Early interceptive treatment of a skeletal open bite using a vertical holding appliance in combination with myofunctional therapy, and a smile-clenching-swallow exercise: a case report with a 3-year follow-up

This case report aimed to describe the effectiveness of myofunctional therapy involving a vertical holding appliance and a smile–clenching–swallow exercise for vertical control, in a growing patient who presented with a high-angle facial pattern. A 10-year-old girl sought treatment for a skeletal open bite. Early interception aimed to reduce the divergent skeletal growth pattern. The patient was asked to perform a smile–clenching–swallow exercise by pushing the tongue dorsum against a palatal resin pad on a transpalatal arch. The action exerted an upward force on the maxillary first molars, which reinforced the effects of myofunctional therapy. This interaction between the tongue and resin pad resulted in positive feedback, and a constant intrusive force delivered to the molars and balanced co-operation from the orofacial musculature. The initial vertical skeletal discrepancy was successfully resolved within 3 months. The subsequent fixed appliance treatment was straightforward. After 3 years of follow-up, the treatment outcome was stable.