title: Treatment effects of a modified quad-helix in patients with dentoskeletal open bites.
abstract: BACKGROUND
  The aim of this study was to investigate the effectiveness of a quad-helix/crib (Q-H/C) appliance in a group of growing subjects with thumb-sucking habits and both dental and skeletal open bites.
  
  
  METHODS
  The records of 23 subjects treated with Q-H/C appliances were compared with a control group of 23 untreated subjects with similar vertical relationships. Lateral cephalograms were analyzed before treatment (T1; mean age, 8.4 +/- 1.4 years) and immediately after treatment (T2; mean age, 9.9 +/- 1.5 years). Mean duration of treatment was 1.5 +/- 7 months. The T2-T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test).
  
  
  RESULTS
  The average increase in overbite during Q-H/C therapy (3.6 mm more than the control group) overcorrected the amount of anterior open bite at T2. However, 4 of 23 subjects did not show positive overbites at T2. Both the maxillary and mandibular incisors had significantly greater lingual inclinations (about 4.0 degrees) associated with greater extrusion (1.4 and 1.0 mm, respectively) in the Q-H/C group than in the control group. In addition, the treated group showed a greater downward rotation (1.2 degrees) of the palatal plane than did the control group. This change was associated with a greater increase in upper anterior facial height (0.7 mm) and a clinically significant reduction in the palatal plane-mandibular plane angle (-1.7 degrees) in the Q-H/C group with respect to the controls. The upper and lower lips showed significant tendencies toward retraction relative to the E-plane in the treated group (2.6 and 2.9 mm, respectively) compared with the controls.
  
  
  CONCLUSIONS
  The Q-H/C appliance was effective in correcting the dental open bite in 90% of growing subjects with thumb-sucking habits and dentoskeletal open bites. The Q-H/C protocol produced a clinically significant improvement in the vertical skeletal relationships because of downward rotation of the palatal plane.
authors.affiliation: Department of Orthodontics, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cozza
authors.forename: Tiziano
authors.initials: T
authors.lastname: Baccetti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Franchi
authors.forename: James A
authors.initials: JA
authors.lastname: McNamara
mesh_terms: D002508:Cephalometry; D002648:Child; D005260:Female; D005386:Fingersucking / Q000009:adverse effects; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D003765:Models, Dental; D024343:Open Bite / Q000209:etiology / Q000628:therapy*; D009967:Orthodontic Appliances; D009971:Orthodontics, Corrective / Q000295:instrumentation*; D010155:Palatal Expansion Technique / Q000295:instrumentation; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014716:Vertical Dimension