Dentoskeletal effects of orthodontic and surgical treatments in non-growing patients with anterior open bite: a systematic review and network meta-analysis

Relative effectiveness among anterior open bite (AOB) treatments regarding vertical control remains controversial. This network meta-analysis (NMA) aims to simultaneously compare skeletal and dental effects of treatments for AOB in non-growing patients. MEDLINE (via PubMed), Scopus, Embase, Cochrane CENTRAL, and Google Scholar were searched until December 2025. Cohort studies or randomised controlled trials were eligible if they were conducted on non-growing patients with AOB and investigated any treatment comparison between fixed appliances (FA), clear aligner therapy (CAT), temporary anchorage device-supported therapy (TST), and orthognathic surgery (OS). Risk of bias was assessed using the Cochrane criteria. Two-stage NMA adjusting for baseline AOB severity was performed to compare the treatments. Sixteen cohort studies and one randomised controlled trial were eligible, comprising 894 patients. NMA of the cohort studies indicated that, in mild-to-moderate AOB, OS and TST were associated with greater anterior face height (AFH) improvements than FA (standardised mean differences [SMD]: -1.67 for OS and -1.10 for TST, translating to -3.54 and -2.33 mm, respectively) and greater mandibular plane angle (MPA) reductions than FA (-2.50 degrees [SMD: -1.23] and -1.42 degrees [SMD: -0.70], respectively). The AFH reductions for OS and TST compared to FA were more pronounced in severe AOB (-5.70 mm [SMD: -2.69] and -4.56 mm [SMD: -2.15], respectively). However, the MPA reduction relative to FA was more pronounced in severe AOB only for TST (-4.32 degrees [SMD: -2.13]) but not for OS. TST and OS were also associated with significantly greater maxillary posterior intrusion than FA, with associations more pronounced with severity. In contrast, CAT and FA showed no significant differences in their vertical skeletal changes. Regarding dental effects, less incisor extrusion tended to be observed with both OS and TST relative to FA in mild-to-moderate AOB, while it was evident only with TST in severe patients. OS and TST are associated with improved vertical skeletal morphology in non-growing AOB patients by potentially clinically meaningful differences, but such findings are not observed with CAT. However, the findings should be interpreted with caution, as the meta-analysed data were from non-randomised studies with predominantly high risk of bias.