Comparative Evaluation of Fixed Versus Removable Tongue-Thrust Habit-Breaking Appliances in the Management of Anterior Open Bite in Pediatric Patients

Introduction: Anterior open bite associated with tongue-thrusting habit is a common malocclusion in children that may adversely affect dentofacial development, oral function, and esthetics. Habit-breaking appliances are frequently used to eliminate tongue-thrusting behavior and facilitate the correction of anterior open bites. However, limited evidence exists regarding the comparative effectiveness of fixed and removable tongue-thrust habit-breaking appliances. This study aimed to compare the effectiveness of fixed and removable tongue-thrust habit-breaking appliances in managing anterior open bites in pediatric patients. Materials and methods: This retrospective observational comparative study included 100 pediatric patients aged 7-14 years diagnosed with an anterior open bite associated with a tongue-thrusting habit. The patients were divided into two groups: fixed (n = 50) and removable (n = 50) appliance groups. Demographic and clinical data were extracted from patient records. The outcome measures included reduction in anterior open bite, percentage correction, treatment duration, complete open-bite closure, and predictors of successful treatment. Statistical analyses were performed using appropriate parametric and regression tests with a significance level of p < 0.05. Results: The two groups were comparable at baseline, with no significant differences in age, sex distribution, baseline open bite severity, duration of habit, or follow-up period (p > 0.05). Both treatment modalities produced significant reductions in the anterior open bite (p < 0.001). The fixed appliance group demonstrated a greater mean reduction in open bite (2.9 ± 1.0 mm) than the removable appliance group (1.9 ± 0.8 mm) (p < 0.001). The percentage correction was significantly higher in the fixed appliance group (76.3 ± 12.4%) than in the removable appliance group (51.4 ± 15.7%) (p < 0.001). Treatment duration was significantly shorter with fixed appliances (10.2 ± 2.1 months) than with removable appliances (11.8 ± 2.6 months) (p = 0.001). Complete open-bite closure was achieved in 35 (70.0%) and 20 (40.0%) patients in the fixed and removable appliance groups, respectively (p = 0.003). Fixed appliance therapy was the strongest independent predictor of successful open bite closure (odds ratio (OR) = 4.00; 95% confidence interval (CI): 1.75-9.14; p = 0.001). Conclusion: Both fixed and removable tongue-thrust habit-breaking appliances were effective in reducing anterior open bites in pediatric patients. However, fixed appliances achieved significantly greater correction, higher rates of complete closure, and shorter treatment durations. Fixed appliance therapy demonstrated superior clinical effectiveness and was the strongest predictor of successful treatment outcomes. These findings support the use of fixed habit-breaking appliances as a preferred treatment option for growing children with tongue-thrust-associated anterior open bites.