An open bite is a type of malocclusion where the upper and lower teeth fail to overlap vertically, leaving a visible gap when the mouth is closed. This lack of vertical overlap can occur at the front (anterior open bite) or along the sides (posterior open bite). Although often diagnosed in childhood, many adults seek treatment for functional issues and aesthetic concerns. Treatment options vary widely, ranging from non-surgical orthodontic solutions to complex surgical procedures, depending on the severity and underlying cause.
Understanding Open Bite and Its Causes
Treatment choice is primarily determined by whether the cause is dental, habitual, or skeletal. A dental open bite results from issues like tooth eruption failure or poor tooth positioning, meaning the jaw structure is relatively well-aligned. Skeletal open bites stem from a disproportionate, often genetically influenced, growth pattern where the maxilla and mandible grow apart instead of in parallel.
Habitual factors are common causes, especially for anterior open bites in adults. These include chronic mouth breathing, prolonged childhood habits like thumb-sucking, and tongue thrusting. Tongue thrusting involves pushing the tongue forward between the front teeth when swallowing or speaking. This applies continuous force that prevents the front teeth from meeting.
Non-Surgical Orthodontic Solutions
Non-surgical approaches are the preferred starting point for correcting mild, moderate, or primarily dentoalveolar open bites. Both traditional braces and clear aligners can be used to intrude, or push, the posterior teeth further into the jawbone. Intrusion of the back teeth allows the mandible to rotate slightly upward and forward, effectively closing the gap.
The use of Temporary Anchorage Devices (TADs) has revolutionized non-surgical correction by allowing stable, controlled force application. These small, temporary screws are placed into the bone as fixed anchors. TADs provide a stable base to apply intrusive forces directly to the molars, enabling significant molar intrusion previously difficult without surgery.
In cases where a tongue thrust is the culprit, orthodontic treatment must be paired with habit modification. Orofacial myofunctional therapy (OMT) retrains the muscles of the face and mouth. OMT establishes a proper resting tongue posture and swallowing pattern, preventing the tongue from pushing the teeth apart and undermining the correction.
When Jaw Surgery is Necessary
Non-surgical orthodontics alone cannot achieve stable correction in cases of severe skeletal open bite. This occurs when the jawbones themselves are significantly misaligned. Orthodontics primarily moves teeth within the bone and cannot correct major discrepancies in jaw size or angle. When the underlying problem is severe vertical skeletal excess, orthognathic surgery becomes necessary.
The surgical procedure involves repositioning the maxilla and/or the mandible to bring them into a harmonious relationship. For open bites, this often means surgically moving the upper jaw upward or rotating the lower jaw. Surgery is nearly always combined with orthodontics, used both before the operation to align the teeth and afterward to refine the final bite. The entire process requires close collaboration between the orthodontist and the oral surgeon.
Long-Term Maintenance and Relapse Prevention
The risk of relapse, where the open bite returns after treatment, is particularly high, making retention strategies extremely important. Once active treatment is complete, a combination of retainers is typically used to hold the corrected position. This often includes a bonded or fixed retainer—a thin wire cemented to the back of the front teeth—paired with a removable appliance for night-time wear.
Retention protocols must be lifelong because the forces that caused the open bite, especially muscle and tongue pressure, persist. Continued detrimental habits, such as low tongue posture or incorrect swallowing, can push the teeth back open even after successful correction. Therefore, continued attention to myofunctional therapy or the use of an active retainer is essential for ensuring long-term stability.