How to Treat an Open Bite in Amelogenesis Imperfecta?

It is completely understandable to feel intimidated by the idea of jaw surgery. When your front teeth do not touch (an anterior open bite), biting into food and speaking clearly can be incredibly frustrating. However, not everyone with amelogenesis imperfecta (AI) will need surgery to correct their bite. Treatment ranges from specialized orthodontics (braces) for milder cases, to jaw surgery for severe skeletal differences, and nearly always requires a coordinated team approach.

Why Your Front Teeth May Not Touch

An anterior open bite is a very common feature for people with AI. Individuals with this condition often experience a “vertical growth pattern,” meaning the jaws grow longer vertically and the lower jaw tends to rotate backward ^[1]. This rotation pulls the front teeth apart, creating a gap when you bite down ^[1].

Researchers believe that the altered enamel in AI may indirectly influence how the jaw and facial bones develop over time ^[2]. However, an open bite is not a guaranteed outcome for everyone with AI, and it does not perfectly correlate with specific genetic subtypes of the condition ^[3].

Orthodontic Options Without Surgery

If your open bite is relatively mild or driven mostly by the angle of your teeth rather than a severe jawbone discrepancy, it might be correctable without surgery.

A highly effective orthodontic approach for some patients is the Multiloop Edgewise Archwire (MEAW) technique ^[4]. Rather than using standard straight wires, MEAW uses wires bent into complex loops. These loops allow the orthodontist to push the back teeth upward into the gums (intrusion) and tilt the entire set of teeth to close the front gap ^[5]. This technique can “camouflage” the skeletal mismatch—meaning the underlying jawbones remain in their misaligned position, but the teeth themselves are tilted to compensate and effectively close the bite ^[5][6].

However, orthodontic treatment in AI comes with unique hurdles:

• Preventing tooth breakage: Because AI teeth are fragile, patients understandably worry that the pressure of braces will break their teeth. Orthodontists must use extremely careful, light forces to safely move the teeth without fracturing the weak enamel ^[7][8].
• Bonding difficulties: Because AI enamel is structurally different, it is much harder for braces brackets to stay glued to the teeth ^[7][9]. While some patients wonder if clear aligners (like Invisalign) can bypass this issue, severe AI open bites generally require the precise control of fixed braces ^[10][11]. Even clear aligners require small glue “attachments” bonded to the teeth to work properly ^[9].
• Sensitivity and gum health: AI patients frequently experience severe tooth sensitivity and gum inflammation, which must be proactively managed to keep the mouth healthy during treatment ^[12][13].

Jaw Surgery for Severe Open Bites

When the open bite is severe and driven by the underlying bone structure, orthodontics alone may not be enough. In these cases, orthognathic surgery (jaw surgery) is indicated to permanently correct the skeletal mismatch ^[14][11].

Common surgical procedures for AI patients include:

• Le Fort I osteotomy: A procedure where the surgeon carefully separates the upper jaw (maxilla) and repositions it to close the bite ^[11][15].
• BSSO (Bilateral Sagittal Split Osteotomy): A procedure to carefully cut and reposition the lower jaw (mandible) so that it aligns correctly with the newly positioned upper jaw ^[11][15].

What to Expect During Surgical Recovery

Jaw surgery is a major procedure, and understanding the recovery process is critical for your peace of mind. Patients typically must adhere to a strict liquid or pureed food diet for several weeks immediately following surgery while the bones begin to fuse ^[16]. Complete healing of the bone can take around 3 months ^[16].

A common and important risk to discuss with your surgeon is temporary or permanent numbness (neurosensory disturbance) in the lips, cheeks, or chin ^[17][18]. This occurs because the nerves in the jaw are stretched during the procedure. While sensation usually returns as the nerves heal, some degree of numbness can be permanent ^[17][18].

Timing and the “Team Approach”

Timing is critical if surgery is a possibility. Orthognathic surgery should only be performed after you have completely finished growing, usually in late adolescence or early adulthood ^[13][15]. Your team may use neck X-rays (cervical vertebral maturation staging) to confirm that your skeletal growth has officially stopped before planning surgery ^[19].

Treating an open bite in AI is rarely done by one doctor. It requires a highly coordinated, interdisciplinary team working together over a timeline of several years ^[10][11]:

1. The Orthodontist aligns the teeth in preparation for surgery.
2. The Oral Surgeon repositions the jawbones to close the open bite.
3. The Prosthodontist (a specialist in tooth restoration) waits for the surgical sites to heal, and then places final crowns or restorations over the teeth. This critical final step protects your fragile enamel and locks the new bite into a stable, long-term position ^[11][15][20].