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Orthognathic classification - Open bite

Symptoms
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery
  • Speech problems
  • Inability to close the mouth naturally
  • Long face often
  • Often dry red swollen gums
  • Chewing problems
  • Joint problems.

In open bites the upper front teeth are forced outwards-upwards. The front teeth do not touch each other when the mouth is closed. When the bite is closed, only the most posterior teeth meet, whilst the rest are open. Those people often have a long face, but not always. Open bites often affect speech patterns. There is a difficult lip seal. Furthermore, those people often complain of dry swollen red gums. They sleep with their mouths open (dry mouth and gingivitis). The surgical treatment is a Le Fort I osteotomy with posterior intrusion or anterior extrusion.
Postoperative instructions & frequently asked questions

People say that open bites are caused by thumb sucking. Is that correct?

Many people think that open bites are caused by thumb sucking and/or pacifiers. Those habits are universally present. The truth is that those open bites close as soon as the habit stops. That is why well over 90% of open bites in children resolve themselves with no external help at all.

Is an open bite caused by tongue-thrust?

A skeletal open bite is a developmental disorder and is hardly ever provoked by bad habits. Tongue thrust (protruding tongue while speaking or swallowing) is present in most open bites. However, the tong-trust is not the cause of it. The tongue simply takes the extra offered space.

Why am I unable to close my mouth naturally and properly with my open bite?

A natural mouth closure is difficult in open bites. For a normal lip closure we use the upper lip muscles. In open bites excessive help from the lower lip muscles is needed in adjunct. This creates a restless and dimpled chin.

Can an open bite be corrected simply by orthodontics without surgery?

Correcting an open bite by orthodontics without surgery tends not to give a permanent result and leads almost always to relapse. As soon as the correcting forces offered by the braces with elastics are removed, the teeth tend to go back to their original open bite position, almost like a spring. The golden standard for open bites is orthognathic surgery: Le Fort I.

What is an important point to ask the orthodontist in open bites?

For the surgeon it is important that the orthodontist aligns the upper teeth in one plane with the front teeth in extra vestibular tipping. Otherwise, the result is not as good as it could be (front teeth being too straight).

My orthodontist proposes to align the upper jaw in three levels. Is this okay?

Some surgeons certainly align the upper jaw in three pieces. This means the orthodontist must align in three levels, and the surgeon needs to cut between the roots of the teeth between the three pieces… It is a choice and a method, but Dr Defrancq prefers one piece surgery.