When the upper and lower front teeth do not meet, biting through food can be difficult, and the gap may make a person self-conscious about smiling. Open bite treatment aims to do more than straighten the teeth: it restores a bite that allows the front teeth to function and helps create a natural smile.
01 Does an Adult Open Bite Always Require Surgery?
“I cannot bite through noodles with my front teeth.” This is something we often hear from patients with an open bite. Their back teeth meet, but a vertical gap remains between their front teeth.
An open bite can be related not only to the position and inclination of the teeth, but also to the relationship between the upper and lower jawbones. When a substantial skeletal problem makes it difficult to improve the bite through tooth movement alone, surgery may also be considered.
However, not every open bite requires surgery. In some cases, non-surgical orthodontic treatment can improve the bite by adjusting the height of the front and back teeth and the inclination of the teeth.
This non-surgical case involved a woman in her thirties whose front teeth did not meet. Invisalign was used to improve both the front bite and the way the molars met on the left and right sides.
02 Before Treatment
A detailed examination confirmed an anterior open bite involving the front teeth between the left and right canines. The upper front teeth were 2.5 mm ahead of the lower front teeth, but a vertical gap of 1.5 mm remained between them, making it difficult to bite through food.
Although the teeth were relatively well aligned, the molar relationships differed on the two sides. The lower arch was relatively forward on the left, showing a Class III tendency, and relatively backward on the right, showing a Class II tendency. The upper and lower dental midlines also did not coincide. Wisdom teeth were still present and were considered when planning treatment.
Treatment plan: adjusting molar height to restore the front bite
Invisalign Comprehensive was used for treatment. We first extracted the upper right wisdom tooth and both lower wisdom teeth to create space behind the molars.
An open bite can be improved not only by moving the front teeth toward contact, but also by adjusting the height of the molars. In this patient, molar intrusion—moving the molars toward the supporting jawbone—helped create more favorable conditions for the front teeth to meet. The height and inclination of the front teeth were also adjusted. The focus was on creating a natural bite without excessive movement of the front teeth alone.
A study of adult open bite treatment with Invisalign also observed intrusion of the upper and lower molars. Together with extrusion of the front teeth, this contributed to open bite correction.[1]
To coordinate the molar relationships, Class III elastics were used on the left and Class II elastics on the right. Applying forces in the directions needed on each side helped adjust both the molar contacts and the dental midlines. Treatment was completed without miniscrews.
03 Three Series of Aligners over About Two Years
Treatment ran from July 7, 2023 to July 15, 2025, approximately two years. Tooth movement was monitored, and two additional series of aligners were made to refine the result step by step, from the front bite to the molar contacts.
- First Invisalign series, 37 stages: improving the open bite
- Second Invisalign series, 17 stages: reducing black triangles between the front teeth
- Third Invisalign series, 9 stages: adjusting the molar contacts
The first series brought the vertically separated front teeth into a natural overlap. We then reduced the small triangular gaps near the gums between the front teeth, known as black triangles. After minimal interproximal reduction to reshape the sides of the teeth as needed, the teeth were brought together to make these gaps less noticeable.
The final stage refined the bite so that the upper and lower molars contacted evenly. Throughout this process, the planned movements were compared with the actual tooth response, and the remaining details were carefully adjusted.
04 Treatment Results: Biting through Food with the Front Teeth
Before treatment, a vertical gap of 1.5 mm separated the front teeth. After treatment, the upper front teeth overlapped the lower front teeth by approximately 2.5 mm. The horizontal distance was also adjusted from 2.5 mm to 2 mm, establishing a natural front bite.
The ability to bite through food with the front teeth was restored. The molar relationships on both sides and the upper and lower dental midlines also improved. The black triangles between the front teeth became smaller, giving the smile a neater appearance.
05 Retention after Treatment
After open bite treatment, it is important to keep checking that contact between the front teeth is maintained. Habits such as tongue thrusting, or changes such as re-eruption of the molars, can affect the bite.
At the end of treatment, fixed retainers were bonded to the inner surfaces of the upper and lower teeth from canine to canine, and removable retainers were prescribed as well. The teeth and bite have since been monitored at regular follow-up visits. To date, the front bite and molar contacts have remained satisfactory.
06 Invisalign Can Be a Non-Surgical Option for Open Bite
An open bite does not necessarily require surgery. The position of the teeth, the relationship between the jawbones, and habits involving the tongue need to be assessed carefully to determine how much improvement is possible through tooth movement.
In this case, Invisalign was used to intrude the molars and adjust the front teeth, improving front-tooth function and the overall bite without surgery. The improved bite has also been maintained after treatment.
The same approach cannot be applied to every open bite. However, when a precise diagnosis establishes the scope for improvement, non-surgical orthodontic treatment with Invisalign can be a treatment option worth considering.
Photographs taken: June 28, 2023–July 15, 2025
Note: Treatment outcomes in this case may differ depending on a person’s skeletal pattern, dental and periodontal condition, and adherence to wearing aligners and elastics. The treatment approach must be determined through a detailed examination and diagnosis by an orthodontic specialist.
References
1. Harris K, Ojima K, Dan C, et al. Evaluation of open bite closure using clear aligners: a retrospective study. Prog Orthod. 2020;21:23. doi:10.1186/s40510-020-00325-5. View article
This study analyzed 45 adults with open bite and observed mean intrusion of 0.47 mm in the upper molars and 0.39 mm in the lower molars. Molar intrusion and incisor extrusion together contributed to open bite correction.
