Surgery and TADs Outpaced Fixed Appliances on Open Bite; Aligners Showed No Edge

Edited by Dentaltown staff

Orthognathic surgery and temporary anchorage device-supported therapy were associated with greater vertical skeletal correction than fixed appliances in adults with anterior open bite, while clear aligner therapy showed no such advantage, according to a systematic review and network meta-analysis published Aug. 20 in BMC Oral Health.

The analysis pooled 16 cohort studies and one randomized controlled trial covering 894 non-growing patients, comparing four approaches: fixed appliances, clear aligner therapy, temporary anchorage device-supported therapy, and orthognathic surgery.

In mild-to-moderate open bite, surgery reduced anterior face height by 3.54 mm more than fixed appliances, and TAD-supported therapy by 2.33 mm more. Mandibular plane angle fell 2.50 degrees further with surgery and 1.42 degrees further with TADs.

The gap widened as severity increased. In severe open bite, the anterior face height reduction relative to fixed appliances reached 5.70 mm for surgery and 4.56 mm for TAD therapy. For mandibular plane angle, only TAD therapy showed a more pronounced effect in severe cases, at 4.32 degrees.

Both surgery and TAD therapy also produced significantly greater maxillary posterior intrusion than fixed appliances, and that difference likewise grew with severity. Clear aligner therapy and fixed appliances showed no significant difference in vertical skeletal change.

On the dental side, less incisor extrusion tended to accompany surgery and TAD therapy in mild-to-moderate cases, and TAD therapy alone in severe cases.

Nantharat Apiwantanakul, Kunlawat Thadanipon, Amarit Tansawet, Pawin Numthavaj, and colleagues conducted the review, searching MEDLINE, Scopus, Embase, Cochrane CENTRAL, and Google Scholar through December 2025 and assessing risk of bias with Cochrane criteria.

Sixteen of the 17 included studies were non-randomized cohorts, and the authors described the pooled evidence as carrying predominantly high risk of bias. They cautioned that the estimates should be read with that limitation in view.

Sources:
BMC Oral Health, “Dentoskeletal effects of orthodontic and surgical treatments in non-growing patients with anterior open bite: a systematic review and network meta-analysis,” published online Aug. 20, 2026: link.springer.com/10.1186/s12903-026-09620-9