Why Maintaining the Results of Open-Bite Orthodontic Treatment Is More Difficult

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What if my teeth separate again after orthodontic treatment?

This is the concern most frequently expressed

by people who have completed orthodontic treatment.

Hello!

This is Seoul Vardi Dental Clinic.

In particular, this concern is fairly well-founded

in the case of open bite.

Today, we will review

relapse after orthodontic treatment

along with the key causes.

| Chapter 1. What Is an Open Bite? |

It is a condition in which the upper and lower front teeth do not come together

and there is a gap between them.

In most cases, the molars touch

but only the front teeth remain separated.

This makes it difficult to bite through things with the front teeth.

Many people say they feel uncomfortable

when biting through noodles or dried seaweed.

Some people also visit because they are concerned

that the gap between their front teeth shows when they smile.

| Chapter 2. How Much Relapse Occurs? |

There is a meta-analysis that followed patients

for an average of two and a half years

after treating open bite by using skeletal anchorage

to intrude the molars.

The front-tooth bite relapsed by an average of 1.23 mm.

That is approximately 19% as a proportion.

The intruded molars also moved back down.

It was approximately 12% in the upper jaw

and approximately 27.2% in the lower jaw.

The authors summarized it as follows:

relapse of approximately 10% to 30% occurs,

at a level similar to that seen with a surgical approach.

(Progress in Orthodontics, 2020)

However, the certainty of this evidence

was rated from very low to low

because the conditions differed between studies.

Even so, one thing is clear:

open bite is more prone to relapse

than other types of malocclusion.

That is why treatment planning

considers the period after orthodontic treatment

from the very beginning.

| Chapter 3. The Explanation That “Tongue Habits Are the Cause” |

There is something I would like

to tell you honestly here.

When you read articles about open bite,

an explanation that tongue thrusting is the cause

almost always appears.

However,

the issue is the sequence of events.

Did the tongue push against the front teeth and create the gap,

or does the tongue move into a gap

that was already present?

The literature states that distinguishing

between these two possibilities is extremely difficult.

The question of whether cases in which tongue thrusting itself is the cause

can be diagnosed

has not yet been definitively answered.

(Orthodontic Update, discussion of tongue thrusting)

Tongue position is not the only relapse factor.

The factors identified in the same literature include

tongue posture, growth pattern,

factors related to the treatment method,

and instability in cases involving surgery.

The tongue is just one of them.

Therefore, it is difficult to say that

“relapse will not occur if you only correct the tongue.”

The issue arises after treatment is complete.

Once the appliances are removed, the barrier that had been preventing movement is gone.

That is why tongue-position training is performed.

You repeatedly practice swallowing

with the tip of your tongue placed just behind the upper teeth,

at the front part of the palate.

However, the evidence supporting

the effectiveness of this training

is still limited.

Therefore, rather than relying on training alone,

it is appropriate to use it together with retainers.

Ultimately, retention is the answer

Open bite treatment does not end

the moment the appliances are removed.

How consistently you wear your retainers

has a major impact on the outcome.

< Do You Have to Wear Orthodontic Retainers for Life? ↓↓ >

Some people use retainers designed

to prevent the tongue from moving forward.

It is also necessary to have

regular orthodontic checkups.

People tend to return repeatedly

to a comfortable posture.

The same applies to tongue position:

even after training, it often returns

to its original position over time.

By checking whether the bite remains stable

at the time of orthodontic examinations,

changes can be identified and addressed early.

The relapse figures mentioned earlier

are the results of an average follow-up period of two and a half years.

This means that it takes that much time for the teeth to move back,

and it also means that there are several opportunities

to check their condition during that period.

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Today, we discussed relapse in open bite.

There are reports that approximately 10% to 30%

of open-bite cases relapse after treatment.

Although tongue habits are often described

as the main cause,

it has not yet been clearly determined

whether the tongue is the cause or the result.

Multiple factors work together

to contribute to relapse.

Therefore, rather than relying on tongue training alone,

using retainers consistently

and attending regular checkups

is a more realistic approach.

Thank you for reading this long post today.

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