What Is an Open Bite?
An open bite means the front teeth (or sometimes the back teeth) do not make contact when you close your jaw. The most common type is an anterior open bite, where the top and bottom front teeth do not overlap vertically, leaving a gap even when the back teeth are fully together.
Open bites are caused by a combination of factors. Some are dental, meaning the teeth themselves have erupted into poor positions. Others are skeletal, meaning the upper jaw, lower jaw, or both grew in a pattern that prevents the front teeth from meeting. Habits like prolonged thumb sucking, tongue thrusting (pushing the tongue against or between the front teeth), and mouth breathing can also cause or worsen an open bite.
Dental vs. Skeletal Open Bite
The distinction between a dental open bite and a skeletal open bite matters because it determines which treatments will work. A dental open bite results from tooth positions that can be corrected by moving the teeth. The jaw bones are in a normal relationship, but the teeth have not erupted properly or have been pushed out of alignment by habits.
A skeletal open bite involves a jaw growth discrepancy. The most common pattern is excessive vertical growth of the back of the upper jaw, which rotates the lower jaw downward and backward, opening the bite in front. This type of open bite often requires orthognathic (jaw) surgery to fully correct because moving teeth alone cannot compensate for the skeletal imbalance.
How Invisalign Corrects an Open Bite
Invisalign for open bite correction uses several mechanical strategies to close the vertical gap between the front teeth. The approach differs from standard Invisalign treatment for crowding or spacing because vertical tooth movement is one of the more challenging movements for clear aligners.
Posterior Tooth Intrusion
One of the primary strategies is intruding (pushing down) the back teeth. When the back teeth are slightly shorter, the lower jaw can rotate closed, bringing the front teeth into contact. Invisalign achieves this through precisely sequenced aligner trays that apply controlled force to the posterior teeth.
This approach works best when the amount of intrusion needed is modest (1-2 millimeters). Larger amounts of posterior intrusion are difficult to achieve predictably with aligners alone and may require temporary anchorage devices (TADs), which are small screws placed in the jawbone to provide additional force.
Elastics and SmartForce Attachments
Invisalign uses small tooth-colored bumps bonded to the teeth called SmartForce attachments. These give the aligners better grip for complex movements. For open bite cases, attachments are typically placed on several teeth to help control vertical movement.
Rubber band elastics may also be prescribed. These connect from buttons or hooks on the upper aligners to the lower aligners and provide vertical forces that the aligners alone cannot generate. Wearing elastics consistently is critical for open bite correction. Skipping elastic wear is one of the most common reasons Invisalign open bite treatment falls short of its goals.
Limitations of Invisalign for Open Bite
Invisalign has improved significantly for open bite treatment, but it still has limitations compared to traditional braces and surgical options.
When Clear Aligners May Not Be Enough
- Severe anterior open bites (gaps larger than 4-5 mm): The amount of tooth movement required often exceeds what aligners can reliably produce.
- Skeletal open bites: When the jaw itself is the problem, moving teeth alone provides limited improvement and may lead to unstable results.
- Cases requiring significant posterior intrusion: Aligners have limited ability to intrude back teeth more than 1-2 mm without additional anchorage.
- Active tongue thrust habit: If the tongue continues to push against the front teeth, it can prevent the bite from closing during treatment and cause relapse afterward.
- Non-compliant patients: Invisalign requires 20-22 hours of daily wear. Open bite cases are particularly unforgiving of poor compliance because the vertical forces need to be applied continuously.
Braces vs. Invisalign for Open Bite
Traditional braces offer more predictable vertical control than clear aligners. Braces are bonded directly to the teeth, so they apply force 24 hours a day without depending on patient compliance. They can generate stronger intrusive forces, especially when combined with TADs, and they allow the orthodontist to make real-time adjustments.
For moderate to severe open bites, many orthodontists consider braces the more predictable choice. Some orthodontists use a combination approach: braces for the initial phase of heavy tooth movement, then Invisalign for refinement and final alignment.
When Surgery Is the Best Option
Orthognathic surgery combined with braces (or sometimes Invisalign for pre-surgical alignment) is recommended for skeletal open bites that exceed what tooth movement alone can correct. Surgery repositions the jaw bones, then orthodontic treatment fine-tunes the bite.
Surgical correction typically produces the most stable long-term results for severe skeletal open bites. Without surgery, these cases have high relapse rates regardless of whether braces or aligners are used for the orthodontic component.
Success Rates and Treatment Timeline
Open bite correction with Invisalign for open bite cases typically takes 12 to 24 months, though timelines vary based on severity. Mild open bites (1-2 mm gaps) may close in 12-15 months. Moderate cases (3-4 mm) often require 18-24 months and may need refinement trays.
Published research on Invisalign's effectiveness for open bite shows mixed but improving results. Studies suggest that mild to moderate dental open bites can be closed successfully with Invisalign in many cases, though the rate of complete bite closure is lower than with braces. Relapse (the bite reopening after treatment) remains a concern for all open bite treatment methods.
Open bite has the highest relapse rate of any common malocclusion. Studies report relapse rates ranging from 20% to 40% depending on the cause, severity, and whether contributing habits were addressed. Retention (wearing retainers) and habit correction are essential for maintaining results.
Habit Correction During Open Bite Treatment
Treating an open bite without addressing the habits that caused or maintain it is likely to result in relapse. The most common contributing habit is tongue thrusting, where the tongue pushes forward against or between the front teeth during swallowing or at rest.
Tongue Thrust and Myofunctional Therapy
Myofunctional therapy (orofacial muscle retraining) teaches patients to swallow and position the tongue correctly. A myofunctional therapist or speech-language pathologist works with the patient on exercises to retrain the tongue's resting position and swallowing pattern. This therapy is often recommended alongside orthodontic treatment for open bite.
For children, addressing mouth breathing and thumb sucking early can prevent open bites from developing or worsening. In adults, tongue thrust retraining during and after orthodontic treatment significantly reduces the risk of relapse.
Cost of Invisalign for Open Bite
Invisalign treatment for open bite typically costs between $4,000 and $8,000, though prices vary by location, provider, and case complexity. Open bite cases often fall into the more expensive end of the range because they require longer treatment, more aligner trays, and additional components like elastics and attachments.
Dental insurance that covers orthodontic treatment may cover a portion, typically up to a lifetime maximum of $1,500 to $3,000. Many orthodontists offer payment plans. If your case requires braces instead of or in addition to Invisalign, the cost is generally comparable. Orthognathic surgery, if needed, is a separate surgical cost that may be partially covered by medical (not dental) insurance.
Why an Orthodontist Should Treat Open Bite
Open bite is one of the most complex orthodontic conditions to treat. General dentists and direct-to-consumer aligner companies are not equipped to manage the vertical bite mechanics, elastic protocols, and habit assessment that open bite correction requires.
An orthodontist completes 2-3 years of full-time residency training beyond dental school, focused on tooth movement, jaw growth, and bite correction. For open bite cases, this training matters more than for simple crowding or spacing. A proper evaluation includes analyzing whether your open bite is dental or skeletal, assessing tongue posture and swallowing patterns, and determining the most predictable treatment approach. Learn more about orthodontic training and treatment on our [orthodontics specialty page](/specialties/orthodontics).
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