hey this is dr. amanda with straight smile solutions and today we're gonna be
talking about closing anterior open bites with elastics and this graphic
that i drew here is an easy way to understand it now of course picture that
your patient is in braces okay so we've got braces on I just want you to
understand the elastic geometry and how this works so at this point first of all
as I always say take a step back because if your patient has an open bite it
might not be something you can correct with just ortho only without jaw surgery
in that case you're gonna need to refer to an orthodontist so it really depends
on the etiology of the open Blois bite and so I always say you need to figure
out why it's there first address that first and then you can do the braces or
address it concurrently so open bites don't just happen they can either be
skeletal in nature which is just the way the jaw bones formed that could be a
result of an airway problem a past or present habit problem or things that
maybe happened in childhood feeding issues stuff like that bottles pacifiers
thumb finger habits digit have it stuffed animal habits pencil habits
stuff like that right or an occluded airway either nasal or fragile so if you
don't address that you're never gonna be able to retain this open but it doesn't
matter what you do it doesn't matter how many bonds your retainers you use so you
got to figure it out right but let's say for example this is a 15 year old
patient let's say the open bite is only really from canine to canine it's an
anterior open bite only it's not a posterior open bite the more the smaller
the open bite is the more isolated is to the anterior teeth if you've totally
corrected the habit and the airway issue you've done a sleep questionnaire and
you know this is just something that you've now corrected and you just need
to fix this equal it up and you're sure there's not a tongue thrust then you
might be able to address it if it's anterior only so there's a lot of layers
that go into the complexity of this so in this case I mean this is a pretty
exaggerated open but this may not be possible to be able to correct Staveley
through braces even if you fixed all the problems that caused it
okay but you can give it a shot that's the main thing you could do and you
definitely would want your patient to sign a compromise form so they realize
that jaw surgery is the best for this patient they've chosen to give it a shot
that way if it relapses you're not liable so you need to make sure you do
that if you don't do that then you very well may be liable so just be careful in
taking these patients I always recommend that if possible sent to an orthodontist
at least they can go over what the surgery would be like if the patient
declines the surgery decides to go with your compromise plan then so it is you
know they understood there was benefits and alternatives you've documented them
you grabbed a signature and now you are no longer responsible but okay so
putting all that aside that's my standard spiel anterior box elastic is
going to be you can do it in a medium elastic as long as you're in night I
wouldn't do it on a 12 night I wouldn't do it on a 14 night I
ideally I'd want to be in an 18 night eye which means we've done most of our
leveling aligning and stuff like that first this anterior you're gonna have to
put Coby hooks on the lateral incisors I've got videos on how to do that you
can just search up Coby KOB eye and it should come up under my videos Coby
hooks this will probably be 5/16 medium or 1/4 medium would be my guess if I had
to guess these side ones if you may not need to do these if the end if the
answer oh but it's only here you don't need to do these but if there is an open
bite that extends to the canines then you'll probably need to do
3/16 medium on these now if you're already in a rectangular wire a heavier
rectangular wire you can do heavy so but this is only if you're an all-rounder
would you do the medium so again 1/4 or 5/16 medium on the anterior trapezoid or
box if you needed to add these triangles on the sides
probably 3/16 medium and if that is if you're in 1890 if you're in a
rectangular wire you can do heavy so hopefully that helps remember again once
you correct this you most likely are going to need a canine to canine bonzer
retainer covered by an Essex so there's a lot that you're gonna need
to retain this and there's no guarantee it's gonna retain if the patient does
have a tongue thrust forget it it's not gonna retain so be really careful in
picking these cases alright hopefully that helps thank you so much