Aligners And Myofunctional Therapy For Anterior Open Bite

This case demonstrates non-surgical, non-extraction treatment of a 15-year-old female with open bite, hyperdivergent growth, and skeletal Class II malocclusion. Combining CAT and OMT via posterior intrusion/anterior extrusion (without TADs) improved aesthetics, managed vertical posterior positioning, and resolved the open bite effectively. First, the patient received guidance on proper tongue positioning (dorsal palate contact during swallowing/resting) and daily gum chewing to strengthen masseter muscles. Following four wisdom teeth extractions, three months of orofacial myofunctional therapy (OMT) reduced the open bite to 0 mm. Treatment involved 67 aligners per arch designed for maxillary molar distalization, maxillary incisor retroclination, and relative molar intrusion. Class II elastics (1/4", 6 oz) were used during maxillary distalization to prevent incisor proclination, then discontinued post-distalization to avoid vertical open bite recurrence. OMT was reinforced during clear aligner therapy (CAT), though the patient declined TADs. Open bite arises from skeletal/genetic factors and abnormal tongue posture/swallowing patterns. OMT (tongue training) combined with CAT (aligner-induced molar intrusion) effectively resolved a severe case without extractions or TADs. OMT corrected tongue thrust, while CAT intruded molars (1.5-1.7 mm) and enabled counterclockwise mandibular rotation, increasing overbite from 0mm to 2mm. This non-surgical approach preserved natural dentition, demonstrating that integrated myofunctional-orthodontic therapy can address skeletal Class II malocclusion and vertical discrepancies sustainably. A patient with a skeletal Class II open bite underwent successful orthodontic treatment with CAT/OMT (no TADs), achieving stable outcomes at 1-year posttreatment.