An open bite is a type of malocclusion where the upper and lower teeth do not meet when the mouth is closed. This creates a noticeable gap, which can occur at the front or back of the mouth. People often seek correction for open bites due to difficulties with chewing, speech impediments, and aesthetic concerns.
Understanding Open Bite
Open bites are categorized by location and cause. An anterior open bite, the most common type, occurs when the front upper and lower teeth do not touch, leaving a visible gap. Conversely, a posterior open bite involves a lack of contact between the back teeth, such as molars or premolars, when the jaw is closed. Open bites are also classified by origin: dental open bites result from tooth eruption or alignment issues, while skeletal open bites stem from jawbone growth discrepancies.
The development of an open bite is often multifactorial, involving genetic predispositions, environmental factors, and oral habits. Common causes include prolonged thumb or pacifier sucking, especially if these habits persist beyond early childhood. Tongue thrusting, where the tongue pushes between the upper and lower teeth during speaking or swallowing, can also contribute. If left uncorrected, an open bite can lead to impaired chewing, speech problems like lisping, and excessive wear on contacting teeth. It can also contribute to temporomandibular joint (TMJ) disorders and affect facial appearance.
Non-Surgical Correction Options
Non-surgical approaches are often the initial consideration for correcting an open bite, particularly in growing patients or less severe cases. Orthodontic treatments like traditional braces are a common method, gradually repositioning teeth and jaws to close the gap. The duration for braces treatment typically ranges from 18 to 36 months.
Clear aligners, such as Invisalign, offer another non-surgical option, especially for mild to moderate open bites primarily caused by dental alignment issues. These custom-made, transparent trays gradually move teeth into position by applying pressure. Clear aligners can achieve correction through extruding anterior teeth (moving them down) or intruding posterior teeth (moving them up), which can lead to a rotational effect in the jaw to close the bite. Specialized appliances, like tongue cribs or bite blocks, may also be used to address habits such as tongue thrusting. While effective for many cases, these non-surgical methods have limitations, particularly for severe skeletal open bites where significant jaw discrepancies exist. Orthodontic treatment alone may not be sufficient in such instances.
Open Bite Surgery Explained
When non-surgical orthodontic treatments cannot adequately address a severe open bite, particularly those rooted in skeletal discrepancies, orthognathic surgery becomes a primary consideration. This surgical procedure involves repositioning the jawbones to achieve proper alignment and bite closure. The process typically begins with a preparatory orthodontic phase using braces, which aligns the teeth within each jaw for their new positions after surgery. This pre-surgical orthodontics can last for several months to over a year.
The surgical procedure, commonly performed under general anesthesia, involves making precise cuts (osteotomies) in the jawbones. For an open bite, surgeons may reposition the upper jaw (maxilla) through a Le Fort I osteotomy, which allows for superior repositioning or impaction of the posterior maxilla. This movement can cause the mandible to autorotate forward, helping to close the open bite.
In some cases, procedures on the lower jaw (mandible), such as bilateral sagittal split osteotomies (BSSO), may also be performed to rotate the mandible or achieve optimal alignment. These bone segments are then secured in their new positions using small plates and screws. Incisions are generally made inside the mouth to avoid visible facial scars.
Post-Surgery Outcomes and Decision Factors
Successful open bite surgery can lead to several positive outcomes, improving oral function and facial aesthetics. Patients often experience enhanced chewing ability, as teeth are properly aligned to meet and break down food efficiently. Speech clarity can also improve, especially for sounds that require proper tooth contact. Beyond functional benefits, surgery can result in a more harmonious facial appearance and reduced strain on other teeth, preventing uneven wear and potential long-term dental issues.
The recovery process following orthognathic surgery involves a period of healing and management. After surgery, patients typically experience swelling and discomfort, managed with medication. A liquid or soft diet is usually required for several weeks, and jaw movements may be restricted or immobilized to facilitate bone healing. The full recovery timeline can vary but often involves a few weeks of initial recovery before gradually returning to normal activities, followed by a post-surgical orthodontic phase to refine the bite.
The decision to undergo open bite surgery is influenced by several factors. The commitment required for recovery, including dietary restrictions and potential time away from work or school, is a practical consideration. Financial investment, which includes surgical fees, hospital costs, and ongoing orthodontic treatment, also plays a role. Patients should weigh individual functional and aesthetic goals against the realities of the surgical process, potential discomfort, and recovery period. A thorough consultation with an oral and maxillofacial surgeon and an orthodontist is essential to evaluate the specific condition, discuss expected outcomes, and understand the treatment and its implications.