The hypothesis that forward posturing of retrognathic mandibles is a compensating mechanism for obstructive sleep apnea (OSA) and can lead to occlusions such as that illustrated in my article is currently under study, although I am not aware of any conclusive findings.
There are two studies1,2 that seem to indicate that anterior open bite is the more probable result of OSA in growth. It does make empirical sense that the body would position the mandible in a forward position to open the airway. It follows that a braced forward position against anterior teeth would provide greater stability than simple forward posturing.
Because this braced position could produce more time with teeth in contact than would bruxing or clenching, it could conceivably produce wear such as that seen in these photos. In researching this response, I was informed that early results of a pilot study3 show that patients with OSA given nonrestrictive bite appliances saw their OSA get worse. The study is too small to draw conclusions, but the loss of a braced position and seating of the condyles in centric relation could be the reason why the OSA worsened.
If Dr. Lockerman’s point is to consider OSA as a possible causative or contributing factor, I believe he is absolutely correct. I would certainly recommend a sleep study if other details of the medical history point to sleep-disordered breathing.
Thank you to Dr. Steve Carstensen of Bellevue, Wash., for sharing his expertise on this subject.
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