Psychologic implications of surgical-orthodontic treatment in patients with anterior open bite

Key Words: TMJ Surgery, Orthodontics, Bite, surgical-orthodontic treatment

Hoppenreijs/Hakman/van’t Hof/Stoelinga/Tuinzing/Freihofer

International Journal of Adult Orthodontics and Orthognathic Surgery

Aims: Two hundred eighty-two patients who received surgical-orthodontic treatment to correct anterior open bite were retrospectively evaluated by interview and questionnaires to determine the motivation and expectations before treatment, experience during treatment, psychosocial impact, functional and esthetic results, and satisfaction.

Methods: All patients underwent a Le Fort I osteotomy, and 126 patients also received a bilateral sagittal split advancement osteotomy. The mean follow-up was 6 years. The most important reasons for treatment, as cited by the patients, were biting and chewing problems (28%), dissatisfaction with facial appearance (26%), and symptoms of temporomandibular joint (TMJ) dysfunction (21%). Patients with anterior open bite had a critical attitude toward facial appearance; therefore, esthetic aspects should be taken seriously.

Results: The expectations on chewing ability, phonetics, nasal passage, and facial appearance were met by the treatment; however, expectations on TMJ function, interincisal relationship, and biting ability were not completely fulfilled. There was a subjective improvement of TMJ sounds in 27% and a worsening in 14% of the patients. Dysesthesia of the infraorbital nerve was noticed in 4% of patients and of the mental or inferior alveolar nerve in 23% of the patients. Chewing and biting abilities improved in 54% and 73%, respectively. Facial appearance, self-confidence, and social interaction had improved. Patients had expected more information before and psychologic support after treatment. Despite the relapse of open bite in 20% of the patients, 75% were satisfied with the dental and 85% with the facial appearance.

As this research has indicated, surgical-orthodontic procedures for TMJ Dysfunction are not always guaranteed to be successful. Only 27% showed improvement in popping/clicking sounds and 14% actually got worse. Additionally, 20% of the patients surveyed had a relapse of their open bite. There are many non-surgical, conservative options available for the treatment of TMJ Dysfunction. Here at AZ TMJ, we focus on conservative types of treatments that have been proven to be successful and are backed by research. Dr. Stan Farrell is Board Certified in Orofacial Pain, making him one of the best options in the Phoenix area to treat a wide variety of head pain and TMJ disorders. Call and schedule a consultation at 480-945-3629.