Professional Documents
Culture Documents
Deep Overbitea Review
Deep Overbitea Review
Abstract :- Deep overbite or Deep bite is one of the common malocclusion which has a varied of etiologies. The
etiology may be present at different levels of structures, Viz. dental skeletal, combination of skeletal and dental
etc..,The treatment plan depends upon the severity and the age of the patient. A review of deep bite in general
with due reference to some treated cases is done in this article
The extent of the intermaxillary distance "freeway In a Class II, division 1 type of malocclusion with
space" is an important factor in treatment planning. large vertical facial height, extrusion of posterior
When the freeway space is minimal or even absent teeth may cause serious functional, esthetic, and
the problem is more severe stability problems. Extrusion of molar furthers
causes the downward and backward rotation of the
1.Treatment modalities in growing and non
mandible worsening the condition. In those cases
growing patients.
the intrusion of anteriors is the treatment option.
Growing patients
Intrusion mechanics are considered if there is
o Intrude anteriors inadequate or normal freeway space.
o Erupt posteriors Encroachment of this space by extrusion of
o Combination of posterior eruption posterior teeth is determinant and bound to relapse.
and anterior intrusion It results in fatigue of the muscles of mastication
Non growing patients (little or no growth expected) which get stretched and predispose to relapse. It
also strains the TMJ.
o Orthognathic surgery
o Intrusion of anteriors (posterior Extrusion of molars
extrusion invariably relapses)
In deep bite with redundant upper and /or lower
whatever the treatment modality the management of
lips, or no interlabial gap, posterior extrusive
deep bite is by intrusion of anteriors, extrusion of
mechanics may be desirable (if other considerations
posteriors or combination of the both
permit).
2. Factors to be considered before intrusion or
If a patient with deep overbite exhibits normal
extrusion
incision-stomion distance, the choice of correction
Interlabial gap of deep bite by an intrusion of maxillary incisors is
Growth pattern whether vertical or often contraindicated since it will give the patient
Horizontal an edentulous appearance. Extrusion of posteriors
Presence of adequate free way space or is the treatment option
interocclusal clearance
In patients having excessive overbite with Class II,
division 2 type of skeletal malocclusion, an
Intrusion of anteriors
extrusion of the posterior teeth met be the treatment
Intrusive mechanics is considered in the following of choice ( if other considerations permit). Extrusion
situations mechanics are considered if there is adequate
interocclusal space.
Deep bite with large interlabial gap(In a relaxed
mandibular position, an individual has normal of 2 Intrusion of incisors Extrusion of molars
to 4 mm) , intrusion is the ideal choice. Extrusion of
Deep bite with large Deep bite with no
posteriors may deteriorate the esthetics and further
interlabial gap interlabial gap
increase the interlabial gap.
If gummy smile is Normal incisor-stomion
present distance
In non skeletal deep bites a utility arch that In class II div I growing patients intrusion or
incorporates molar and incisor teeth can be used prevention of excessive eruption of the lower
during the mixed dentition to intrude, tip, or incisors is achieved by leveling out an excessive
reposition both molars and incisors. Realistically, curve of Spee with the continuous arch wire
although bite depth changes can be made in the mechanics from molar to incisors.
mixed dentition by intrusion of anterior teeth,
In the absence of growth, absolute intrusion is
intrusion is difficult to retain-even in later phases of
required and segmented arch mechanics must be
full appliance therapy. For this reason, intrusion as
used to achieve this . Eruption of the first molars
a part of early treatment is seldom required. It is
can be aided by the use of a flat maxillary bite plane
often better to defer this treatment until the early
permanent dentition, using an intrusion arch during or a monobloc and the incisors depressed with
utility archwire.
Vol I issue 1 July – September 2009 -15-
Annals and Essences of Dentistry
Mild cases of skeletal deepbites in adolescent are Deep bites can be treated using removable, fixed or
treated with full-banded or bracketed appliances. In myofunctional appliances.
moderate cases a flat maxillary bite plane is used in
conjunction with full-banded therapy. Severe cases I. Removable appliances
of complex deep bite may require orthognathic
surgery later. Even in the most severe problems, it a. Maxillary acrylic bite plate or anterior bite
is preferable to attempt treatment in adolescence plane ( Fig 14 A and B)
and force the decision toward surgery by the
inadequate response to conservative therapy. The most popular method for correcting a deep
Adolescent treatment of moderately severe cases overbite is by or anterior bite plane. The anterior
usually more successful in boys then girls since bite plane is a modified Hawley’s appliance with a
boys normally have more remaining growth to utilize with a built-in flat acrylic bite plate or inclined plane
the treatment or platform lingual to the maxillary incisors . The
anterior bite plane consists of Adam’s clasps on the
4) Treatment planning in adults (Fig 13) molars which help in retaining the appliance. A
labial bow is also incorporated to counter any
In adult patient showing excessive deep overbite of forward component of force on the upper anteriors.
100 per cent or more, with accompanying; The bite plane may be extended labially not to cover
more than 1/3rds to produce the same effect ie.., to
1. High smile line. 2. decreased Vertical facial
prevent the protusion of upper anteriors.
height. 3. Alveolar problems, the length of treatment
may be very long. In this instance, the patient With this appliance in the mouth during the
should be given a choice for an Orthognathic mandibular closing movement, the mandibular
correction of the problem. In these patients, the incisors come in contact with the acrylic platform,
treatment plan to correct the excessive overbite which causes a disocclusion of the posterior teeth.
should be done in conjunction with an The disocclusion leaves the molars free to erupt.
oromaxillofacial surgeon. The disocclusion of the bite accelerates the
passive eruption of the posterior teeth, which stops
Maxillary surgery The maxilla can be moved up
when one or more opposing teeth come in contact .
quite successfully with Lefort I. Surgically
It is advisable not to disocclude the posterior teeth
repositioning of maxilla in superior direction can be
more than 2 mm. If bite opening in the anterior
done by complete maxillary osteotomy. The
region is not sufficient, the acrylic platform can be
correction of deep bites resulting from vertical
augmented in small increments several times during
maxillary excess can be effectively corrected by this
the treatment.
method.
Small increments also apparently do not cause a
Mandibular surgery Patients with a short face sudden temporomandibular joint or myofunctional
(skeletal deep bite) problem are characterized by a change. If used with a correct treatment plan, the
long mandibular ramus, square gonial angle and bite plate can also help in minor labiolingual and
short nose-chin distance. They are treated most mesiodistal movements of teeth with the help of a
predictably and successfully by mandibular ramus labial bow or auxiliary springs
surgery that allows the mandible to move downward
only at the chin, increasing the mandibular plane The patient wears this appliance almost 24 hours a
angle. They are treated best by sagital split day. The use of bite plates, at the time of attaining
mandibular ramus surgery to rotate the mandible the desired overbite, should not be suddenly
slightly forward and down and the gonial angle open stopped, the bite plate itself should be used as a
up. retainer and its discontinuance should be gradual.
The deep bites in the anterior mandibular alveolar
region can be corrected by subapical osteotomy.
Appliances and methods used in the treatment
of deep bite