Topic describe about manam of deep bite

1. DEEP BITE
AND
OPEN BITE
Dr.Kailash Rathi
Dept of Orthodontics and
Dentofacial Orthopedics
S.B. Patil intitute for Dental
Sciences and Research

2. Deep bite: -
is a condition where there is
an excessive vertical
overlapping of the mandibular
anteriors by maxillary
anteriors.
DEEP BITE

3. DEEP BITE

4. According to Graber, Deep
bite is 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.
DEFINITION

5. DEEP BITE

6. Deep bite can be of two types:
1) Incomplete deep bite: -
2) Complete deep bite: -

7. CLASSIFICATION
1. Skeletal deep bite
2. Dental deep bite
1. Skeletal deep bite: -
a) Usually of genetic origin.
b) Caused by upward and
forward rotation of the mandible.

8. Characterized by the presence
of the following features: -
A) Exhibit a horizontal growth
pattern.
B) Anterior facial height is
reduced.
C) Reduced inter-occlusal
clearance
D) Cephalometric planes
such as mandibular
plane, F.H. plane, S.N. plane
are parallel to each other .

9. 2. Dental deep bite: -
A) Occur due to over eruption of
anteriors or
B)Due to infra-occlusion of
molars.
a) Deep bite due to over eruption
of anteriors: -
i) usually seen in class II
malocclusion.
ii) these patients hence
exhibit an excessive curve of
spee.

10. b) Deep bite due to Infra –
occlusion of molars: -
i) The presence of lateral
tongue posture or lateral
tongue thrust
ii) Due to premature
loss of posterior teeth.

11.  Characterized by the
presence of:
- partially erupted molars.
- large interocclusal
clearance.

12. DEEP BITE

13. Diagnosis: -
1. Clinical examination
2. Study models
3. Lateral cephalograms
SASSOUNI’S cephalometric
analysis helps in assessing
skeletal deep and open bite.

14. Factors considered in treatment of deep bite -
1. Lip relationship: -
- Short upper lip or a gummy
smile should be treated by
intrusion of anteriors.
- Patients exhibiting normal
upper lip with only 2-3mm of
maxillary incisal edge
exposed ,it is ideal to extrude
the molars

15. 2. Consideration of vertical
facial relationship: -
Extrusion of posterior teeth is
done in treating skeletal deep
bites with excessive
horizontal growth and upward
rotation of mandible.

16. Consideration of inter-occlusal space
 Increased inter-occlusal
space indicates that the
molars are not fully erupted.
 In such cases molars can
be extruded.
 Presence of normal inter
occlusal clearance is an
indication for intrusion of
the incisors.

17. Treatment of deep bite
A. Removable appliances
 Anterior bite plane: -
(i) Is a modified Hawley’s
appliance with a flat ledge
of acrylic behind the upper
anteriors .
(ii) Consists of Adam’s clasps
and a labial bow

18. Anterior bite appliance

19. Anterior bite plane

20. B. Myofunctional appliances
 Treated by an activator
designed to allow the
extrusion of teeth.
Bionator can also be used.

21. ACTIVATOR

22. BIONATOR

23. C.Fixed appliance therapy
(i) Use of anchorage bends
(ii) Use of arch wires with
reverse curve of Spee.

26.  Thus through the above
mentioned methods
deep bite can be corrected.

27. OPEN BITE
An open bite: When there is
a lack of vertical
overlap between the
maxillary and the
mandibular teeth.

28. OPEN BITE

29. Classification of open bite
i) Based on the location of the open
bite , they may be classified as:
Anterior open bite
Posterior open bite
ii) Based on the dental or skeletal
components involved ,open bites can
be classified as
Skeletal open bite,or
Dental open bite.

30. ETIOLOGY
Habits
Anterior tongue thrust
Digit sucking habits
Mouth breathing
Abnormally increased tongue size
inherited or acquired, abnormal
growth pattern

32. DENTAL ANTERIOR OPEN BITE
Intra-oral features:
1.Open bite limited to the anterior
segment ,often asymetrical.
2. Proclined maxillary and /or
mandibular incisors.
3.Spacing between maxillary and/or
mandibular anteriors.

33. 4. Narrow maxillary arch is a
possibility.
5.”Fish mouth” appearance.
Extra oral feature:
No unusual features

34. FEATURES OF SKELETAL ANTERIOR
OPEN BITE
Extra-oral features:
1. Long face due to increased lower
anterior face height
2. Incompetent lips
3. An increased mandibular plane
angle
4. An increased gonial angle
5. Marked antegonal notch

35. 6.A short mandible is a possibility.
7.Maxillary base may be more inferiorly
placed (vertical maxillary excess)
8. The angle formed by the mandibular and
maxillary planes is also increased

36. Intra- oral features:
1. Mild crowding with upright incisors
2. Gingival hypertrophy
3. Maxillary occlusal and palatal planes
tilt upwards
4. Mandibular occlusal plane canted
downwards

37. Etiology
Tongue thrust
(Pre-adolescent)
Tongue thrust
(Adolescent or
adult)
Digit sucking
(Pre-adolescent)
Appliance used for
correction
Fixed tongue crib / rake
Fixed or removable
tongue crib / rake
Motivation and / or
medicaments
Acrylic digit caps Fixed
tongue crib / rake

42. ETIOLOGY APPLIANCE USED
FOR CORRECTION
• Digit sucking
(Adolescents
rarely seen)
• Mouth breathing
(Pre-adolescent)
• Mouth breathing
(Adolescent and adult
Fixed tongue crib /
rake
ENT check- up
followed by
Breathing exercises
Mouth shield
ENT checkup followed
by
Breathing exercises
Orthodontic trainer

43. CORRECTION OF ANTERIOR
OPEN BITE
• Appliances used for the corrections of
anterior open bites are used in
conjunction with the habit breaking
appliances
• In cases with a minor skeletal
components appliances should be used
in conjunction with a removable or fixed
habit-breaking appliance.
• Box elastics may be used for the
correction of mild to moderate open
bites.

44.  Chin cup with a vertical pull head cap
used for the correction of anterior open
bites in the pre-adolescent age group.[
 Skeletal open bites treated surgically after
the correction of the existing habit.
Surgery generally involves the Le Fort I
osteotomy to impact the maxilla
posteriorly. Muscle-retraining exercises
may be required following the surgical
correction.

46. POSTERIOR OPEN BITES
 Posterior open bites are
characterized by lack of contact
between the posterior teeth when the
teeth are brought in occlusion
 Caused mainly because of a lateral
tongue thrust habit or submerged/
ankylosed posterior teeth.

47. CORRECTION OF POSTERIOR
OPEN BITE
• If lateral tongue thrust is encountered as
the etiologic factor, the use of lateral
tongue spikes either fixed or incorporated
in a removable appliance, forms the first
line of treatment.
• Vertical elastics used along with fixed
orthodontic appliances can be used once
the lateral tongue thrust habit has been
controlled.
• Fixed appliances are the most frequently
used means for the correction of
submerged and impacted teeth