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Cousley RR. J Orthod 2014; 41 (Suppl 1): s39–46

Some strategies for correcting an anterior open bite have limitations: 1) extraction of premolar teeth in order to encourage mesial movement of the molars and thereby reduce the mandibular 'hinge axis' may indeed increase lower facial height, 2) a combination of headgear and functional appliances may only retard posterior dentofacial growth, and 3) surgery (maxillary impaction osteotomy) can be associated with morbidity and lack of long-term stability. The key distinction between tooth extraction and headgear anchorage, and the use of mini-implants or mini-plates to enable molar intrusion, is that the latter approach '...improves the vertical skeletal and soft tissue parameters...and lip competence, with minimal incisor extrusion'. As molar intrusion may cause incisor extrusion, the author cautions against this approach in those who have a 'gummy smile' and a Class III skeletal pattern. Because the correction of an anterior open bite is unstable, it is advised that the patient should wear full-time, thermoplastic retainers for at least three months.