Deep Bite.docx
- 1. Deepbite. 1. Introduction: Definition: Malocclusion in which the mandibular incisor crowns are excessively overlapped vertically by the maxillary incisors when the teeth in centric occlusion. Unfavorable sequel of deep bite : - Abnormal function - Improper mastication - Excessive stress - Trauma - Bruxism - Clenching - TMJ Joint disturbance. Classification: - Dentoalveolar deep bite or skeletal deep bite - True deep bite or pseudo deep bite - Incomplete deep bite or complete deep bite 2. Etiology. Inherent factors : - Tooth morphology - Skeletal pattern - Malocclusion - Condylar growth pattern. Acquired factors : - Prolonged thumb sucking - Muscular habits - Changes in tooth position - Loss of posterior supporting teeth - Lateral tongue thrust 3. Clinical features: Supraeruption of anteriors
- 2. Excessive overjets Infraocclusion of the posterior teeth Alterations of tooth morphology Early loss of teeth may result in lingual tipping of the anterior teeth Decreased ramal height Convergent jaw bones Growth discrepancies of the jaw bones Anterior facial height is often short Horizontal pattern growth 4. Treatment The choices of treatment depends on : - Etiology of deep bite - Amount of remaining growth - Vertical dimension - Relationship of the teeth with the adjoining soft tissue structures. Treatment modalities : a) Extrusion of posterior teeth - Indicated in horizontal growing patients with normal interlabial gap and upper incisors to lip relation. i. Bite planes - Load the incisors for an intrusive effect but leave the posterior teeth to erupt - Can be modified into Sved bite planes or may be fixed bite with GIC bonded bite planes with composite resins on the palatal aspect of the maxillary incisors. - It also can be incorporated in Nance appliances. ii. Functional appliances. - May be fixed or removable - Can help in positioning the lower jaw forward thereby disoccluding the posterior teeth and causes the posterior teeth to erupt. - Mayofunctional appliances allows the extrusion of posterior teeth thus opening the bite.
- 3. - For a successful treatment, one have to wear the functional appliances full time. This requires the patient cooperation. - If the patient fail to do so this problem can be overcome by using fixed appliances. iii. Headgears - Cervical headgears exert a vertical downwards forces that resulting in extrusion of molars. - By this the deep bites can be corrected. b) Intrusion of anterior teeth For intrusion of teeth the force should pass through center of resistance so as to translate the teeth without tipping Any force away from centre of resistance may cause flaring of incisors. i. Beggs technique - Bite opening ends are given so as to intrude the upper and lower anterior teeth to correct anterior deep bites. ii. Correction of deep bite with lingual orthodontics c) Combination of intrusion and extrusion. - By altering position of brackets; by placing anterior brackets occlusally and posterior brackets gingivally. - Simultaneous intrusion of anterior teeth and extrusion of posterior teeth can be achieved. d) Correction of deep bites with mini implants as an anchorage system. Mini implants can be used for intrusion of anterior teeth. Can be placed at interdental bone between roots of canine and lateral incisors bilaterally. The placement should be done after levelling and alignment. e) Correction of deep bite with orthodontics and Surgery. An adult who has more than 6 mm overbite or 8 mm overjet could be considered a candidate for surgery solely on the basic of dental relationships without even considering facial aesthetics.
- 4. References: - Management of deep bite: Review by Dr Irum Uzma, Prof Mohd Tariq, Dr Saba Khan and Dr Grateful - Deep bite its etiology, diagnosis and management: Review by Suchita Daokar and Gauri Agrawal