Metal Mouth Message Board

Hello all.

I have an anterior open bite that started to open when I was around 19 or 20. I had braces when I was in middle school and it fixed all of my bite problems for a few years. My bite opening back up seems to have also coincided with me quitting to wear my upper retainer at night time. The bite issue didn't bother me very much until a dentist a few years ago recommended I have an ortho look at it. I briefly looked into treatments including jaw surgery, but didn't take any action at that time. I have issues biting through certain foods with my front teeth. This has caused some wear on my back teeth.

I am now 28 and again a dentist told me to look into ortho treatment or surgery to fix my bite. I met with an orthodontist yesterday and asked him about jaw surgery. He was very against me getting surgery, and said the bite could be fixed by orthodontics alone. I am happy to hear this as I do not want surgery if I really don't need it, but I am still a bit concerned. Through my online research my appearance matches that of other people who have had jaw surgery. I have lip incompetence and my chin will dimple when I force them close. The ortho said I had a slightly recessed chin, but that he thought my face was balanced, and he didn't think there was anything in my x-rays that indicated an issue with the ways my jaws had formed. He thinks that some of the cosmetic concerns can be helped greatly just through orthodontics. He said that if at the end of treatment I am not happy with my profile I could get a genioplasty.

I am wondering if anyone on these forums has had a similar issue (mainly the open bite) that has successfully been treated through braces alone. I would really like to avoid jaw surgery. I found a couple of older threads but am hoping for newer input.

Orthodontics alone = quite likely fine, provided you don't have a really gummy smile or certain other issues. Miniscrews, plates or some other devices are attached and used to intrude molars. Your orthodontist should have a collection of before and afters for similar patients, and be able to show you pictures of them with appliances installed.

google search:
closure of open bite using skeletal anchorage
closure of open bite using temporary anchorage devices (TADS)

Note that when upper molars are intruded the result is that the lower jaw will slide forward a little, so having a slightly recessed mandible with overjet can be a good thing.

My story is about the same, though I'm a few years older. My open bite is only 2-3mm right now because I've worn down the molars. Otherwise, it'd be closer to 5mm I hear. I saw an oral surgeon and he said we could try TADs but when I saw his orthodontist he didn't think it would be stable. I got a second opinion from another and got the same opinion. Another out of state said braces should be fine though. Do you have jaw pain yet? Mine only started 1-2 years ago and I'm about 6 years older than you.

kiligeorge wrote: I saw his orthodontist he didn't think it would be stable. I got a second opinion from another and got the same opinion.

The question is...are these guys just saying that because it's not a treatment they use? I'm being treated for a large open bite and the method being used on me has been done by some Japanese guys since the late 90s and by my own orthodontist for close to 10 years. While there isn't a great deal of literature on long-term stability, it's enough time for orthodontists who have used this treatment to form judgements based on anecdotal evidence.

They didn't elaborate. I know it's new and so they can't really say either way. I also know that intruding molars presents the greatest risk for root resorption so it may be a matter of risk vs reward. I have a little bump on my upper jaw and both my upper and lower jaws ramp up in the back, around the last molar and wisdom teeth and I hear those can be hard spots for orthos to reach. I also have severe sleep apnea so they may just be thinking that surgery kills a few birds with one stone.

The evidence I have seen, and been told, indicates that intruding molars results in root resorption but it's not clinically significant. So I doubt that is a factor. And there are risks associated with cutting out a piece of one's maxilla, too :/

If you need maxillary advancement then obviously it's not the treatment for you.

My ortho did not discuss TAD's with me, just braces and wearing rubberbands. I don't remember how big my open bite is but I don't think it's severe. My lower jaw isn't too short but it grew more downwards than out. My ortho said that if I had jaw surgery that when my lower jaw swung up (assuming I would have the BSSO where my upper jaw was moved up) that it would give me an underbite, and that my appearance would be negatively effected.

Anyways my ortho seemed very confident that my bite can be fixed with just braces. I've done more reading and watched Youtube videos and it seems you can have success this way. I'm getting them on tomorrow.... very nervous and not looking forward to all of the 'why did you get braces?' comments but also so excited to get this bite fixed!

Strange comment for BSSO. I would double check that with another ortho or an oral surgeon. My surgeon's concern was that TADs are new and there isn't much data on long term stability. Opinions have been mixed from people I've seen. Typically after braces you need a retainer for life to keep your teeth straight. The same principle doesn't work for intruding teeth though.

My uncle seemed skeptical about whether TADs won't work for me either. One ortho said I definitely didn't need surgery to fix my bite. Of course that wouldn't impact my sleep apnea.