Management of open bite in patients with temporomandibular joint degeneration

Open bite is a multifactorial problem, which is a challenging type of malocclusion for the orthodontist to treat. A careful and detailed diagnosis is important to ensure the correct treatment approach. With the use of temporary skeletal anchorage devices (TSADs), it is now possible in most cases to treat these malocclusions without surgical intervention. Several etiological factors are involved in the development of this malocclusion, including the patient's facial growth pattern, persistent sucking habits, tongue dysfunction, and mouth breathing due to compromised airways. These factors should always be identified early in a patient's life. Treatment strategies have included habit control, tongue crib, and correction of any airway problems, while in the more severe open bite patients, orthognathic surgery was necessary to correct the problem. Now, it can be treated by the intrusion of the posterior teeth using TSADs. This article presents one type of open bite resulting from condylar degeneration. In the past, this problem could have only been corrected with orthognathic surgery. Here, we demonstrate the result of an acquired open bite treated by intruding the posterior teeth with TSADs. In addition, we provide guidelines for selecting those cases that lend themselves to treatment with TSADs and those where combined orthodontic and orthognathic surgical correction is still needed.