Case Study: Tonya

This patient came to see me complaining that she was unable to bite into her food with her front teeth. Upon evaluating her bite it was discovered that she had a strong anterior tongue thrust swallow pattern. Meaning that every time she swallowed, she protruded her tongue forward between her front teeth. With this type of bite, referred to as an anterior open bite, the tongue, a very strong muscle, pushes between the front teeth all day long spreading them apart.

Treatment consisted of full braces on the top and bottom teeth with the addition of a ‘crib’ appliance that was attached to her lower molars to prevent her tongue from passing between her teeth while retraining her to swallow normally. In addition, we used temporary skeletal anchors to intrude the upper and lower molars. Rather than pulling the front teeth together, which is very unstable, I elected to intrude the molars into the bone thereby allowing the jaws and teeth to overlap in the front. Each time the patient closed her mouth, the molars touched thus keeping them from re-emerging and relapsing.

Treatment progressed normally lasting just over 24 months. It is evident that not only was she able to put her front teeth together again and chew her food normally, but her smile was much improved as well. This extremely difficult case is normally treated in conjunction with jaw surgery, but with the use of skeletal anchors, patients no longer have to undergo such painful procedures.