Dentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial

doi:10.1016/j.ajodo.2020.06.031

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 159, Issue 1, January 2021, Pages 10-20

https://doi.org/10.1016/j.ajodo.2020.06.031 Get rights and content

Highlights

•
Two protocols for anterior open bite treatment in children were evaluated.
•
Treatment with spurs and posterior build-ups was compared with treatment with spurs alone.
•
Overbite increase was similar.
•
The experimental group showed smaller maxillary molar extrusion and similar counterclockwise rotation of the mandible.

Introduction

This single-center 2-arm parallel randomized clinical trial aimed to compare the dentoskeletal effects of bonded spurs combined with posterior build-ups vs conventional bonded spurs in the treatment of anterior open bite malocclusion in the mixed dentition.

Methods

Patients aged from 7 to 11 years with anterior open bite, recruited at a university orthodontic clinic, were randomly allocated into 2 groups. The experimental group consisted of patients treated with bonded spurs combined with posterior build-ups. The comparison group comprised patients treated with conventional bonded spurs. Lateral headfilms were obtained at pretreatment and after 12 months of treatment. The primary outcome was the change in the overbite. Randomization was performed using the Web site www.randomization.com. Sequentially numbered opaque and sealed envelopes were used for allocation concealment. Blinding was applicable for outcome assessment only. Intergroup comparisons were performed using t or Mann-Whitney U tests (P <0.05). Mean difference (MD) and 95% confidence interval (CI) were obtained.

Results

The experimental group included 24 patients (17 female, 7 male; mean age, 8.22 ± 1.06 years) and the comparison group comprised 25 patients (14 female, 11 male; mean age, 8.30 ± 0.99 years). Baseline demographic and cephalometric characteristics were similar between groups. After 12 months, all patients showed improvements. Both groups showed similar improvements of the overbite (MD, 0.00 mm; 95% CI, −0.92 to 0.91), similar slight decreases of the gonial (MD, 0.02°; 95% CI, −1.11 to 1.15) and mandibular plane (MD, 0.15°; 95% CI, −0.64 to 0.93) angles, and similar mandibular molar extrusion (MD, 0.14 mm; 95% CI, −0.27 to 0.56). The experimental group showed significantly smaller extrusion of the maxillary first molar than the comparison group (MD, −0.70 mm; 95% CI, −0.92 to −0.49). The other dentoskeletal variables showed similar changes without statistically significant intergroup differences. No serious harm was observed other than plaque accumulation around the spurs.

Conclusions

Similar overbite increases and dentoskeletal changes were observed in both groups after 12 months of treatment. Although the experimental group showed significantly smaller extrusion of the maxillary molars, no greater counterclockwise rotation of the mandible than the comparison group was observed.

Registration

This trial was registered at Clinicaltrials.gov (Identifier NCT03702881).

Protocol

The protocol was not published.

Funding

This trial was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES), Finance Code 001; and by grants: no. 2017/06440-3, no. 2018/05238-9 and no. 2018/24003-2, São Paulo Research Foundation (FAPESP).

Section snippets

Specific objectives or hypotheses

This study aimed to compare the dentoskeletal changes of bonded spurs combined with posterior build-ups vs conventional bonded spurs in anterior open bite early treatment. The null hypothesis tested was that both therapies produce similar dentoskeletal effects.

Trial design and any changes after trial commencement

This project was a single-center RCT with 2 parallel arms and a 1:1 allocation ratio. This RCT followed the Consolidated Standards of Reporting Trials statement and guidelines,²¹ and did not require changes in methods after trial commencement.

Participants, eligibility criteria, and settings

This study was approved by the Ethics in Research Committee of Bauru Dental School, University of São Paulo, Bauru, Brazil (protocol no. 68551617.8.0000.5417/2.112.035). In addition, the protocol of this study was registered at Clinicaltrials.gov with the

Participant flow

A total of 1025 children were assessed for eligibility; 969 were excluded because they did not meet the inclusion criteria, and 6 declined to participate. Fifty patients were randomized in a 1:1 ratio (Fig 2).

Baseline data

The groups showed similar characteristics regarding age and sex distribution and initial cephalometric variables (Tables II and III; Fig 3, A).

Number analyzed for each outcome, estimation, and precision

One out of 25 patients (4%) was lost during the follow-up in the experimental group because the patient moved to another city. Considering that the

Main findings in the context of the existing evidence and interpretation

Early treatment of anterior open bite malocclusion has been studied, and different protocols were reported to treat this condition.10, 11, 12^,14, 15, 16, 17^,²³^,28, 29, 30 However, RCT evaluating conventional and new associated protocols are still necessary.6, 7, 8, 9

Previous studies have reported the efficiency of bonded spurs alone for early treatment of anterior open bite.10, 11, 12 Bonded spurs combined with posterior build-ups could produce a combined effect of eliminating deleterious

Conclusions

1.
Both treatment protocols produced similar overbite increases and showed similar dentoskeletal changes after 12 months of treatment.
2.
Although the bonded spurs combined with posterior build-ups showed significantly smaller extrusion of the maxillary molars, no greater counterclockwise rotation of the mandible was observed in comparison with conventional bonded spurs alone in the short term.

Acknowledgments

The authors thank Morelli (Sorocaba, São Paulo, Brazil) and FGM Dental Products (Joinville, Santa Catarina, Brazil) for their support.

References (34)

Z.B. Al-Bitar et al.
Bullying among Jordanian schoolchildren, its effects on school performance, and the contribution of general physical and dentofacial features
Am J Orthod Dentofacial Orthop
(2013)
P. Cozza et al.
Sucking habits and facial hyperdivergency as risk factors for anterior open bite in the mixed dentition
Am J Orthod Dentofacial Orthop
(2005)
L.F. Canuto et al.
Anterior open-bite treatment with bonded vs conventional lingual spurs: a comparative study
Am J Orthod Dentofacial Orthop
(2016)
H.N. Işcan et al.
Effects of vertical chincap therapy on the mandibular morphology in open-bite patients
Am J Orthod Dentofacial Orthop
(2002)
F. Pedrin et al.
A prospective study of the treatment effects of a removable appliance with palatal crib combined with high-pull chincup therapy in anterior open-bite patients
Am J Orthod Dentofacial Orthop
(2006)
M.A. Cassis et al.
Treatment effects of bonded spurs associated with high-pull chincup therapy in the treatment of patients with anterior open bite
Am J Orthod Dentofacial Orthop
(2012)
F.W. Worms et al.
Open-bite
Am J Orthod
(1971)
N. Pandis
Randomization. Part 1: sequence generation
Am J Orthod Dentofacial Orthop
(2011)
N. Pandis
Randomization. Part 3: allocation concealment and randomization implementation
Am J Orthod Dentofacial Orthop
(2012)
N. Pandis
Blinding or masking
Am J Orthod Dentofacial Orthop
(2012)

T.K. Koo et al.

A guideline of selecting and reporting intraclass correlation coefficients for reliability research

J Chiropr Med

(2016)

P. Cozza et al.

Treatment effects of a modified quad-helix in patients with dentoskeletal open bites

Am J Orthod Dentofacial Orthop

(2006)

N. Pandis

The evidence pyramid and introduction to randomized controlled trials

Am J Orthod Dentofacial Orthop

(2011)

N. Pandis

Use of controls in clinical trials

Am J Orthod Dentofacial Orthop

(2012)

I.L. Nielsen

Vertical malocclusions: etiology, development, diagnosis and some aspects of treatment

Angle Orthod

(1991)

P. Ngan et al.

Open bite: a review of etiology and management

Pediatr Dent

(1997)

G. Janson et al.

Open-Bite Malocclusion: Treatment and Stability

(2014)

Cited by (6)

Effects of bonded spurs, fixed and removable palatal crib in the early treatment of anterior open bite: A systematic review and meta-analysis
2023, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
Mucedero et al28 compared quad-helix with crib appliances with the combined use of 3 appliances, that is, transpalatal arch, high-pull headgear, and lip bumper, in treating AOB. Bonded spurs associated with posterior build-ups and bonded spurs alone were assessed in 2 articles.29,30 Dental arch changes after AOB treatment produced by the miniscrew-supported palatal crib and conventional fixed palatal crib were evaluated by Fouda.31
Bonded spurs, fixed or removable palatal cribs have been used to treat anterior open bite (AOB) in growing children. Different conclusions have been brought out by different authors. This meta-analysis aimed to evaluate the effect of bonded spurs, fixed and removable palatal cribs in the early treatment of AOB.
A comprehensive electronic search was carried out through PubMed, Embase (via Ovid), MEDLINE (via Ovid), Cochrane Central Register of Controlled Trials, and Web of Science up to May 1, 2022. This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The work was carried out by 2 reviewers in duplicate and independently, including electronic searching, data extracting, risk of bias assessment, quality of evidence grading, heterogeneity and statistical power analysis, and eligibility evaluation of the retrieved articles.
Four studies out of 181 articles were recruited in the meta-analysis after applying the inclusion and exclusion criteria. The results showed that bonded lingual spurs and fixed palatal crib or spurs produced similar overbite changes (mean difference, −0.32; 95% confidence interval, −1.06 to 0.43; P = 0.41; I² = 27%; meta power = 0.099). Fixed palatal crib and removable palatal crib also exhibited comparable effects in correcting AOB (mean difference, −0.02; 95% confidence interval, −0.90 to 0.86; P = 0.96; I² = 0%; meta power = 0.2182). The quality of evidence about these 2 outcomes assessed with GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was low.
Bonded lingual spurs, fixed palatal crib or spurs, and removable palatal crib had similar effects in the early treatment of AOB. Because the number of included studies was limited and only the overbite changes before and after treatment were assessed, more clinical randomized controlled studies with longer follow-ups are needed to get more clinically significant advice.
Authors’ response
2022, American Journal of Orthodontics and Dentofacial Orthopedics
Dental arch changes after open bite treatment with spurs associated with posterior build-ups in the mixed dentition: A randomized clinical trial
2021, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
Some patients in both groups still had a residual AOB at T2 and continued with bonded spurs for a longer time. This has been reported in previous studies and was related to the initial AOB severity, associated with greater skeletal vertical involvement at pretreatment, a short-term follow-up period, and persistence of some oral habits (thumb/finger sucking, pacifier, and tongue habits).9,10,13,28 Further research with greater samples should be planned to confirm our results.
This single-center, 2-arm, parallel-group randomized clinical trial aimed to compare the dimensional dental arch changes after anterior open bite (AOB) treatment with bonded spurs associated with posterior build-ups vs bonded spurs alone.
Patients aged between 7 and 11 years with AOB were recruited at a university clinic and randomly allocated into 2 groups. The experimental group was treated with bonded spurs associated with posterior build-ups (SBU) and the comparison group with bonded spurs alone (S). Digital dental models were obtained at pretreatment and after 12 months of treatment. The overbite change was the primary outcome. The randomization list was obtained at the Web site www.randomization.com. Allocation concealment involved sequentially numbered, sealed, and opaque envelopes. The outcomes’ assessment was blinded. Analysis of covariance was used for intergroup comparisons (P <0.05). Mean difference (MD) and 95% confidence interval (CI) were obtained.
Twenty-four patients (mean age, 8.22 ± 1.06 years; 7 males and 17 females) were included in the SBU group, and 25 patients (mean age, 8.30 ± 0.99 years; 11 males and 14 females) were included in the comparison group. After a 12-month follow-up, the overbite increased approximately 4 mm in both groups (MD, −0.11 mm; 95% CI, −1.03 to 0.80). Means of anterior dentoalveolar vertical development ranged from 2.24 mm (S group) to 2.49 mm (SBU group) and from 1.31 mm (SBU group) to 1.55 mm (S group) for the maxilla (MD, −0.24 mm; 95% CI, −0.91 to 0.44) and mandible (MD, 0.29 mm; 95% CI, −0.39 to 0.96), respectively. The maxillary intermolar distance decreased in the SBU group and increased in the S group (MD, −0.48 mm; 95% CI, −0.92 to −0.03). The mandibular intermolar distance increased in the SBU group and decreased in the comparison group (MD, 0.26 mm; 95% CI, 0.004-0.52). Plaque accumulation around the spurs was observed in some patients.
Both protocols demonstrated similar improvements in the AOB with similar effects on the dental arches. The SBU group showed a slight decrease in the maxillary intermolar distance and a slight increase in the mandibular intermolar distance, whereas opposite changes were observed for the S group.
This trial was registered at Clinicaltrials.gov (Identifier NCT03702881).
The study protocol was not published.
This work was supported by the São Paulo Research Foundation (FAPESP) grants nos. 2017/06440-3, 2018/05238-9, and 2018/24003-2; and financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES), Finance Code 001.
Oral health-related quality of life, adaptation/discomfort during open bite treatment with spurs: complementary analysis from a randomized clinical trial
2024, Scientific Reports
Three-dimensional dentoalveolar changes in open bite treatment in mixed dentition, spurs/posterior build-ups versus spurs alone: 1-year follow-up randomized clinical trial
2022, Scientific Reports
Evaluation of periodontal parameters and gingival crevicular fluid cytokines in children with anterior open bite receiving passive orthodontic treatment with a spur
2022, Korean Journal of Orthodontics

: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

: This trial was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES), Finance Code 001; and by grants: no. 2017/06440-3, no. 2018/05238-9 and no. 2018/24003-2, São Paulo Research Foundation (FAPESP).

: This article is based on research submitted by Dr Aron Aliaga-Del Castillo in partial fulfillment of the requirements for the degree of PhD in Orthodontics at Bauru Dental School, University of São Paulo, Bauru, Brazil.

View full text

Randomized controlled trialDentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial

Highlights

Introduction

Methods

Results

Conclusions

Registration

Protocol

Funding

Section snippets

Specific objectives or hypotheses

Trial design and any changes after trial commencement

Participants, eligibility criteria, and settings

Participant flow

Baseline data

Number analyzed for each outcome, estimation, and precision

Main findings in the context of the existing evidence and interpretation

Conclusions

Acknowledgments

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

J Chiropr Med

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Vertical malocclusions: etiology, development, diagnosis and some aspects of treatment

Angle Orthod

Open bite: a review of etiology and management

Pediatr Dent

Open-Bite Malocclusion: Treatment and Stability

Randomized controlled trial
Dentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial