Deep bite(1)

Seminars 253 inOrthodontics,Vol19,No4(December) 1

DEEP BITEAND IT’SMANAGEMENT

Dr. Saba BasitMCPS ResidentOrthodontics

03/2/2015

2

Definition:‘A condition of

excessive overbite where the vertical

measurement between the maxillary and mandibular incisal margins is excessive

when the mandible is brought into habitual or centric occlusion.’

(GRABER)

‘The amount and percentage of overlap of lower incisors by the upper incisors .

The overbite may be calculated as a

percentage of the clinical crown height

of one of the mandibular central incisors.’ (NANDA)

03/2/2015


Prevalance:

The prevalence of severe deep bite varies between racial groups twice as common in Caucasian Americans compared to African Americans and Hispanics.

03/2/2015


Types:

3-5mm

5-7mm

>7mm03/2/2015


Classification

03/2/2015


Skeletal Deep Bite:

03/2/2015


Skeletal Deep Bite:

Characterized by:

03/2/2015

REDUCED


Skeletal Deep Bite:

Characterized by:

03/2/2015


Skeletal Deep Bite:

03/2/2015


Dentoalveolar Deep Bite:

Characterized by the absence of any skeletal complicating features which are seen in skeletal deep bites.

Occurs due to: Over-eruption of anteriors Infra-occlusion of molars.

03/2/2015


Contd.

Over-eruption of anteriors Usually seen in class II Increased overjet causing over eruption of lower

anteriors untill they meet palatal muosa. Excessive curve of spee

03/2/2015


Contd.

Infra-occlusion of molars:Occurs due to Partially erupted molars/reduced crown length Large interocclusal clearance Lateral tongue posture/thrust (preventing molars erupting in normal

occlusion) Premature loss of posteriors

03/2/2015


Soft tissue deep bite:

They are often associated with class IImalocclusion and hypodivergent facial patterns. This tends to have:

1. Strong mandibular elevator muscle2. High mentalis activity3. Deep mento labial folds4. Everted lower lip

03/2/2015


Diagnostic Aids:

A. Clinical examinationB. Study castC. Lateral ceph

03/2/2015


Treatment Modalities:

1. Mecahnaical consideration▪ Intrusion of incisors▪ Extrusion of moalrs▪ Proclination of incisors

2. Considerations in growing individuals3. Considerations in nongrowing patients4. Esthetic considerations5. Treatment challenges6. Guidlines for stability7. Conclusion

03/2/2015


Mechanical considerations:

Intrusion of incisors is indicated when:1. Excessive distance between incisal edge and stomion2. Large interlabial gap3. More occlusal level of central incisor to lateral incisor

Methods to intrude incisorsa) Continuous arches b) Segmenal techniques

Adjunct applainces High pull headgear

03/2/2015


Cont.

Extrusion of posteriors: 1mm extrusion of posteriors teeth causes 1.5 to 2.5mm reduction in incisor overlap.Indicated when1. Short facial height2. Increased curve of spee3. Incisor display ranging from normal to

minimal.

03/2/2015


Contd.

Proclinaion of incisors:It decreases the amount of overbite and usuallyoccurs as a side effect of other treatmentmodalities.Indicated to include it separately in the

treatmentplan when Lingually tipped incisors in class II div 2 Class III

03/2/2015


Contd.

Strategies to extrude molars:1. Altering bracket height2. Leveling dental arches by using RSC wire in

mandible and ECS wire in maxilla.3. Including 2nd molars in fixed assembly.4. Increasing step bends from anterior teeth to

posteriors.5. Giving anterior bite plane6. Using class II elastics

03/2/2015


Consideration in growing children:

AIMEnhncement of posterior eruptionMaintaining height of posteriors(esp in hypodivergents)

What we can do?1. Removable appliance with ant. bite plane2. Fixed 2/4 appliance with appropriate anchorage situations with intrusion arch wire.

03/2/2015

2103/2/2015

2203/2/2015


Consideration in Nongrowing patients:

Orthognathic surgery is the treatment option in malocclusion with severe skeletal problems.

Extractions are to be avoided in most of the cases of deep bite avoiding worsening of deep bite.

However treatment with minimal intervention leads to compromised results:

1. Lengthy treatment2. Reduced esthetics3. Periodontal compromise4. Root resorption5. Orthognatic surgery eventually

03/2/2015

Seminars 253 inOrthodontics,Vol19,No4(December) 2403/2/2015

293 Seminars inOrthodontics,Vol19,No4(December),2013


Esthetic considerations:

Upper lip line in relation to maxillary incisors. Depth of mental sulcus in realtion to

mandibular incisor.Contraindication for intrusion:

1. Low lip line2. Reduced lower anterior facial height

(hypodivergent)

03/2/2015


Maxillary Incisor Esthetic Diffrential Extrusion


Treatment challeanges

1. Addressing limited objectives to resolve a specific patient complaint,reduce treatment time, or avoid surgery.

2. Giving more weight to esthetic considerations and awareness, sometimes at the expense of evidence available for occlusal stability.

3. Minimizing the side effects of treatment such as a) root resorptionb) periodontal complicationsc) temporomandibular joint dysfunction

03/2/2015


Limitations of Treatment:

1. Nature of the occlusion (missing teeth and mutilated dentition).

2. Compromised dental health(existing restora- tions/severe caries and root resorption).

3. Mechanical limitations (difficult space closure, especially extraction spaces,and resistance to intrusion—mainly in adults).

03/2/2015


SUCCESS

Compliance Growth direction and amount1. a headgear

2. a functional appliance3. removable bite plates4. elastics


Stability

03/2/2015

Importance should be given in:

Posterior teeth extrusion in severe hypodivergent faces with hyperactive musculature.

Proclanation of mandibular incisors and clockwise rotation of mandible.


Stability

03/2/2015

Contributing factors1. Growth 2. Muscle strength3. Muscle adaptation4. Original musculature


Guidilines for stability:

1. Treat a developing deep overbite early.2. Avoid extraction of premolars, particularly in

very deep bites.3. Long-term retention.4. Enhance sustainability of the correction such

as the use of a bite plate at least at night.

03/2/2015


Conclusion:

Dental or skeletal deep bite Esthetical considerations Stability considerations Long term retention

03/2/2015


THANK YOU FOR YOUR PATIENCE

Deep bite(1)

Health & Medicine

Transcript of Deep bite(1)