Relapsed Open Bite After Jaw Surgery Successfully Retreated with Invisalign

Presentation

Chief complaint. 'I am concerned about my recurrent open bite and want to improve my bite without undergoing another major jaw surgery if possible."

Diagnosis. 35-year-old female with a skeletal and dental Class II malocclusion, convex facial profile, and history of maxillary first premolar extractions and two jaw surgery. She does not show much incisal show at rest. She presents with Class II molar and canine relationships, a premolar-to-premolar anterior open bite of approximately 3 mm, 4 mm overjet, mandibular midline deviation to the right, and mild maxillary and mandibular crowding. She has a history of double-jaw surgery complicated by condylar resorption and subsequent relapse.

Measurements

Cephalometric values before and after treatment
Measure	Norm	Pre	Post
SNA	82	77	77
SNB	80	68	71
ANB	2	8	6
Wits	0	2	0
SN-MP	32	52	50
U1-SN	102	94	94
L1-MP	90	86	88
Overjet (mm)	2–3	4	2
Overbite (mm)	2–3	-3	2

Treatment

Objectives. Close the recurrent open bite through posterior molar intrusion and mandibular autorotation, while allowing controlled maxillary incisor extrusion to improve incisor display at rest. Level the Curve of Spee, achieve ideal overjet and overbite, improve facial balance, and establish a stable functional occlusion without repeat jaw surgery.

Plan. Use Invisalign to intrude the posterior teeth, allowing the mandible to autorotate and close the open bite. Level and align both arches, level the Curve of Spee, and allow controlled extrusion of the maxillary incisors to improve incisor display. Use vibration therapy to improve aligner seating and facilitate posterior intrusion. Retain with posterior-coverage Invisalign retainers and bonded permanent retainers to maintain the correction.

Outcome

Successfully closed the recurrent open bite and achieved 2 mm overjet and overbite without repeat jaw surgery. Posterior intrusion and mandibular autorotation improved facial balance, while controlled maxillary incisor extrusion increased incisor display at rest.

Retention

Fixed U2-2 permanent retainer
Fixed L3-3 permanent retainer
Invisalign Vivera retainers to be worn at night