Clear Aligners Effective for Dentoalveolar Deep Bites, Less So for Skeletal Cases: Study

Clear aligners (CA) can effectively treat dentoalveolar deep bites but often require adjustments for precision and are less effective than fixed functional appliances (FFA) in managing skeletal bite cases, finds a recent study published in the journal of Clinical Oral Investigations. 

An excessive amount of vertical overlap between the maxillary and mandibular front teeth results in a deep bite, sometimes referred to as a deep overbite. A deep overbite occurs when the maxillary anterior teeth occupy more than one-third of the mandibular anteriors' crown length. A normal overbite is between two and four millimeters.

The teeth, surrounding periodontal tissues, and the TMJ are all negatively impacted by deep bites, which can result in problems with the appearance and functionality of oral structures. They may result in speech problems, gingival recession, and increased dental attrition. A deep bite affects 21.9% of the general population, according to the National Health and Nutritional Estimates Survey III.

The use of transparent aligners for deep bite correction has grown in popularity due to its comfort and cosmetic appeal. Additionally, when compared to braces, aligners allow for better oral hygiene maintenance, which reduces the risk of periodontal disease and shortens treatment times. The accuracy and efficacy of clear aligners for correcting deep bites in the skeleton and teeth were assessed in this systematic study.

From launch until May 2024, searches were done in PubMed, Cochrane, Embase, and grey literature. All age groups with skeletal and/or dental deep bites treated with CA were included in the studies, which might have either prospective or retrospective designs and included control groups. Risk Of Bias In Non-randomized Studies-of Interventions ("ROBIN-I") was used to measure the risk of bias.

A total of 18 of the 829 studies that were examined were included. There were 8 studies that evaluated the accuracy of CA, eight that evaluated its efficacy, and two that looked at both. In all investigations, the accuracy of deep bite correction varied from 33% to 48.88%, while the efficacy of bite opening ranged from 0.4 mm to 3.8 mm.

Despite comparable findings across trials, GRADE assessed the evidence for both CA accuracy and efficacy in deep bite therapy as low quality because to a high risk of bias, indirectness, and imprecision.

Overall, although CA can successfully treat mild to moderate dentoalveolar deep bites, it is still unclear how well it works in skeletal situations when compared to full-fixed appliances. Overcorrection or modifications are required to obtain the intended treatment outcomes because planned correction of deep bites with CA frequently falls short of the actual achieved repair.

Source:

Husain, F., Riccardi, J., Alletto, L., Stellrecht, E., Bejehmir, A. P., & Al-Jewair, T. (2025). Effectiveness and accuracy of clear aligners in treatment of deep bite: a systematic review. Clinical Oral Investigations, 29(6), 306. https://doi.org/10.1007/s00784-025-06381-7