Decision-Making for Sleep-Disordered Breathing with Open Bite: Surgical vs. Non-Surgical Approaches

In this session we discussed the complexities of pediatric open bite management, focusing on vertical control, skeletal expansion and real-world clinical decision making.

One of the first challenges we discussed is that many children grow predominantly in the vertical dimension, and traditional orthodontic mechanics alone are often insufficient.

Why is this patient growing vertically?

Airway obstruction, enlarged tonsils or adenoids, chronic mouth breathing, and sleep-disordered breathing are frequent drivers of downward and backward facial development, narrow maxillae, and persistent open bites. During this session of the Advanced Implementation Course, I shared multiple cases demonstrating that meaningful orthodontic correction occurs only after airway inflammation is addressed. Growth modification cannot be separated from improving nasal breathing, and the interplay between airway health and skeletal development is central to achieving stable outcomes. A major portion of the session focused on expansion strategies and appliance biomechanics.

Key Objectives:

• Severe transverse discrepancies: Learn non-surgical MARPE strategies for patients with 6–14 mm discrepancies, including stepwise expansion protocols and custom 3D-printed appliances capable of achieving up to 90% skeletal expansion.
  

• Complex open bite in growing children: See techniques for molar intrusion and mandibular rotation to improve occlusion, utilizing extension hooks, TADs, and aligner protocols for predictable anterior bite closure.
  

• Airway-conscious treatment planning: Explore cases with tonsil and adenoid hypertrophy where vertical control is essential to prevent further facial elongation, demonstrating how nasal breathing therapy can be integrated with orthodontic interventions.
  

• Challenging occlusal planes: Gain strategies for managing two-plane lower arches to minimize gingival recession and extrusion, employing sequential intrusion and autorotation techniques.
  

• Functional and esthetic outcomes: Discover methods to preserve impacted canines, enhance nasal breathing, and optimize facial aesthetics through carefully sequenced skeletal and dental expansion protocols.

Gain actionable guidance on designing appliances, sequencing expansion, and integrating airway and vertical control considerations into pediatric open bite treatment, delivering predictable and stable results even in the most challenging cases.

To watch the full video, join the Advanced Implementation Course with Dr. Yoon.

Live meeting sessions are held on the last Monday of every month at 6PM PT. All sessions are recording and available for replay.