Skeletal openbite is known as the most challenging mallocclusion to treat.The general morphology in openbite malocclusion is the high angle skeletal pattern characterized by steep mandibular plane. The common etiologic factor in skeletal openbite malocclusion is the impaired nasal breathing. In order to open the airway, tongue is placed in a downward and forward position, which results in the overextrusion of the maxillary posterior teeth. As seen in this functional matrix, eruption of the maxillary posterior teeth is the key factor for the development of the openbite malocclusion. General principle in treatment is to correct the affected morphegenic pattern. True treatment requires the impaction of the overerupted maxillary posterior segment, achieve anterior rotation of the mandible and correct the affected skeletal pattern. Orthognahtic surgery is the only proven method which is used to impact the maxilla succesfully and achieve the anterior rotation of mandible and correct the malocclusion. Zygomatic implant supported openbite treatment is a method which was developed as an alternative to orthognahtic surgery. In this procedure, two orthodontic miniplates are fixed in the zygomatic buttress area bilaterally and the extentions are bent in the form of a hook. Openbite appliance with acrylic caps covering the posterior teeth bilaterally, including the canines are connected by two palatal bars. Bilateral sagittal bars, extending from molars to the canines are mounted, passing 3 mms apart from the acyilic cap. Coil springs are extended between the sagittal bars and the hooks of the zygomatic implants. In this force system three independent forces are created to be used for the impaction of maxillary posterior segment; -Force coming from coil springs -Functional force transmitted through the body of the tongue to the palatal bars -Force created by muscle tonus. This protocol has been used for more than 20 years in our clinic and its effectiveness was shown in many studies . We can say that this protocol is an alternative method to orthognatic surgery. In this presentation, zygomatic implant supported openbite treatment method will be described in detail and some treated cases will be presented along with long term follow up results.


Learning Objectives
After this lecture, you will be able to establish the treatment of skeletal openbite by zygomatic anchorage
After this lecture, you will be able to establish the method for effective intrusion of maxillary posterior dentoalveolar segment
After this lecture, you will be able to define the zygomatic anchorge protocole, when and how.