Three-Dimensional Analysis of Anterior Open Bite Treatment Modalities in Growing Patients: a comparison of Clear Aligner Therapy and Temporary Anchorage Devices

Abstract

Aim: The aim was to compare the skeletal and dentoalveolar effects of clear aligner therapy (CAT) with Invisalign® versus intrusion of maxillary posterior teeth with Temporary Anchorage Devices (TADs) in growing patients with anterior open bite (AOB) using three- dimensional (3D) imaging.

Methods: Fifteen adolescents treated exclusively with Invisalign® and fourteen with TADs were assessed retrospectively. Rigid-wise, voxel-based registration of pre- and post-treatment CBCTs were performed using the anterior cranial base, maxillary plane, and mandibular body as reference regions. Treatment outcomes were compared between both groups using median regression modelling.

Results: Both treatment modalities resulted in similar correction of AOB. Compared with CAT, TADs demonstrated significantly greater intrusion of the maxillary first molars when measured from the mesio-buccal [Right: (2.09mm; 95% CI: 1.05-3.12), Left: (2.98mm; 95% CI:2.00-3.96)] and palatal cusps [Right: (2.08mm; 95% CI: 1.15-3.01), Left: (2.83mm; 95% CI:1.92- 3.74)] as well as less extrusion of the upper incisors [12: (-1.30mm; 95% CI, -2.13 to -0.47), 11: (-1.30mm; 95% CI, -2.40 to –0.20), 21: (-0.92mm; 95% CI, -1.73 to –0.12), 22: (- 0.85mm; 95% CI, -1.71 to –0.00)]. Upper and lower incisors tipped lingually while lower incisors extruded with no statistical difference between the two groups.

Conclusion: TADs demonstrated greater maxillary molar intrusion whilst CAT induced greater maxillary incisor extrusion in growing patients with AOB.