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Face and Jaw Surgery

Recurring open bite

01/30/2007

Question:

I am an 18 year old student with a quickly progressing open bite (I believe it is classified as an anterior open bite.) I have been treated with orthodontics twice, once at age 13 and again at 17. Both times my open bite has returned, resulting in a larger opening on the right side of my mouth than on the left. This is creating minor lateral lisping, which is certainly a daily inconvenience and source of embarrassment. I was diagnosed with a "tongue thrust" habit by a TMJ specialist, which I have since corrected with speech therapy, but the bite continues to worsen. I am aware that surgery can correct an adult open bite, and it is a path I am most certainly willing to take, but both my TMJ doctor and my orthodontist have told me that we can take no further action until the source of the open bite is determined. They have also told me, however, that they can do nothing more to determine the cause. Obviously, this is extremely frustrating to me, and I am being forced to seek help elsewhere. I was curious as to whether or not you had ever encountered any other cases similar to mine, and if so, what course of action was taken?

Answer:

This is not an uncommon situation when someone develops an anterior open bite or apertognathia.  If the cause of the discrepancy is due to a skeletal growth disturbance, it really doesn't matter how much orthodontic forces you apply to the teeth, they will eventually tend to return to their original position, because the orthodontic movement is making the dentoalveolar (teeth and bone) segment unstable.  This process or phenomenon is referred to as relapse, and to prevent it from happening again, corrective jaw surgery is necessary. 

A word of caution: some anterior open bite develop due to resorption of the condylar heads (the top bits of the jaw bone that conform the temporomandibular joint).  If this is the case, management is quite different. 

My recommendation is for you to set up a consultation appointment with a local oral & maxillofacial surgeon who performs orthognathic surgery.

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Response by:

Guillermo  E Chacon, DDS Guillermo E Chacon, DDS
Formerly:
Associate Professor of Dentistry
College of Dentistry
The Ohio State University