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Deep Bite
Deep Bite
In a well balanced face, the profile line relates the chin to the lip and
bisects the point of the nose
In Class II bimaxilliary protrusion, the profile line is out of the nose.
In Class II low Angle cases, the profile line bysect the nose.
The location of the chin must be evaluated in Class II faces: by using
the Z line with a retrognathic chin, we thus risk making a wrong
decision. Many class 2 cases present a mandibular deficit with a well
balanced maxilla. So, one must have a sagittal reference plane: we
use the Schwarz construction
On the patient profile photographs, the Dreyfus Plane is drawn
perpendicular to Frankfort, passing through the nasal base and the
Simon's Orbitary plane, perpendicular to Frankfort, through the
Orbital, (pupilla). The space between these two planes is called the
mandibular space.
We can appreciate if the chin is located inside or outside the
mandibular space.
This drawing underlines the significance of the lips and the chin in
the facial harmony.
The aesthetic analysis is completed with the use of the naso-labio
angle.
On this case, there is a nice harmony between the front, the nose
and the upper lip. The upper face is a Class I face, related to a skeletal
Class I. The lower face is a Class II face, related to a skeletal Class II
with a retrognathic mandibula. Most of Class IIs low Angle cases
present a Normal Class I upper face.
Growth considerations
The childhood and pre-Adolescent period can be defined as the
period of life where dento facial developments and the rate of facial
growth will occur. The transition from the mixed dentition to the
permanent dentition is a very important period in orthodontic
decisions
During growth, each structure is growing in its size by surface
remodeling and passive displacement.
For the naso maxillary complex, between ages 7 to 14, one third of
the total forward movement is due to the passive displacement.
For the mandibula, growth in size, body lenght and Ramus height,
increase continusly at a steady rate before puberty.
The total displacement downward and forward, depends on passive
displacement of the craniobase, the total growth by surface
remodeling, the chin growth and the type of rotation of jaw during
growth. (matrix rotation and intra matrix rotation)
During this period of growth, in Width, Length and Height, the
transition from the mixed to the permanent dentition will interfere
each other. There are interactions between jaw rotation and tooth
eruption.
The fonctional matrix facilitates the lower face growth in three
dimensions, in relation to the occlusion.
So in early dentition, it is extremely important to correct
dysfonctions and liberate occlusal bloks as:
-Incisor overbite
-Deep occlusal curve
-Transversal constriction of the maxillary arch form
- Mesial rotation of the upper first molars
-Anterior and Lateral crossbites.
It is time to realise that the world has tree dimensions. The benefit
for mixed dentition treatments does not lies on 1 or 2 mm
mandibular growth, but in the fonctional remodeling of the total oro
facial space.
The second evidence is the nonsence to treat a Class II case by distal
mouvement of the upper arch. The upper molar never moves distally.
We just have a disto rotation of the crown, around the palatal root,
that, in some cases, opens 2 or 3 mm. The last evidence is the total
mistake to treat a Class II overjet with upper bicuspids extractions!
That is ashame for the smile.
It is time to realize that in Class IIs the upper incisors are well
located in the smile and the upper structures. The treatment is
always a mandibular management, in growth, and in sagital,
transversal and vertical reposition of the lower face.
In low Angle cases, the key is on the position of the upper incisors,
not on the lowers:
In low FMA angle cases, the FMIA looses all significance in correction
of facial imbalance because the priority becomes to maintain or
increase the vertical dimension.
We do not give a lot of credit on contreversies. As we have had the
non extraction versus extraction debate, we have today an other
wave, an other fashion : the one stage versus two stage treatment.
We must face the fact that a lot things we dont believe in, are true.
And conversely, a lot of things that we believe in are not true.
For many reasons, we strongly beleave in mixed dentition therapy.