1. A patient aged 12 years present to thedental clinic with mucosal trauma resultingfrom a deep overbite. Discuss themanagement of such problems.Aghimien Osaronse Anthony

2. IntroductionDefinitionClassification of traumatic deep overbiteManagementHistoryPatient assessmentClinical record/investigationtreatment 3. Treatment aimsTreatment considerationsTreatment optionsPrognosisRetentionFollow upConclusion 4. Malocclusion can occur as a form of verticaldiscrepancy as well as transverse andanterio-posterior relationship.overbite is the distance which the maxillaryincisor margin closes vertically past themandibular incisor margin when the teethare brought into habitual or centricocclusion. The deviation from this can bean open bite or deep overbite. 5. Traumatic deep overbite is mostlyassociated with skeletal class IIcomponent associated with incisal class IIdivision I or II.These manifest as trauma to the palatalmucosal, gingival, gingival stripping, foodpacking, enamel stripping, dentinhypersensitivity etc. 6. A condition of excessive overbite where thevertical measurement between themaxillary and mandibular incisors marginsis excessive when mandible is brought intohabitual or centric occlusion( Graber). 7. Several classification exist but Akerly hasdetailed classification that would aid theunderstanding of this patient condition.AKERLY 1.Has a skeletal class II patternAngles class II division ILower incisor push against the palatalmucosal causing mucosal trauma of thepalate away from the palatal gingivalmargin. 8. AKERLY IISP I or IIAngles class II div I/IICauses trauma to palatal gingival ofmaxillary incisorCauses impaction of food of foreign body inthe gingival crevices 9. AKERLY IIISP II Angles class II division I Stripping of the lower labial and upper palatalgingival surrounding the incisor teethAKERLY IV SP I or II Angles class I or II division IWear facets on the palatal surface of theupper incisor and labial surfaces of the lowerincisors.usually due to loss of occlusalsupport or para-functional habit 10. HistoryPatient assessmentClinical record/investigationtreatment 11. Age ; patient is 12 years old.active growth periodaid timing of interventionaid in selection of appliance to be useassessment of patient dentition; as patientshould be in late mixed/early permanentdentitionpatient ability to tolerate removableappliances is better than early mixed dentition 12. Sex; this was not stated but;female mature earlier than males hence,intervention at this age for females wouldjust be appropriate.Sporting activities; these predisposes themale patient to trauma if anterior teeth areseverely proclined. 13. History of presenting complains;mucosal painproclined anterior teethteasing from peer group 14. History of etiology;inherent/genetic; family member with suchcondition. Patient growth pattern, directionwould need proper assessment.abnormal muscular activity; leads to increasewear facets of posterior teeth especiallyamong bruxist.lateral tongue thrust habit leads to infra-occlusionof posterior teeth.loss of posterior 15. History of complicationmucosal ulcerationGingival recessiontrauma to anterior teeth; if teeth areproclined 16. Any history of trauma to anterior teeth fromfalls or contact sport; anterior teeth wouldprotection by a mouth gag. 17. Extra-orally skeletal pattern II or I as the case may be incompetent lip; from proclined maxillaryincisors in Angles class II div. I Competent lip ; in Angles class II div. iicases facial profile; severely convex for severeSkeletal pattern II facial height; appear clinical reduced. high mentalis activity deep mento-labial fold everted lower lip 18. Proclined maxillary incisors with increasedoverjet with deep and traumatic overbite inclass II div. IRetroclined maxillary central and distaltipping of the laterals with decreasedoverjet and deep and traumatic overbite.Presence or absence of other mal-occlusionlike rotations, crowding. 19. Indentation of incisal edges of lower incisorson the palatal mucosal behind the palatalincisorsMucosal could be inflamed with some level oferythemal or ulceration depending on thelevel of trauma. Stripping of palatal gingival causingrecession; as patient attempt to reposture thelower jaw forward in an attempt to avoidpalatal mucosal trauma. 20. Patient is in late mixed/ early permanentdentition. This also depend whether patientis an early erupter(earll maturer) or lateerupter(late maturer). This will assist intiming of treatment whether a 2-stage earlyand late treatment or a 1-stage treatmentwill suffice.Wear facets on the molars; bruxism Over-erupted incisors Under-erupted molars Exaggerated curve of Spee 21. Treatment planningMid-treatment comparisonMedico-legal 22. Treatment planning space analysisMeasurement of arch width and archlengthFabrication of appliance if needed 23. To assess stage of development of theteeth To ascertain presence of the remainingpermanent teeth To rule out impacted teeth, supranumerary,pathology like odontome. 24. If the traumatic overbite is of skeletalorigin the following will be evident;Reduced facial heightReduced gonial angleParallel Sassouni planesIncreased ramus heightReduced mandibular plane angleReduced Jarabak ratioReduced Y-growth axis 25. If of dental origin;o Height of the lower incisor from the incisaledge to the lower border of the mandiblewill increase indicating incisal supra-eruptiono Height of cuspal tip of the molars to thepalatal plane and lower border of themandibular plane is reduced for upper andlower teeth respectively 26. Treatment aimsTreatment considerationsTreatment optionsPrognosisRetentionFollow up 27. 1. To alleviate pains from trauma to thepalatal mucosal2. To treat any complicated existingperiodontal problems3. To prevent trauma to maxillary anteriorteeth in class II div, I cases4. To correct vertical discrepancies5. To correct anterio-posterior discrepancies6. To ensure a stable result 28. 1. Patient growth pattern/direction2. Patient growth spurt; male/female3. Patient compliance4. Duration of treatment5. Cost of treatment 29. 1. Ensure a sound surrounding soft tissuehealth and periodontal support2. Correction of vertical and antero-posteriordiscrepancies 30. 1. Warm saline mouth bath with mildanalgesic(acetaminophine); to relief painand ensure sound palatal mucosal.This is important as patient wound beneeding a functional appliance that mightcontact the palatal mucosal and couldmake not to wear the appliance if it causesdiscomfort.2. Scaling and removal of foreign bodyinpaction 31. CORRECTION OF VERTICAL ANDANTERIO-POSTERIORDISCREPANCIES. 32. 1. Two-stage(early and late) treatment2. One-stage(late) treatment 33. Early stage.Use of function appliance to1. Reposture the lower jaw forward2. Facilitate eruption of the molarsAt 12 years patient has some amount of expectedand this will facilitate functional appliance.Time of wear; almost 24 hours for Twin block orabout 10 hours(evening and night) for Andresenappliance.Duration; depends on the level of compliance, from8-10 months 34. Reposturing the mandible forward help toreduce the mandible.Mandibular growth is redirected downwardand backward and with the eruption of themolars the bite is opened up and alsoincreasing the facial height.Andresen appliance will give a good resultas it causes passive eruption of the molarswhile it also reposition the mandibleforward. 35. Twin block although reposition the mandibleforward but intrude the molars which couldworsen the overbite and makes transitioninto the second phase of fixed appliancedifficult, thereby prolonging treatment time 36. Late stage;Functional appliance is discontinue andreplace with fixed appliance.The anterior are further intruded and othercomplicating mal-occlusion are corrected 37. Possible reasons1. Delay eruption of permanent teeth2. Patient not complaint with functionalappliance3. To avoid long time of treatmentassociated with the two-treatment option.4. To reduce the financial cost of two-stagetreatment 38. A single stage fixed upper and lowerorthodontic treatment.Anterior teeth are intruded while theposterior teeth are extruded. This willreduce the overbite.Retraction of the maxillary anterior segmentto help reduce the overjet. 39. Under-eruption of molars: by relativeintrusionA removable appliance with an anteriorbite will cause supra-eruption of themolars. This will reduce the biteSupra-eruption of incisors:a bypass arch or utility arch can be use tointrude incisors in the fixed orthodontictherapy. 40. A post-treatment cephalometric radiographwould be take for super-imposition on thepre-treatment radiograph.This will aid comparison and to ascertain theamount of movement achieved. 41. Retainer will be given to patient at thecompletion of treatmentThis ensure stability of the treatment andprevent relapse.Maxillary Hawleys retainer would be wornactively about 24 hours about 3-4 monthsand thereafter only at night for another 2months.Bonded palatal retainer can be given topatient to prevent relapse. 42. The ensure compliance especially whenpatient is on removable retainer,preventing relapse.To ascertain the level of stability of thetreatment achieved by taking anotherlateral cephalometry radiograph 43. Identification of etiology of the traumaticdeep overbite coupled with correct facialskeletal assessment is important.Growth status vis-a-vis pattern and directionshould be assessed.A stable is said to be joy of an orthodonticand effoert should be made to achieve this. 44. Thanks for listening