Managing Bite Issues and Jaw Alignment

Amelogenesis Imperfecta (AI) does more than change the surface of the teeth; it often influences how the jaws grow and how the upper and lower teeth meet ^[1]. Many patients with AI develop specific “bite” patterns that require specialized orthodontic care or, in some cases, jaw surgery to correct ^[2][3].

Why AI Affects the Bite

A very common finding in people with AI is an anterior open bite (AOB) ^[1]. This occurs when the back teeth touch, but the front teeth do not meet, leaving a gap even when the mouth is closed ^[1][2].

• Skeletal Growth: Many AI patients have a “vertical” growth pattern, meaning the face grows longer, the lower jaw may be positioned further back (Class II pattern), and the jaw angle is wider than average ^[1][4].
• Why it Happens: While the exact reason is still being studied, these growth patterns are thought to be linked to the same genetic factors that affect the enamel, or they may be a result of the way the tongue and jaw adapt to sensitive teeth ^[1][5].

Challenges of Braces with AI

Traditional orthodontic treatment (braces) can be more difficult for patients with AI because the enamel is not as strong as it should be ^[3].

• Bonding Issues: Brackets are usually “glued” to the enamel. In AI, especially the hypocalcified type, the “glue” (adhesive) often fails to hold because the enamel surface is too soft or rough ^[3][6].
• Specialized Solutions: To overcome this, orthodontists may use orthodontic bands (metal rings that wrap around the whole tooth) instead of just brackets, or they may place brackets on temporary crowns rather than the natural enamel ^[3][7]. Alternatively, clear aligners (like Invisalign) might be used in certain cases, as they bypass the need to bond brackets to weak enamel altogether ^[3].

Specialized Techniques and Surgery

For some, the goal is to correct the bite without major surgery. For others, surgery is the best way to achieve a stable, long-term result.

The MEAW Technique

The Multiloop Edgewise Archwire (MEAW) is a specialized orthodontic wire with many small loops that gives the orthodontist precise control over each tooth ^[8][9]. This technique has been used successfully in AI patients to close even large open bites without surgery, focusing on moving the teeth into a better position to “compensate” for the jaw’s shape ^[8][9].

Orthognathic (Jaw) Surgery

In more severe cases, where the jaw alignment is significantly off, orthognathic surgery may be recommended once the patient has finished growing ^[2][10].

• Procedures: This might include a Le Fort I osteotomy (repositioning the upper jaw) or surgery to reposition the lower jaw ^[2][7].
• The Goal: Surgery aims to align the skeletal base of the face. This provides a stable foundation so that the dentist can later place permanent crowns that fit and function correctly for a lifetime ^[7][11].

Because these issues involve both the teeth and the bones of the face, it is essential that your orthodontist and prosthodontist work closely together from the very beginning of your treatment ^[11][3].