Treatment Options for Underbites

An underbite occurs when the lower front teeth sit in front of the upper front teeth.

Etiology

This skeletal pattern has a large genetic component. A small upper jaw often patterns with enlarged tonsils, mouth breathing, low tongue posture, and nasal blockage. 1

Treatment

Treatment for this dental and skeletal pattern is predictable if initiated early. The upper jaw is connected to the base of the skull at a series of sutures - growth plates of the bones. If we connect an appliance (maxillary expander) to the upper teeth in a growing child and apply a forward force, we can expand and grow the sutures. We can additionally attach a protraction facemask to the appliance, applying an extra-oral force. This will help guide forward growth of the upper jaw. These treatment plans are a predictable, stable, and efficient way to help correct an underbite in a year or less. 2

Timing

The ideal time to treat an underbite is by age six or earlier. After age eight, predictability decreases. By age nine, most changes achieved with tooth-borne appliances are dental rather than skeletal. 3, 4

Benefits

Maxillary protraction can increase airway dimensions and potentially reduce the risk of obstructive sleep apnea in children. 5 For older patients, TAD-based appliances can be used to achieve maxillary protraction without the need for invasive surgery. 6, 7, 8

If you or someone in your family has an underbite, please come see us to learn about treatment options, no matter your age. We will complete a complimentary consultation, including imaging, and review the treatment options available.

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Reference List

1. Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing, and malocclusion. Acta Otorhinolaryngol Ital. 2016 Oct;36(5):386-394. doi: 10.14639/0392-100X-770. PMID: 27958599; PMCID: PMC5225794.)
2. Ngan P, Moon W. Evolution of Class III treatment in orthodontics. Am J Orthod Dentofacial Orthop. 2015 Jul;148(1):22-36. doi: 10.1016/j.ajodo.2015.04.012. PMID: 26124025
3. Ngan P, Fields H. Orthodontic diagnosis and treatment planning in the primary dentition. ASDC J Dent Child. 1995 Jan-Feb;62(1):25-33. PMID: 7775680.
4. Ngan P, Wilmes B, Drescher D, Martin C, Weaver B, Gunel E. Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment. Prog Orthod. 2015;16:26. doi: 10.1186/s40510-015-0096-7. Epub 2015 Aug 25. PMID: 26303311; PMCID: PMC4547969
5. Ming Y, Hu Y, Li Y, Yu J, He H, Zheng L. Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2018 Feb;105:138-145. doi:10.1016/j.ijporl.2017.12.013. Epub 2017 Dec 14. PMID: 29447802
6. Feng X, Li J, Li Y, Zhao Z, Zhao S, Wang J. Effectiveness of TAD-anchored maxillary protraction in late mixed dentition. Angle Orthod. 2012 Nov;82(6):1107-14. doi: 10.2319/111411-705.1. Epub 2012 Mar 29. PMID: 22458766; PMCID: PMC8813151
7. Suresh S, Sundareswaran S, Sathyanadhan S. Effect of microimplant assisted rapid palatal expansion on bone-anchored maxillary protraction: A finite element analysis. Am J Orthod Dentofacial Orthop. 2021 Oct;160(4):523-532. doi: 10.1016/j.ajodo.2020.04.040. Epub 2021 Jun 30. PMID: 34215468.
8. Ngan P, Moon W. Evolution of Class III treatment in orthodontics. Am J Orthod Dentofacial Orthop. 2015 Jul;148(1):22-36. doi: 10.1016/j.ajodo.2015.04.012. PMID: 26124025.

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We offer our patients in Seattle braces, Seattle orthodontic expansion, Seattle Invisalign, Seattle sleep apnea treatment, and Seattle surgical orthodontic treatment. We offer our patients in Bellevue braces, Bellevue orthodontic expansion, Bellevue Invisalign, Bellevue sleep apnea treatment, and Bellevue surgical orthodontic treatment.