A Wholesome Approach: Mastering Complex Open Bites with Clear Aligners
Every orthodontist knows the feeling: a new patient presents with a complex anterior open bite. It’s a clinical challenge that tests the limits of our skills, demanding a plan that addresses not just the teeth, but the underlying causes—be it skeletal, muscular, or habitual. How do we provide a solution that is not only effective but also aligns with the patient’s lifestyle and goals?
In a revealing webinar hosted by SEBARIS, Dr. Guilherme Bernd, CEO of Click Aligner, offered a refreshingly complete perspective on this very challenge. Moving beyond mere mechanics, he presented a philosophy rooted in deep diagnosis, clinician-led strategy, and a strong doctor-patient partnership.
Here are the key insights to create more predictable, stable, and wholesome outcomes for your open bite cases.
Why Are Clear Aligners So Effective for Open Bites?
Before diving into specific cases, Dr. Bernd clarified why clear aligners are uniquely suited for open bite treatment. Their power lies in their inherent design:
Superior Vertical Control: Every aligner covers the occlusal surface of the posterior teeth, acting as a mini bite block. This creates a slight intrusive force on the molars with every bite, a critical mechanism for allowing the mandible to autorotate and help close the bite from the back.
Predictable Force Application: Unlike wires, which can have unintended extrusive effects, aligners provide controlled, targeted forces. This is especially useful for achieving “relative extrusion” of the anterior teeth by retroclining them—a far more stable movement than simple vertical pulling.
Enhanced Patient Comfort & Hygiene: For adult patients who are often the primary demographic for these complex cases, the benefits of removability for cleaning and eating cannot be overstated.
The Three Pillars of Success: A Deeper Look
Dr. Bernd emphasized that success isn’t about the plastic; it’s about the strategy. He revisited his three pillars with added depth:
Forensic Diagnosis: A surface-level look isn’t enough. The diagnostic phase must be thorough. Dr. Bernd urges clinicians to create a checklist: Are third molars present and causing occlusal interferences? Is there any sign of ankylosis? In one of his own cases, a central incisor’s failure to track was the only clue to underlying ankylosis, a discovery that completely changed the treatment plan. This highlights the need to be a detective before being a strategist.
Autonomous Planning: The orthodontist, not the software, must be in command. This means personalizing every plan, dictating the precise amount of IPR, and strategically planning for overcorrection. Especially in open bite cases, planning for stronger anterior contacts than you think you need is essential to prevent relapse. Dr. Bernd recommends specific tools like semi-lunar attachments for extrusion and rectangular anchoring attachments on molars to ensure the planned movements are executed flawlessly.
Collaborative Execution: This pillar is a partnership. Dr. Bernd shared that even the most perfect plan will fail if the patient is not on board. Success depends on their commitment to wear-time. This collaborative spirit also extends to managing expectations, especially when unexpected biological responses occur.
Lessons from the Trenches: Real Cases, Real Solutions
The true value of the webinar came from its honest look at complex clinical realities.
The Patient Who Wanted to Avoid Surgery: A case of severe open bite caused by mandibular condylar resorption seemed destined for surgery. However, respecting the family’s wishes, Dr. Bernd proceeded with aligners first. To his and his team’s surprise, the aligners achieved a remarkable result on their own. The outcome was a testament to both the technology’s potential and the importance of patient-centered care.
When Health is the Primary Goal: An older patient presented with an open bite and significant periodontal loss. The objective here wasn’t a perfect Class I occlusion, but to improve the patient’s comfort, health, and quality of life. Using gentle forces and IPR to close black spaces, the treatment dramatically improved aesthetics and function, demonstrating that success is defined by the patient’s well-being.
The Final Piece of the Puzzle: Retention: What happens after the bite is closed? Dr. Bernd was unequivocal: retention is for life. He recommends a post-treatment retainer, similar in form to an aligner, to be worn indefinitely at night. This ensures the hard-won results are maintained, protecting the patient’s investment in their smile.
Conclusion: Blending Technology with Human Expertise
Dr. Bernd’s presentation was a powerful reminder that while digital tools give us unprecedented control, the core of orthodontics remains deeply human. It’s about combining our diagnostic acumen with patient collaboration and a humble willingness to adapt when biology presents a surprise.
By adopting this wholesome approach—grounded in meticulous planning, patient partnership, and a clear understanding of the tools at our disposal—we can confidently and successfully treat even the most challenging open bite cases.
Your Partner in Predictability
For all SEBARIS Providers, log into your Dashboard to view the new updates including the Tools/Calculators to improve your aligner treatment practice. This is located on the right side panel of the dashboard
Tools include:-
- Predictability Calculator
- Aligner Cost Estimator
- Orthodontic Case Difficulty Grader [CAT-CAT Score] for Clear Aligner treatment