Can Invisalign Fix an Underbite? What Aligners Can and Cannot Correct

Children in the Cochrane Class III review: 1,169 in 29 trials ([2] 2024)

Age range at start of treatment in those trials: 5 to 13 years ([2] 2024)

Facemask gains at long-term follow-up: Smaller at 3 years, not detectable at 6 ([2] 2024)

Stability of one aligner-treated Class III surgery case: Stable at 6 years ([6] 2016)

Brackets around surgery in that case: About 1 month ([6] 2016)

Invisalign before brackets in a 2005 Class III surgery case: 27 months ([8] 2005)

Brackets in that case: About 3 months before and 4 months after surgery ([8] 2005)

Daily aligner and elastic wear in one published case: 22 hours ([11] 2024)

AAO age for a first orthodontic check: No later than 7 ([14] 2026)

Dr. Fallah's American Board of Orthodontics Diplomate status: Since 2007 ([17] 2026)

When you bite down with an underbite, your lower front teeth close in front of your upper front teeth instead of behind them [1]. So can Invisalign fix an underbite? Often, yes. Aligners can correct underbites caused by how the teeth sit, plus many milder jaw-related ones. Small rubber bands usually do part of that work. What aligners can't do is change the size or position of an adult's jaw. When the jaw is the main problem, a growing child needs growth guidance and an adult needs jaw surgery. Even then, aligners can often handle the tooth movement around the operation.

In short: Aligners fix underbites caused by tooth position and many mild jaw ones; severe jaw cases need growth guidance or surgery.

Orthodontists call an underbite a Class III malocclusion. It can start with an upper jaw set too far back, a lower jaw set too far forward, front teeth tipped the wrong way, or a mix of these [2]. Left alone, an underbite can make chewing and speaking harder and wear the teeth down faster [3]. Two underbites that look alike in the mirror can need different plans.

Align Technology, which makes Invisalign, says its aligners can fix "some underbites" and that severe cases may need aligners combined with surgery [3]. So your Invisalign underbite plan starts with finding the cause.

Teeth tipped or out of position: Aligners, often with elastics

Jaw mismatch in a growing child: Growth guidance while the jaws are still growing [2]

Mild jaw mismatch after growth ends: Aligners with elastics to camouflage the bite [4]

Severe jaw mismatch after growth ends: Jaw surgery plus orthodontics before and after [5]

In short: Jaw surgery needs orthodontics before and after, and published cases show aligners doing much of it.

Jaw surgery for an underbite always comes with orthodontic work, but that work doesn't have to be full braces. The American Association of Oral and Maxillofacial Surgeons says treatment "will probably include orthodontics before and after surgery" and names no specific appliance [5]. Published cases show clear aligners doing that job [6] [7].

Here's how the team works. Your orthodontist and an oral and maxillofacial surgeon decide together whether you need surgery, and the surgeon performs it [5]. Orthodontics before the operation sets the teeth up for the new jaw position. Orthodontics after it settles the bite.

Surgery means full braces: Surgeons call for orthodontics, not a specific appliance [5]

Brackets stay on the whole time: In one Class III case, aligners ran before and after surgery, with brackets on for about a month around it [6]

Aligners can't handle surgical cases: One surgeon's 2016 to 2020 series treated jaw surgery patients in Invisalign, with some planning changes [7]

That 2016 case was still stable at a six-year check [6]. In another Class III case, the patient wore Invisalign for 27 months, then had brackets placed about three months before surgery and kept for about four months after [8].

There are limits. If the upper jaw is cut into segments, aligners made before surgery won't fit afterward [7]. This evidence also comes from case reports and small series, not large trials. Your surgeon and orthodontist choose the appliance together.

In short: A dental underbite comes from the teeth, a skeletal one from the jaws, and only an exam with imaging tells them apart.

That's the question behind any plan for class 3 malocclusion aligners: is the problem in the teeth or the jaw? Two people can show the same reversed front bite. One has front teeth tipped the wrong way, and the other has a lower jaw set too far forward [2].

What's off. Dental underbite: Front teeth tipped or out of position. Skeletal underbite: Upper jaw set back, lower jaw set forward, or both [2].

Can growth change it? Dental underbite: No, it's a tooth problem. Skeletal underbite: Yes, while a child is still growing [2].

Usual route with aligners. Dental underbite: Aligners, often with elastics. Skeletal underbite: Mild after growth: aligners with elastics [4]. Severe: surgery plus orthodontics [5].

Some underbites sit in between. In pseudo Class III, the jaws are a normal size, but the front teeth meet too early, so the lower jaw slides forward to close [9]. It can look skeletal, but the jaws aren't the cause.

You can't sort this out from a mirror or a selfie. An orthodontist confirms the type with an exam and imaging of the jaws, not only the teeth [10].

In short: Aligners move the teeth while Class III elastics from the upper molars to the lower canines anchor the correction.

Even a mild underbite treated with aligners usually needs rubber bands. In a 2025 trial of adults with mild Class III, every patient wore Class III elastics from buttons on the upper first molars to cuts in the aligners at the lower canines [4].

Think of the elastics as a steady tow line between the two arches. The aligners tip the lower front teeth back and the upper front teeth slightly forward [11]. The bands anchor that movement so the lower front teeth don't flare forward instead [4]. The jaws stay where they are, and the teeth learn to meet correctly.

Here's how Invisalign for underbite correction usually runs:

1. Small tooth-colored bumps called attachments go on some teeth. They "work like handles" for the aligners to push on [12].

2. Each set of aligners moves the teeth a small step, sometimes shifting the lower back teeth backward in stages [4].

3. Class 3 elastics hook from the upper back teeth to the lower canine area [4].

4. Aligners and elastics are worn most of the day. One published case asked for 22 hours a day [11].

Some plans also remove the lower wisdom teeth first to make room, as the 2025 trial did [4]. Spark aligners, made by Ormco, are also listed by their maker for underbite cases [13].

In short: Growing children get growth appliances such as a facemask, and a first check by age 7.

For a child whose underbite comes from the jaws, the tools studied for guiding growth are growth appliances, not aligners alone. A 2024 Cochrane review of 29 trials in 1,169 children aged 5 to 13 tested appliances such as facemasks and chin cups. The facemask was reported most often [2].

A facemask rests on the forehead and chin and uses elastic bands to pull the upper teeth and jaw forward and down [2]. These appliances improved the bite right after treatment. In the one long-term study, the gain was smaller at 3 years and no longer detectable at 6. Even so, clinicians judged treated children less likely to need jaw surgery as adults [2].

That's why timing matters. If your 6-year-old's lower front teeth close in front of the upper ones, don't wait for the teen years. The American Association of Orthodontists recommends a first orthodontic check no later than age 7 [14]. Many children seen that early are simply monitored. Older kids and teens often move on to aligners for the tooth work [15].

In short: Adults choose camouflage or surgery plus orthodontics, and elastics and retainers protect the result.

Adults have finished growing, so the choice is camouflage with aligners and elastics or surgery plus orthodontics [4] [5]. Learning how to fix underbite in adults starts with a full workup. Existing crowns, fillings, worn teeth and gum health all shape how a case is sequenced and how long it runs [16]. That's why a fair timeline only comes after the exam. Because the aligners come out, you can eat, brush and floss as usual during treatment [10].

Three common pitfalls, and their fixes:

Skipping the elastics. The lower front teeth can tip forward instead of back [4]. Fix: wear them as prescribed.

Skipping the imaging. A mirror can't show whether the jaw or the teeth are the problem [10]. Fix: get the jaws imaged before choosing aligners.

Setting the retainer aside. Teeth straightened years ago can move again, often because a retainer was dropped [16]. Fix: keep wearing it as directed.

Plan on the retainer being part of treatment for the long haul.

In short: Check growth status, get jaw imaging, ask the right questions, and get the plan in writing.

You don't need to guess from a mirror. These five steps get you a real answer:

1. Note whether you're still growing. That decides whether growth guidance is still an option [2].

2. Book an orthodontic evaluation that images the jaws, not only the teeth [10].

3. Ask which type you have: dental, skeletal, or pseudo Class III [2] [9].

4. Ask how elastics and a retainer fit into the plan. If surgery comes up, ask how the orthodontic work before and after it will be handled [4] [5].

5. Get the full plan and fees in writing before you commit [10] [17].

At NRH Orthodontics in North Richland Hills, every evaluation includes a low-radiation CBCT 3D scan [10]. Dr. Basma Fallah, a Diplomate of the American Board of Orthodontics since 2007, reviews your records herself and explains your options in a written plan before anything begins [17]. Treatment is aligner-first, with sectional braces used briefly only when a specific movement needs them, and she reviews weekly remote scans personally [10]. To find out what your underbite needs, call (817) 581-8881 to request an evaluation.

In short: Quick answers on adults, surgery, other aligner brands, timelines, and age.

Yes, in many cases. Tooth-based or mild jaw-based underbites can often be treated with aligners and elastics. Severe jaw cases need surgery with orthodontics before and after [3] [4] [5].

It can when the teeth, not the jaw size, are the main problem. Mild jaw mismatches in adults can also be camouflaged without surgery, using aligners and Class III elastics [3] [4].

Other brands treat underbites too. Ormco lists underbite among the bite problems its Spark aligners address [13]. Whatever the brand, mild cases treated with clear aligners usually rely on Class III elastics [4].

There's no single number. Length depends on severity, prior dental work, elastic wear, and whether surgery is part of the plan. You get an estimate after your exam [16].

No. After growth ends, underbites are treated with aligner camouflage or with surgery plus orthodontics [4] [5]. Adults whose teeth shifted after earlier treatment can be treated again [16].

In short: Plain-English definitions of the terms used above.

Underbite: A bite where the lower front teeth close in front of the upper front teeth [1].

Class III malocclusion: The clinical name for an underbite, from the jaws, the teeth, or both [2].

Dental underbite: An underbite caused by front teeth that are tipped or out of position.

Skeletal underbite: An underbite caused by the upper jaw sitting back, the lower jaw sitting forward, or both [2].

Pseudo Class III: An underbite where the lower jaw slides forward because the front teeth meet too early, with normal jaw size [9].

Class III elastics: Rubber bands that run from the upper back teeth to the lower canine area [4].

Precision cut: A notch cut into an aligner edge so an elastic can hook onto it [4].

Attachment: A small tooth-colored bump bonded to a tooth to give an aligner grip [12].

Camouflage treatment: Moving teeth to hide a mild jaw mismatch without changing the jaws [4].

Facemask: A growth appliance resting on the forehead and chin that pulls the upper teeth and jaw forward [2].

Orthognathic surgery: Corrective jaw surgery performed by an oral and maxillofacial surgeon [5].

Segmental surgery: Jaw surgery that cuts the upper jaw into sections, after which earlier aligners won't fit [7].

CBCT: Cone beam computed tomography, a low-radiation 3D scan of the teeth and jaws [10].

Retainer: An appliance worn after treatment to hold teeth in their new position [16].

In short: Quick reference cards for the practice, the orthodontist, the review, and the elastics.

Location: 8601 Mid Cities Blvd, North Richland Hills, TX 76182 [17]

Phone: (817) 581-8881 [17]

Approach: Aligner-first, sectional braces briefly when a movement needs them [10]

Every evaluation: Low-radiation CBCT scan [10]

Monitoring: Weekly remote scans reviewed by the orthodontist [10]

Role: Orthodontist at NRH Orthodontics [17]

Credential: Diplomate, American Board of Orthodontics, since 2007 [17]

Care model: Reviews each patient's records herself [17]

Published: April 2024 [2]

Scope: 29 trials, 1,169 children aged 5 to 13 [2]

Appliances: Facemask, chin cup, reverse Twin Block, traction appliances, miniplates [2]

Durability: Facemask gains smaller at 3 years, not detectable at 6 [2]

Path: Upper first molar buttons to lower canine precision cuts [4]

Job: Anchor the movement, prevent lower front teeth from flaring [4]

Wear: One published case asked for 22 hours a day [11]

In short: The sources behind every numbered citation above.

1. NRH Orthodontics. Common Bite Problems. https://www.nrhorthodontics.com/patient-resources/common-bite-problems

2. Owens D, Watkinson S, Harrison JE, Turner S, Worthington HV. Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database of Systematic Reviews 2024, Issue 4. CD003451. https://www.cochrane.org/evidence/CD003451_do-braces-correct-or-improve-underbite-prominent-lower-front-teeth-children-and-teens

3. Align Technology. Underbite: Causes, Treatment. Invisalign.com, December 2023. https://www.invisalign.com/resources/treatable-cases/underbite

4. Soft-tissue modification in Class III non-growing patients treated with clear aligners: a prospective clinical trial. Frontiers in Dental Medicine, 2025. https://www.frontiersin.org/journals/dental-medicine/articles/10.3389/fdmed.2025.1584088/full

5. American Association of Oral and Maxillofacial Surgeons. Corrective Jaw Surgery. Updated September 2026. https://myoms.org/what-we-do/corrective-jaw-surgery/

6. Pagani R, et al. The Use of Invisalign System in the Management of the Orthodontic Treatment before and after Class III Surgical Approach. Case Reports in Dentistry, 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC4939349/

7. Aziz SR. Clear aligner orthognathic surgery: an overview. Frontiers of Oral and Maxillofacial Medicine, 2022. https://fomm.amegroups.org/article/view/55257/html

8. Surgical-Orthodontic Treatment of Two Skeletal Class III Patients with Invisalign and Fixed Appliances. Journal of Clinical Orthodontics, April 2005. https://www.jco-online.com/archive/2005/04/245-surgical-orthodontic-treatment-of-two-skeletal-class-iii-patients-with-invisalign-and-fixed-appliances/

9. Al-Hummayani FM. Pseudo Class III malocclusion. Saudi Medical Journal, 2016;37(4):450-456. https://smj.org.sa/content/37/4/450

10. NRH Orthodontics. Invisalign. https://www.nrhorthodontics.com/services/invisalign

11. Clear aligners for Class III malocclusion and severe open bite camouflage: a case report. APOS Trends in Orthodontics, January 2024. https://apospublications.com/clear-aligners-for-class-iii-malocclusion-and-severe-open-bite-camouflage-a-case-report/

12. Align Technology. Invisalign Attachments. Invisalign.com, September 2023. https://www.invisalign.com/resources/living-with-invisalign/invisalign-attachments

13. Ormco. Spark Clear Aligners: Treatment Options. https://ormco.com/en-us/spark/treatment-options

14. American Association of Orthodontists. When Should a Child See an Orthodontist? The Age 7 Visit. https://aaoinfo.org/whats-trending/when-should-your-child-see-an-orthodontist/

15. NRH Orthodontics. Children and Teen Orthodontics. https://www.nrhorthodontics.com/services/orthodontics-for-children-and-teens

16. NRH Orthodontics. Adult Orthodontics. https://www.nrhorthodontics.com/services/adult-orthodontics

17. NRH Orthodontics. Home. https://www.nrhorthodontics.com/