Open bite surgical/orthodontic cases.  Open bite cases pose a challenging problem.  They can many times be closed by orthodontic means only but, have a high tendency for relapse (especially on a non-extraction basis).  In adults that do not require extractions, the orthodontic closure of anterior open bites utilizing elastics will many times reopen.  In these cases, surgical posterior maxillary impaction allows for auto rotation of the mandible and a stable open bite closure.  I will leave the second molars slightly out of occlusion and allow them to spontaneously erupt since these may have been the only teeth to occlude prior to treatment.  More next week on non-surgical open bite closure.

Class II surgical/orthodontic cases.  If the mandible is too retrognathic, surgical advancement may be in order.  Unlike class III surgical cases we do not always have to wait for growth to cease prior to pursuing the surgery.  The surgeons tell me that the mandible must be matured to the point that it does not splinter or greenstick fracture during surgery.  Prior to the surgery it is necessary for us to level the curve of Spee in the lower arch and close all lower spaces that are not planned for implants or restorations. Otherwise, maximum advancement of the mandible cannot be expressed.  Surgical advancement of the mandible will improve the airway in most retrognathic patients and may lessen the chance for obstructive sleep disorders in the future.

Class III surgical/orthodontic cases.  Patients that display significant class III malocclusions will many times require orthognathic surgery in cooperation with their orthodontic treatment (once growth has ceased).  It is not uncommon to find the upper incisors flared facially while the lower incisors are retroclined lingually.  It is important to consider the airway, overbite and profile when determining if the mandible needs to be positioned distally, the maxilla mesially or both.  Since it is wise to wait on definitive orthodontic treatment until growth has stopped, we will sometimes pursue a first phase of upper braces while the patient is growing to facilitate a nice smile and increased self-confidence.