Conventional Palatal Crib Versus Bonded Spurs for Anterior Open Bite Treatment

Anterior open bite (AOB) is defined as the absence of vertical overlap between the maxillary and mandibular anterior teeth when the posterior teeth are in occlusion. It is often associated with parafunctional habits such as tongue thrusting, which can lead to dentoalveolar imbalance and malocclusion during growth. Early intervention is essential to prevent functional, esthetic, and psychosocial complications.

Various treatment modalities have been proposed to correct anterior open bite associated with tongue thrusting, including palatal cribs, tongue spurs, functional appliances, and myofunctional therapy. Conventional palatal crib (CPC) appliances act as a mechanical barrier that prevents the tongue from exerting pressure on the anterior teeth, while bonded spurs (BS) provide continuous sensory feedback that discourages improper tongue posture.

This study is designed as a randomized clinical trial with a 1:1 allocation ratio. A total of 20 patients aged 7 to 12 years with dental anterior open bite (≥1 mm), Class I skeletal and dental relationships, and tongue thrusting habit will be recruited. Participants will be randomly assigned to either the CPC group or the BS group.

In the CPC group, bands will be fitted on the maxillary first permanent molars, and a conventional palatal crib constructed from 0.9 mm stainless steel wire will be soldered to the bands. The crib will be positioned posterior to the maxillary incisors to prevent anterior tongue thrust. In the BS group, prefabricated bonded spurs will be placed on the palatal surfaces of the maxillary incisors.

All participants will undergo intraoral scanning before treatment and after 6 months. Outcome measures will include overbite, overjet, and anterior open bite symmetry. Cephalometric analysis will be performed to evaluate skeletal and dental changes, including Sella-Nasion-A point (SNA), Sella-Nasion-B point (SNB),and A point-Nasion-B point (ANB), mandibular plane angle, and incisor inclinations. Vertical dentoalveolar measurements: Upper anterior dental height (UADH), upper posterior dental height (UPDH), lower anterior dental height (LADH), and lower posterior dental height (LPDH) will also be assessed.

Patient-reported outcomes will be evaluated using the Child Perceptions Questionnaire (CPQ8-10), which assesses oral symptoms, functional limitations, emotional well-being, and social well-being. Scores will be recorded at baseline and after treatment.

Data will be statistically analyzed to compare pre- and post-treatment changes within and between groups. The findings of this study are expected to provide clinical evidence regarding the effectiveness and patient acceptance of conventional palatal crib and bonded spurs in the management of anterior open bite.

Inclusion criteria

• Children aged 7 to 12 years
• Skeletal Class I relationship
• Angle Class I dental relationship
• Dental anterior open bite ≥ 1 mm
• Open bite limited to the anterior segment (incisors and canines)
• Presence of tongue thrusting habit with anterior tongue posture
• Patients in mixed dentition stage
• Fully erupted upper and lower central incisors
• Fully erupted maxillary first permanent molars
• Good oral hygiene
• No gender restrictions
• Upper arch with no or mild crowding

Exclusion criteria

• Mouth breathing
• Skeletal anterior open bite
• Presence of posterior crossbite
• Congenitally missing teeth
• Dental anomalies
• Presence of any systemic disease