Huge open bite mostly fixed without surgery

[bigopenbite]

I have at interesting story, I thought I would share it for anyone else who may be in a similar situation. I had a 7mm anterior open bite since childhood. I had numerous consultations over the years and I was a textbook surgery case for bimax surgery and there was no non surgical option. I know the surgery is relatively safe and most likely to give the best result, however it still obviously is a significant risk compared to no surgery.

Fast forward a few years I'm in my late 30's and sick of my openbite and decide to go ahead with the surgery if nessary. I was told at this latest consult that surgery was the only way, I asked about TAD's for posterior intrusion but the ortho said it probably won't work.(I have also found that it was very difficult to find an ortho with much experience using TAD's). So I reluctantly agreed to the surgical plan and the braces went on. The orthodontist told me my openbite may get worse before the surgery.

After 2 years in braces I'm ready for surgery, but I chickened out. Also by this point my 7mm openbite has decreased to 5mm instead of getting worse as predicted. TAD's are investigated again, some back and forth with the oral surgeon who reluctantly agrees to put them in(the surgeon did not use TAD's often, was worried about infection, and did not think the posterior intrusion would work anyways). I'm about to have the TADs put in and I ask the orthodontist if there is any other way to apply a similar force. He says we can try high pull headgear. I tried wearing it 12 hrs a day and nothing. I decided I was not going to get screws in my jaw or have surgery to avoid the embarrassment of wearing headgear, so I started wearing it 24/7, and my openbite began to rapidly disappear.

So now after 3 years of braces with the last year in 24/7 headgear I have one mm of overbite. I think maybe another few months of headgear, and maybe another year max in braces.

After my Ortho saw my progress and actually believed that I had worn the headgear 24/7, he and the other orthodontists in the office were surprised with the amount of closure. They said they can't plan on that level of compliance so they usually don't even consider it. I wonder how many people have accepted the relatively low, but still significant risk of orthgranathic surgery, when less invasive procedures are available.

It kind of sucked at first but I quickly got used to wearing the headgear and it bothers me no more then braces. Had this treatment been offered to me in the past I would have had it done years ago. If they had given me the headgear right away, I think my braces would already be off.

I know stability could be a issue for me but I'm told that can be the case even if I had surgery, a small fraction may need a second surgery etc. Assuming this bite stays mostly closed I will be glad I didn't have the surgery.

[trifecta]

I am glad to hear you are having success closing your anterior open bite with the high pull. When I had braces for the second time about ten years ago I developed an anterior open bite mid-treatment which I did not have at the start. We spent over a year trying to close the open bite with elastics with no success. After about six months with the open bite and no luck closing with elastics I started asking my ortho if high pull headgear could close the open bite but he wanted to keep trying with elastics. I think he didn't want to be "that" orthodontist who still used headgear. I think he was considering TADs but holding off on that as well. Finally after a year of elastics and asking about head gear a couple of times I got a surprise. I came in to the operatory for my adjustment and there was a high pull headgear waiting for me. It was at the same time the most exciting and most terrifying moment of my entire treatment. I was REALLY ready to be rid of the open bite but not sure what my wife would think of me wearing head gear. After about six months of 12 hour per day wear the open bite was gone! Like your story, if we had gone to the head gear sooner I probably could have cut almost a year off of my treatment time. Best of Luck!

[Lancel0t50]

Hello. I'm very interested in this technique. I'm in the shopping around/consultation phase of braces. I have been diagnosed with an open bite. I absolutely don't want to entertain any sort of surgery as I don't think the unintended consequences are worth the risk -- even if it's low risk. I've also seen a multi-loop (MAW) method in my research. Being of age 50, I know bones are pretty solid at this point. So I hope some of these more non-invasive options are viable for me. Thank you all for your wisdom!

[bigopenbite]

Yes I read about that technique as well, though I believe it mainly depends on anterior extrusion. From what I understand anterior extrusion is the least stable mode of correction and should be avoided as much as possible. TADs or headgear can intrude the posterior which is thought to be more stable, while some extrusion may still occur the less the better. As openbite stability can be challenging even with surgery sometimes, I think most orthodontists would agree anterior extrusion should be avoided as much as possible.

[Lancel0t50]

I've not found an ortho who is knowledgeable in the MEAW method around me. Seems I'm talking science fiction when I've brought it up. If it's ok, I think I'll take a copy of the results achieved here as some information to take with me. That's the best a consumer can do now is be armed with good info. I really appreciate your experiences!

[bigopenbite]

Most orthodontists don't like to deviate from the methods they know best. For a moderate to severe openbite surgery is considered the primary treatment, this is very apparent in the literature. Other methods are much less certain, though there is increasing evidence about the efficacy of posterior intrusion with TAD's etc. Orthos know they can slap braces on and do surgery, within 2-3 years the bite is fixed 95% of the time. It took me decades to find an orthodontist even willing to attempt a non surgical approach most would refuse treatment if I didn't agree to surgery. Even then they told me I'd only get a 50% correction and highly recommend against it. I eventually agreed to a surgical treatment plan if absolutely necessary but I still asked about TAD's etc at every appointment. The answer was always no until after a year of braces and I was ready for surgery (I had a surgery date and refused). Only after the surgical refusal did the orthodontist agree to attempt non surgical treatment.

[bigopenbite]

Good news at the Ortho today, no more 24/7 headgear! I only have to wear it 16hrs a day now!

[Dunnyet]

Hello, that is no doubt good news! I’ve often wondered what it must be like to have to wear headgear in public, to school or to work. Does the facebow affect speech ? All the best to you! Cheers!

[bigopenbite]

Really it's no big deal once you get used to it, I can even eat most things with it in. It does very slightly affect speech but nowhere near as much as some palatal appliances.

[Dunnyet]

Thank you for your reply. It can’t be easy wearing headgear 24/7, but you avoided surgery you didn’t feel comfortable with. It’s always best to trust one’s gut instinct! I’ve read some horror stories in this forum about surgeries and extractions that people have come to regret. There are no guarantees in life, nor are there any in dental work. All the best to you! Cheers!

[Lancel0t50]

That's great news and very encouraging. I think jumping to surgeries/extractions are their default gotos for the issues at hand. I really like conservative approaches that are the least invasive -- one of the reasons I like my current general dentist and his methodologies. Were there any major downsides to headgear wear like that? Thank you for the update.

[bigopenbite]

Yah that's true there are no guarantees, maybe I will have relapse issues, but at least no surgical side effects.

Most clinicians also prefer the least invasive option. However it also needs to be shown to be easily and repeatability effective through the best evidence available with average or below patient
compliance. While there is certainly lots of evidence headgear is very useful, there is also lots of evidence people especially kids don't wear it enough to work. They even have difficulty getting people to wear it 12hrs a day let alone 24/7. I think they should show people a video of a le fort 1 ossectomy and they might be more compliant. I feel there is an attempt to pass the surgery off as like a routine wisdom tooth removal.

No significant downsides. There was some minor discomfort when I got it, and sometimes it can cause a little tenderness after adjustments but it seams to be more comfortable the more you wear it. If you are a side or stomach sleeper I recommend you google and order the open space pillow for headgear otherwise the facebow will press on your pillow causing an uncomfortable pressure on your teeth. The hardest thing to get over is the perceived embarrassment but that's all in your head. People you are around routinely like at work get used to it and ignore it but you do get occasional looks in public because it's not a common sight, but even most people don't care, and neither do I. In the 14 months I wore my headgear 24/7 I had maybe a dozen people I know ask me about it, maybe 2 strangers and I seem to remember one teenager laughing at me.

[trifecta]

I am a bit behind the times but that is great that you are able to cut back on the headgear hours. You were brave to go the 24/7 route. I wore mine in public a few times but chickened out more often than not.
I would think you would be approaching the end of your treatment!!! I also found the open space pillow on line and used one while I was wearing my high pull headgear and agree that it is helpful. I am currently 18 months into a 6 month treatment plan (lower brackets only) to close a space that developed in front of my first molar. (Got tired of the food trap.) Space was not that big but slow going in closing. I am ready to finish so have been asking my ortho about reverse pull headgear but I think they are reluctant due to compliance issues as you point out. Best of luck!

[bigopenbite]

I think ill be a little longer yet. As mentioned there were some big delays in my treatment due to my refusal to get jaw surgery, but it's getting close. Yah they pretty much assume headgear is a waste of time and will not consider it unless there are no other option. I had to be on a surgical waitlist for years and refuse my surgery date before they would try it. A good a way to convince them you are complaint is to wear your headgear to appointments. I had to move last year and thus switched orthodontist, I wore my head to the first appointment and their were no questions as to my compliance after that. Interesting that you had high pull, and now might be getting reverse pull, what is the reason for that?

[Lancel0t50]

Hello. It's been awhile since my last post so I thought I'd throw out an update as this forum was very helpful for me. And thank you all for your input and experience provided. I feel armed with this info it helped me search and select an orthodontist that I could work with. I have a 4mm open bite and wasn't interested in any form of invasive surgery. It seems they are keen to only accept braces giving a certain result before surgery picks up the slack. I wasn't interested in that. So that really narrowed down the choices and made my search take much longer. So in December I finally locked down an ortho and setup the process and financing, etc. He feels that if headgear has any chance of closing my open bite that I will have to be 1000% diligent in wearing it. The ortho fully discloses this is not standard protocol for adults but is willing to work with me and give it our best shot. Estimated treatment time will be 20-24 months and I will start this Friday.