Open bite Closed without Surgery, declined elsewhere

For patients with a high mandibular plane angle and an anterior open bite who want to avoid surgery, Invisalign is my preferred appliance when nonsurgical correction is feasible. In this case, my goal was to close his severe open bite, improve his ability to bite into food, and establish functional contact between the front teeth. I chose Invisalign for its coverage of the biting surfaces and the ability to incorporate posterior intrusion into the treatment plan. My focus was on controlling the back teeth and allowing the lower jaw to rotate upward and forward as the bite closed, with less reliance on extrusion of the front teeth. His high angle jaw pattern was masking an underlying Class III relationship. I anticipated that forward mandibular rotation would make the underbite more apparent, so I planned lower distalization alongside the vertical correction. After third molar removal, I sequentially distalized the lower teeth while incorporating posterior intrusion, with greater planned intrusion in the upper arch. Class III elastics, closure of the lower spacing, and controlled lower incisor retroclination helped camouflage the remaining Class III discrepancy. I also referred him for myofunctional therapy to address his tongue thrust and swallowing pattern. Fixed retainers and nighttime Vivera retainers were included to help maintain the correction. Over 15 months, we closed the 6 mm anterior open bite, achieved 2 mm of overjet and overbite, and established Class I molar and canine relationships without surgery.