Role of Tongue and Transpalatal Arch in the Correction of Anterior Open Bite Malocclusion

Normal posture of the tongue in the mouth at rest is such that the tip of it lies against the lingual aspect of mandibular incisors and the dorsum against the hard palate. In anterior open bite malocclusion the tongue lies low in the floor of the mouth with its tip in between maxillary and mandibular incisors. Tongue forces during mastication and deglutition could be harnessed to help intrude maxillary molars and this feature of it in conjunction with a transpalatal arch could be put to good use in correction of anterior open bite malocclusion. The objective of the case report was thus to evaluate the efficiency of a low lying transpalatal arch alongwith fixed appliance therapy in the correction of an anterior open bite malocclusion with an orthognathic maxilla and a mildly prognathic mandible with bi-maxillary dento-alveolar protrusion and forward tongue posture. A pre-adjusted edgewise appliance, (Roth's prescription (0.022 x 0.028-inch slot), alongwith a low lying transpalatal arch 4mm away from the palatal mucosa was strapped up. A non-extraction approach was followed. The case was evaluated at the beginning (T0) and end of orthodontic treatment (T1). At T1, the anterior open bite was corrected and the canines were treated to a Class I relation. The proclination of maxillary incisors and proclination and imbrication of mandibular incisors was corrected with fixed appliance therapy. With the aid of a low lying transpalatal arch and the pressures generated by the tongue during deglutition and mastication, anterior open bite malocclusion with forward tongue position was thus successfully treated.