Underbite Treatment in Shelby Township: How to Fix an Underbite
An underbite means the lower front teeth sit in front of the upper front teeth when the jaws close. Orthodontic specialist Dr. Thomas Fredal Jr. treats underbites at Fredal Orthodontics.
He treats growing children with a reverse-pull facemask. When a case needs jaw surgery, he coordinates it with an oral surgeon.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.
What Is an Underbite?
In a typical bite, the upper front teeth sit slightly in front of the lower front teeth. In an underbite, the lower front teeth sit in front of the upper ones. Orthodontists call it a Class III bite, or Class III malocclusion (a bite that does not fit together well). It can come from the teeth, the jaws or both.
Every case at Fredal Orthodontics is diagnosed in 3D with an i-CAT CBCT scan (a 3D X-ray) and an iTero digital scan. These show Dr. Fredal the roots, the bone around them, how the jaws relate and the airway, not only the crowns (the visible parts) of the teeth.
His findings can change decisions such as whether to widen the jaw, guide growth, use braces or Invisalign, or recommend surgery.
Types of Underbite: Dental, Skeletal or Both
Dental Underbite
The jaws are a normal size and in a normal position. The underbite comes from the front teeth: the upper ones tip back, the lower ones tip forward, or both.
Skeletal Underbite
The jaws do not match. The upper jaw (maxilla) is small or set back, the lower jaw (mandible) is large or set forward, or both.
Combined
Both are present: the jaws do not match, and the front teeth are tipped as well.
When to Have a Child’s Underbite Checked
Dr. Fredal advises an orthodontic evaluation for every child by age 7. Each evaluation includes a 3D i-CAT CBCT scan. It lets him assess jaw growth, the teeth coming in and the airway.
He decides not only how to treat but when treatment should begin. He weighs growth, dental development, skeletal relationships (how the jaws relate) and the goals of treatment.
Dr. Fredal’s Approach to Early Treatment
Dr. Fredal is an advocate of early treatment, also called Phase 1 (treatment that starts while a child is still growing). When early treatment is indicated, he uses growth-guided approaches such as palatal expansion. Fredal Orthodontics treats children from age 7.
Underbite Correction at Fredal Orthodontics
Growing Children: Facemask and Palatal Expander (Phase 1)
For growing children, Dr. Fredal uses a reverse-pull facemask with a palatal expander. A palatal expander is an appliance that widens the upper jaw. The facemask is a removable frame worn on the face, connected by elastics to an appliance on the upper teeth.
Treatment includes three to four weeks of active expansion. During that time, parents turn the expander once a day at home.
Facemask wear is asked for during the evening and overnight, not through the school day, and children adapt faster than most parents expect. Dr. Fredal asks for 8 to 10 hours of wear a day.
Teens and Adults: Braces or Invisalign
For teens and adults, Fredal Orthodontics offers Damon Ultima braces and Invisalign clear aligners. Dr. Fredal gives his recommendation for your case at your consultation, after a personal review of your complete records with you.
When Does an Underbite Need Jaw Surgery?
Whether an underbite needs orthognathic surgery (jaw surgery) depends on the case. Dr. Fredal weighs how severe the skeletal (jaw) difference is. He also weighs facial balance and profile, the bite, tooth position, function and your goals.
When moving the teeth alone cannot properly fix the jaw difference, surgical orthodontic treatment may be discussed.
An oral and maxillofacial surgeon does the surgery. Fredal Orthodontics gives the orthodontic care before and after it, and works with your surgeon on the plan. Each surgical case is planned with Virtual Surgical Planning (VSP), which plans the surgery on a computer. The practice does not offer surgery-first care (surgery before any braces or aligners).
If You Also Have Jaw Pain
Dr. Fredal screens the bite, the jaw joints and the chewing muscles at the consultation, free of charge. You may have active or worrying TMD symptoms (problems with the jaw joints or chewing muscles). If so, treatment does not start until a qualified specialist has checked you and cleared you.
That may be an orofacial pain specialist or an oral and maxillofacial surgeon. It may also be Dr. Abigail Schmidt, DDS, MS, or the TMD and orofacial pain service at the University of Michigan.
Braces and Invisalign are not offered as a treatment or cure for TMD. Once you are cleared, treatment may go ahead when you need it for its own sake. The practice does not promise that TMD symptoms will get better.
Underbite Treatment Options Compared
| Treatment | Who It Is For | What It Involves | Price |
|---|---|---|---|
| Facemask + Expander | Growing children, in Phase 1 | A reverse-pull facemask. An expander widens the upper jaw from the middle of the roof of the mouth (midpalatal expansion) | $4,180 Phase 1 total |
| Metal Braces | Teens and adults, with or without jaw surgery | Damon Ultima self-ligating braces. They hold the wire without elastic ties. | $5,280 starting at |
| Invisalign | Teens and adults, with or without jaw surgery | Clear aligners you can take out | $5,280 starting at |
| Jaw Surgery + Orthodontics | When moving the teeth alone cannot fix the jaw difference | Surgery by an oral surgeon. Braces or aligners before and after, planned with VSP. | The surgeon bills on their own |
How Long Underbite Treatment Takes
| Stage | How Long | What Happens |
|---|---|---|
| Phase 1 facemask (growing children) | A typical facemask phase runs 3 to 6 months. Then Dr. Fredal checks the bite again. | Palatal expansion and facemask wear at night |
| Braces or Invisalign | About 12 to 18 months for many comprehensive cases (full treatment) | Dr. Fredal gives you an estimate for your own case once your records are reviewed. Braces visits are every 6 to 8 weeks. Invisalign visits are every 10 to 12 weeks. You switch to a new aligner each week. |
| Jaw surgery cases | 6 to 12 months before surgery and 3 to 9 months after | Braces or aligners before surgery. Then the surgeon does the surgery. Detailing (fine-tuning the bite) comes after. |
| Retainers | After treatment | One set of Essix retainers (clear plastic retainers) comes with comprehensive treatment. |
What to Expect at Your Consultation
-
Records.
You get a free CBCT scan on the i-CAT FLX V17. You also get an iTero Lumina scan of your teeth, and photos of your face and teeth. -
Your visit.
The visit takes 50 minutes. You spend 20 of them with Dr. Fredal, who leads every consultation himself. -
His advice.
He goes over all your records with you and tells you what he recommends. Sometimes he advises against treatment. -
The exact cost in writing.
You get the exact cost of treatment in writing. Before treatment starts, the team explains your orthodontic insurance benefits. It also gives you a clear estimate of what you will pay. -
Photo ID.
The practice asks for a photo ID at your first consultation.
Before & After
How Much Does Underbite Treatment Cost?
Phase 1 facemask and palatal expander: $4,180 total, $500 down
Comprehensive braces or Invisalign: $5,280, $6,880 or $7,175, by case complexity
Braces with MARPE: a package from $10,080, $2,000 down
Jaw surgery: The fee from Fredal Orthodontics covers the orthodontic part. That includes diagnosis, treatment planning, braces or Invisalign when appropriate, coordination with your surgeon, Virtual Surgical Planning and all orthodontic visits before and after surgery. The surgeon and the hospital or surgery center bill separately for the surgery, facility fees and anesthesia.
Medical insurance may provide benefits for the surgery when specific medical criteria are met. The team helps coordinate care with your surgeon and explains what each provider charges before treatment begins.
MARPE (miniscrew-assisted palatal expansion, which widens the upper jaw with the help of tiny screws) is offered for older teens and adults. Dr. Fredal coordinates placement of the mini-screws with a surgeon.
Your fee does not change with how long treatment takes. It includes every appliance your case needs, and elastics are included in comprehensive treatment.
Insurance & Financing
Fredal Orthodontics is in network with Delta Dental. For other PPO plans (preferred provider dental plans) it accepts, the team files your claims on your behalf as a courtesy. You get your benefits verification in writing. You can also pay with HSA or FSA funds (money in a health savings or flexible spending account).
In-house financing has 0% interest and no credit check, with monthly payments from $179 and plans of up to 30 months. The down payment is $750 for comprehensive braces or Invisalign. Cherry and CareCredit financing are also offered.
Paying in full takes 5% off by cash, check or ACH (a bank transfer), or 3% by credit card, on the part you pay after insurance. Phase 1 qualifies too. Insurance details Discounts.
Frequently Asked Questions About Underbite
What is the best age to treat an underbite?
It depends on the child, so the first step is an evaluation. Dr. Fredal advises one for every child by age 7, with a 3D CBCT scan to assess jaw growth, the teeth coming in and the airway. He then decides when treatment should begin, based on growth, dental development and how the jaws relate. Fredal Orthodontics treats children from age 7, as well as teens and adults.
Does my child wear the facemask at school?
No. Dr. Fredal asks for facemask wear in the evening and overnight, 8 to 10 hours a day, not through the school day. A typical facemask phase runs 3 to 6 months before he re-evaluates. The Phase 1 total for the facemask and palatal expander is $4,180, and every treatment fee includes the appliances a case needs.
Does Fredal Orthodontics use a chin cup for an underbite?
No. Fredal Orthodontics does not offer a chin cup. For a growing child, Dr. Fredal treats an underbite with a reverse-pull facemask together with a palatal expander. Teens and adults can be treated with Damon Ultima braces or Invisalign, and surgery may be discussed when the jaw difference cannot be properly treated by moving the teeth alone. He gives his recommendation at your consultation.
Can Invisalign fix an underbite?
It depends on your bite. For an adult thinking about Invisalign, Dr. Fredal checks whether the problem is mainly dental or skeletal. He also checks the roots, bone support, gums and how the bite works. If Invisalign cannot give the healthiest, most efficient or most predictable result, he recommends braces instead. If you start in aligners and need to switch to braces, it costs nothing extra.
Does Fredal Orthodontics treat underbites in adults?
Yes. Fredal Orthodontics treats children, teens and adults. Dr. Fredal routinely treats complex adult cases, including severe bite discrepancies and orthodontic preparation for jaw surgery. When moving the teeth alone cannot properly fix the jaw difference, surgery may be discussed. The practice then coordinates care with an oral and maxillofacial surgeon, who bills for the surgery separately.
Is an underbite consultation free?
Yes, for new patients, and it includes a free 3D CBCT scan. If you are in treatment with another orthodontist, a transfer consultation costs $250, credited toward treatment if you start here. A second opinion on treatment elsewhere is free. A return visit before you start is free too, unless you missed a consultation as a no-show; then it costs $100.
Related Conditions and Treatments
Concerned About an Underbite?
New patients can book a free consultation at Fredal Orthodontics in Shelby Township. It comes with a 3D CBCT scan. Community discounts take $250 off the part you pay after insurance, one per patient. They are for military, teachers and school staff, and first responders. They are also for health care workers, students and extra family members in treatment.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.