What Is an Open Bite?
An open bite occurs when the front teeth (or sometimes the side teeth) do not overlap or contact each other when you close your mouth. The back teeth may come together normally, but there is a visible gap between the upper and lower front teeth. This gap can make it difficult to bite into food, affect speech, and cause uneven wear on the teeth that do make contact.
Open bites are classified into two categories. A dental open bite is caused by the position of the teeth themselves and can usually be corrected with braces alone. A skeletal open bite is caused by abnormal growth patterns of the upper jaw, lower jaw, or both, and often requires a combination of braces and jaw surgery for a lasting correction.
Common Causes of Open Bite
- Thumb sucking or pacifier use beyond age 3 to 4, which pushes the front teeth outward and prevents them from meeting.
- Tongue thrusting, a habit where the tongue pushes forward against or between the front teeth during swallowing or at rest.
- Skeletal growth patterns where the lower jaw grows downward and backward more than normal (sometimes called long face syndrome).
- Genetics. Some patients inherit jaw proportions that predispose them to an open bite.
- Temporomandibular joint (TMJ) conditions that alter how the jaw closes.
How Braces Correct an Open Bite
Braces close an open bite by moving teeth vertically, not just horizontally. The goal is to either push the back teeth up into the jawbone (intrusion) or pull the front teeth down (extrusion) so the upper and lower teeth meet properly when you close your mouth. Most treatment plans use a combination of both approaches.
Elastics (Rubber Bands)
Elastics are small rubber bands that connect upper and lower braces to apply force in specific directions. For open bite correction, vertical elastics are placed between the upper and lower front teeth to pull them toward each other. The patient wears these elastics 20 to 22 hours per day, removing them only to eat and brush.
Consistent elastic wear is critical. Skipping elastics, even for a few hours a day, slows progress significantly. Orthodontists consider patient compliance with elastics one of the biggest factors in open bite treatment success.
Temporary Anchorage Devices (TADs)
TADs are small titanium screws (about the size of an earring post) temporarily placed into the jawbone through the gum tissue. They act as fixed anchor points that allow the orthodontist to apply forces that would be difficult or impossible with braces and elastics alone.
For open bite treatment, TADs are commonly used to intrude (push up) the back teeth. By moving the back teeth upward, the lower jaw can rotate forward slightly, which helps close the front gap. TAD placement is a minor in-office procedure done under local anesthesia and typically causes minimal discomfort. The screws are removed once treatment is complete.
Extrusion of Front Teeth
In some cases, the orthodontist will use archwire mechanics or elastics to extrude (pull down) the front teeth so they close the gap. This approach works well when the back teeth are already in a good position and the front teeth simply need to be brought together.
Extrusion of front teeth tends to be less stable long-term compared to intrusion of back teeth, which is why many orthodontists prefer TAD-assisted intrusion when possible. Your orthodontist will determine which mechanics or combination of mechanics will produce the most stable result for your specific bite.
Can Invisalign Fix an Open Bite?
Invisalign and other clear aligner systems can correct mild open bites, particularly dental open bites in adults where the gap is small and the underlying jaw relationship is normal. Aligners can extrude front teeth and, to a limited degree, intrude back teeth.
However, moderate to severe open bites typically require mechanics that aligners cannot reliably deliver. Vertical tooth movement is one of the most challenging movements for clear aligners. Braces with elastics and TADs provide more predictable control for significant open bite correction. Some orthodontists use a hybrid approach: braces for the main correction phase, then clear aligners for finishing and refinement.
If you are interested in Invisalign for an open bite, an orthodontist can evaluate whether your specific case falls within the range that aligners can predictably treat.
When Is Jaw Surgery Needed for an Open Bite?
Skeletal open bites in adults, where the jaw itself has grown in a way that prevents the teeth from meeting, often cannot be fully corrected with braces alone. In these cases, orthognathic (jaw) surgery may be recommended in combination with orthodontic treatment.
The orthodontist first aligns the teeth with braces (typically 12 to 18 months of pre-surgical orthodontics). An oral and maxillofacial surgeon then repositions the upper jaw, lower jaw, or both to correct the skeletal discrepancy. After surgery, braces remain in place for several more months to finalize the bite.
Surgery is typically recommended when the open bite is large (more than a few millimeters), when the cause is clearly skeletal rather than dental, or when previous orthodontic treatment without surgery has relapsed. The combined cost of orthodontics and surgery can exceed $20,000, though medical and dental insurance may cover portions of the surgical component when it is deemed medically necessary. Costs vary by location and provider.
Why Stopping Habits Is Essential
If a habit like thumb sucking or tongue thrusting caused the open bite, that habit must stop before or during treatment for the correction to be stable. Braces can move the teeth into the correct position, but if the tongue continues to push against the front teeth after treatment, the open bite will likely return.
For children, a habit appliance (such as a tongue crib or rake) can be built into braces to help break the habit. For older patients, myofunctional therapy, a series of exercises that retrain the tongue to rest in the correct position and swallow properly, is often recommended. An orthodontist can refer you to a myofunctional therapist if this applies to your case.
Relapse rates for open bite correction are higher than for most other orthodontic problems. Habit control and long-term retainer wear are the two most important factors in maintaining your results.
Treatment Timeline and Cost
Open bite cases are among the more complex orthodontic treatments. Expect a longer treatment time compared to straightforward crowding or spacing cases.
How Long Does Treatment Take?
Braces for open bite correction typically take 18 to 30 months. Mild dental open bites may be corrected in as few as 12 to 18 months. Severe or skeletal cases that include surgery may take 24 to 36 months total, including pre-surgical and post-surgical orthodontic phases.
Consistent elastic wear and habit cessation can significantly affect the timeline. Patients who are diligent with their elastics and address underlying habits tend to finish treatment faster.
How Much Do Braces for Open Bite Cost?
The cost of braces for open bite correction typically ranges from $5,000 to $8,000 for non-surgical cases. If TADs are needed, they may add $300 to $600 per screw. Surgical cases that include orthognathic surgery can cost $20,000 to $40,000 total for orthodontics and surgery combined. Costs vary by location, provider, and case complexity.
Most orthodontic practices offer payment plans. Dental insurance typically covers a portion of orthodontic treatment (often up to a lifetime maximum of $1,500 to $2,500). Medical insurance may cover jaw surgery when it is deemed medically necessary.
When to See an Orthodontist
If you or your child has a visible gap between the upper and lower front teeth when the mouth is closed, an orthodontic evaluation is the first step. The American Association of Orthodontists recommends that children have their first orthodontic evaluation by age 7, which is early enough to detect open bite tendencies and intervene with habit appliances if needed.
For adults, it is never too late to address an open bite. An orthodontist can determine whether braces alone, braces with TADs, or braces combined with surgery will produce the best result. Because open bite treatment is more complex than many other orthodontic corrections, seeing a specialist rather than relying solely on a general dentist's assessment is particularly important.
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