Deep bite(1)

Deep bite

1. DEEP BITE AND IT’S MANAGEMENT Dr. Saba Basit MCPS Resident Orthodontics 03/2/2015 1 Seminars 253 inOrthodontics,Vol19,No4(December)

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 2

3. 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 3 Seminars 253 inOrthodontics,Vol19,No4(December)

4. Types: 3-5mm 5-7mm >7mm 03/2/2015 4 Seminars 253 inOrthodontics,Vol19,No4(December)

5. Classification 03/2/2015 5 Seminars 253 inOrthodontics,Vol19,No4(December)

6. Skeletal Deep Bite: 03/2/2015 6 Seminars 253 inOrthodontics,Vol19,No4(December)

7. Skeletal Deep Bite: Characterized by: 03/2/2015 7 Seminars 253 inOrthodontics,Vol19,No4(December) REDUCED

8. Skeletal Deep Bite: Characterized by: 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 8

9. Skeletal Deep Bite: 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 9

10. 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 Seminars 253 inOrthodontics,Vol19,No4(December) 10

11. 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 Seminars 253 inOrthodontics,Vol19,No4(December) 11

12. 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 Seminars 253 inOrthodontics,Vol19,No4(December) 12

13. Soft tissue deep bite: They are often associated with class II malocclusion and hypodivergent facial patterns. This tends to have: Strong mandibular elevator muscle High mentalis activity Deep mento labial folds Everted lower lip 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 13

14. Diagnostic Aids: Clinical examination Study cast Lateral ceph 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 14

15. Treatment Modalities: Mecahnaical consideration Intrusion of incisors Extrusion of moalrs Proclination of incisors Considerations in growing individuals Considerations in nongrowing patients Esthetic considerations Treatment challenges Guidlines for stability Conclusion 03/2/2015 15 Seminars 253 inOrthodontics,Vol19,No4(December)

16. Mechanical considerations: Intrusion of incisors is indicated when: Excessive distance between incisal edge and stomion Large interlabial gap More occlusal level of central incisor to lateral incisor Methods to intrude incisors Continuous arches Segmenal techniques Adjunct applainces High pull headgear 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 16

17. Cont. Extrusion of posteriors: 1mm extrusion of posteriors teeth causes 1.5 to 2.5mm reduction in incisor overlap. Indicated when Short facial height Increased curve of spee Incisor display ranging from normal to minimal. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 17

18. Contd. Proclinaion of incisors: It decreases the amount of overbite and usually occurs as a side effect of other treatment modalities. Indicated to include it separately in the treatment plan when Lingually tipped incisors in class II div 2 Class III 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 18

19. Contd. Strategies to extrude molars: Altering bracket height Leveling dental arches by using RSC wire in mandible and ECS wire in maxilla. Including 2 nd molars in fixed assembly. Increasing step bends from anterior teeth to posteriors. Giving anterior bite plane Using class II elastics 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 19

20. Consideration in growing children: AIM Enhncement of posterior eruption Maintaining height of posteriors( esp in hypodivergents ) What we can do? Removable appliance with ant. bite plane Fixed 2/4 appliance with appropriate anchorage situations with intrusion arch wire. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 20

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23. 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: Lengthy treatment Reduced esthetics Periodontal compromise Root resorption Orthognatic surgery eventually 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 23

24. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 24 293 Seminars inOrthodontics,Vol19,No4(December),2013

25. Esthetic considerations: Upper lip line in relation to maxillary incisors. Depth of mental sulcus in realtion to mandibular incisor. Contraindication for intrusion: Low lip line Reduced lower anterior facial height ( hypodivergent ) 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 25

26. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 26 Maxillary Incisor Esthetic Diffrential Extrusion

27. Treatment challeanges Addressing limited objectives to resolve a specific patient complaint,reduce treatment time, or avoid surgery. Giving more weight to esthetic considerations and awareness, sometimes at the expense of evidence available for occlusal stability. Minimizing the side effects of treatment such as root resorption periodontal complications temporomandibular joint dysfunction 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 27

28. Limitations of Treatment: Nature of the occlusion (missing teeth and mutilated dentition). Compromised dental health (existing restora - tions /severe caries and root resorption ). Mechanical limitations (difficult space closure, especially extraction spaces,and resistance to intrusion—mainly in adults). 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 28

29. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 29 SUCCESS Compliance Growth direction and amount a headgear a functional appliance removable bite plates elastics

30. Stability 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 30 Importance should be given in: Posterior teeth extrusion in severe hypodivergent faces with hyperactive musculature . Proclanation of mandibular incisors and clockwise rotation of mandible.

31. Stability 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 31 Contributing factors Growth Muscle strength Muscle adaptation Original musculature

32. Guidilines for stability: Treat a developing deep overbite early. Avoid extraction of premolars, particularly in very deep bites. Long-term retention. Enhance sustainability of the correction such as the use of a bite plate at least at night. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 32

33. Conclusion: Dental or skeletal deep bite Esthetical considerations Stability considerations Long term retention 03/2/2015 33 Seminars 253 inOrthodontics,Vol19,No4(December)

34. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 34 THANK YOU FOR YOUR PATIENCE