How to Avoid Posterior Open Bites (POB) with Posterior Crossbite Correction

1. Understanding the Risk of POB During Crossbite Correction

• Dr. Amanda from Straight Smile Solutions addresses the complications of correcting posterior crossbites, particularly the risk of developing posterior open bites (POBs).
• ClinCheck or other aligner planning setups like Clear Pilot may suggest that a crossbite is fixable, but their recommendations are based on AI estimations, not biological certainty.
• Just because software shows possible movement doesn’t mean it’s achievable, especially in adults, where bone doesn’t remodel easily.
• The bone must be present and responsive for safe expansion; adult bone often does not adapt the way children’s bone might grow.

1. Biological Limits of Expansion in Non-Growing Patients

• In non-growing (adult) patients, the risk of POB increases because the maxillary bone is often rigid and may not accommodate expansion.
• Courses or systems that promote “expanding away from crowding” oversimplify real biological constraints—Dr. Amanda labels this as “a load of BS.”
• Even orthodontists can’t always predict how bone will react; case progression should be monitored incrementally (expand → evaluate → repeat).
• Relying on software projections without imaging is risky—true bone response is unpredictable.

III. Importance of CBCT in Treatment Planning

• Incorporating CBCT imaging into aligner setups (e.g., Invisalign, Spark) gives clearer insight into whether there’s adequate bone support for expansion.
• CBCT doesn’t guarantee bone will move, but it confirms whether expansion is even anatomically possible from the outset.
• Without CBCT and cautious planning, the risk of creating an iatrogenic posterior open bite increases significantly.

1. Legal and Clinical Responsibility

• If aligners or wires are delivered without proper follow-up protocols, the clinician remains legally responsible, even if the patient ghosts or disappears.
• Emails, letters, and texts are not always enough to shift liability if a patient fails to return and complications arise.
• Clinicians must adopt a conservative, monitor approach when they treat complex crossbites, especially in non-growing adults.

1. Final Recommendations

• Do not rely solely on AI-generated plans for crossbite correction.
• Always evaluate the patient’s skeletal anatomy through CBCT when available.
• Proceed incrementally, reassessing throughout treatment to avoid POBs.
• Understand your liability in treatment outcomes—always document and follow up carefully.