Severe Anterior Open Bite Case Study | TADs & Extractions
Severe Anterior Open Bite Case Study: TADs, Extractions, and Profile Correction
A 30-month adult orthodontic transformation focused on bite closure, lip competence, and facial balance
By Wael Kanaan, DDS MSD
Case Overview
This case study shows the orthodontic transformation of a 22-year-old female patient who presented with a severe anterior open bite, protrusive upper teeth, lip incompetence, and a full facial profile. She was unable to bite on her eight front teeth and had difficulty closing her lips comfortably at rest.
After a complete orthodontic evaluation, including facial analysis, bite assessment, cephalometric analysis, and clinical records, a customized plan was developed using Temporary Anchorage Devices (TADs), four dental extractions, and carefully controlled light forces.
Dr. Wael Kanaan was the treating orthodontist for this case. Using his expertise in complex orthodontic biomechanics, TAD-assisted open bite correction, extraction planning, and light-force mechanics, Dr. Kanaan guided the patient through a carefully controlled 30-month treatment to help her achieve this smile, improved bite function, and a more balanced facial profile.
For a general explanation of open bite causes, diagnosis, and treatment options, please visit our main guide: Open Bite Treatment in Houston and Sugar Land. This page focuses only on one complex adult case and the mechanics used to achieve the result.
Why This Case Was More Complex Than a Routine Open Bite
The patient had more than an opening between the front teeth. Her case included several combined problems:
Severe anterior open bite with no contact on the eight front teeth
Protrusive upper teeth
Lip incompetence and difficulty closing the lips comfortably
Full facial profile with lip strain
Increased vertical facial dimension
Need for both bite correction and facial profile improvement
Because the patient was an adult, growth modification was no longer available. The treatment plan needed to control the vertical dimension, close the anterior bite, retract protrusive teeth, and improve lip posture without unwanted side effects.
Treatment Goals
Close the severe anterior open bite and allow the patient to bite on the front teeth.
Retract the protrusive anterior teeth to improve lip competence and facial profile.
Use skeletal anchorage with TADs to help control vertical tooth movement.
Close all extraction spaces while maintaining healthy, controlled tooth movement.
Create a stable, functional, and aesthetic result.
Widen her smile using upper and lower expander appliances.
Dr. kanaan used 6 TADs to correct the case.
Treatment Mechanics: TADs, Extractions, and Light Forces
TADs -manufactured by IOS- were placed strategically to assist with intrusion of the upper and lower dentition and to help control the vertical dimension. These small temporary anchorage devices allowed more precise orthodontic control during a difficult adult open bite correction.
Because the patient also had protrusive teeth and a full profile, four teeth were extracted. The extraction spaces created the room needed to move the anterior teeth backward, reduce lip strain, and improve the side profile.
Light orthodontic forces were used throughout treatment. In a case like this, force control is critical because the goal is not only to close the open bite, but to do it in a healthy, stable, and esthetic way.
Notice how the TAD is also used to hook intraoral elastics to help correct the bite
Treatment Time
Total treatment time was approximately 30 months. During treatment, the open bite gradually closed, the teeth were aligned, the extraction spaces were closed, and the patient’s profile improved.
Before Treatment
Before treatment, the patient had a severe anterior open bite, protrusive teeth, lip incompetence, a full facial profile, increased vertical facial dimension, and difficulty closing her lips comfortably.
[Insert Before Photos Here]
Suggested image caption: Before treatment: severe anterior open bite, protrusive teeth, and lip incompetence.
Suggested image alt text: Before orthodontic case study showing severe anterior open bite and protrusive teeth.
During Treatment
During treatment, TADs helped control vertical tooth movement while the extraction spaces were used to retract the anterior teeth. As the teeth moved into a better position, the open bite began to close and the lips became more relaxed.
Final Result
At the end of treatment, the anterior open bite was fully corrected. The patient was able to bite on her front teeth, all extraction spaces were closed, her lips became more competent, and her side profile became more balanced. The patient was extremely happy with the final result.
This transformation reflects careful diagnosis, detailed treatment planning, and Dr. Kanaan’s experience managing severe open bite cases where both the smile and facial profile must be considered together.
Six-Month Follow-Up
At the six-month follow-up, the bite remained closed and the smile continued to look balanced. Follow-up visits are especially important in open bite cases because stability is a major part of long-term success. Retainers, proper tongue posture, and continued monitoring all help protect the result.
Six-month follow-up: stable anterior bite closure and happy patient
Measured Cephalometric and Facial Changes
IMPA improved from 96 degrees to 91 degrees.
The anterior overjet improved from 7 mm to 3 mm.
Anterior facial height was reduced from 83.5 mm to 80.5 mm.
These changes supported a healthier bite, improved lip competence, better facial balance, and a more harmonious profile.
What This Case Shows
This case demonstrates how carefully planned orthodontic mechanics can improve both function and facial esthetics in selected adult patients. TADs helped with vertical control, while extractions helped create the space needed to retract protrusive teeth and improve lip posture.
Can Every Severe Open Bite Be Treated Without Jaw Surgery?
No. Some adult open bite cases still require orthognathic surgery for the best and most stable result. The correct approach depends on the bite, skeletal pattern, facial profile, airway considerations, periodontal support, habits, tongue posture, and the patient’s goals. This case shows what may be possible in a carefully selected patient with the right diagnosis and controlled biomechanics.
Schedule a Complex Orthodontic Consultation
If you have a similar problem, such as a severe anterior open bite, protrusive teeth, difficulty closing your lips, or concerns about your facial profile, do not hesitate to call Dr. Wael Kanaan for a consultation. A complete orthodontic evaluation can help determine whether TADs, braces, Invisalign, extractions, jaw surgery, or another customized treatment option is best for your case.
At iSmile Specialists, every complex case begins with diagnostic records, facial analysis, bite evaluation, and a customized treatment plan. Dr. Kanaan will evaluate your bite, smile, and facial profile carefully and explain the treatment options that may help you achieve a healthier bite and a more confident smile.
Keywords
adult open bite case study
TADs open bite case
open bite with protrusive teeth case
lip incompetence orthodontic case
open bite extraction orthodontic case
open bite profile correction case
30-month open bite orthodontic case
About the Author:
Dr. Wael Kanaan is an orthodontist and the orthodontist as iSmile Specialists in Sugar Land, Texas. He completed his orthodontic residency, certificate, and master’s degree at Saint Louis University, with additional orthodontic training at Harvard School of Dental Medicine. Dr. Kanaan has extensive experience in advanced orthodontic treatment, including MARPE, mini-implants, Invisalign, impacted teeth, and complex bite correction. He has lectured nationally and internationally and is the author of a published case report in the AJO-DO Clinical Companion.
Severe Anterior Open Bite Case Study | TADs & Extractions
Severe Anterior Open Bite Case Study: TADs, Extractions, and Profile Correction
A 30-month adult orthodontic transformation focused on bite closure, lip competence, and facial balance
By Wael Kanaan, DDS MSD
Case Overview
This case study shows the orthodontic transformation of a 22-year-old female patient who presented with a severe anterior open bite, protrusive upper teeth, lip incompetence, and a full facial profile. She was unable to bite on her eight front teeth and had difficulty closing her lips comfortably at rest.
After a complete orthodontic evaluation, including facial analysis, bite assessment, cephalometric analysis, and clinical records, a customized plan was developed using Temporary Anchorage Devices (TADs), four dental extractions, and carefully controlled light forces.
Dr. Wael Kanaan was the treating orthodontist for this case. Using his expertise in complex orthodontic biomechanics, TAD-assisted open bite correction, extraction planning, and light-force mechanics, Dr. Kanaan guided the patient through a carefully controlled 30-month treatment to help her achieve this smile, improved bite function, and a more balanced facial profile.
For a general explanation of open bite causes, diagnosis, and treatment options, please visit our main guide: Open Bite Treatment in Houston and Sugar Land. This page focuses only on one complex adult case and the mechanics used to achieve the result.
Why This Case Was More Complex Than a Routine Open Bite
The patient had more than an opening between the front teeth. Her case included several combined problems:
Treatment Goals
Close the severe anterior open bite and allow the patient to bite on the front teeth.
Retract the protrusive anterior teeth to improve lip competence and facial profile.
Use skeletal anchorage with TADs to help control vertical tooth movement.
Close all extraction spaces while maintaining healthy, controlled tooth movement.
Create a stable, functional, and aesthetic result.
Widen her smile using upper and lower expander appliances.
Treatment Mechanics: TADs, Extractions, and Light Forces
TADs -manufactured by IOS- were placed strategically to assist with intrusion of the upper and lower dentition and to help control the vertical dimension. These small temporary anchorage devices allowed more precise orthodontic control during a difficult adult open bite correction.
Because the patient also had protrusive teeth and a full profile, four teeth were extracted. The extraction spaces created the room needed to move the anterior teeth backward, reduce lip strain, and improve the side profile.
Light orthodontic forces were used throughout treatment. In a case like this, force control is critical because the goal is not only to close the open bite, but to do it in a healthy, stable, and esthetic way.
Treatment Time
Total treatment time was approximately 30 months. During treatment, the open bite gradually closed, the teeth were aligned, the extraction spaces were closed, and the patient’s profile improved.
Before Treatment
Before treatment, the patient had a severe anterior open bite, protrusive teeth, lip incompetence, a full facial profile, increased vertical facial dimension, and difficulty closing her lips comfortably.
[Insert Before Photos Here]
Suggested image caption: Before treatment: severe anterior open bite, protrusive teeth, and lip incompetence.
Suggested image alt text: Before orthodontic case study showing severe anterior open bite and protrusive teeth.
During Treatment
During treatment, TADs helped control vertical tooth movement while the extraction spaces were used to retract the anterior teeth. As the teeth moved into a better position, the open bite began to close and the lips became more relaxed.
Final Result
At the end of treatment, the anterior open bite was fully corrected. The patient was able to bite on her front teeth, all extraction spaces were closed, her lips became more competent, and her side profile became more balanced. The patient was extremely happy with the final result.
This transformation reflects careful diagnosis, detailed treatment planning, and Dr. Kanaan’s experience managing severe open bite cases where both the smile and facial profile must be considered together.
Six-Month Follow-Up
At the six-month follow-up, the bite remained closed and the smile continued to look balanced. Follow-up visits are especially important in open bite cases because stability is a major part of long-term success. Retainers, proper tongue posture, and continued monitoring all help protect the result.
Measured Cephalometric and Facial Changes
IMPA improved from 96 degrees to 91 degrees.
The anterior overjet improved from 7 mm to 3 mm.
Anterior facial height was reduced from 83.5 mm to 80.5 mm.
These changes supported a healthier bite, improved lip competence, better facial balance, and a more harmonious profile.
What This Case Shows
This case demonstrates how carefully planned orthodontic mechanics can improve both function and facial esthetics in selected adult patients. TADs helped with vertical control, while extractions helped create the space needed to retract protrusive teeth and improve lip posture.
Can Every Severe Open Bite Be Treated Without Jaw Surgery?
No. Some adult open bite cases still require orthognathic surgery for the best and most stable result. The correct approach depends on the bite, skeletal pattern, facial profile, airway considerations, periodontal support, habits, tongue posture, and the patient’s goals. This case shows what may be possible in a carefully selected patient with the right diagnosis and controlled biomechanics.
Schedule a Complex Orthodontic Consultation
If you have a similar problem, such as a severe anterior open bite, protrusive teeth, difficulty closing your lips, or concerns about your facial profile, do not hesitate to call Dr. Wael Kanaan for a consultation. A complete orthodontic evaluation can help determine whether TADs, braces, Invisalign, extractions, jaw surgery, or another customized treatment option is best for your case.
At iSmile Specialists, every complex case begins with diagnostic records, facial analysis, bite evaluation, and a customized treatment plan. Dr. Kanaan will evaluate your bite, smile, and facial profile carefully and explain the treatment options that may help you achieve a healthier bite and a more confident smile.
Keywords
adult open bite case study
TADs open bite case
open bite with protrusive teeth case
lip incompetence orthodontic case
open bite extraction orthodontic case
open bite profile correction case
30-month open bite orthodontic case
About the Author:
Dr. Wael Kanaan is an orthodontist and the orthodontist as iSmile Specialists in Sugar Land, Texas. He completed his orthodontic residency, certificate, and master’s degree at Saint Louis University, with additional orthodontic training at Harvard School of Dental Medicine. Dr. Kanaan has extensive experience in advanced orthodontic treatment, including MARPE, mini-implants, Invisalign, impacted teeth, and complex bite correction. He has lectured nationally and internationally and is the author of a published case report in the AJO-DO Clinical Companion.