Orthodontic Clinic Near Hakdong Station: A Case of Correcting an Open Bite and Asymmetry Without Surgery

Hello? I’m Director Kim Sun-min of Ceramic Dental Clinic, an orthodontic clinic near Hakdong Station. Today, I’d like to introduce a case of a patient who was diagnosed at a university hospital as needing surgical orthodontic treatment, but achieved excellent results through orthodontics alone, without surgery.

In fact, the process of treating this patient was very special to me as well. As each stage of treatment progressed, I could clearly see the patient’s facial appearance improving, and there were many moments that made me very happy as a medical professional. In particular, after treatment, the patient’s image changed into such a lovely and cute face that I cannot fully express how proud and happy I felt seeing it.

So today, I’d like to share my orthodontic knowledge and this joyful transformation process with you, more happily than ever. I hope this post can offer not only practical information but also encouraging hope to those who may be worried about the possibility of surgery.

Now, shall we take a closer look at the patient’s case?

Before-and-after comparison

Before treatment

This female patient in her early 20s had three major concerns when she first visited us.

• "My front teeth won’t close"

• "My face is asymmetrical"

• "I want my mouth to be less protrusive"

The patient had already visited a university hospital, where she was told that surgical orthodontic treatment would be absolutely necessary to address these skeletal problems. However, feeling a great psychological burden in the face of such a major procedure, she came to our clinic desperately seeking an alternative without surgery.

Diagnosis at Ceramic Dental Clinic

The discomfort the patient felt was also clearly confirmed by the detailed examination at Ceramic Dental Clinic. Even when the molars were brought together, the front teeth did not close, showing an open bite, along with facial asymmetry and mild protrusion of the mouth.

The oral condition was also complex. One upper left tooth was missing, and because of that space, the teeth were generally spread apart. It was a case with intertwined problems complex enough for it to be easy to understand why the university hospital recommended surgery.

(Left) Even when the molars are closed, the front teeth do not touch and remain open. (Right) On the patient’s "left" side, there is only one molar

However, after closely analyzing the detailed examination results, all of these problems ultimately stemmed from one root cause. The upper jaw (maxilla) was simply too small compared with the lower jaw (mandible).

In a normal structure, the upper jaw should be slightly wider than the lower jaw so that the upper teeth naturally cover the lower teeth. But in this patient, the upper jaw was so small that the lower molars were actually positioned farther outward than the upper ones. The lower teeth were forced to tip inward as much as possible in order to make contact with the upper teeth.

(Left) Normal occlusion (Right) Because this patient’s upper jaw is small, the lower molars are tipped inward in order to contact the upper teeth

So how did a small upper jaw lead to three problems—open bite, protrusion, and asymmetry? Let’s go through the connection one by one.

1. Why the front teeth would not close (open bite)

When the upper jaw is narrow, there is not enough space for the tongue to stay comfortably inside the mouth. With nowhere to rest, the tongue naturally moves forward to find a more comfortable position. As the tongue keeps pushing the front teeth forward, the upper and lower front teeth no longer touch, resulting in an open bite.

2. Why the mouth looks protrusive

When the jaw is narrow, there is far too little space for the teeth to line up neatly. With no room available, the teeth move forward to avoid the narrow path, making the mouth appear generally protrusive. In such cases, crowded teeth often occur as well, but fortunately(?) this patient was missing one upper left molar, so the teeth dispersed into that space and did not progress to crowding.

3. Why the facial asymmetry became more pronounced

When the jaw is small, the upper and lower teeth cannot interlock stably. Certain areas touch first, or one side bites higher than the other, creating an imbalance in bite height, which makes the asymmetry visible on the outside even more noticeable. In fact, this patient also had a structurally longer right-side bone. The incorrect bite was further intensifying this congenital asymmetry.

The right jaw (red) is longer than the left (yellow). Bone length can only be changed through surgery.

Treatment method: maxillary expansion using MARPE

So is it really possible to enlarge a fully grown upper jaw through orthodontics alone?

In general, orthodontic treatment mainly aims to move the position of the teeth, and it is said that changing the size of fully developed bone itself is not possible. Fortunately, however, there is one exception: the upper jaw can be widened.

For this, we decided to use a relatively recently developed MARPE (Miniscrew-Assisted Rapid Palatal Expansion) device.

What is MARPE?

MARPE is a device that places mini-screws in the palate and applies force to both the mini-screws and the teeth at the same time to expand the upper jaw bone sideways.

In the past, such maxillary expansion procedures were thought to be possible only for children who were still growing. In adults, the suture in the palate bone (the midpalatal suture) has already hardened firmly, so even if a device is used, it was easy for only the teeth to tip outward as a side effect rather than the bone actually separating.

However, the use of mini-screws changed the situation. Because the screws are fixed directly to the bone and serve as a strong, stable support, even the hardened sutures of adults whose growth has already ended can be safely opened without surgery.

Thanks to this device, the patient was able to widen the narrow upper jaw, which was the fundamental framework, without going to the operating table, and at last secured enough space for the teeth to find their proper positions.

Treatment process

We applied MARPE to the patient and carried out the following treatment.

Step 1: Maxillary expansion (widening the upper jaw)

The first thing we did was to comfortably widen the narrow upper jaw sideways. As the upper jaw expanded, the width balance with the lower jaw began to align. If you look at the before-and-after photos, you can clearly see the difference: the narrow arch became wider with a gentle curve.

Step 2: Occlusion improvement (adjusting the bite)

After the upper jaw framework was secured, we carefully adjusted the upper and lower molars so they would fit together properly. In fact, even up to this stage, many changes occur. As the tongue returns to its proper position, much of the space where the front teeth had been pushed forward improves, and as the abnormally high bite stabilizes, the jaw also appears much shorter to the naked eye.

Step 3: Precise adjustment of tooth alignment and asymmetry

Finally, we used the secured space to place the front teeth in their correct positions and completed the treatment. At this stage, I used my own hidden card to address the facial asymmetry. We placed a mini-screw on the right side, where the bone length was longer, and slightly intruded the upper teeth toward the gums.

When the upper teeth move slightly upward, the right side of the jaw bites more deeply than before. As a result, the longer-looking right jaw creates a visual effect that makes it appear shorter, which further improves the overall facial asymmetry.

Treatment results

With that, all treatment was completed. Let me summarize once again how the patient’s three original concerns improved.

Resolution of the open bite in the front teeth

As the narrow palate widened, the tongue that had nowhere to go naturally found its proper position. With the force that had been pushing the front teeth forward gone, the lifted front teeth finally began to fit together normally. The patient can now comfortably bite food with the front teeth, and the smile became much prettier as well.

Improvement of the protrusive mouth appearance

Once enough space was secured for the teeth to be arranged, the teeth that had been protruding forward moved into their proper positions. In the process, the lip line naturally shifted backward, completing the refined and comfortable mouth shape the patient wanted.

Reduction of facial asymmetry

We carried out a precise adjustment process to make the bite height of the molars on both sides even. In particular, by slightly intruding the upper teeth using mini-screws and guiding the right jaw to bite more deeply, the visibly apparent facial asymmetry improved despite the skeletal limitations.

Orthodontics without surgery, a change made with sincerity

Not every surgical orthodontic case can be solved with orthodontics alone. In cases of severe skeletal problems, surgery is absolutely necessary. However, if the underlying cause of the problem is accurately identified and the appropriate device is used, as in this patient’s case, there are many situations in which a satisfying result can be achieved without surgery.

In fact, treating this patient brought me personally many very happy and rewarding moments. As treatment progressed, I could see the patient’s hidden charm come to life, and watching her transform into such a cute face made me feel excited and happy as well. For medical staff, witnessing such dramatic change together is truly a great joy.

If you have been diagnosed with surgical orthodontic treatment but feel burdened or afraid of surgery, please do not worry alone. I recommend that you consult thoroughly with an orthodontic specialist and review the various treatment options that suit you.

We will think together for your bright smile. Thank you.