Should anterior open bite and deep bite be treated immediately regardless of dental development stage?

Treatment Timing for Anterior Open Bite and Deep Bite

Anterior open bite and deep bite should NOT be treated immediately in all cases—treatment timing depends critically on the etiology, severity, and dental development stage, with many cases in the mixed dentition benefiting from observation rather than immediate intervention.

Anterior Open Bite Management by Dental Stage

Primary and Early Mixed Dentition

• Observation is the primary management approach for anterior open bite in young children, particularly when associated with digit-sucking habits, as spontaneous correction frequently occurs during normal dental development 1, 2.
• Simple open bites may resolve completely during the transition from mixed to permanent dentition if the digit-sucking habit is broken, making early active treatment unnecessary 2.
• Active early treatment should NOT aim for active correction of the anterior open bite itself, but only address other aspects of malocclusion and intercept dysfunctional habits, given the significant possibility of self-improvement in the pre-pubertal phase 3.
• Early treatment involves substantial financial and biological costs with questionable benefit, as many cases self-correct 3.

Late Mixed and Permanent Dentition

• More significant open bites extending to the terminal molars rarely resolve spontaneously and require intervention 2.
• Referral to an orthodontist is indicated when eruption asymmetry or malocclusion requires treatment, typically in the late mixed or permanent dentition 1.
• Treatment options for skeletal anterior open bite include temporary anchorage devices (TADs) for molar intrusion, which can avoid orthognathic surgery in selected cases 2, 4.
• The gold standard for severe skeletal anterior open bite remains combined orthodontic treatment with orthognathic surgery, though TADs offer a less invasive alternative 4, 5.

Deep Bite Management

General Approach

• The provided evidence does not contain specific guidelines for deep bite treatment timing across dental stages.
• Based on the cardio-facio-cutaneous syndrome guidelines, malocclusion with open bite and posterior crossbite should receive routine dental examinations, appropriate hygiene, restorative care, and orthodontic care if needed 6.
• Orthodontic care should be provided when clinically indicated rather than immediately in all cases 6.

Diagnostic Workup

Radiographic Evaluation

• Do NOT prescribe orthopantomography (OPT) earlier than age 6 for suspected eruption abnormalities, as permanent tooth buds are not adequately visible before this age and radiation exposure is not justified 1.
• After age 6, OPT is indicated for persistent malocclusion, clinical suspicion of impacted teeth, supernumerary teeth, or tooth agenesis 1.
• Observation with periodic monitoring should precede radiographic evaluation unless there are specific clinical indications 1.

Key Clinical Pitfalls to Avoid

• Avoid over-treatment in the early mixed dentition: The significant possibility of spontaneous improvement makes aggressive early intervention inappropriate for most anterior open bite cases 3.
• Do not assume all open bites require immediate treatment: Etiology matters—habit-related open bites have better prognosis for spontaneous correction than skeletal open bites 2, 7.
• Avoid premature radiographic imaging: Radiation exposure before age 6 is rarely justified for malocclusion evaluation 1.
• Recognize that skeletal open bites require different management than dental or habit-related open bites, with skeletal cases rarely self-correcting and often requiring complex treatment 2, 5.

Treatment Decision Algorithm

1. Assess etiology: Determine if open bite is habit-related, dental, or skeletal 2, 7
2. Evaluate dental stage: Primary, early mixed, late mixed, or permanent dentition 3
3. For early mixed dentition with habit: Focus on habit cessation and observation rather than active correction 3
4. For persistent cases after age 6-7: Consider radiographic evaluation and orthodontic referral 1
5. For severe skeletal cases in permanent dentition: Plan for TADs or combined orthodontic-surgical approach 2, 4, 5