Deep bite Flashcards
(24 cards)
Deep bite
Deep bite
Dentoskeletal malocclusion where upper incisors overlap more than half of lower incisors
Deep bite
How degree of incisor overlapping classified in deep bite cases
- Moderate Overbite=>
- Overlap up to half of lower incisors
- Borderline between normal and pathological
- Deep Bite=>
- Overlap more than half of lower incisors
Deep bite
Two main variations of deep bite malocclusion
-
Developmental Deep Bite=>
* Skeletal Deep Bite=>
* Associated w/ horizontal growth pattern
* Dento-alveolar Deep Bite=>
* Over-eruption of anterior teeth or underdevelopment of posterior segments -
Acquired Deep Bite=>
Caused by lateral tongue thrust, early loss of deciduous teeth, wearing of occlusal surface
Deep bite
Factors contributing specifically to skeletal deep bite
- Upward and forward rotation of mandible
- Downward and forward inclination of maxilla
- Combination of both factors
Deep bite
Extraoral clinical findings associated with skeletal deep bite
- Reduced lower anterior face height
- Prominent chin
- Deepening of nasolabial and mentolabial sulcus
- Reduced gonial angle
- Reduced mandibular plane angle
-Intraoral=>Overlapping of upper front teeth over lower, causing gingival smile
Deep bite
Intraoral clinical findings associated with skeletal deep bite
- Incisor overlap beyond half of clinical crown
- Complete incisor coverage
- Overlap of part of vestibular mucosa
- Occlusion of lower incisors w/ papilla incisive
Deep bite
Accompanying deformities seen with deep bite malocclusion
-
Jaw-related deformities=>
* Protrusion of upper jaw
* Retrusion of lower jaw
* Bimaxillary retrusion -
Occlusion-related deformities=>
* Distal occlusion
* Mesial occlusion
Deep bite
Distinguishing features between dental and skeletal deep bite
- Dental deep bite=>
- Absence of skeletal complications found in skeletal deep bite
- Occurs due to=>
- Over-eruption of anterior teeth
- Infra-occlusion of molars
Deep bite
Disturbances associated with deep bite malocclusion
- Aesthetic issues=>
- “aged appearance”.
- Masticatory function=>
- Restricted to predominantly vertical movements, w/ impeded sagittal and transverse movements
- Speech problems=>
- Result in speaking “through teeth
Deep bite
Other complications that can arise from deep bite
- Temporomandibular joint (TMJ) disturbances
- Trauma to palatal mucosa=>
- Painful soft tissue and periodontal defects
- Bruxism
- Excessive attrition of anterior teeth
Deep bite
Diagnostic aids used to assess deep bite malocclusion
- Clinical examination
- Study models
- Lateral cephalogram
Deep bite
How diagnosis of deep bite malocclusion made clinically
- Clinical observation=>
- Focus on incisor overlap and any accompanying deformities
- Clinical test in physiologic rest position=>
- Distance between distal teeth
- 2-3 mm distance=>overdevelopment of front segment
- Over 4 mm distance=>underdevelopment of lateral segments
Deep bite
Radiographic methods used for diagnosis
- Profile cephalogram helps identify=>
- Skeletal deep bite w/ hypodivergent growth patterns
- Decreased lower facial third
- Nahoum index over 0.8
- Decreased vertical angles
- Forward rotation of mandible
- Position of the TMJ
Deep bite
Primary goal of prophylaxis for deep bite malocclusion
- Avoid and eliminate etiological factors that contribute to deep bite=>
- Deleterious habits(e.g., thumb sucking) and addressing carious lesions
- Assessing dentition for issues like premature extraction, hyper- or hypodontia, and generalized caries
Deep bite
Treatment approaches based on the growth pattern for deep bite malocclusion
- Intrusion of front teeth=>
- Front teeth over-erupted
- Extrusion of distal teeth=>
- Back teeth need to erupt more to correct bite
Deep bite
Treatment modalities available for deep bite malocclusion
- Intrusion of upper and/or lower incisors
- Extrusion of upper or lower posterior teeth
- Combination of anterior intrusion and posterior extrusion
- Proclination of incisors
- Adult surgery
Deep bite
Difference between relative and absolute intrusion of incisors
-
Relative Intrusion=>
* Preventing eruption of incisors while growth allows posterior teeth to erupt into vertical space
* Twin block
* Anterior bite plate
* Functional appliances
* Anchor bend -
Absolute Intrusion=>
* Pure intrusion of incisors without extrusion of posterior teeth
Moving dentition deeper into bone
* Face bow
* Segmental mechanics
* Implants
Deep bite
How extrusion of upper or lower posterior teeth impacts deep bite treatment
- Active extrusion of posterior teeth=>
- Increase in lower anterior face height
- Downward and backward rotation of mandible
Deep bite
How combination of anterior intrusion and posterior extrusion achieved
- Placing anterior brackets more incisally and posterior brackets more gingivally
- Using reverse curve archwire
Deep bite
When is surgical treatment considered for deep bite malocclusion
- in severe skeletal deep bite cases to=>
- Increase efficiency of orthodontic mechanics
- Improve facial aesthetics
- Enhance long-term stability
Deep bite
How deep bite treated in different dentition phases
-
Primary Dentition=>
* Generally not treated unless deformity blocks development of lower jaw (e.g., in distal occlusion) -
Mixed Dentition=>
* Considered during changing of lateral teeth, especially during II and III physiologic bite openings -
Permanent Dentition=>
* Extrusion of distal teeth and intrusion of front teeth
Deep bite
How deep bite treated in cases of supraposition of the front segment
- Eliminating causes of overdevelopment of alveolar ridge=>
- Intruding teeth in supraposition
- Restoring normal tooth overlap
Deep bite
Types of orthodontic appliances used in deep bite treatment
-
Removable Appliances=>
* Mechanically active appliances=>
* Upper lingual plate w/ bite blocks and tubes for EOA
* Upper lingual plate w/ inclined plane
* Activator
* Functional appliances=>
* BALTERS, KLAMMT, FRÄNKEL -
Fixed Appliances=>
* Fixed brackets and wires applied directly to Teeth
Deep bite
Upper lingual plate with bite blocks in deep bite treatment
- Aids in:
- Moving mandible to a Class I molar occlusion
- Applying muscle force to maxilla and mandible
- Changing mandibular condyle position
- Providing interocclusal acrylic to disocclude bite
-The acrylic is trimmed to guide tooth eruption.
