orthodontic deep bite

etiology and management of deep bite are presented

1. ORTHODONTICD
EEP BITE
By; Ammar Abdul-kareem Dae’r
Supervisor
DrMaher Fouda

2. -Definition
-Types of deep bite
-Etiology
-Diagnosis
-Factors concerned in deep bite
-treatment of deep bite

3. Definition
It is the vertical distance between the tips of upper and
lower incisors in occlusion. It is governed by the degree of
vertical development of the anterior dento-alveolat
segments

5. Overbite is a vertical measurement

6. The maxillary incisors overlap to the
lower incisors are described either in
millimeters or as a percentage of the
lower incisor crown length which is
more accurate than the first method
because there is a significant
individual variations in incisor
length.

7. Deep bite as a clinical problem is not
defined in terms of millimeters
seen today but in the light of future
changes in esthetics and function.
(MOYERS)

8. The normal overbite should range from
1\4 to 1\3 of the lower incisor length ,and
in some cases it may reach to 40%
without harmful effect. So , the deep
over bite should not considered unless
there is harmful effect and should also
evaluated not only from the labial
aspect but also from the palatal aspect to
determine the point where the palatal
surface restricted by the lower incisors.

9. A study of occlusion of teeth
between 2.5&3years of age (done by
foster & Hamilton1969) in 100
children, show that the incisal
overbite matched up to the ideal in
only 19% of the children. There was a
reduced overbite in 37%, an anterior
open bite in 24% and an excessive
overbite, with the lower incisors
occluding on the palate, in 20%.

10. Type of Deep Bite
Deep bite can be differentiated into
two types based on the interocclusal
clearance:
1. True deep bite
2. Pseudo deep bite

11. The true deep bit with a large
interocclusalclearance is caused by
infraocclusionof posterior
segments. This infraocclusionis
often the result of a lateral tongue
posture or tongue thrust

12. The pseudo deep bite problem,
with a small interocclusalspace,
already has normal eruption of
the posterior teeth. Some class II
division2 malocclusion with a
((gummy smile)) and a poor lip
line relationship can fall into
this category

13. Etiology
It may be:
-genetic
-Acquired
-muscular

14. Genetic:
a-skeletal pattern e.gmalrelationof dental bases
b-pseudo skeletal deep bite Dentoalveolar
malocclusion
-infraocclusionof molars
-supraocclusionof incisors
C-tooth morphology e.glong crown of anterior teeth

15. Six specific growth increments are responsible for
overbite and or open bite. These are
(1)the mandibular condyles.
(2)the body of the maxilla which has the effect of
lowering the occlusal plane.
(3)posterior alveolar process of the maxilla.
(4)posterior alveolar process of the mandible.
(5)vertical growth of the anterior alveolar process
of the maxilla.
(6)Vertical growth of the mandibular incisors.

16. Dentoalveolartype may be due to;
a)premarureloss of a permanent teeth causing a
lingual collapse of maxillary or mandibularanterior
teeth.
b) Similarly loss and/or anterior tipping of the
posterior teeth may also cause a deepening of the
overbite .
c) A lateral tongue thrust or postural position. This type
of dysfunction produces an infraocclusionof the
posterior teeth .
d) The wearing away of the occlusal surface or tooth
abrasion can produce an acquired secondary deep
overbite.
e) Occasionally a deep overbite may be caused or
accentuated by tooth morphology .This can be
diagnosed by carefuleanalysis of size and shape of the
teeth

17. Accordingly the deep bite that is
due to the infraocclusionof the
posterior teeth has the
following symptoms :
1.The molars are partially
erupted
2.The interocclusalspace is large
3.A lateral tongue posture and
thrust are present.
4.The distance between the
maxillary and mandibular
basal planes and the occlusal
plane are short.

18. The deep overbite caused by over eruption
of the incisors has the following
characteristics:
1.The incisalmargins of the incisors
extend beyond the functional occlusal
plane.
2.The molars are fully erupted
3.The curve of spee(compensating curve)
excessive.
4.The interocclusalspace is small

19. Deep overbite of skeletal origin:
The skeletal deep bite is characterized by
a horizontal type of growth pattern.
The anterior facial height is short particularly the lower
facial third.
While the posterior facial height is long.

20. A skeletal type of overbite may be
due to either malrelationshipof
alveolar bones and/or underlying
mandibular or maxillary bone to an
overgrowth or undergrowth of one
of more alveolar segments .In the
mandibular dentition it may be
manifest as a deep curve of speeor
a reverse curve of speein the
maxillary dentition.

22. When the problem is in the anterior
maxillary region the patients often
show excessive gingival tissue
during smiling or even speaking.
Even when the upper lip is of
adequate length.

23. Acquired:
Premature loss of deciduous molars or
early loss of permanent posterior
teeth lingual tipping of the
anterior teeth
Incorrect axial inclination of the
anterior teeth absence of incisalstop.
Incomplete eruption or attrition of the
posterior teeth.

24. Muscular:
*lateral tongue thrust result in
infraocclusionof the posterior
teeth of characterized by increased
free way space.

25. Diagnosis
A successful treatment of a deep over bite
requires :
1-clinical examination of; dentition ,
occlusion, and jaw movements .
2-diagnostic aids an dental cast a,
intraoral radiographs, lateral
cephalogramsat rest and at occlusion

26. Cast analysis alone or observations
based solely on the usual occlusal
position are insufficient: a proper
cephalometricanalysis and
determination of the interocclusal
freeway space are necessary.

27. Sassoni described the constitution of
skeletal deep bite as follow:
-positional deviation, The four planes of
the ace (supraorbital.palatal.occlusal.
And mandibular ) as seen from lateral
cephalometric are horizontal and
nearly parallel to each other.

29. The total posterior height is nearly equal
to the total anterior facial height
(supraorbital to menton). The lower
face height (ANS_Me) is smaller than
the upper face height (supraorbital to
ANS) .
The facial weadths (minimum frontal
,bigonial diameters) tend to be equal to
total facial height giving a square
appearance from the frontal view.

30. Unfaverable sequalae of deep
overbite
Deep overbite where incisor edges of
lower incisors hit the palatal gingiva of
the maxillary incisors or the upper
incisors hits the labial gingival tissue
often results bad esthetics,
periodontal tissue destruction, anterior
migration of maxillary teeth and wear of
mandibular incisors, TMJ disorder

32. These effects are influenced by many factors:
*amount of anterior overjet;
as the overjetincreases, the traumatic effect
of deep over bitedecreases, also less
interference will occurs between the lower
incisors and the cinqularidges of the
maxillary incisors in lateral excursions.
However if the deep over bite is associated
with a lingual inclination of the maxillary
incisors the traumatic occlusion will be
Severe even with large overjet.

33. *Frequency, duration, degree of force:
Some patient with deep over bite with less
harmful effect as they masticate
primarily by hinge movement, also
remain their occlusal contact only for
short time ,the reverse will Grinding
habit persons.

34. It can be seen that excessive incisal
overbite will occur if the incisors
are retroclined or proclined so that
they fail to meet correctly, or if they
fail to meet because of skeletal
discrepancy. In all these
circumstances vertical
development may continue to an
excessive degree.

37. In the class II Division 1 occlusion
vertical development of the lower
anterior dento-alveolar segment is
usually excessive, development of the
upper anterior segment being limited
by the lower lip. In class II Division 2
occlusion the lower lip usually
functions in front of the upper teeth,
and excessive vertical development of
both upper and lower anterior
segments can occur.

38. Class II
division 1
Class II
division 2

39. If the overbite seems excessive in the mixed
dentition when there is a class I molar
relationship and normal skeletal morphology, it
usually is due to one or more of the following
related factors:
a) Over development vertically of the incisal
regions,
b) Inadequate elevation of the maxillary first
molars (i.e., the anatomic crown of the molar
has not erupted to its full clinical crown height).
c) Failure to recognize a normal stage of
development. The overbite is greater just after
eruption of the permanent incisors and
decreases with eruption of the posterior teeth.

40. Factors concerned in deep bite
1) Interlabialgap
2) Incisor _stomiondistance
3) Occlusal plane and curve of spee
4) Vertical relationship
5) Free way space
6)Length of treatment and patient’s age
Dr.Maher’spapers
Angle Orthodontist, Vol74, No 2, 2004

41. Interlabial gap:
In relaxed mandibular position, the
normal individual should have 2 to 4
mm interlabial gap so the treatment of
deep overbite by extrusion of the
posterior teeth is sometimes
contraindicated as it will increase the
interlabial gap which gives bad esthetics
, also inability to close the lip without
strain, the reverse condition is true.

43. Incisor_stomion distance:
The distance between the incisal edge
of maxillary incisors and lower most
border of the upper lip varies from 2-
4mm.
In those patient with normal
incisor_stomion (2_4) ,the treatment
of overbite by intrusion of maxillary
incisors is contraindicated as it gives
edentulous appearance .

44. David M. Sarver, DMD,
MSdefined the smile arc
as the relationship of the
curvature of the incisal
edges of the maxillary
incisors and canines to the
curvature of the lower lip.
The ideal smile arc has
the maxillary incisal edge
curvature parallel to the
curvature of the lower lip.
American Journal of Orthodontics and DentofacialOrthopedics Sarver
99 Volume 120, Number 2

45. :
One of the objectives of treatment is to
provide the patient with a flat occlusal
plane but sometimes this can not be
achieved and step-type occlusal plane
may be created between posterior and
anterior teeth to compromise with other
factors.
occlusal plane:The imaginary surface on which upper and lower teeth meet in occlusion.
curve of spee:The occlusal and incisal surfaces of the tooth crowns in either dental arch
describe, from a sagittal perspective, a curve, ordinarily concave upward with reference to
the mandibular arch and convex for the maxillary arch.
Occlusal plane and curve of spee

47. Vertical relationship:
We know that extrusion of maxillary
molars will result in downward and
backward relation of the mandible,
increasing the lower face height ,so
in planning the treatment all
factors must be balanced as to their
beneficial effects.

48. Length of treatment and patient
age:
In adult patient with increase
vertical facial height, alveolar
problem treatment of deep
overbite will take a very long time
so treatment time should
evaluated first depending an
these factors.

49. Free way space:
We should note that extrusion of
molars in to the free way space
will relapse due to muscle strain .
free-way space: The clearance or
interocclusaldistance between the
upper and lower teeth when the
mandible is in the postural resting
position.

50. Treatment of deep bite
The incisal overbite may be excessively deep, or,
at the other extreme, there may be anterior
open bite. Correction of deep overbite depends
entirely on correction of reversed overjet. If the
incisors can be placed in correct antero-
posterior relationship during the growth
period, vertical development of the buccal
dento-alveolar segments should bring about a
normal overbite relationship.
BLACKWELL SCIENTIFIC PUBLICATION

51. In class II Division 1 treatment, if the incisal
overbite is excessive it is not possible to
reduce the overjetcompletely without first
reducing the overbite. Reduction of overbite
is therefore a frequent part, and is usually
carried out as one of the first stages.
1_ By using an anterior bite plane on an upper
removable appliance.
2_ By using a lower fixed appliance to apply
direct downward force to the lower incisors.
3_By using an upper fixed appliance to apply
direct upward force to the upper incisors.

52. Methods of Reducing Overbite:
* Bite planes
Increased overbite are readily reduced
by the use of a flat anterior bite plane
incorporated in an upper removable
appliance. The bite plane will produce
relative depression of the incisors .

53. Except when removed for cleaning; the
appliance should be worn full time. With the
appliance in place, the buccal segments
should be separated by a small amount
(1_2mm).
As the lower incisors are depressed the bite
plane is increased in depth by the addition of
cold cure acrylic to the surface which
occluded with the lower incisors, in order to
maintain buccal segment separation.
Following the use of a bite plane, a lower fixed
appliance will be required to maintain the
overbite reduction which has been achieved,
in order that the overjetcan be reduced with
a fixed appliance.

55. The overbite reduction is probably
brought about by continuing vertical
development of the lower buccal
dento-alveolar structures, which are
kept free from occlusal contact by the
anterior bite plane.
It will be seen from that, Increased
vertical development of the buccal
segment will result in an increase in
the total vertical dimension of the
jaws in occlusion .

56. The use of a Bite Ramp in the
treatment of deep bite:
The bite ramp is
Leonardo Tavares Camardella; Elvira Gomes Camardella; Guilherme Janson
an orthodontic device that is bonded on lingual
face of the maxillary central incisors. This procedure
also allows the bonding of mandibular incisors and
facilitates the over correction of overbite because
the brackets can be bonded on a more incisal

57. Biteplanescan be used in Class I and Class II,
division 1 and 2 cases for the correction of deep
bite with moderate overjetand their shape was
inspired by the lingual orthodontic brackets.
The bite ramp advantages are: it is not
necessary to be built, it is easy to bond
and it is hygienic. The only
disadvantage is that this orthodontic
device is more expensive than the
other ways of opening the bit

58. Rick-A-Nator
May act as a removable anterior
bite plane, lingual anterior arch
Form appliance, and as a
removable Nance appliance when
designed as
such. It is virtually undetectable
from an aesthetic point of view
and
may be worn 24 hours per day.
TP Orthodontics laboratory services (www.tporthp.com)

59. This case concern an 12-year-old
male, presenting with a Class II
division 2 malocclusion, with an
accentuated curve of Speeand deep
overbite.

60. After three months, the deep bite was
corrected and the posterior teeth occluded,
what shows the effectiveness of the bite
ramp, mainly because the full-time use.

61. It’s use show decrease treatment
time during leveling curve of Spee
and overbite correction. ,
Use of a Bite Ramp in Orthodontic Treatment
Leonardo Tavares Camardella; Elvira Gomes Camardella;
Guilherme Janson

62. As far as, the anterior bite plane causes
reduction in overbite by allowing
vertical development of the posterior
dento-alveolar segments. There is some
evidence that fixed appliances may
reduce overbite by causing intrusion of
the anterior segment, at least in the
short-term, as well as by allowing
vertical development of the posterior
segment. It seems likely that, in the
long-term, permanent reduction of
overbite is associated with vertical
growth of the jaw.

63. The reduction of incisaloverbite
either with the use of bite planes or
of multibandedappliances,
depends on the restriction of
vertical development of anterior
segments. at the same time
allowing vertical development of
the buccal segment. For this to be
successful, the buccal segment
must undergo active vertical rather
than over-eruption of the teeth.

64. (Shroff et al., 1995)
Bilateral tip-back moments to
correct the
molar axial inclination and deep
bite may be produced by using
a three-piece base arch.
Bilateral tip-back springs are
hooked to the distal
extensions of an anterior
segment of wire which
includes the four maxillary
incisors.
Anterior intrusive
forces and posterior
Extrusive forces are
Produced with the molar
tip-back moments. European Journal of Orthodontics 19 (1997) 93–101

65. The intrusive force is placed
through
the centre of resistance of
the upper incisors to
prevent flaring. As
tip_back of the molars
occurs, the anterior hooks
of the tip-back springs
slide distally along the
distal extension of the
anterior segment of wire.

66. The three-piece base arch is
composed of an anterior segment
of wire placed passively into the
brackets of the four incisors. This
anterior segment of wire is
fabricated from 0.021 ×0.025
stainless steel wire to obtain high
rigidity. Tip-back moments are
applied to the molars bilaterally
by using tip-back springs
extending from the
auxiliary tube of the molar
to the distal extension of
the anterior segment of
wire.

67. The anterior portion of
this spring has a hook that
is free to slide along the
distal extension of the
anterior segment of wire.
These tip-back springs are
fabricated from 0.017 ×
0.025 TMA wire and 70 g
of intrusive
force can be applied
on the right and left
sides of the anterior
segment of wire.

68. TREATMENT WITH TIP-BACK MOMENTS

69. When an excessive overbite
is seen in the primary
dentition, it is likely to
have a skeletal basis.
Activator type appliance
may be used to direct
differential alveolar
growth, reduce the
interocclusal distance, and
improve skeletal
morphology.(moyers)

70. Herman van Beek
Headgear
Activator:
Effective in Class I Division
1 ,
open or deep bite cases.
Upper anteriorsare covered
with acrylic for torque
control. Lower anteriors
are
free to move lingually
while
acrylic prevents labial
crown tipping.
TP Orthodontics laboratory services (www.tporthp.com)

71. Frankel I:
Corrects overcrowding
in Class I cases and
reduces the overbite
and overjet in Class II,
Division 1 cases.
External
muscle pressure is
eliminated
by the vestibular
shields. Promotes
transverse arch
development dentally
and skeletally.
TP Orthodontics laboratory services (www.tporthp.com)

72. Eruption of the first molars
can be aided by the use of a
flat maxillary bite plane or a
monoblocand the incisors
depressed with utility
arches. Such appliances may
help, too, if the curve of spee
is excessive. The functional
jaw orthopedic appliances,
(e.g.,Actiator) are ideally
suited to direct vertical
skeletal development and to
control adaptive alveolar
growth in class I deep bite as
well as class II.
TP Orthodontics laboratory services (www.tporthp.com)

73. Severe Class II Anterior Deep Bite
Malocclusion Treated with a C-Lingual
Retractor
Angle Orthodontist, Vol 74, No 2, 2004
A C-lingual retractor was
placed on the lingual
aspects of the six
maxillary anterior
teeth in patients
with a Class II
anterior deep-bite
malocclusion.

74. The C-lingual retractor mechanics developed
by Chung et al. and Kim et al. is an
alternative method for obtaining a direct
controlled retraction force on the maxillary
anterior teeth.
A C-lingual retractor for intrusion and
retraction
has three components:
(1) mesh part soldered lever arm,
(2) wire with bent hook, and
(3) auxiliary hook soldered
for intrusion force

75. C-lingual retractor for retraction and intrusion. (A) Mesh
part soldered. (B) Lever-arm wire with bent hook. (C)
Auxiliary hook soldered for intrusion force. (D)
Transpalatal arch soldered

76. Treatment was initiated with the leveling and
intrusion of the lower anterior dentition. Because of
the patient’s dental and skeletal problems, the
maxillary first premolars were removed to create
space for the intrusion and retraction of the
maxillary anterior teeth.

77. Preadjusted 0.022 3 0.028-inch brackets were
placed on all teeth except the maxillary
anterior segment, and this was followed by
the placement of buccal segments of 0.018 x
0.025-inch stainless steel stabilizing arch
wires. The permanent first and second molars
were banded. transplantal arches (TPAs) were
soldered to the lingual aspects of both the
upper molar bands. The C-lingual retractor
was placed on the upper six anterior
teeth and used until space closure was
complete.

78. NiTi coils that delivered 300 g per side provided a retraction
force for space closure. In addition, the intrusion force of
the C-lingual retractor was 60 g per side. The patient was
instructed to wear her high-pull headgear during the night
to reinforce anchorage (350 g per side).

79. Occlusal view of orthodontic treatment. (A) After
C-lingual retractor delivery. (B) During en masse
retraction. (C) After en masse retraction of upper six
anterior teeth. (D) During leveling. (E) Post treatment.

80. Pretreatment
Intraoral
photographs
Posttreatment
intraoral photos

81. OVERBITE REDUCTION
(W.J.B. HOSTON AN INTRODACTION TO FIXED APPLIANCES)
Two possibilities exist for depressing the lower incisors:
_TRUE DEPRESSION: This involves depressing the lower
incisors axially into the alveolus so that the distance
between the lower border of the mandible and the
incisal edges decreases. True depression is very difficult
to achieve.
_RELATIVE DEPRESSION: The lower incisor vertical
development is arrested while the buccal segments
continue to develop vertically .This is associated with an
increase in the maxillary_mandibular planes angle,
which is liable to revert towards its former value after
treatment.

82. Both relative and true
depression may occur
together when afixed
appliance is used.

83. •Archwires for overbite Reduction:
-PLANE ARCHWIRES : a plain Archwires lying in
the molar tubes rests passively will below the
level of the incisor band bracket.
Archwires of progressively increasing diameter are
used, the final Archwires being constructed with
a reverse cure of spee.
Archwires which are very flexible such as
multistrand Archwires or multilooped archwires
are not effective in producing overbite reduction
and initial alignment of the lower arch must be
achieved before overbite reduction can be
completed.
W.J.B. HOSTON AN INTRODACTION TO FIXED APPLIANCES

85. _LOOPED ARCHWIRES:
An Archwires
incorporating
horizontal loops in
the incisors region
will provide
sufficient flexibility
for leveling and
hence overbite
reduction.

86. _ACCESSORY ARCHWIRES:
these are designed to engage the molar
tubes and lower incisors only whilst
buccal segment tooth position is
controlled by sectional Archwires: this
necessitates the use of additional lower
molar buccal tubes. These Archwiresare
activated gingivally, and the long
unsupported buccal section increases
the flexibility of these Archwiresin the
vertical plane.

88. Connecticut Intrusion
Arch:
It is developed by Dr.
Ravindra Nanda for
anterior intrusion ,
molar extrusion and
distal tip back for
posterior anchorage
preparation and class
II correction .
www.OrthoOrganizers.com

89. _UPPER ARCH INTRUSION:
When movement of the upper incisors
towards the maxillary base is required
to produce a stable interincisal
relationship, anchorage bends may be
used in the upper arch. This
movement can be aided by the use of
high pull headgear and J hooks,
engaged on the anterior part of the
upper Archwires.
W.J.B. HOSTON AN INTRODACTION TO FIXED APPLIANCES

90. Michael C. Alpernsaid:
If the patient is a Class II Division 2 deep bite and involve
deficient maxillary and or mandibular width, the RPE-
BP appliance system includes right and left molar tubes
can be used. Bonding of the RPE-BP appliance is
accompanied by orthodontic bracket bonding of
incisors.

91. As soon as the RPE-BP expansion
has been completed, a sectional
rectangular Bio Force arch wire
is inserted from cuspid to cuspid
or lateral incisor to lateral incisor.
An .018 x .025 Bio Force wire is
constructed, which exits the
molar tubes. Double helical
coils and intrusion bends are
formed, and the arch wire then
"piggy backs" under the incisal
edge of the incisor orthodontic
brackets, and is secured with an
elastic thread or ligature .

94. This wire is periodically activated (every 6-8
weeks). The four months of RPE-BP
stabilization permits adequate time for
significant incisor intrusion to occur.
Insertion of intrusion wires in special
tubes.
Intrusion wires for maxillary anteriors.
Copyright, Michael C. Alpern, D.D.S., M.S., Port Charlotte, Florida, January, 1999
The Fixed Functional Splint, Dr_ Michael Alpern.htm

95. Overbite Correction and Smile
Aesthetics
stevenJ. Lindauer,ShannonM. Lewis, and BhavbaShroff 2005
The purpose of their prospective clinical study
was to investigate differences in outcomes
from two common procedures used to reduce
deep overbite: maxillary incisor intrusion
using an intrusion arch and posterior tooth
eruption using an anterior bite plate.

96. They concluded that:
Both intrusion mechanics and use of an
anterior bite plate proved to be effective
means of reducing overbite in a sample of
patients presenting with deep overbite
before treatment. The mechanism of
correction was significantly different
between the two treatment procedures
with the intrusion arch group
demonstrating significant maxillary incisor
intrusion accompanied by a significantly
greater decrease in maxillary anterior tooth
display (lip to tooth)

97. Bite plate: patients exhibited more
lower incisor intrusion,
significant flaring of the lower
incisors, and a small but
significant increase in the
mandibular plane angle. About
half of the patients in both the
intrusion arch and the bite plate
groups experienced flattening of
the smile arc during the overbite
correction phase of treatment.

98. The data from this and previous
studies suggest that flattening of the
smile arc is a common occurrence
during orthodontic treatment and
not necessarily related to maxillary
incisor intrusion.

99. Note:
Smile arcs were classified as
“consonant’’if the incisaledges of
the maxillary teeth followed the
contour of the lower lip, “flat’’if
they were straight, and “reverse’’if
the were aligned in an arc opposite
to the lower lip line.

100. CIA: Connecticut Intrusion
Utility Arch
CIA is made of preformed .016x.022.The vertical forces are
balanced by tip back moment on acting
on molar. An intrusion arch is an auxiliary appliance for
incisor intrusion and/or molar tip-back. The intrusion
arch is ligated to an anterior segment.
Proper distance from intrusion wire to anterior brackets
(before activation) is 10-12 mm, which can produce force
45-50 grams for four incisors
Biomechanical Strategies for a Contemporary Busy Orthodontic Practice Presented by Dr.
RavindraNanda, B.D.S., Ph.D. on June 2, 2000, at the Southern Region Meeting.
Summarized by Dr. Hong B. Moon, Southern Region Editor.

102. James J. Hilgers, DDS, MS
Mission Viejo, California (clinical
impressions)
Multifunctional archwire
He said, when the
lower arch is completely
leveled, the upper
buccal segments in
a Class I, and still
have a latent deep bite with
spaces mesial to the upper cuspid
, The solution is to open the bite
in order to close the space .He
used the reverse curve TMA with
“T”loop to close space, open the
bite and increase torque while the
arch wire is in place.

103. The “T”Loop in the TMA
archwirecould be more
accurately described as an
asymmetrical “T”loop because
the distal extension of the loop
is about one third longer than
the mesial. It’s this
asymmetrical
design that allows the clinician to
create a
step-up from the cuspidsto the
incisors, effectively treating
them as individual segments.

104. The archwire comes in three different
sizes: .016 x .022, .017 x .025 and .019 x
.025. It’s available with six different
anterior lengths, measured from the
distal of the upper lateral incisors.
*Its exaggerated curve of Spee acts to
extrude and seat the buccal segment
while aiding the intrusion of the
upper incisors.

106. After selecting the appropriate archwire size, activate
the “T”Loop by pinching the anterior portion of the
loop closed (Figure A) and opening the distal extension
of the loop (Figure B). This creates a step-up in
the archwire from its anterior to posterior components
from 1 to 5 mm, depending on the bite opening you
desire (Figure C).
Figure A Figure B Figure C

107. A unique advantage of the Reverse Curve TMA with
“T”Loops is that torque in the anterior segment can
be enhanced while the archwire is completely engaged.
This can be accomplished by pinching the horizontal
portion at the top of the “T” Loop using a small
optical plier to place a gabling torque of up to 30˚ in
the anterior portion of the wire.

109. A complete 8 to 10 mm overbite can often be
reduced in two to three months.

110. Although anterior bite opening
is possible with traditional
mechanics using reverse curve of
Spee wires,
bite opening usually takes upward
of 8-12 months, unless bite
opening auxiliaries are bonded
to the molars or incisors. The
Ortho Implant can be used in
these cases to open the bite in
less than half the time, thereby
allowing lower bonding
sooner.
Correction of deep bite with
Ortho Implant:

111. The Ortho Implant Using the Cope Placement Protocol™: Big Results From a Tiny Implant
www.3MUnitek.comby Jason Bryan Cope, D.D.S., Ph.D.
Incisor intrusion. A, Anterior photograph at initial Ortho Implant placement
and loading. B, Anterolateral photograph at initial Ortho Implant placement
and loading. C, Anterior photograph after 5 months of loading allowing lower
bracket placement. D, Anterolateral photograph after 5 months of loading.

112. Dr. Stefano Velo:Numerous techniques
have been suggested to intrude upper and
lower incisors without anchorage loss. In
fact many malocclusions present a
moderate to severe deep bite that requires
pure intrusion of the front teeth as part of
the treatment planning to level the occlusal
plane. Using miniscrews simultaneously in
the maxilla and in the mandible in young
patients may be too excessive unless the
deep bite is severe enough to require
absolute anchorage.
Skeletal anchorage with miniscrews: indication and clinical application.
www.orthodont-cz.cz

113. To intrude the upper
incisors, the best placement
of the mini-screw is between
the upper lateral incisors
and the canines. The
placement of the mini-
screws should be done after
leveling and alignment. In
order to avoid tipping the
upper incisors buccally
during the intrusion, the end
of the archwire should be
cinched back.

114. The placement of the
mini-screws should be
done after leveling and
alignment, in order
to maximize the
interradicular space at
the placement site. In
order to avoid tipping
the upper incisors
buccally during the
intrusion, the end of the
archwire should be
cinched back.

115. *Free-way space: The clearance or interocclusal
distance between the upper and lower teeth
when the mandible is in the postural resting
position.
*Functional occlusion: An arrangement of the teeth
intended to minimize stress on the
temporomandibular joint; maximize function,
stability and esthetics of the teeth; and provide for
protection and health of the periodontium.
*Functional occlusal plane: IS a plane averaging the
points of posterior occlusal contact from the first
permanent molars to the primary molars or
bicuspids. It makes on reference in incisors and
cuspids landmarks.

116. THANK YOU