Copy of deep bite..

DEEP OVER BITE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Contents
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Introduction
Definition
Classification
Diagnosis
Clinical features
Treatment IN PEA
Treatment in begg’s
Treatment in functional appliance

Introduction
• Deep overbite presents an orthodontist
with challenge in any of its many forms.
• Diagnosis
,treatment
planning
and
appropriate mechanics form an backbone
of successful orthodontic treatment.


Etiological Consideration
• According to etiological stand point over
bite
can
be
differentiate
into
developmental deep bite and acquired
deep bite.


Developmental ( Genetic) Deep Bite

• Skeletal over deep over bite with a
horizontal growth pattern is a common
malocclusion.
• Dentoalveolar deep bite caused by supra
occlusion of the incisors, these cases the
interocclusal clearance is usually small
meaning the over bite is functionally a
pseudodeep bite.

Acquired Deep Bite
• A lateral tongue thrust or postural position
frequently can produce acquired deep bite
this type of function produce a infraocclusion of the posterior teeth which
intern leads to a deep over bite, the
freeway space is large which is favorable
for dentofacial orthopedics functional
appliance treatment.
• E.g. class II div. II.

• Premature loss of deciduous molars or
early loss of permanent posterior teeth
can cause an acquired secondary deep
over bite, particularly if the contiguous
teeth are tipping into the extraction sites.
• The wearing away of the occlusal surface
or teeth abrasion can produce an acquired
secondary deep over bite in some
patients.

•

Deep over bite can be localized in either

1. Dentoalveolar
2. skeletal.


Dentoalveolar deepover bite

Skeletal deep over bite


Dentoalveolar deep over bite
1. Deep overbite caused by infraocclusion
molars has the following symptoms.
2. Molars are partially erupted.
3. Interocclusal space is large.
4. A lateral tongue thrust and posture are
present.
5. The distance between the maxillary and
mandibular basal plane and occlusal
plane are short.

•
1.
2.
3.
4.

Deep over bite caused by over eruption
of the incisors has the following
symptoms:
Incisal margins of the incisors extend
beyond the functional occlusal plane.
Molars are fully erupted.
Curve
of
spee
is
excessive(compensating curve).
Interocclusal space is small.

Skeletal Deep Over Bite
• Is characterized by a horizontal type of growth
pattern.
• Anterior facial height is short, particularly the
lower facial third, where as posterior facial height
is long.
• The horizontal cephalometric planes (sellanasion, palatal, occlusal and mandibular planes)
are parallel or convergent.
• Interocclusal clearance is usually small

The inclination of the maxillary base is significant
in the evaluation of the treatment plane for this
type of problem.
1. An extreme horizontal growth pattern can be at
least partially compensated by an up and
forward inclination of the maxillary base (antiinclination).
2. The combination of the horizontal growth
pattern with a downward and forward
inclination (retroinclination) of the maxillary
base results in a more severe skeletal deep
bite.

Vertical Malocclusion – Deep Bite
Excessive over bite – deciduous dentition.
• Over bite is the considered to be excessive
when the incisors overlap by more than half.
• Genuine deep bite in a deciduous dentition
where the lower anterior teeth are covered
completely as result of an increased in the
height of the upper anterior alveolar process.
• An excessive overbite may be encountered
during any developmental period of dentition.

Deep bite with class III malocclusion
• Deep bite conjunction with mandibular
prognathism and inverted over bite.
• This vertical deviation can be related with
any anteroposterior
or transverse
malocclusion.


Length of the clinical crown
• Deep bite in a patient with long crowns of
the incisors but without any increase in
height of the anterior alveolar process.


Closed bite caused by loss of posterior
teeth
• Gingivally supported closed bite resulting
from premature extraction of teeth in the
mixed dentition.
• Pathologically the closed bite is caused by
an increased forward and upward rotation
of the mandible, resulting form lack of
posterior dental support.

Functional Classification
According to Hotz and Muhlemann (1952)
one should different between two types:
1.True deep over bite.
2.Pseudodeep overbite.


True deep over bite
1. Infraocclusion of
molars.
2. Large freeway
space.
• The prognosis for
successful therapy
with functional
method is favorable.

Pseudo deep over bite
1. Molars are fully
erupted.
2. Over eruption of the
incisors.
• The prognosis for
successfully therapy
with functional
method is
unfavorable.


• If the freeway space is small, extrusion of
the molars adversely effect the rest
position and may create TMJ problems or
cause a relapse of the deep overbite.


• Occlusal position.
• Pseudo deep bite with small freeway
space.
• True deep overbite with large freeway
space.


Dentoalveolar
Cephalometrically features are :
1. Deep over bite in a case of vertical
growth type, combined with antiinclination of the maxilla.
2. Lingual tipping of the lower incisors and
infra-position of first molar.
3. As downward and backward rotation of
the mandible is to be expected, the
prognosis for therapeutic bite opening is
favourable.

Skeletal Deep Bite
Cephalometrically features are :
1. Deep over bite is caused by the marked
horizontal growth direction of the
mandible, which is not compensated by
the anti-inclination of the maxilla.
2. Dento-alveolarly, the skeletal displasia is
increased by the lingo-version of the
upper anterior teeth.

Deep overbite cephalometric
features
Dentoalveolar

skeletal


Vertical plane –normal incisor position
•

•

•

In
a
correct
vertical
relationship the incisal edges
contact the occlusal plane.
The occlusal plane and the
tuberosity
plane
perpendicularto it.
The occlusal plane is defined
by the tangent which runs
through the tips of the
mesiobuccal cusps of the first
molars and the buccal cusp of
the premalars


•

•

•

The depth of the cure of spee is
defined as the distance from the
vertx of the curvature to the side
of a plastic template placed over
the lower arch.
The templates touches anteriorly
the incisal edges and posteriorly
the distsl-most molar cusps.

Supraversion of the incisors with
overeruption in relation to the
occlusal plane


Tomographic of theright left temporomandibular joints in full inter
cuspation.
differences between the right and left sides regarding the shape
of the condyles, the roof of the fossa, and the with of the joint
space.
Right ---the condyle and the roof of the fossa are flattened severly;
the condyle is dislocated anteriorlyin the glenoid cavity


Adolescent with classII,division I
malocclusions and lip dysfunction (lip
biting or sucking) are most frequently
affected by TMJdisorders. For this
reason,orofacial dysfunctions must also be
assessed as a part of the functional
analysis as they may lead to unbalanced
loading of the joints and thus trigger off
tempromandibular joint disturbances in
adolescents.


Factors effecting the overbite
•

•

Growth of body of maxilla.
Vertical growth of the maxilla pushes the mandible
downwards and backward thus increasing in anterior
facial height and its is due to vertical growth of the
maxilla.
Ramus height
The length of the ramus increased it cause the
mandible to move away from the maxilla and therefore
increase the interocclusal space, if growth of ramus
length was restricted its slow down the eruption of the
posterior teeth but it did not stop eruption of the
anterior teeth leading to an deep overbite.

• Madibular condyle
Proportionate or disproportionate growth
to the rest of the mandible can occur
which will effect the over bite.
Molar height
Degree of eruption of posterior teeth.
Incisor height
Degree of eruption of incisors.

• The degree of overbite was related to the
mesiodistal dimension between the upper
and lower incisor teeth.


Morphological features
1.
2.
3.
4.

The mandible in skeletal deep over bite
shows certain distinct feature.
Ramus is broad anteroposteriorly with a big
coronoid process indicating a strong
temporalis muscle.
Flaring of gonial process laterally seen
indicating a strong massceter action with the
absence of the anti-gonial notch.
The ramus and corpus length or almost equal.
Mandibular symphysis is broad but short
vertically.

THREE POSSIBLE WAYS FOR INTRUSION

• True intusion is achived by moving the root
apices closer to the lower border.
• Relative intrusion of the incisors is achived by
keeping them where they are ,while the
mandible grows and the posteriors teeth erupt
• Apparent intusion is achived by extrusion of
posteriors teeth


THREE POSSIBLE WAYS FOR INTRUSION
ABSOLUTE INTRUSION

RELATIVE INTRUSION

EXTRUSION


Principles of intrusion
•

Controlling force magnitude

Lowest magnitude of force capable of intruding
must be used.
Heavier forces may not increase the rate of
intrusion, but
1. Increase in the rate of root resorption
2. the side effects felt by the anchorage unit.


• Anterior single point contacts
Not inserted in brackets-torque may be
introduced
If lingual root torque is present intrusive
forces reduced.
Undesirable curves may be introduced
in wire.

Point of force application
• If the force is passed through center of
resistance of any tooth it will intrude the tooth
without producing any labial or lingual rotation of
the tooth.
• Procumbent incisors must be handled carefully
• Because the intrusive force is farther from the
center of resistance ,a much greater moment
occurs and much more lingual root movement
occur

•

There are two ways to handle it:

1. To apply the vertical force lingual to the center
of resistance either with a continuous intrusion
arch or three piece intrusion arch.
2. To retract the anterior teeth first and produce
more upright axial inclinations and then
proceed with intrusion


Selective intrusion
• In classII division 2 cases ,the central incisors
should be intruded using intras-egmental
intrusion, so first central should be intruded
more than the laterals
• Indiscriminately placing an alignment segment
into the four incisor will level them by erupting
the laterals to the level of the centrals rather
than intruding the centrals ,also movements are
produced which cause the roots to converge
mesially.

Control of reactive units
•
•

Basic side effects could be anticipated from
intrusion mechanics.
Alters the plane of occlusion of the buccal
segment , it is caused by the moment
produced by the intrusion arch on the buccal
segments. in maxilla, the plane of occlusion
steepens in the mandible it flattens.


To minimize this side effect,several steps must be
taken:
1. In the anchorage unit , incorporate as many
teeth as possible
2. Keep the force of the intrusion arch as low as
possible
3. Transpalatal arch in he maxilla or a lingual
arch in the mandible
4. Do as much retraction initially as possible to
decrease the length of the moment arm.


Avoiding extrusive mechanics
1. Extensive mechanics ,such as class II and
class III elastics and cervical headgear with
high outer bows to the maxillary arch.
2. Placement of reverse cure of spee in the loxer
arch
wire
to
prevent
extrusion
of
premolars,because patients who need genuine
intrusion


Treatment of skeletal deep over bite
1. The treatment of skeletal deep over bite
required
consideration
of
the
sagittal
dimensions most skeletal deep over bite or
combined with class ii sagittal intercuspation.
2. During the growth period, the unfavorable
inclination of the jaw bases should be
corrected. This can be achieved by the use of
extra-oral forces or partly by an functional
therapy.

3. Growth inhibition of the upper jaw and growth
promotion in the lower jaw combines with
dentoalveolar changes should result in the
improvement of deep over bite. Treatment can
be performed by using headgear in combined
with an activator.
4. Distalization and elongation of the upper first
permanent molar is the first step. The eruption
of the teeth in the posterior segment can be
guided properly trimmed activator.

5. Dentoalveolar compensation for a deep bite is
needed especially in skeletal deep over bite
treated after the growth period completed.
This compensation can be achieved by the
extrusion and distalization of the maxillary
molars. Aided by second molar extraction
intrusion and labial tippping of the lower
incisors with leveling of the curve of spee
further
benefits
the
dentoalveolar
compensation.

Dentoalveolar Deep Over Bite
True Deep Over Bite
1. In true deep bite the choice of treatment
is extrusion of posterior teeth.
2. If a lateral tongue thrust is present, a
lateral tongue crib is added to the palatal
plate.


Treatment of acquired deep bite
• Treatment being carried out during
eruption levelling of the curve of spee can
be carried out by the use of an activator.
• Anterior bite plane can be used.


Begg’s Techniqe
• Anchor bend given in the arch causes intrusive
force component.
• Class II elastics has vertical and horizontals
component of forces.


F1.swf

F12.swf


3


F13.swf

4


F14.swf

5


F15.swf


F16.swf

Intrusion Mechanic In Pre Adjusted
Edgewise Appliance
• Intrusion arch wire
• With continous arch wire that bypass the
premolar and canine teeth.
• With segmented base arch wire (so that
there is not connection along the arch
between anterior and posterior segment).


Indications for Intrusion
1. Large interlabial gap.
2. Large incisor stomiondistance.
3. Short upper lip.
4. High gingival smile line.
5. Large lower facial height.


Bypass Arches
Intrusion Utility Arch:
• The components of utility arch:
1.
2.
3.
4.
5.

Molar segment.
Posterior vertical segment.
Vestibular segment.
Anterior vertical segment.
Incisal segment.


Selection Of Wire For
Fabrication Of Utility Arch

In a 018 slot
In a 022 slot

0.016 X 0.022
0.019 X 0.019

TMA or
TMA


0.016 X 0.016

Activation of The Intrusion Utility Arch
• Activated so that it delivers 60-100 gms of force.
• 30-400 of activation bend placed at posterior
vertical segment and vestibular segment.
• Pull and chinch the arch wire to prevent flaring of
incisors.
• “V” bend facing occlusally in the vestibular
segment, this bend should be closed as much
as possible to the distal vertical segment.
•

FORCED PRODUCED BY UTILITY ARCH
ACTIVATION


INTRUSION OF THE LOWER INCISOR
PRODUCED BY THE INTRSION BY THE
UTILITY ARCH

MILD INTRUSION AND
RETRACTION

GREATTER INTRUSION AND
RETRACTION


Intrusion with Alpha and Beta Movements

• Anterior intrusion can be performed by
application of differential movement.
• When retracting an anterior segment a net
instrusive force can be produced on the
anterior segment using a small anterior
alpha movement than posterior beta
movement.


Intrusion of Six Anterior Teeth
• A alpha and beta bend are placed mesial and
distal leg of the retraction loop. These produces
moment in the anterior and posterior segments.
• If the beta moment is greater than alpha
moment, an anchorage enhanced by the mesial
root moment of the posterior segment and there
is net intrusive force on the anterior teeth.
•


Apparent intrusion in PEA
Exaggerated reverse curve of spee
• Springs about intrusion of anterior along
with extrusion of the posterior teeth.
• Reverse curve NiTi wire may also be used
for the same.


• Anterior bite plane
• In growing patients anterior bite plane
inhibits the vertical development of the
lower incisors and allows differential
eruption of the posterior teeth to take
place.
• The posterior teeth will be occlusion and
the over bite will reduced with in about 2
months.

Inclusion of second molars
Extrusion of second molars brings about a
great of bite opening in the incisor region.
Second molars are extruded by keeping
molar tube more gingivally.
One mm of extrusion of both upper and
lower molars will be lead to back ward
rotation of the mandible.

Three Peace Intrusion Arch
Components
• Posterior anchorage unit.
• Anterior segment with posterior extension.
• Intrusion cantiliver.


• Anterior segment should be made up of 0.021 x
0.025” s.s. wire, so that it should prevent side
effect created by bending of the wire during
force application.
• Intrusion cantiliver should be made up of 0.017 x
0.025” TMA. This wire is bend gingivally mesial
to the molar tube and helix is formed.
• The mesial end of the cantiliver is bend into a
hook.

Activation of Three
Piece Intrusion Arch
• With this we can intrude flared incisors and tract,
these teeth simultaneously.
• The center of resistance of the four incisors is
usually estimated to be half way between the
crest of alveolar and apex lateral incisors.
• An intrusive force through the center of
resistance will cause pure intrusion of these
incisors along the line of the action of the force.


• If intrusion along the long axis of the incisors
indicated the point of intrusive force can be
moved interiorly and small distal force will help
to direct the intrusive force along the long axis of
the incisor.
• If the intrusive force is placed distal to the
centre of resistance and an appropriate small
distal force is applied intrusion and simultaneous
retraction of the anterior teeth occur. This is
because of the clockwise movement created
around the centre of resistance of the anterior
segment.

THREE PIECE INTRUSION ARCH

PASSIVE POSITION

ACTIVE POSITION


Tip back springs
• Indicated:
Deep over bite
deep curve of spee
Growing patients with forward growth rotation.
the anchor molars are reinforced with TPA
In the upper and lingual holding arch in the lower
arch.


• The intrusion spring are made from 0.017x0.025TMA
wire with out helix or0.017x0.025 SS wire with a helix so
that the force can be made optimal for intrusion
• The wire is bent gingivally mesial to the molar tube and
then helix is formed .the mesial end of the spring is bent
into a hook and is engaged on to the main archwire
distal to the lateral incisor
• The mesial end of the spring lies passively at the height
of the mucobuccal fold and the spring is activated by
pullying the hook down and engaging it on to the wire.


Correction of deep bite with activator

In a dentoalveolar deep overbite:
1.

2.

When the deep overbite is due to infraocclussion of the
poaterior teeth, the interocclusal clearance is large and
hence the construction bite is made high or moderate
accroding to thee size of the freeway space.
When the deep overbite is due to supraocclusion of the
incisors, the interocclusal distance is small, high
construction bite should not be used.


Correction of deep bite with activator
•

In a skeletal deep overbite:
The construction bite should be such that it is
5-6mm,more than the freeway space .
Deep overbite due to infra occlusion of the molars,
Can be treated with an activator which has been
selective trimmed in such a manner so as to allow the
supra eruption of the posterior teeth.
Alternatively eruption of the upper molars can be inhibited
while the mandibular molars are allowed to erupt.


• Extusion of the molars is brought about by allowing the
lingual surface of the maxillary teeth to touch above the
area of the greatest contour and the mandibular teeth
touch below the greatest convexity

Intrusion of the lower incisors:
• Activator only minimal intrusion is possible.
• The intrusion which occur is relative, because the
poterior teeth are allowed to erupt.
• Labial bow is placed on the incisal third of the tooth so
that it will not interfere with the intrusion of the incisor.


Correction of deep bite with Bionator
The bionator is not rigid appliance some parts of the
appliance are used as anchorage unit
Balter called the anchorage areas as loading or prevention
of growth areas; and the trimmed areas were called as
unloading or grwth promotionareas.
As treatment progress self curing acrylic is added or
trimmed off accordingly, so that overbite due to infraocclusion of the molars and premolars can be corrected
effectively.


Labial bow with buccinator loop


Correction of deep bite with Frankel
• Abnormal perioral muscle function has an ability to exert
a deforming action that prevents optimal growth and
development.
• Frankel appliance has buccal sheilds and lip pads that
the prevent the deforming muscle action in the
dentoalveolar region both during deglutation and at rest.
• Frankel is indicated in the mixed dentition with short
lower anterior facial height ,deep overbite and abnormal
activity,leading to bite opening and facial esthetics.


Conclusion
• All these various modalities described for
the correction of the deep overbite have
been time proven to be successful
provided the right method of treatment is
selected as per the demands if a particular
case


Thank you


mm


INTRODUCTION


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