با عرض سلام،

برای اصلاح هر ناهنجاری فکی، ابتدا بایستی علت ایجاد آن را تشخیص داد. بر اساس اطلاعات داده شده در مورد نمونه شما، گفته اید که اپن بایت این خانم با شروع درمان تشدید شده است...

Ba arz salam,
In order to correct any malocclusion you first need to know its etiology. According to your information about this case, you mentioned that her open-bite became more severe with start of treatment, therefore, this patient had some degree of open-bite pre-treatment. The most common etiology for open-bite is mouth breathing which in return causes a tongue-thrust habit and a low posturing of the tongue. If this is the case for your patient, controling her tongue posture and her habit is very important. First you need to make sure that patient can infact breathe through her nose, if not the reason for blockage should be identified and treated, ie, referral to an ENT specialist is the first step.
The only appliance that can help your patient control her tongue habit is a Tongue-crib that can either have sharp prongs or be rounded at the ends. A sharp prong if tolerated by patient is more effective. This appliance should be fixed to upper molars for about 6-8 months. patient should be instructed about proper tongue positioning during swallowing and speech. So a speech therapist can be utilized for this. Once you have controlled the tongue posture, you can see the open-bite close automatically but use of vertical elastics can expedite the bite closure. Make sure witdth of maxilla is adequate or if needed expand maxilla. Sometimes mandibular width across lower 6s and 7s need to be constricted with a lingual arch concurrently. Prematurity on 6s, 7s and wisdom teeth need to be equlibrated accordingly.
Proper bracket and band positioning is very important in orthodontics, reposition them as needed early in treatment.
Always make sure you have a correct Centric Relation before start of treatment so you have a correct vision of true malocclusion. Many open-bites are skeletal in nature but the severity of it maybe masked by mandibular posturing.
Many open-bite cases relapse even with surgical correction and the culprit is always the tongue. So controlling the tongue is paramount in stability of the case.

Good luck
Sincerely,
M Tavakolijou
Orthodontist