Non-Extraction Invisalign Orthodontic Retreatment for Unilateral Open Bite, Scissor Bite, and Protrusion

Hello,

This is Apgujeong Orthodontic Clinic.

Today, we will introduce a retreatment case of open bite in a patient in their 30s.

The treatment method was Invisalign.

24.06~25.11

This patient in their 30s had undergone orthodontic treatment 20 years ago, but the condition relapsed, so they came in for retreatment.

24.06

The gums around the two lower front teeth have receded noticeably.

There is an open bite on only one side relative to the midline. This could be an open bite caused by a one-sided tongue-thrusting habit, or it could be due to malocclusion caused by deformation of the retainer.

A scissor bite is also visible, where the upper and lower teeth bite in a crossed pattern at the premolars.

The molar occlusion is also fairly good.

The blue arrow indicates the tooth causing the scissor bite.

24.06

In the facial view, when the lips are relaxed, slight lip incompetence is visible.

24.06

The cause is the protrusion of the upper front teeth.

The treatment plan was to avoid extractions, move the molars backward using the space from the wisdom teeth, and improve the protrusion, open bite, scissor bite, and other issues.

For the lower front teeth, whose roots had receded noticeably, we planned to move the roots into the alveolar bone to help prevent further gum recession.

Invisalign was selected for the treatment.

25.02

We also placed an orthodontic mini-screw to help move the molars backward.

At present, elastic bands that are mainly removed and reinserted are prescribed, but if the patient is highly compliant with wearing the appliance, backward movement can also be achieved with elastics attached directly to the teeth.

25.02

The molars are moving sequentially into the wisdom tooth space, creating room.

The premolars, which had tipped inward, are being uprighted after sufficient space has been created.

In June 2025, after wearing all 50 appliances from the first set for one year, this is the result.

25.06

The midline is still deviated, but the open bite has been resolved.

The occlusal relationship is Class I, but the molar occlusion is slightly open.

The alignment is good.

To correct the remaining issues, we started remaking the additional set of appliances.

After wearing all 20 appliances from May to November 2025, the treatment was completed.

25.11

After the additional appliances, the midline is now well aligned.

The molar occlusion shows a tight Class I relationship.

Now let’s look at the before-and-after comparison.

The total treatment period was 1 year and 5 months, and one remaking was performed.

This is the result including the retainer.

24.06~25.11

The gums around the lower front teeth have filled in slightly compared to the beginning. This is because the treatment plan was designed so that the front tooth roots would move stably into the alveolar bone, and in this way, even adults in their 30s sometimes show recovery.

24.06~25.11

24.06~25.11

Now let’s compare the facial appearance.

24.06~25.11

As the horizontal distance between the upper and lower teeth decreased, lip incompetence was resolved.

24.06~25.11

24.06~25.11

A cleaner smile after resolving the upper front tooth protrusion

25.11

During the 1 year and 5 month retreatment period, there was no root resorption.

The root parallelism looks good.

24.06~25.11

As the upper tooth protrusion decreased, the spacing between the lower teeth also decreased, and the lips were able to close naturally.

Retreatment needs to be more delicate and more careful.

I hope this was helpful for those considering retreatment.