical patterns, thus, confirming the differences observed by traditional morphometry. True skeletal overdevelopment appears to be present only in open-bite cases having a mesial jaw relationship. All open-bite groups have in common that the mandibular ramus is compressed, but marked differences are seen in terms of vertical development of the maxilla. This differentiated view of open-bite cases should be taken into consideration during individual etiology assessment and treatment planning.

Zusammenfassung

Ziel

Erfassung und Darstellung der skelettalen Morphologie des offenen Bisses anhand von Fernröntgenseitbildern unter Berücksichtigung der sagittalen Kieferlagebeziehung.

Material und Methode

Fernröntgenseitbilder von 197 unbehandelten Erwachsenen wurden in Onyx Ceph 3™ (image instruments, Chemnitz) ausgewertet. Anhand der Vertikalen (Index) und Sagittalen (individualisierter ANB) wurden 4 Gruppen gebildet. Die Kontrollgruppe mit sagittal und vertikal neutraler Relation bildeten aus dieser Gesamtheit 99 Patienten. Als Untersuchungsgruppen mit vertikal offener Relation wurde nach der Sagittalen in neutral (Klasse I, n = 34), mesial (Klasse III, n = 38) und distal (Klasse II, n = 26) selektiert. Die xy-Koordinaten von 28 skelettalen Punkten je Fernröntgenseitbild wurden nach Methoden der geometrischen Morphometrie analysiert. Die Erfassung der relativen Größe erfolgte anhand der Centroid-Größe (CS). Die formbestimmenden Faktoren der Gruppen wurden nach Procrustes-Transformation mittels Permutationstest verglichen und die Gruppenunterschiede in Thin-Plate-Splines visualisiert.

Ergebnisse

Bei Betrachtung der Größe (CS) war diese in der offen-mesialen Gruppe signifikant erhöht, alle anderen zeigten keinen Unterschied zur Kontrollgruppe. Nach Procrustes-Transformation zeigten sich deutliche Formunterschiede zwischen den Gruppen. Diese waren statistisch signifikant (p < 0,001) und wiesen charakteristische Merkmale auf; offen-neutral: Kompression im Ramus mandibulae bei vertikaler Expansion im Molarengebiet des Unterkiefers und in der Region der Spina nasalis anterior bei gleichzeitiger Kompression im anterioren oberen Gesichtsdrittel offen-mesial: deutliche vertikale und sagittale Verkleinerung im posterioren Bereich des Oberkiefers bei verkürztem Ramus mandibulae offen-distal: Expansion im Bereich des Pterygoids bei komprimiertem Ramus mandibulae.

Schlussfolgerungen

Der offene Biss stellt keineswegs eine homogene Gruppe dar. Neben den Unterschieden, die sich in den Analysen der klassischen Morphometrie zeigen, weisen auch die Betrachtungen anhand der geometrischen Morphometrie charakteristische Muster aus. Nur bei der mesialen Kieferrelation scheint eine echte skelettale Überentwicklung vorzuliegen. Die Gruppen eint die Kompression im Ramus mandibulae, deutliche Unterschiede sind jedoch in der vertikalen Entwicklung des Oberkiefers zu sehen. Diese differenzierte Betrachtung des offenen Bisses sollte bei den Überlegungen zur Ätiologie und bei der Therapieplanung Berücksichtigung finden.

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Compliance with ethical guidelines

Conflict of interest. K.-F. Krey, K.-H. Dannhauer, and T. Hierl state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Einhaltung ethischer Richtlinien

Interessenkonflikt. K.-F. Krey, K.-H. Dannhauer und T. Hierl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Department of Orthodontics and Orofacial Orthopedics, Center for Dental, Oral and Craniomandibular Sciences, University Medicine Greifswald, Rotgerberstr. 8, 17475, Greifswald, Germany

    K.-F. Krey M.M.E.

  2. Department of Orthodontics and Orofacial Orthopedics, University Medicine Leipzig AöR, Leipzig, Germany

    K.-H. Dannhauer

  3. Department of Oral and Maxillofacial Plastic Surgery, University Medicine Leipzig AöR, Leipzig, Germany

    T. Hierl

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  1. K.-F. Krey M.M.E.
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Krey, KF., Dannhauer, KH. & Hierl, T. Morphology of open bite. J Orofac Orthop 76, 213–224 (2015). https://doi.org/10.1007/s00056-015-0290-8

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