The open bite she had learned to hide

Before treatment — in their own words

She described the way she ate with a matter-of-factness that made clear how long she had been adapting. Sandwiches required tilting. Apples were out. Anything that needed front-tooth incision — biting into food rather than chewing it — either required technique or was simply avoided. She had not connected this to a dental problem. She thought her teeth were just "the way they were." It was a routine dental examination that identified the open bite and referred her for orthodontic assessment.

She was in her late twenties. The open bite had been there since adolescence.

The clinical picture

The anterior open bite measured 4mm at its widest point. The upper and lower front teeth did not touch or overlap at any position — a complete absence of incisal contact. The posterior teeth had been carrying all occlusal load for years. A tongue-thrust swallowing pattern was present — the tongue pushed forward against the open bite space on swallow and at rest, a behaviour that had both contributed to and was now being maintained by the open space. The Class I dental relationship was otherwise normal. No skeletal contribution to the open bite was identified on analysis. Surgical treatment was not required.

The plan

Invisalign Comprehensive treatment was planned using a vertical intrusion strategy: molar intrusion with optimised posterior attachments would allow the front of the bite to close as the posterior teeth were gently depressed. This approach closes open bites by rotating the occlusal plane rather than extruding the anterior teeth, which is more stable long-term. A myofunctional therapy referral was arranged concurrently to address the tongue-thrust pattern — without behavioural change, open bite relapse risk is significantly higher. The patient completed the tongue therapy exercises diligently throughout treatment.

The outcome

At the end of twenty months, the open bite was fully closed. The upper and lower incisors were in contact with 1mm of overbite. The patient reported being able to bite into food normally for the first time in her adult life. She described the experience of eating an apple as something she was not sure she had done since childhood.

A Vivera retainer was fitted with instructions for consistent long-term wear, with the myofunctional therapist continuing reviews for a further six months to consolidate the tongue posture change and reduce relapse risk.