Lingual treatment of an adult patient with an iatrogenic class II anterior open bite: Report of a case with a non-surgical orthodontic approach

Introduction > The treatment of adult patients presenting an open bite is a real challenge for orthodontists due to the complexity of the malocclusion. The diagnosis is essential to identify aetiological factors and establish the best aesthetic and functional therapeutic prognosis. Among the aetiological factors, iatrogenic treatment history has to be considered. It is the case here where a regrettable unsuitable splint for bruxism treatment forced an open bite to appear. Material and method > This case report presents an adult women with a large open bite due to an occlusal splint not covering the last mandibular molars. It was not really a vertical skeletal excess but more a mandibular clockwise rotation linked to the molar extrusions, which created a dentoalveolar open bite and labio-mental contractions during lip closure. Treatment objectives were the intrusion of the third and second molars, the extrusion of incisors to obtain a counter clockwise mandibular rotation. The patient was treated with an aesthetic and customized lingual appliance with no orthognathic surgery. A physiotherapy was followed by the patient when the open bite was closed in order to facilitate and stabilize the intercuspation. Results > A complete closing of the open bite was reached after two years of treatment. The superimposition showed the anticlockwise mandibular rotation. The levelling with posterior intrusion and the incisors extrusion reduced the vertical dimension with success. After 3 years of retention, the occlusal stability was obtained. Conclusion > The intrusion of the molars associated with a counter clockwise mandibular rotation made it possible the incisor extrusion. The occlusal balance with physiotherapy and patient compliance maintained the closure. In this way, the iatrogenic effects of the poorly designed bite splint were repaired.