Non-Surgical Correction of an Anterior Open Bite and Lisp - 11 Years On
SUZI JOSEPH 11 YEAR STUDY one visit Smile Lift
Suzi, a charismatic patient, had lived for years with an uneven bite that affected far more than her smile. A visible gap between her upper and lower teeth was contributing to a lisp, and the discomfort of her bite – alongside general tooth discolouration – had left her self-conscious about something as simple as speaking and smiling with confidence. What Suzi didn’t fully appreciate until afterwards was how much correcting her bite would improve not just her appearance, but her speech and day-to-day comfort.
COMPLEX AESTHETICS: ANTERIOR SKELETAL CLASS I/III OPEN BITE
Understanding an Anterior Open Bite
An anterior open bite occurs when the upper and lower front teeth don’t meet, leaving a visible gap even when the back teeth are closed together. It can develop for several reasons – in Suzi’s case, likely linked to childhood thumb-sucking and a residual tongue thrust, which had shaped a “V”-shaped upper arch with large negative spaces on both sides.
Left uncorrected, an open bite doesn’t just affect appearance. It can influence speech, contributing to a lisp, and place uneven pressure on the back teeth over time. Suzi also showed general canting of her tooth alignment and centreline, an uneven gum line, and a smile line that canted to one side – all part of the same underlying skeletal pattern.
Initial Presentation
Examination, study models, photographs and x-rays confirmed general tooth discolouration alongside the anterior open bite, canted centreline, and uneven gum line. The premaxillary segment – the upper front part of the jaw – had tipped upward against the maxilla’s normal downward growth pattern, contributing to the overall asymmetry. Suzi’s periodontal health and jaw function were otherwise stable, giving us a solid foundation to work from.
Because Suzi also showed a tendency to grind on her back teeth, a night guard was planned from the outset to protect both her natural teeth and any future restorations.
Treatment Approach
The aim of treatment was to improve dental harmony while complementing Suzi’s natural facial appearance – correcting the jaw discrepancy, anterior open bite and midline deviation without surgery.
To achieve this predictably, we used a diagnostic process developed by Dr Sarkis Nalbandian: applying tooth-coloured material directly to the teeth, without permanent bonding, to test speech, comfort, and both dental and dentofacial aesthetics before committing to any irreversible treatment. This is where art meets science.
Following this composite mock-up, we assessed Suzi’s speech, smile line and overall aesthetics together. The results were clear: her speech improved, with a noticeably diminished lisp, alongside improved comfort and appearance.
Given the stage of Suzi’s life and time factors involved, orthodontic or surgical correction wasn’t the right option. We also discussed porcelain veneers, but agreed this would require considerable, irreversible tooth preparation for limited additional benefit in this case. Composite veneers offered a genuinely conservative alternative — minimal intervention, biologically favourable, and easy to modify in shape, contour and colour if needed down the track.
Treatment involved composite veneers on the upper teeth (14, 13, 12, 11, 21, 22, 23 and 24), with selective composite build-up on the lower front teeth (31 and 41) to improve overall alignment, plus minor recontouring of the upper front teeth (11, 21) to refine the emergence profile. Slight gum recontouring was also planned at tooth 14, alongside composite restoration of lower cervical erosive lesions (teeth 34, 36, 33, 43, 44 and 45).
We were upfront with Suzi that this is best regarded as a long-term, provisional measure — one that can guide future reconstruction with porcelain veneers if she chooses, or simply be resurfaced with new composite materials over time to extend its life affordably. As with any cosmetic dental work, a short habituation period followed treatment, and ongoing 6–12 monthly check-ups help protect the longevity of both the restorations and Suzi’s oral health.
Treatment Outcome
The result was completed in a single visit -no drilling, no injections, and no pain. Because composite veneers require no cutting of the natural tooth structure, Suzi’s own teeth remained completely intact beneath the restoration.
The results had settled beautifully, with harmony and balance established between the dentition and surrounding soft tissue.
The original ten composite veneers were still performing well, a genuine testament to both the conservative approach and the accuracy of the original diagnostic planning.
One Smile says it all!
The results have stood the test of time. Suzi’s smile, speech and confidence have remained transformed for over a decade – proof that a non-surgical, minimally invasive approach can deliver results that genuinely last.
This is aesthetic dentistry at its best: zero tooth invasion, because the teeth underneath were, and remain, completely intact. It was a pleasure treating this charismatic patient – and most importantly, the result complemented her natural facial aesthetics as a whole, an outcome Dr Nalbandian describes as dentofacial rejuvenation.
About the Clinician
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)