Did you try to use mail-order aligners to fix your smile, and now your back teeth don’t come together? Developing a posterior open bite is one of the most common outcomes of using direct-to-consumer (DTC) orthodontic tooth aligners. What causes this, and can it be fixed?

Moving the teeth usually changes the bite
First, here’s my disclaimer. I’m an orthodontic specialist. I’ve been fixing smiles for almost 30 years and believe that your teeth are too important to trust to an online aligner manufacturer. The human body, including your jaws, teeth, and gums, is a complex system. There is more to orthodontic treatment than just moving teeth into a straight line. In your case, aligning your teeth has messed up your bite. Here’s what happened.

Resolving crowding and closing spaces change arch length
Most patients have a stable, usable bite, even if their teeth are crooked. When you start moving teeth, you change the bite. Changes in the bite usually take place because straightening the teeth changes your “arch lengths.” Aligning crooked teeth requires that teeth spread out or “expand.” Straight teeth take up more room than overlapping ones. On the other hand, if you have extra space between your teeth (most commonly in the upper arch), closing the gaps makes your arch length shorter. Teeth with no spaces between them take up less space and occupy less arch length.

Altering arch length changes the bite
Although spreading out your teeth or pushing them closer together may make them look better, changing your arch lengths in this way affects your bite – the way the top and bottom teeth come together. Changing your arch lengths may prevent your back teeth from coming together for two reasons. First, if you had spaces in the top but not in the bottom, closing them probably scooted the top teeth back as they moved together (reducing your arch length). Because the upper teeth moved inward, you are now hitting in the front first, preventing your back teeth from coming together. Second, if you had more crowding on the bottom than on the top, aligning the lower teeth probably moved the lower front teeth further forward than the top ones, and you are now hitting on the lower incisors prematurely. Both scenarios are common in orthodontics and are easily preventable.

Posterior open bites can be prevented
Orthodontists prevent posterior open bites by creating the clearance necessary for spreading out the lower teeth or closing spaces between the upper ones. They may do this by “opening the bite” (reducing the amount that the upper incisors overlap the lower ones) or altering the sizes of the teeth themselves so that they fit correctly. Opening the bite usually requires attachments on the teeth (with either aligners or braces) that are not possible with mail-order aligners. Changing the size or shape of the teeth requires adding composite or polishing away enamel to make them smaller. Both procedures require procedures in the office of a local orthodontist. When a patient is seen in person, their orthodontist evaluates how aligning crowded teeth or closing spaces between them will affect the bite and plans accordingly. Before creating a posterior open bite, they create the necessary clearance or adjust the size of the teeth. Doing so allows the teeth to be straightened without screwing up your bite.

An orthodontist can fix your bite
If you’ve tried online aligners and they didn’t work out for you, it is not too late. There are very few orthodontic “messes” that a local orthodontist can’t fix. If your bite isn’t what it was before you started wearing your DTC aligners, give an orthodontist a call today!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen’s 29 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author’s written permission.