Which Anterior Open Bite Is a TRICK? (Will Relapse) And which is a POTENTIAL TREAT? (Will Stay Nice)

I. Introduction
Dr. Amanda from StraightSmile Solutions presents a “trick or treat” diagnostic challenge.
Two anterior open bite cases with the same SNA, SNB, and incisor position, same patient, just different front teeth.
One is a trick (guaranteed to relapse). One might be a treat (potentially stable).
Which is which?

II. The Setup
Both cases: 10mm interarch distance, identical cephalometrics.
Key difference: One is a SPACING case. One is a CROWDING case.
That changes everything.

III. The Mechanics of Open Bites
When you close spaces, teeth retract. Retraction closes open bites naturally.
When you resolve crowding, teeth flare. Flaring opens bites further.
Spacing case = treat (potentially). Crowding case = trick (definitely).

IV. Why the Crowding Case Is a Trick
Fixing crowding will flare incisors and make the open bite worse.
Even if you somehow close it mechanically, the underlying cause remains.
If the original habit or myofunctional issue is still active, it will pop back open.
Bonded retainers, Essix, Hawley, doesn’t matter. It will relapse.
Patient will be pissed. You’ll be giving a refund at best.

V. Why the Spacing Case Might Be a Treat
Closing spaces retracts teeth, which helps close the bite.
Mechanics work WITH you instead of against you.
But, and this is critical, only if the underlying cause is GONE.

VI. The Real Issue: Open Bites Don’t Just Happen
95% of dentists rely on patient history: “They said they stopped thumb sucking.”
Patient said it doesn’t work. Not objective. Not evidence. Not defensible.
Will that stand up in court? No. Dental board? No.
You need objective screening. In-house myo assessment. Referral to a myofunctional therapist if needed.

VII. The OMT Requirement
Before touching an AOB case, get clearance from a myofunctional therapist.
Therapy takes 6-18 months; it’s watching grass grow.
May involve surgery, periodontics, cervical chiropractor. Rarely covered by insurance.
Dr. Amanda spent $10-15K on her own OMT journey. Worth every penny.
Her speech, breathing, face, and health all improved afterward.

VIII. The Bottom Line
Don’t take AOB cases. Seriously. Just don’t.
If you must, the spacing case is your only shot and only with OMT clearance.
The crowding case? A trap. A trick. A lawsuit waiting to happen.
Document everything. Get specialists involved. And know that even then, relapse is common.
Some things are better referred to. Anterior open bites are one of them.