Orthodontics

Fifth Class College of dentistry

Dr Firas Lecture no. 9

Overbite
Overbite is defined as the vertical overlap of the incisors. Normally, the lower incisal
edges contact the lingual surface of the upper incisors at or above the cingulum (i.e.,
normally there is a 1 to2 mm overbite). In open bite, there is no vertical overlap, and
the vertical separation of the incisors is measured to quantify its severity.

Overbite is described as:

• Increased if the maxillary incisors overlap the mandibular incisor crowns vertically
by greater than one-half of the lower incisor crown height.
• Decreased if the maxillary incisors overlap the mandibular incisors by less than one-
third of the lower incisor crown height. If there is no vertical overlap between the
anterior teeth, this is described as an anterior open bite and a measurement should
be made of the incisor separation.
Complete overbite

• Complete if there is contact between incisors, or the incisors and opposing mucosa;
and
• Incomplete if there is no contact between incisors, or the incisors and opposing
mucosa.

If the overbite is complete to the gingival tissues, it

is described as traumatic if there is evidence of
damage. This is most commonly seen on the palatal
aspect of the upper incisors or labial aspect of the
lower.

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 Therefore the measurement of the overbite in a percentage is believed to be more
accurate. A 5% to 25% overlap of the mandibular anteriors by the maxillary anteriors
is considered normal. An overbite greater than 40% is considered abnormal and is
considered a deep bite.
Two more terms are used in association with deep bite. They are the cover bite
and closed bite. Cover bite is a condition that is characterized by complete covering of
the mandibular anteriors by the maxillary anteriors due to excessive overbite and
retroclination of the maxillary anteriors such as in a Class II div 2 malocclusion. Closed
bite on the other hand is a condition where there is
an excessive overbite as a result of loss of the
posterior teeth. This condition generally occurs in
adults and rarely in children.

CLASSIFICATION
Deep bite can be broadly classified into:
1. Skeletal deep bite
2. Dental deep bite

Skeletal deep bite

Skeletal deep bites are usually of genetic origin. This kind of deep bite is caused by
upward and forward rotation of the mandible. The deep bite can be further worsened
by a downward and forward inclination of the maxilla. These skeletal deep bites are
characterized by the presence of the following features:

a. Patients exhibit a horizontal growth pattern.

b. The anterior facial height is reduced.
c. A reduced inter-occlusal clearance (freeway space).
d. A cephalometric examination reveals that most of the horizontal cephalometric
planes such as mandibular plane, F.H. plane, S.N. plane etc., are parallel to each other.

Dental deep bite

This kind of deep bite is characterized by the absence of any skeletal complicating
features that are seen in skeletal deep bites. Dental deep bites occur due to over-
eruption of anteriors or infra-occlusion of molars.

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DIAGNOSIS
The routine diagnostic aids such as clinical examination, study models and lateral
cephalogram are used for the diagnostic exercise. The orthodontist should be able to
differentiate skeletal deep bite from dental deep bite. Lateral cephalometric analysis
of the skeletal pattern helps in diagnosing a skeletal deep bite. These patients show a
reduced mandibular plane angle as well as a reduced anterior facial height.

FACTORS TO BE CONSIDERED IN TREATMENT OF DEEP BITE

Deep bites are usually corrected by intrusion of the anterior teeth or by extrusion
of the posterior teeth. The orthodontist should decide which of the two modalities is
indicated for a given patient. There are certain factors that help in deciding whether
to intrude the anteriors or extrude the molars.

1- Lip relationship
Patients with deep bite who exhibit a short upper lip, a gummy smile or excessive
exposure of the upper incisors should be treated by intrusion of the anteriors. In
patients exhibiting normal upper lip with only 2 – 3 mm of maxillary incisal edge
exposed, it is ideal to extrude the molars.
2- Growth factor
Treatment of deep overbites in growing patients is considered easier to accomplish.
In addition the results of the treatment are more stable in the presence of growth.
3- Consideration of vertical facial relationship
Extrusion of one or more posterior teeth usually results in downward and backward
rotation of the mandible. Thus an increase in anterior facial height occurs. This can be
a benefit in treating skeletal deep bites with excessive horizontal growth and upward
rotation of mandible.

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 4- Consideration of Inter-occlusal space (Free Way Space) The average inter-
occlusal space; in rest position; is 2-4 mm in the premolar region. Presence of
an increased inter-occlusal space is an indication that the molars are not fully
erupted. In such patients the deep bite can be treated by extrusion of the
posterior teeth.

TREATMENT OF DEEP BITE

Deep bites can be treated using removable, fixed or myofunctional appliances.

Removable appliances
Anterior bite plane is the most commonly used removable appliance for treatment of
deep bite.

The anterior bite plane is a modified Hawley's appliance with a flat ledge of acrylic
behind the upper anteriors. When the patient bites, the mandibular incisors contact
the bite plane thus dis-occluding the posteriors that are free to erupt.
The height of the anterior bite plane should be just enough to separate the posteriors
by 1.5 to 2 mm. As the posterior teeth erupt the height of the bite plane is gradually
increased.

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Myofunctional appliances
Deep bite cases diagnosed to be due to infra- occlusion of molars can be treated by
an activator designed and trimmed to allow the extrusion of these teeth. The inter-
occlusal acrylic is trimmed gradually to encourage the eruption of the posterior teeth.

Fixed appliance therapy

Fixed orthodontic appliances can be used to intrude the anteriors. The following are
some of the methods used in fixed appliances to treat deep bite.

Use of anchorage bends: Anchorage bends are given in the arch wire mesial to the
molar tubes so that the anterior part of the arch wire lies gingival to the bracket slot.
Thus when these arch wires are pulled occlusally and engaged into the brackets, a
gingivally directed intrusive force is exerted on the incisors, which reduces the deep
bite.

Use of arch wires with reverse curve of Spee: Resilient arch wires that have been
curved in a direction opposite to that of the curve of Spee can be used to intrude
anteriors.

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Use of Intrusion arches: Burstone describes the use intrusion arches in his segmented
arch technique for the correction of deep overbites. The appliance consists of two
posterior stabilizing units in the buccal segments and anterior segment consisting of
the incisors. The intrusion arch is a cantilever type of spring that is inserted into the
auxiliary tube of the molar tube and it bypasses the premolars and the canines. The
anterior segment is brought down incisally and is tied to the anterior segment arch
wire. This brings about the intrusion of the anteriors.

Use of utility arches: They are arch wires that are bent in such a way that they bypass
the buccal segment and are engaged on the incisors.

Use of fixed anterior bite planes: Two types of fixed anterior bite planes are in use.
The first type consists of a wire framework that is soldered lingually to the molar bands
and anteriorly incorporates a bite plane. The other type consists of bonded type of
bite planes that are made of composite or glass ionomer blocks that are bonded on
the lingual surface of the maxillary incisors.

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Use of mini implants: Mini implants skip all the problems of molar extrusion during
the intrusion of anterior segment.

END

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