Invisalign System as a Treatment of a Skeletal Open Bite: A Case Report With a 5-Year Follow-up

Background: Orthodontic treatments of skeletal open bite are among the most challenging and at high relapse. Available therapies vary from behaviour-modifying appliances in growing patients to surgical approach in adults. Recently, clear aligners, such as Invisalign®, have also been proposed as a treatment modality, to be used alone or in combination with temporary anchorage devices. Case report: A 19-year-old female presented with 3-mm anterior open bite, peg-shaped upper lateral incisors, incorrect tongue posture at rest and during function. Due to aesthetic request, an orthodontic camouflage with Invisalign® was carried out for 17½ months, along with myofunctional therapy and composite veneers on upper lateral incisors. During the first months of retention, intermaxillary vertical elastics were maintained at night-time as positive feedback to the tongue. A 5-year follow-up confirmed stability of the results. Conclusions: A system of clear aligners in combination with myofunctional therapy was effective in the treatment of a skeletal open bite malocclusion, with stability at 5 years. The closure of the anterior open bite was obtained through a combination of lower molar intrusion, incisor extrusion and counterclockwise rotation of the mandible. In selected cases of optimal compliance, Invisalign® may constitute a feasible treatment option in management of open bite in non-growing patients.