Open Bite in Barcelona

That’s the first question we need to answer, because the treatment is completely different. An open bite occurs when the teeth are misaligned (often due to a habit of pushing the tongue between them while swallowing), but the maxilla and mandible are properly positioned: it is treated with orthodontics and, when a tongue habit is present, with speech therapy. A skeletal open bite, on the other hand, is a problem with the facial bones: the upper jaw has grown too far downward, the lower jaw has an unfavorable rotation, or both. In this case, moving only the teeth with braces can temporarily close the bite, but relapse often occurs because the bone structure continues to push it open. At Clínica Birbe in Barcelona, we perform a differential diagnosis using a clinical examination, cephalometric teleradiography, and CBCT before recommending any treatment. Knowing the correct type from the start is the best way to prevent recurrence.

Because in many cases of skeletal open bites, orthodontic treatment can temporarily close the bite, but the bone structure that caused it remains. When the braces are removed, the weight of the tongue, the facial muscles themselves, and the pattern of vertical growth cause the bite to open up again within a few months or a few years. Added to this, in many cases, is an untreated tongue-thrust habit: the patient continues to push the tongue between the teeth when swallowing between 1,000 and 2,000 times a day, and that overcomes any orthodontic retention. That is why, when the diagnosis confirms a skeletal component, it is not a matter of “longer” or “stronger” orthodontic treatment: it is orthodontic treatment combined with orthognathic surgery and, if necessary, speech therapy. It is the only way to achieve a result that remains stable over time.

Yes, in select cases. When the problem is limited to an open bite and there are no other abnormalities—no prognathism, long face, asymmetries, or associated aesthetic issues—unimaxillary orthognathic surgery may be considered. The two common techniques are posterior maxillary impaction (raising the back of the upper jaw so that the mandible rotates and closes the bite) or counterclockwise rotation of the mandible. These procedures are less extensive than bimaxillary surgery, with a somewhat more comfortable postoperative recovery, and are very effective when performed for the right indication. If, on the other hand, there are associated abnormalities (short or long jaw, long face, asymmetries), bimaxillary advancement typically yields better functional and aesthetic results. Dr. Birbe uses 3D planning before surgery to determine which technique is best suited for each case.

In cases of open bites with atypical swallowing or tongue interposition, speech therapy is not an optional add-on: it is part of the treatment. The tongue is one of the strongest muscles in the body relative to its size, and if it continues to push forward between the front teeth when swallowing and speaking, it will eventually undo any orthodontic or surgical results. That is why, at Clínica Birbe, we work with a speech-language pathologist starting from the diagnostic phase to correct the resting position of the tongue, the swallowing pattern, and, when necessary, the articulation of the affected syllables. In adult patients, it requires persistence (it’s usually a 6- to 12-month process), but that’s what turns a good short-term result into a stable result 10 or 20 years down the road. Performing orthodontic treatment or placing braces without correcting a tongue habit—when one exists—is a recipe for relapse.

Orthognathic surgery to correct severe malocclusions, including skeletal open bite with functional repercussions (mastication, speech, TMJ), is covered under the National Health System and CatSalut in Catalonia when there is a documented medical indication. In practice, wait times are long, prior orthodontic treatment is not usually covered (which accounts for a significant portion of the actual cost of treatment), and very few public facilities perform orthognathic surgery frequently enough to maintain experienced teams. In the private sector, some mutual insurance companies partially cover the surgical procedure, depending on the policy, but rarely cover the orthodontic phase. At Clínica Birbe in Barcelona, we help each patient review their insurance policy, prepare the necessary reports, and understand exactly what each treatment option covers before making a decision. And we offer a fixed-price quote and financing options so that the financial aspects are transparent from day one.