Early Orthodontic and Orthopedic Interventions for Anterior Open Bite in the Mixed Dentition: A Systematic Review

Anterior open bite (AOB) is a complex malocclusion prevalent in the mixed dentition, with multifactorial etiology involving skeletal, dental, and habitual components. Early intervention during this developmental stage is advocated to correct the malocclusion and guide growth, but the most effective and stable approaches remain debated. This systematic review aims to evaluate the efficacy of early orthodontic and orthopedic interventions for correcting AOB in the mixed dentition. A systematic search was conducted across four electronic databases (PubMed, Embase, Web of Science, and ClinicalTrials.gov) for randomized controlled trials (RCTs) published from January 2020 to October 2025. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies investigated children in the mixed dentition treated for AOB with any early intervention. Study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool were performed independently by two reviewers. A qualitative synthesis was undertaken due to clinical heterogeneity. Eight RCTs were included. All interventions, including bonded spurs, palatal cribs, the rapid molar intruder (RMI), and functional appliances, demonstrated statistically significant overbite improvement, with mean increases ranging from 2.8 to 4.9 mm. The primary mechanism of correction was dentoalveolar, involving incisor extrusion and lingual tipping. However, the RMI produced favorable skeletal changes, such as reduction of the mandibular plane angle, indicating true orthopedic mandibular rotation. One study reported high long-term stability (92.31%) for bonded spurs at a four-year follow-up. Another study found that interventions, particularly those with posterior build-ups, significantly improved oral health-related quality of life. The overall risk of bias was low for most included studies. Early intervention for AOB in the mixed dentition is highly effective. A range of appliances can successfully correct the overbite, primarily through dentoalveolar adaptation, though some can induce positive skeletal changes. Treatment also demonstrates promising long-term stability and improves patient-reported outcomes. The choice of appliance should be tailored to the specific etiology and desired treatment goals. These findings support a proactive interceptive approach in managing AOB.