Whether braces alone can correct an open bite without surgery depends entirely on the underlying cause and severity. Braces are effective for closing the bite, but non-surgical success relies on distinguishing between issues rooted in tooth position and those caused by major jaw misalignment. Modern orthodontic techniques, particularly those utilizing temporary anchorage devices, have expanded the range of cases treatable without orthognathic surgery. For patients seeking correction, a thorough diagnosis is the first step in planning the path toward a stable, closed bite.
Understanding the Open Bite Condition
An open bite is a type of malocclusion where a vertical gap exists between the upper and lower teeth when the jaws are closed. This condition can manifest in the front (Anterior Open Bite) or in the back (Posterior Open Bite), where molars or premolars fail to meet. Anterior open bites are the most common form, often leading to difficulties with speech and biting into food.
The two fundamental distinctions that guide treatment are a dental open bite and a skeletal open bite. A dental open bite is confined to the teeth and their supporting bone, typically caused by habits like chronic thumb-sucking or persistent tongue thrusting, which impede tooth eruption. A skeletal open bite, conversely, is a more complex issue rooted in the disproportionate growth of the jaw bones, often involving excessive vertical development of the mid-face. The severity of the skeletal discrepancy determines the feasibility of a non-surgical orthodontic correction.
Orthodontic Mechanics for Closing the Bite
Orthodontic treatment for an open bite involves mechanics focused on reducing the vertical space between the upper and lower arches, primarily by moving teeth. For dental open bites or mild skeletal cases, traditional braces are used in conjunction with interarch vertical elastics. These small rubber bands are worn diagonally between the upper and lower arches to apply a continuous, gentle extrusive force, pulling the anterior teeth into contact.
Another common appliance used with braces is the placement of bite turbos or bite blocks, small ramps bonded to the biting surfaces of posterior teeth. These devices intentionally separate the back teeth, removing the heavy force of chewing from the molars. This allows the molars to slowly intrude, or move further into the jaw bone. This intrusion causes the lower jaw to rotate upward and forward, closing the open bite in the front.
For more challenging non-surgical cases, orthodontists employ Temporary Anchorage Devices (TADs), also known as miniscrews. These tiny anchors are temporarily placed into the jaw bone, providing a stable, immovable point of anchorage. TADs allow powerful, controlled vertical forces to be applied directly to the posterior teeth. This technique enables significant molar intrusion, a highly effective way to close a severe open bite by physically shortening the back of the face, triggering the desired counter-clockwise rotation of the mandible. Treating the underlying cause, such as using a tongue crib to stop tongue thrusting, must also be part of the mechanics to ensure the newly closed bite remains stable.
When Surgical Intervention is Necessary
When the open bite is classified as severe skeletal malocclusion, the limits of orthodontic treatment are reached. Braces and TADs can move teeth within the jaw bone, but they cannot drastically alter the size, shape, or position of the foundational bone structure. Skeletal open bites often involve an excessive vertical dimension in the face, characterized by an abnormally long lower facial third.
For these severe discrepancies, the definitive treatment is orthognathic surgery, or corrective jaw surgery, performed by an oral and maxillofacial surgeon. This procedure involves physically repositioning the upper jaw (maxilla) and/or the lower jaw (mandible) to achieve proper alignment. A common surgical approach for an open bite is to move the maxilla upward, which effectively reduces the excessive vertical height of the face and allows the front teeth to meet.
Surgery is typically performed in conjunction with pre-surgical orthodontics, which aligns the teeth within each jaw so they will fit together perfectly once the jaws are surgically moved. Patients who refuse surgery may opt for orthodontic camouflage, a compromise where the teeth are maximally moved to hide the skeletal problem. Although camouflage can improve the bite, it is often less stable and does not address the underlying skeletal and facial imbalance as completely as surgery.
Maintaining the Corrected Bite
The correction of an open bite is associated with a higher risk of relapse compared to other types of orthodontic problems. This instability is often due to the persistent influence of soft tissues, such as the tongue and facial muscles, which can push the teeth back into their original open position. For this reason, the retention phase following active treatment is important for ensuring a lasting result.
Orthodontists prescribe a variety of retainers to prevent the bite from reopening.
- Fixed retainers are thin wires permanently bonded to the back surfaces of the front teeth.
- Removable retainers, such as vacuum-formed clear aligners or Hawley retainers, must be worn diligently, often full-time for several months before transitioning to night-time only wear.
- Specialized retention protocols often include removable retainers with posterior bite blocks, which cover the chewing surfaces of the back teeth to prevent re-eruption.
- Temporary Anchorage Devices (TADs) used for correction may be repurposed for skeletal retention, providing long-term, stable resistance against the vertical forces that cause relapse.
Addressing any remaining oral habits, such as retraining the tongue’s resting posture through myofunctional therapy, is an integral part of maintaining the achieved correction.