This case demonstrates the use of Invisalign clear aligner therapy combined with interproximal reduction to address anterior open bite and dental crowding in an adult patient. Despite skeletal and dental contributions to the open bite, the patient opted for non-surgical treatment and achieved stable functional and aesthetic results maintained over a three-year follow-up period.

Patient Overview

The patient presented to the practice seeking treatment for dental crowding and an anterior open bite. The patient was interested in improving both the function and appearance of their smile.

Chief Complaint

The patient's primary concerns were crowding and an anterior open bite that affected both the appearance of their smile and functional occlusion.

Diagnostic Findings

Clinical examination revealed an anterior open bite with both dental and skeletal components contributing to the malocclusion. A tongue thrust habit was identified as a contributing factor. Additional findings included maxillary and mandibular arch spacing inadequacies that contributed to the overall crowding presentation.

Treatment Options Considered

Three treatment approaches were presented to the patient:

• Orthognathic surgery to address the skeletal component of the open bite
• Extraction-based orthodontic treatment
• Non-extraction treatment utilizing interproximal reduction with Invisalign clear aligners

The patient was informed that without surgical intervention, the open bite would not be fully corrected due to the skeletal component of the malocclusion.

Selected Treatment Plan

After reviewing all three treatment options, the patient elected to proceed with the non-surgical approach using Invisalign treatment combined with interproximal reduction. The patient understood the limitations of non-surgical treatment regarding complete open bite closure but prioritized the less invasive approach.

Procedures Performed

Initial records were obtained, and the patient was scanned for fabrication of Invisalign aligners. At the first appointment, the Invisalign aligners were delivered with detailed instructions for wear and care, and initial interproximal reduction was performed to create space for tooth movement.

At the second appointment, interproximal reduction was performed on different areas of the dentition to facilitate continued alignment. The third appointment involved additional interproximal reduction in other areas as needed to support the progression of tooth movement.

At the fourth appointment, the patient was rescanned to generate additional aligners to refine the alignment and continue open bite correction. The following appointment consisted of delivery of the new refinement aligners. After two additional monitoring appointments to assess tracking and progress with the second set of aligners, the patient reached the treatment endpoint and was debanded.

Materials and Technologies Used

Invisalign clear aligner system was utilized throughout the treatment. Interproximal reduction was performed at multiple stages to create the necessary space for alignment without extractions.

Clinical Challenges

The primary challenge in this case was the presence of both dental and skeletal components contributing to the anterior open bite. The patient was counseled that non-surgical treatment would not fully correct the skeletal portion of the open bite. Additionally, the patient presented with a tongue thrust habit, which can compromise stability and contribute to relapse of the open bite.

To address the myofunctional component, the patient was referred to a myofunctional speech therapist to work on the tongue thrust pattern. Despite these challenges, the patient demonstrated strong compliance throughout treatment, with the teeth tracking well with the aligner progression.

Final Outcome

The patient was seen for follow-up appointments at four months post-treatment, then again eight months later, and subsequently at three years following treatment completion. At all follow-up visits, the patient's occlusion and smile remained stable. The patient achieved what was described as good ideal occlusion and a great smile with maintained stability over the three-year observation period.

Clinical Lesson for Other Dentists

This case illustrates that adult patients with combined skeletal and dental open bite presentations can achieve meaningful functional and aesthetic improvements with non-surgical Invisalign treatment, provided they are counseled appropriately about the limitations of non-surgical approaches. Strategic interproximal reduction performed in stages throughout treatment facilitated non-extraction space management.

Addressing myofunctional habits such as tongue thrust through referral to a myofunctional therapist is an important adjunct to orthodontic treatment when such habits are identified. Patient compliance is critical to successful outcomes with clear aligner therapy, and this case demonstrated that when patients are well-informed and committed, stable long-term results can be achieved even in cases with skeletal involvement.

Long-term retention protocols are essential, particularly in open bite cases where relapse potential exists. Nighttime retainer wear for life was prescribed and reinforced at all follow-up visits to maintain treatment results.

Treatment Results

• Resolution of dental crowding through staged interproximal reduction and Invisalign aligner therapy
• Improvement of anterior open bite with both dental and skeletal components using non-surgical approach
• Achievement of functional occlusion with improved bite relationship
• Enhanced smile aesthetics reported by patient
• Stable occlusion and smile maintained at four months, twelve months, and three years post-treatment
• Successful patient compliance with nighttime retainer wear protocol
• Referral to myofunctional therapist for tongue thrust management as adjunct to orthodontic treatment

Related Dental Services

No related services are available at this time.