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Deep bitehttps://www.slideshare.net/slideshow/cephalometric-landmarks/61126083

1. Deep Bite BY Students: 1) Ezzaldeen Qaid 2) Ibrahim Fawaz 3) Ali Al- Hamzi Supervisor: Dr. Ghamdan Al- Harazi 24-2-1446 & 21-08-2024

2. Deep bite

3. Nor m ally the low er incisal edges contact the lingual surface of the upper incisors at or slightly above the cingulum Usually normal overbite is 2-3 mm or 30 % or 1/3 the clinical crown height of the mandibular incisor. Introduction

4. The term "overbite" applies to the distance which the maxillary incisal margin closes vertically past the mandibular incisal margin. In the concept of normal occlusion, the maxillary central incisors slightly overlap the mandibular memory Introduction

5. Deep bite 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 deep bite or deep over bite can be defined by the excess amount or percentage of overlap of the lower incisors by the upper incisors,

6. Deep bite is one of the frequently seen malocclusions, it occur along with other associated malocclusions. Overjet implies horizontal overlapping of incisors Overbite refers to vertical overlapping of incisors. Deep bite

7. CLASSIFICATION OF DEEP BITE According to dentition Depending on the Extent of deep bite According to functional According to its origin

8. Deep bite according to its origin Dental deep bite occur to due to over eruption of anteriors and/or infraocclusion of molars , This type characterized by absence of any skeletal complicating features. Simple deep curve of Spee in the mandibular Reverse curve of Spee in the maxillary dentition A. Dental deep bite (simple)

9. Deep bite according to its origin Dental deep bite occur to due to over eruption of anteriors and/or infraocclusion of molars , This type characterized by absence of any skeletal complicating features. Simple deep curve of Spee in the mandibular Reverse curve of Spee in the maxillary dentition A. Dental deep bite (simple)

10. Deep bite due to infraocclusion of molars Deep bite due to over eruption of anteriors

11. B. Skeletal deep bite (complex) Skeletal deep bite usually genetic origin, and caused by upward and Forward rotation of the mandible, and its characterized by: 1. Patients exhibit a horizontal growth Patton 2. The anterior facial height is reduced 3. A reduced inter- occlusal clearance 4. A cephalometric examination Complex deep bite is frequently associated with class 11 div 2 and occasionally with Class III

12. Deep bite according to its origin Dental deep bite occur to due to over eruption of anteriors and/or infraocclusion of molars , This type characterized by absence of any skeletal complicating features. Simple deep curve of Spee in the mandibular Reverse curve of Spee in the maxillary dentition A. Dental deep bite (simple)

13. Deep bite according to its origin Dental deep bite occur to due to over eruption of anteriors and/or infraocclusion of molars , This type characterized by absence of any skeletal complicating features. Simple deep curve of Spee in the mandibular Reverse curve of Spee in the maxillary dentition A. Dental deep bite (simple)

14. Deep bite according to its origin Dental deep bite occur to due to over eruption of anteriors and/or infraocclusion of molars , This type characterized by absence of any skeletal complicating features. Simple deep curve of Spee in the mandibular Reverse curve of Spee in the maxillary dentition A. Dental deep bite (simple)

15. A C B D Skeletal deep bite A , B and C intraoral frontal and buccal views

16. Deep bite according to functional A. True deep bite The inter- occlusal clearance It is usually large and characterized by the Infraocclusion of molars It is often associated with a lateral tongue posture or lateral tongue thrust. This is caused by infraocelusion of the posterior segments ie , molars. These patients have near flat curve of spee

17. B. Pseudo deep bite .  Pseudo deep bite is the inter- occlusal clearance is usually normal or small over eruption of the anterior teeth. Due to the presence of the increased overjet , the lower incisors to over-erupt until they meet the palatal mucosa. An excessive curve of Spee It is frequently observed in dental malocclusions, particularly deep overbites . - It leads to muscle imbalance That can impact overall dental occlusion and function. Its implications are crucial for orthodontic treatment planning.

18. A. Complete over bite B. Incomplete over bite Deep bite depending on the Extent of deep bite An incisor relationship in which the lower incisor fails to occlude with either the upper incisors or the mucosa of the palate when teeth are occluded. An incisor relationship in which lower incisor contacts the palatal surface of the upper incisors or the palatal tissue when the teeth are in centric occlusion

19. Cephalometric landmarks . 1 Nasion . 2 Sella . 3 Articulare . 4 Posterior Nasal Spine. 5 Upper Incisor Apex. 6 Anterior Nasal Spine. 7 A Point. 8 Prosthion . 9 Z Point. 1 0 Upper Incisal Edge. 11 Upper Lip Point. 12 Lower Lip Point. 13 Lower Incisal Edge. 14 Upper Molar Tip. 15 Lower Molar Tip. 16 lnfradentale . 17 Lower Incisor Apex. 18 B Point 19. Pogonion . 20 Menton . 21 Gonion https://doi.org/10.1179/bjo.13.1.23

20. Measurement of overbite incompleteness (i) measurement along long axis of 1 11 (ii) measurement (Z-LIE) at 90° to maxillary plane

21. Primary dentition deep bite Mixed dentition deep bite Permanente dentitions deep bite Deep bite according to dentition   When an excessive overbite is seen in the primary dentition, could be a skeletal basis with a developing Class II malocclusions The overbite is greater just after eruption of the prominent incisors and decreases with eruption of the posterior teeth. In class 1 with normal incisor angulation, better to wait and till the eruption of the posterior teeth   Malocclusion phenotype, misalignment in the vertical dimension of teeth, characterized by excessive overlap of the upper front teeth over the lower front teeth

22. Loss and/or mesial tipping of posterior teeth, diminished posterior dental height. Early loss of teeth Overeruption of the incisor teeth, infraocclusion of the buccal segment or both. When the posterior vertical chain of muscles is strong and anteriorly positioned, a greater depressive action is transmitted to the dentition a. lateral Tongue thrust swallow b. Finger sucking, c. Lip sucking

23. Etiology of dental deep bite: Dental Habits Muscular

24. Etiology of Skeletal deep bite: The etiology of deep overbite is a complex problem and may include one or more of the following; A. Hereditary It is a malocclusion type in families due to genetic factors. Particularly, a common cause is when the lower jaw (or maxilla) is small, and in general, the vertical mandible grows toward the maxilla.

25. An excess of growth of the ramus and posterior cranial base permit the mandible to rotate upward. Thus long ramus and short body with decreased gonial Angle Is characteristic feature B. Skeletal

26. B. Skeletal Skeletal: Horizontal growth pattern or forward rotation or anticlock wise rotation of the lower jaw Class 1 Class 2 Class 3

27. Features Extraoral features

28. Brachycephalic and europroscopic face. Oval shaped face ( mesocephallic to dolicocephallic in frontal view. The increased forces from the muscles of mastication may inhibit extrusion of posterior teeth. Facial profile types, i.e., straight Convex profile. Deep mento labial sulcus Posteriorly divergent face Extraoral features:

29. Short anterior face height. measured from nasion to Gnathion . Anterior face height N-Me Posterior face height S-GO Diminished anterior lower face height. Clinical experience suggests that a low face height not only increases the probability of a deep overbite, but also adds to the difficulty of overbite reduction

30. Mento labial sulcus There is usually deep furrow, or sulcus, between the prominent chin and the lower lip

31. Mandibular deficiency characterized by... Long mandibular ramus and short body Square gonial angle, tlat mandibular plane Prominent zygoma and prominent chin Many of these features are common to class Il div II

32. Intra oral features Maxillary dental arch is broad, with often a maxillary bucecal cross-bite. In skeletal deep bites the patient may exhibit gummy smile if there is clockwise rotation of maxilla. The palatal vault is flat. Intra oral features

33. Intra oral features A deep curve of Spee in lower arch or a reverse curve of Spee in the maxillary dentition Often the maxillary incisors are tipped lingually in angles class 1. division 2 pattern

34. Diagnosis Extraoral & intraoral examinations of the patient should be thoroughly done & history of oral habits to be noted Following diagnostic aids are used: – Clinical examinations – Orthodontic study models- to evaluate extent of severity of deep bite – Lateral cephalograms - to evaluate ramus height, interincisal angle & Frankfort mandibular plane angle.

35. Management of deep overbite Treatment modalities in growing and non growing patients 2. Factors to be considered before intrusion or extrusion 3. Planning Treatment in different age groups Treatment modalities in growing and nongrowing patients Growing patientso Intrude anteriorso Erupt posteriors Combination of posterior eruption and anterior intrusion

36. Correction of deep overbite Intrusion of incisors Extrusion of molars Deep bite with large interlabial gap Considered if Inadequete Deep bite with no interlabial gap freeway space is there considered if adequate freeway space is there large vertical facial height short vertical facial height

37. Treated by extrusion

38. Interlabial gapInterlabial gap (0 to 2 mm ) ( the distance between the incisal edge of the maxillary central incisor to the lower most the upper lip is an average of 2 to 4 mm) Midface height (a’), lower facial height (a”), upper lip length (b), upper lip vermillion (c), interlabial gap (d), and facial contour angle (e)

39. Presence of adequate free way The interocclusal clearance Intrusion of anterior sIntrusion mechanies are considered if there is madequate or normal freeway space. Encroachment of this space by extrusion of posterior teeth is determinant and bound to relapse. It results in fatigue of the museles of mastication which get stretched and predispose to relapse. It also strams the TMJ

40. Appliances used in the treatment of deep bite Deep bites can be treated by using: a. Removable appliances II. b. Fixed orthodontic appliances. c. Orthognathic surgery 2. archwire with revers curve of spee 1) Anchorage bend of intrusion of interior teeth C B A A

41. Factors to considered to treatment in deep bite • Brought about by maxillary anterior intrusion, maxillary posterior extrusion, mandibular anterior intrusion, mandibular posterior extrusion or combination of these • Light forces are used for incisor intrusion whereas heavier forces for extrusion of posteriors. • Deep bite can be treated by using removable, myofunctional or fixed orthodontic appliances

42. Summary Understanding the deep bite and its classification Types of deep bite skeletal Diagnosis of deep bite Treatment of deep bite

43. Thank you for your attention