If your lower front teeth sit in front of your upper front teeth when you bite, you have what most people call an underbite. Dentists may also describe this as a Class III bite. For some people, it is very minor and doesn’t really cause a problem. For others, it can affect the appearance of their smile, the way their teeth meet, chewing, tooth wear or simply how they feel about their teeth.
A question we hear fairly regularly is whether Invisalign can fix an underbite without braces, extractions or jaw surgery. Sometimes it can. But the more important question is: what is actually causing the underbite?
Not All Underbites Are the Same
An underbite can come primarily from the position of the teeth, from the relationship between the upper and lower jaws, or from some combination of the two. That distinction matters quite a bit.
A Dental Underbite
Sometimes the jaws themselves are reasonably well positioned, but the teeth have developed or moved into a relationship where the lower front teeth sit ahead of the uppers. These cases can often be treated orthodontically by changing the position of the teeth. Depending on the individual situation, Invisalign can be a very reasonable option.
A Skeletal Underbite
In other patients, the problem is more closely related to the jaws themselves. The lower jaw may be positioned farther forward, the upper jaw may be relatively deficient, or there may be a combination of the two. In an adult, Invisalign doesn’t fundamentally change the size or basic position of the jaw bones.
What orthodontic treatment may be able to do is move the teeth within those jaws and improve the way they meet. In some cases, this can camouflage the underlying skeletal discrepancy very effectively. In other cases, the discrepancy is simply too significant for orthodontic treatment alone to provide the result the patient wants. That’s where proper assessment becomes particularly important.
How Can Invisalign Help an Underbite?
Invisalign uses a series of removable clear aligners to gradually move the teeth toward planned positions. For some Class III or underbite cases, aligners alone may be enough. In others, elastics, commonly called rubber bands, may be used along with the aligners to help change the relationship between the upper and lower teeth. Elastics can be extremely useful, but patients have to wear them for them to work.
That sounds obvious, but compliance is a major part of orthodontic treatment. A technically ideal treatment plan isn’t necessarily the best treatment plan if the patient knows they will not follow it. The same applies to extractions or surgery.
Some patients are very clear from the beginning that they are not interested in elastics, don’t want teeth extracted, or would never consider jaw surgery. That doesn’t necessarily mean there is nothing we can do. It means we have to understand the limitations, decide what is realistically achievable within those boundaries, and determine whether the likely improvement is worthwhile to the patient.
Invisalign, Braces or Jaw Surgery?
There isn’t one answer that applies to every underbite.
Invisalign
For selected cases, Invisalign can provide a significant improvement in tooth position and the way the bite comes together. It is removable, relatively inconspicuous and, for many adults, much easier to integrate into daily life than conventional braces.
Braces
Traditional braces remain an excellent orthodontic tool. There are situations where the movements required are better or more predictably accomplished with braces, particularly as cases become more complicated. That doesn’t necessarily mean braces are required for everyone with an underbite.
Jaw Surgery
When there is a significant skeletal discrepancy, surgery may be the treatment that most completely addresses the underlying problem. But not every patient wants that. For someone who is opposed to surgery, the question then becomes whether orthodontic treatment can produce enough improvement to make treatment worthwhile while accepting the limitations of what orthodontics alone can accomplish. Those are very individual decisions.
What About Children With an Underbite?
Children are different. In a growing child, we may have opportunities to influence growth and jaw relationships that we simply don’t have once growth is complete. For that reason, an underbite in a child deserves an orthodontic assessment rather than assuming that the same treatment approach used for an adult will apply. Early assessment doesn’t necessarily mean early treatment, but it gives us the opportunity to understand what is developing and whether timing might matter.
How Do We Assess an Underbite at NEESH Dental?
The first step is really just to have a look. At NEESH Dental, our assessment includes examining your teeth and bite and taking a 3D digital scan. We also use photographs and appropriate X-rays where indicated. The scan gives us a very detailed record of your teeth and allows us to look at possible tooth movements and treatment options.
If we think there is a significant skeletal component or the case is beyond what should reasonably be managed in general practice, we refer to an orthodontist for a more comprehensive orthodontic assessment. There is no benefit in pretending that every underbite can or should be treated with Invisalign. The objective is to understand the problem first and then discuss what the realistic options are.
If Your Underbite Bothers You, Start With a Consultation
Having an underbite doesn’t automatically mean you need braces, extractions or jaw surgery. It also doesn’t mean Invisalign will necessarily be able to correct everything. If your bite or the appearance of your teeth is something that bothers you, I think it is worth finding out what your options actually are rather than assuming what treatment you would need.
It starts with a consultation. We can examine your bite, take a 3D scan, discuss what you would and wouldn’t be comfortable with, and give you a realistic idea of what may be possible. If the case should be treated by an orthodontist, we will tell you that as well. The point is simply to understand the options before deciding what, if anything, you want to do.
Frequently Asked Questions (FAQs)
Can Invisalign Fix a Severe Underbite?
Sometimes Invisalign can still produce meaningful improvement in a more significant underbite, but severity is only part of the question. We also need to know how much of the problem is coming from the teeth and how much is coming from the jaws.
A significant skeletal Class III relationship has limitations that moving teeth alone cannot completely overcome. That doesn’t automatically mean a patient has to choose surgery. It simply means that the goals of treatment and the limitations need to be understood before starting.
Do You Have to Wear Elastics With Invisalign?
No. Some underbite cases need elastics and others don’t. If elastics are required to achieve a particular movement, however, they need to be worn consistently for that treatment plan to work as intended.
If you already know that you are not willing to wear elastics, tell us. That is useful information. We would much rather design a treatment plan around what you are realistically prepared to do than design the theoretically perfect treatment that doesn’t fit your life.
Is Invisalign Better Than Braces for an Underbite?
Not necessarily. The better treatment is the one that is appropriate for the particular problem and for the person receiving the treatment.
For one patient that might be Invisalign. For another it might be braces. For someone with a significant skeletal discrepancy who wants full correction of the jaw relationship, it might involve surgery. And for another patient, a more limited orthodontic correction may be completely satisfactory.