Open Bite Treatment in the UK: Braces, TADs, and Surgery

What is an anterior open bite?

An anterior open bite describes a situation where the upper and lower front teeth do not make contact when the back teeth are closed together. The gap can be a few millimetres or several centimetres in severe skeletal cases. Unlike an overbite — where the upper teeth cover the lower — an open bite leaves a visible space at the front. It affects the ability to bite into food, can cause a lisp or air escape during speech, and often leads patients to use their tongue to seal the gap, which in turn perpetuates the problem. Open bites that affect only the back teeth (posterior open bite) are less common and usually related to tongue posture or mouth breathing.

Dental vs skeletal causes

Open bites fall into two broad categories. Dental open bites are caused by habits or soft-tissue pressures that have pushed teeth out of position without significantly altering the underlying bone. The most common causes are prolonged thumb or finger sucking beyond age 4 to 5, dummy use past the recommended age, tongue thrusting — where the tongue presses forward against the front teeth during swallowing — and mouth breathing, which alters resting tongue posture. These cases often respond well to orthodontics alone once the habit is addressed. Skeletal open bites arise from a vertical jaw growth pattern where the lower jaw grows in a downward and backward direction, causing the back teeth to come together while the front teeth remain apart. Skeletal open bites in adults typically require surgical correction for the best long-term result.

Orthodontic treatment — braces and vertical box elastics

For dental open bites, fixed braces are the primary treatment. Upper and lower brackets are bonded across the full arch and vertical box elastics — small rubber bands worn in a rectangular pattern between upper and lower front teeth — apply a gentle intrusive and extrusive force to help the teeth close together. Treatment duration is typically 18 to 24 months. Compliance with elastics is critical; wearing them for fewer than 20 hours per day significantly slows progress. Clear aligners can treat mild to moderate dental open bites but require precision attachments and, in more complex cases, may be less predictable than fixed braces. Your orthodontist will advise which approach is more appropriate for your specific open bite depth and cause.

Temporary anchorage devices (TADs) to intrude posterior teeth

Skeletal open bites — particularly in adults — often have excessive eruption of the posterior (back) teeth that tips the lower jaw downward. Temporary anchorage devices, or TADs, are small titanium miniscrews placed directly into the jawbone under local anaesthetic. They act as stable anchor points from which the orthodontist can apply intrusive forces to push the back teeth upward into the bone. As the molars are intruded, the jaws rotate closed and the front teeth begin to meet. TADs have significantly expanded the range of open bites that can be corrected without surgery. The miniscrews are typically 1.5 to 2 mm in diameter and are removed painlessly once treatment is complete. This approach requires careful case selection and regular monitoring.

Myofunctional therapy for habit correction

When tongue thrust, thumb sucking, or abnormal swallowing patterns are contributing to an open bite, orthodontic treatment alone may not be sufficient — the habits will continue to push teeth apart after the braces come off. Myofunctional therapy is a structured programme of exercises to retrain the muscles of the tongue, lips, and face to adopt correct resting posture and swallowing patterns. A trained myofunctional therapist works alongside the orthodontist, typically over 3 to 6 months. Correcting the underlying muscle function before or during orthodontic treatment dramatically reduces the risk of relapse. In children, breaking a thumb-sucking habit early — ideally before age 7 — can allow some self-correction as growth continues.

Orthognathic surgery for skeletal open bite in adults

Adults with a severe skeletal open bite who have finished growing are unlikely to achieve a stable, functional result with orthodontics alone. Orthognathic (jaw) surgery combined with orthodontic treatment is the gold standard for these cases. The surgical procedure most commonly used is a Le Fort I maxillary osteotomy — repositioning the upper jaw upward and sometimes rotating it — often combined with a bilateral sagittal split osteotomy of the lower jaw. Pre-surgical orthodontic preparation decompensates the teeth so the jaws can be moved accurately. Surgery is carried out under general anaesthetic, usually with a one to three night hospital stay. Full recovery takes 6 to 12 weeks; the total treatment span including orthodontics is typically 2 to 3 years. Combined cases are eligible for NHS funding at consultant-level in appropriate cases through the OMFS pathway.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.