How Underbite Correction Actually Works.

How Underbite Correction Actually Works.
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How Underbite Correction Actually Works.Clinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. Palate Expanders
  2. Jaw Surgery
  3. Kids & Adult Braces
  4. Adult Aligners
  5. Common Misconceptions
  6. Professional Assistance
  7. References

Dentists use the term prognathism to describe an underbite. You might call the same condition unsightly.

how to correct an underbite

Your bottom teeth should fit beneath your upper teeth rather than shooting forward and asking for attention. If you have an underbite, or you've discovered that your child has the condition, treatment options include:

  • Expanders: Use these tools in kids, when their bones are growing, to shift the jaws into the right position.
  • Jaw Surgery: Adults with closed growth plates can opt for surgery to straighten their jaws.
  • Braces: Metal brackets and wires, either with or without surgery, can amend tooth position.
  • Aligners: A mild underbite could benefit from treatment with convenient plastic trays.

Let's discuss each option in detail so you can make a smart decision.

For kids: palate expanders.

During childhood, jawbones grow incrementally along fault lines called growth plates. Intervening early, before those plates close, can mean optimizing a child's smile without heavy-duty hardware or surgery.

Underbites in kids can stem from small upper jaws. The teeth crowd and bunch together, and the lower teeth slide in front of their upper counterparts. A palate expander:

Is Invisible
The device sits on the roof of the mouth, with wires that wrap around back teeth. No one will know your child is having work done.
Slowly Expands
Orthodontists use a key to make the device bigger, and the bones respond by widening.
Works Fast
Experts say kids wear these devices for three to six months.

Jaw pressure is uncomfortable. Not surprisingly, palate expanders can and do cause pain. Researchers say the discomfort lessens after about 10 lengthening appointments, and it's the worst at the sixth visit. In some cases, your child may need over-the-counter pain medication to ease discomfort.

Palate expanders don't directly straighten teeth. Instead, they create more space for tooth growth. Sometimes, teeth use that newfound room to straighten themselves. But often, kids follow up palate expanders with a round of braces or aligners to perfect their smile.

For adults: jaw surgery.

When growth plates fuse, it's nearly impossible to use tools like palate expanders to adjust their shape. If your underbite is severe, your doctor may recommend surgery to bring your smile into alignment.

During surgery, doctors break existing bones and lengthen them using rods and screws. Your smile is permanently altered with one surgery, and you don't need a follow-up procedure to remove the hardware.

Your doctor might suggest this intervention:

After Treatment with Braces or Aligners
You'll wear braces for 12 to 18 months before surgery, experts say. Your aligner time might be much shorter. When your teeth are straight, your doctor uses surgery to finish perfecting your smile.
Before Braces or Aligner Therapy
The surgery-first approach involves optimizing your jaw before straightening your teeth. Experts say this is a good option for people with jaws that are mildly crowded with teeth00630-7/abstract).

Like all surgical procedures, jaw alignment comes with risks. You need general anesthesia, and your organs must clear those chemicals when the cutting is done. You also face the risk of blood clots, infections, and slow healing times. Bone surgeries can also be quite painful, and you'll need medication as you heal.

You may also experience a shift in breathing patterns, researchers say. Your jaws influence the width of your airway, and pushing the lower set back can reduce the amount of oxygen flowing into your body. If you had breathing problems before surgery, this could be a serious risk.

Several nerves run through your face and lips, and surgery can nick them. In severe cases, you can experience persistent numb lips after surgery. In a study of the issue, only 44 percent of people had normal lip sensation after jaw surgery.

When lower teeth peek out in front of upper counterparts, braces, surgery, aligners, and expanders are a few available treatment options, while some people use all of these tools to fix their smiles.

For kids and adults: braces.

Some people use braces before or after jaw surgery to straighten their teeth. Others skip the surgery altogether and rely solely on braces to amend an underbite.

Common appliances used with braces include:

  • Brackets: Metal brackets are glued to the teeth. They work as anchors for other pieces of hardware in the mouth.
  • Wires: Metal wires connect all the upper teeth and all the lower teeth.
  • Anchors: Hooks and special brackets dot the smile.
  • Bands: Rubber bands attach to anchors.

For someone with an underbite, the bands might connect upper and lower teeth in a crisscrossing pattern. The therapy is slow, as teeth need time to move.

Researchers say most people wear rubber bands for four to six months, and some switch to a different type of band eight months later. But this therapy could eliminate the need for surgery, and for many people, that's worthwhile.

Band therapy is uncomfortable. The pressure is constant, and if bands snap, they can hit cheeks and teeth with incredible force. Brackets and wires can also poke and press on cheeks and gums, causing even more discomfort.

For adults: aligners.

Aligners are plastic trays molded to the shape of your teeth. Experts use 3D modeling to predict how your teeth should move over time, and they create new trays to guide your teeth into new positions. Aligners can, in some cases, be used to amend an underbite.

Aligners tend to work best:

With Surgery
After jaw adjustment surgery, aligners complete the work and push the teeth into new positions. Researchers say they can do this work within three months.
To Address Mild Issues
Even without surgery, aligners can help jaws to take up new positions. But the treatment tends to work best in mouths with minor, not major, alignment problems. This might change, researchers say, as aligner therapy grows and changes all the time.

Aligners tend to cause less pain than braces. They don't come with wires and brackets to poke and prod.

But aligners can come with side effects. Researchers say, for example, that some people clench their teeth while wearing aligners. That can cause sore muscles.

Common misconceptions.

lenty of people have questions about how underbite correction works. Many more hold misconceptions about therapy that can keep them from getting the help they need.

Common misconceptions involve:


You aren't required to choose between braces, aligners, and surgery. Some people use combinations of two solutions. Others use all three as they amend their teeth.

Each tool works in a different way and delivers different results. You may need the help of every tool we've mentioned. If you do, an orthodontist and oral surgeon will guide you through the process.

Braces Dominance

Braces always seem to come first in discussions of underbite correction. They are valuable solutions for some people, but they aren't the only option open to you.

Other options might work better to amend your smile. If you are looking for a more discrete, affordable, and faster treatment approach, aligners might be a good fit.

Only Cosmetic Concerns Driving Treatment

An underbite can be unsightly, and researchers say that people tend to experience an improved quality of life when therapy is over and they look better.

But underbites also strain muscles and teeth. Sometimes, they make cleaning hard. It's reasonable to fix the issue to protect overall health.

Consult a professional.

Underbites are both common and treatable. People with the issue shouldn't let misinformation and miscommunication keep them from the help they need.

If you have a minor to moderate overbite, you might start with a consultation with an aligner company. This comes in the form of an impression kit you’ll use at home to take molds of your teeth. A doctor will review these impressions and determine if their aligner product can correct your underbite.

If you aren’t a candidate for aligners, talk to an orthodontist about the best treatment path for you. Severe overbites may require a combination of approaches like surgery, braces, or aligners.


Palatal Expanders. (August 2012). Dear Doctor.

Reports of Pain by Children Undergoing Rapid Palatal Expansion. (February 2000). Pediatric Dentistry.

Surgical Treatment to Correct a Bad Bite: Frequently Asked Questions. (November 2018). University of Iowa.

Surgery-First-Orthognathic-Approach (SFOA) to Prognathism: Indications and Limitations. (August 2008). Journal of Oral and Maxillofacial Surgery.

Change of the Airway Space in Mandibular Prognathism After Bimaxillary Surgery Involving Maxillary Posterior Impaction. (June 2016). Maxillofacial Plastic and Reconstructive Surgery.

Asymmetric Mandibular Prognathism: Outcome, Stability and Patient Satisfaction After Surgery. A Retrospective Study. (December 2014). Journal of Cranio-Maxillofacial Surgery.

Nonsurgical Treatment of Mandibular Prognathism in Adults. (August 2017). Journal of Dentistry and Oral Biology.

Clear Aligner Use Following Surgery-First Mandibular Prognathism Correction. (September 2019). Journal of Craniofacial Surgery.

Effect of Clear Aligner Therapy on Jaw Motor Function. (November 2019). University of Toronto.

Moving Toward Precision Orthodontics: An Evolving Paradigm Shift in the Planning and Delivery of Customized Orthodontic Therapy. (June 2017). Orthodontics and Craniofacial Research.

Reduction Genioplasty Enhances Qualify of Life for Female Patients With Prognathism and Maxillary Hypoplasia Undergoing Bimaxillary Osteotomy. (September 2013). International Journal of Oral and Maxillofacial Surgery.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.