In these jaw misalignments, the vertical dimension of the bite plays a crucial role, influencing biting function and facial aesthetics. Due to developmental growth patterns, an open bite is usually found in patients with long faces, whereas a deep bite is associated with a shortened, compressed facial type — both conditions often involve significant functional limitations. These may include restricted nasal breathing, an increased susceptibility to infections, and strain or pain in the masticatory muscles and joints. Treating these types of malocclusion requires close collaboration between oral surgeons and orthodontists to ensure optimal results both functionally and aesthetically.
Treatment of Open Bite (Open Bite with “Long Face”)
In an open bite, uncoordinated upper jaw growth leads to a narrow and downward-developed maxilla, which negatively affects mandibular development. This results in malocclusion with misaligned teeth — a so-called skeletal open bite. It is typically classified as a severe condition.
An open bite (commonly referred to as “open bite” or “gummy smile”) is often accompanied by crooked teeth, excessive gum visibility, and a retruded lower jaw. Patients are often unable to close their lips comfortably, even at rest. The bite function is impaired, and the habitual mouth breathing associated with restricted nasal breathing causes dry oral mucosa and lips, higher susceptibility to tooth decay, gum disease, and frequent infections.
Changes in the temporomandibular joint (TMJ) can also contribute to an open bite, making a detailed joint examination essential. Additionally, tongue dysfunction — such as an altered swallowing pattern or tongue thrusting — must be ruled out or treated concurrently.
Accurate diagnostic analysis is vital for both treatment planning and long-term stability.
For patients with open bite, orthodontic correction through tooth movement alone should be avoided. Reducing the vertical gap between upper and lower dental arches or widening the upper arch without addressing skeletal discrepancies may lead to relapse after fixed braces are removed.
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Treatment of Deep Bite (Deep Bite with “Short Face”)
In deep bite cases, the upper jaw develops too narrowly and insufficiently downward toward the lower jaw due to uncoordinated growth, which also negatively affects mandibular development. As a result, the lower teeth are hidden deep beneath the upper teeth.
A deep bite is characterised by a loss of bite height and, consequently, reduced facial height. This occurs due to a pronounced vertical discrepancy between the lower front and side teeth — the front teeth are significantly higher than the molars. In addition, a retruded lower jaw (mandibular retrognathia) is often present. This shortens the lower third of the face relative to the midface and forehead, making the upper facial region appear disproportionately larger, while the teeth become less visible overall.
Because of the deep bite and backward jaw position, the mandibular joint heads are often displaced posteriorly, which can cause temporomandibular joint (TMJ) discomfort and clicking sounds. Excessive clenching or grinding may lead to overstrain of the masticatory muscles, resulting in muscle hypertrophy (for example, masseter hypertrophy) and tension. This can make the jawline appear broader. In many cases, a subsequent chin correction can aesthetically enhance and complete the final treatment outcome.
