ORTHODONTICS

1. MANAGEMENT OF
DEEP BITE
UNDER THE GUIDANCE OF
DR. MRIDULA TREHAN

2. CONTENT
 Definition
 Classification
-Skeletal
-Dental
 Diagnosis
 Factors to be considered in treatment of deep
bite

3.  Treatment of deep bite
 Principles of bite plane therapy in deep bite
 Changes that can be effected by means of bite
plane
 Construction of bite plane
 Myofunctional appliance
 Fixed appliance therapy

4. LEARNING OBJECTIVES
The students should acquired the following
knowledge:
 Classification of deep bite
 Diagnosis
 Factors to be considered in treatment of deep
bite
 Treatment of deep bite

5. DEFINITION
 Excessive vertical overlapping of mandibular
anteriors by maxillary anteriors is called deep
bite
 By Graber-Condition of excessive overbite
where the vertical measurement between the
maxillary and mandibular incisal margins is
excessive when the mandible is brought into
habitual/centric occlusion

6.  Vertical overlap of incisors can be expressed
either in millimeters or as a percentage of the
lower incisor crown length covered by the
upper incisor.
 Percentage is more descriptive because of the
variation in the crown height of the mandibular
incisors.
 Deep bite refers to the increase of overlap of
maxillary incisors over mandibular incisors
beyond 30-40%.

7. CLASSIFICATION
SKELETAL DENTOALVEOLAR
TRUE PSEUDO

8. SKELETAL DEEP BITE
 Genetic origin
 Features:
1) Horizontal growth pattern
2) Reduced anterior facial height
3) Reduced IOG
4) Horizontal ceph planes such as FHP, SN
plane, mandibular plane etc are all parallel to
each other

9. DENTAL DEEP BITE
 Due to:
1) Over-eruption of anteriors- Usually seen in
Class II div 1 malocclusion.
Excessive curve of Spee
Normal IOG
2) Infra-occlusion of Molars- Due to lateral
tongue thrust.
Increased IOG

10. DIAGNOSIS
1) Clinical examination
2) Study models
3) Lateral Ceph- To differentiate between
skeletal and dental deep bite. In skeletal the
mandibular plane angle and anterior facial
height are reduced

11. FACTORS TO BE CONSIDERED
IN TREATMENT OF DEEP BITE
 Whether to intrude anterior teeth or extrude
posterior teeth
1) Lip relationship- Patients who exhibit a short
upper lip or a gummy smile are treated by
intrusion of anteriors
When the upper lip is normal with
only 2-3 mm of maxillary incisal
edge exposed, then extrude the
molars

12. 2) Consideration of vertical facial relationship-
In skeletal deep bite with excessive horizontal
growth and upward rotation of mandible
extrude posterior teeth. This will result in a
downward and backward rotation of the
mandible causing an increase in anterior facial
height

13. 3) Consideration of inter-occlusal space- When
IOG is increased- extrude posterior teeth and
when IOG is normal- intrude the anterior teeth

14. TREATMENT OF DEEP BITE
 REMOVABLE APPLIANCES- ANTERIOR
BITE PLANE APPLIANCE

15. PRINCIPLE OF BITE PLANE
THERAPY IN DEEP BITE
 When there is an excessive IOG in which the
VRO is not in harmony with VRR as the
posterior teeth have not erupted sufficiently the
bite plane can stimulate eruption of the
posterior teeth

16.  Anterior Bite Plates - Can be removable or
fixed.
 Very effective in growing patients.

17.  Fixed auxiliaries include composite platforms
placed freehand or bite turbos (prefabricated
bracket like platforms )bonded on the palatal
surface of maxillary incisors to separate the
posterior teeth.
 -Used when overjet is not increased .

18. MYOFUNCTIONAL APPLIANCE
 If due to infra-occlusion of molars-use
activator or bionator

19. FIXED APPLIANCE THERAPY
 To intrude anteriors
1. Use of anchorage bends-Mesial to molar
tubes so that anterior part of archwire lies
gingival to bracket slot

20. 2. Use of archwires with reverse curve of Spee-
When these archwires are inserted into the
molar tubes the anterior segment curves
gingivally

21. 3. USE OF UTILITY ARCHES-Bypass the
buccal segment and are engaged on the
incisors.Produce intrusion of
incisors.Activated by giving a V bend in the
buccal segment.

22. MICROIMPLANTS FOR INTRUSION
 Placed between the roots of the incisors.
 Force can be applied from the microimplant
directly to the segmented arch.
 For symmetrical intrusion at least 2 mini-
implants are used.
 Cause intrusion of anterior teeth without the
problem of unwanted movement of anchor
teeth.

23. BIBILOGRAPHY
 Bell, Jacobs , and Legan: Treatment of class II
deep bite by orthodontics and surgrical means.
Am J Orthod 1984; 1-20
 Engel : Treatment of deep bite cases. Am J
Orthod 1980; 1-13
 Graber TM : Orthodontics: Principles and
practice. WB Saunders, 1988

24.  Hellsing : Craniomandibular disorders and
deep overbite. Am J Orthod 1990; 516-522
 Hinkle : Surgical treatment of class II,
division 2 malocclusion. Am J Orthod 1989;
185-191
 Ligthelm – Bakker, Wattel, Uljee , and Prahl-
Andersen: Vertical growth. Am J Orthod
1992; 509-513
 Nanda : Growth patterns in subject with long
and short faces. Am J Orthod 1990; 247-258

25.  Ortial : Vertical dimension and therapeutic
choices. Am J Orthod 1995; 432-441
 Parker , Nanda and Currier: Treatment of deep
bite malocclusion changes. Am J Orthod 1995;
382-393
 Profitt WR: Contemporary orthodontics, St
Louis, CV Mosby, 1986