Development and diagnosis of deepbite

Development and Diagnosis
of Deep bite.
www.indiandentalacademy.com

Introduction:
Malocclusion is a developmental condition. In most
instances, malocclusion and dentofacial deformity are
caused, not by some pathologic process, but by moderate
distortions of normal development. More often these
problems from a complex interaction among multiple
factors that influence growth and development, and it is
impossible to describe a specific etiologic factor.

The term “overbite” applies to the distance which the
maxillary incisal margin closes vertically past the
mandibular incisal margin, when the teeth are brought into
habitual or centric occlusion.
The term “closed bite” or “deepbite” describes 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.

Types of Deepbite.
Based on etiology
• Developmental deepbite and
• Acquired deepbite.
Two types of developmental or genetically determined :
1. Skeletal deepbite: due to horizontal growth pattern and
is a common malocclusion.
2. Dentoalveolar deepbite: caused by supraocclusion of
the incisors, also is common. Interocclusal clearance is
usually small, i.e. overbite is functionally a pseudo-deep
overbite. www.indiandentalacademy.com

An acquired deep overbite may be caused by:
1. A lateral tongue thrust or postural position produces an
infraocclusion of the posterior teeth, which in turn leads
to a deep overbite. The freeway space is usually-large.
Eg: classic Class II, division 2 malocclusion.
2. Premature loss of deciduous molars or early loss of per-
manent posterior teeth, particularly if the contiguous
teeth are tipped into the extraction sites.
3. The wearing away of the occlusal surface or tooth
abrasion.

Etiology:
Role of muscles in functional movements:
The mandible is the only movable bone in the head and
face.
It can only be moved in certain directions (limitations of
morphology and structure TMJ)
The postural function must be effective enough to permit
the muscle activity associated specifically with mastication,
deglutition, respiration and speech. Thus, a number of
functions are superimposed on the primary and postural
function.

1. Anterior and posterior fibers of
temporalis;
2. Lateral pterygoid;
3. Anterior, middle and posterior
components of masseter;
4. Suprahyoid;
5, Infrahyoid. - Medial pterygoid
not shown.
Muscles primarily responsible for mandibular movements:

Opening movement:
• Gravity and contraction of the lateral pterygoid muscles.
• The temporal, masseter and medial pterygoid muscles
show a controlled relaxation as the mandible opens
(serves to make the opening movement smooth.)
• Articular disk is brought forward by the lateral pterygoid
muscle and intimately related capsular ligaments as the
condyle rotates against the inferior surface of the disk and
as the disk itself glides forward on the articular eminence.

Closing movement:
• More power is elicited due to bilateral activity of the
masseter and temporalis muscles, assisted by the smaller
medial pterygoid muscles.
• While mastication may call for the most potent effort
from the associated muscles, Such complex activity
naturally brings into function associated muscle
elements, and this makes an analysis of the role of any
individual muscle quite difficult.

Drawing to show normal muscle
activity associated with normal
jaw relationship and normal
occlusion. Electromyographic
recordings would show even
distribution of anterior, middle
and posterior temporalis and
deep and superficial fiber
activity.
LAT. PTERYGOID
MED. PTERYGOID

• A good motto for the cranial, facial, masticatory,
suprahyoid and infrahyoid muscles plus the
prevertebral and postvertebral muscles is "team work."
• This team work means that adjusting or compensatory
muscle activity is available as the functional demands
vary.
• This also means that where there is a malocclusion or
abnormal morphologic relationship, certain
compensatory or adaptive muscle functions may arise,
either to restrain the dental malocclusion or to actually
increase the discrepancy.

A small change in any of the variables affecting the
temperomandibular joint (TMJ) may cause pathology.
Eg: lack of harmony of postural vertical dimension
(PVD) and occlusal vertical dimension (OVD), with
mandibular overclosure.
Excessive interocclusal space and overclosure, or
"deep bite," may change this harmonious, stabilizing,
balancing and smooth action.

Where there is a Class II
malocclusion, mandibular
retrusion and excessive apical
base difference, middle and
posterior temporalis and deep
masseter fibers show greater
magnitude of contraction.
exerting a posterior thrust on the
mandibular condyle (and disk).
This adapts to and enhances the
mandibular retrusion.

In forced retrusion,
electromyographic records
show a dominance of
• posterior temporalis,
• posterior masseter and
• Posterior suprahyoid muscles.

With Class II malocclusion and
deep overbite, the functional
retrusion tendency is increased. In
addition to dominance and posterior
and deep masseter activity, stretch
reflex and subsequent muscle
contractions or spasms may be
elicited for the lateral pterygoid fibers
which insert into the articular disk.
This serves to pull the disk forward
as the condyle is functionally
retruded (see arrow). Condyle may
then impinge on retrodiscal pad.
DIAGASTRIC
GENIOHYOID

While the lateral pterygoid muscle serves as the
protractor for the disk, moving it forward by virtue of
insertion of fibers into the capsule and disk, only the
retrodiscal tissue and capsule, and integrity of the
ligaments serve to retract the disk.
There is no articular disk retracting muscle. In
other words, the lateral pterygoid has no opposing
stabilizing and antagonistic muscle force, as far as the
disk is concerned.

Resistance to posterior
condylar displacement by the
lateral pterygoid muscles (2) is
apparently insufficient, since
primary function is that of
opening, not closing, and
secondary stabilizing
assignment on closure can
result in excessive forward
movement of the articular disk
on maximum contraction.

Tracing of lateral cephalogram
showing:
1. open mouth position;
2. postural resting position;
3. premature initial contact;
4. retruded occlusal position.
Tooth guidance from point
of premature initial contact has
changed the path of closure from
upward and forward to upward and
backward.

• The condyle, riding over the posterior periphery of the
disk, produces a discernible click, and then impinges on
the postarticular connective tissue.
• The postarticular tissue is supplied by nerve fibers from
the auriculotemporal nerve and is less adapted to stresses
of mandibular function.
• Joint structures may adapt to deviate activity for a time,
but with constant stimulation of stretch reflex, forward
pull of the disk, impingement on postarticular connective
tissue, muscle spasm and .overclosure, these structures
may not continue to adapt indefinitely.

• Irritation and lack of harmony of the structures is
clinically observed in the form of clicking and crepitus.
• Pain can be caused either by impingement on retrodiscal
tissues, or by pterygoid spasm (MPD).
• Whatever the sequence of events, there is broad
agreement on the lack of harmony of condyle, disk and
eminence during the opening and closing movements.

Effects of growth pattern:
Rotation of Jaws during Growth:
Until longitudinal studies of growth using metallic implants
in the jaws (1960s, Bjork and coworkers in Copenhagen),
the extent to which both the maxilla and mandible rotate
during growth was not appreciated.
The reason is that the rotation that occurs in the core
of each jaw, called internal rotation, tends to be masked by
surface changes and alterations in the rate of tooth eruption.
The surface changes produce external rotation.

The core of the mandible is the bone that surrounds the
inferior alveolar nerve.
The functional processes include the alveolar process (bone
supporting the teeth and providing for mastication), the
muscular processes (the bone to which the muscles of
mastication attach), and the condylar process, the function
in this case being the articulation of the jaw with the skull.

If implants are placed in areas of stable bone away
from the functional processes, it can be observed that in
most individuals, the core of the mandible rotates during
growth in a way that would tend to decrease the
mandibular plane angle (i.e., up anteriorly and down
posteriorly).

Terminology, rotational changes.
Condition Bjork Shudy
Ant. Growth > post.
Post. Growth > ant.
Forward rotation
Backward rotation
Clockwise rotation
Counterclockwise rotation
Bjork Solow, Houston Proffit
Rotation of mandibular
core relative to cranial
base
Total rotation True rotation Internal rotation.
plane relative to cranial
base
Matrix rotation Apparent rotation Total rotation
plane relative to the core of
mand.
Intramatrix rotation Angular remodeling of the
lower border
External rotation

• Internal rotation of the mandible varies between
individuals, ranging up to 10 to 15 degrees.
• For an average individual with normal vertical facial
proportions, however, there is about a -15 degree
internal rotation from age 4 to adult life. (25% - matrix
rotation and 75% - intramatrix rotation.)
• During the time that the core of the mandible rotates
forward an average of 15 degrees, the mandibular plane
angle, representing the orientation of the jaw to an
outside observer, decreases only 2 to 4 degrees on the
average.

Reason that the internal rotation is not expressed in jaw
orientation, of course, is that surface changes (external
rotation) tend to compensate.
This means that the posterior part of the lower border of
the mandible must be an area of resorption, while the
anterior aspect of the lower border is unchanged or
undergoes slight apposition.

Superimposition on implants for an individual with a normal pattern of
growth, showing surface changes in the mandible from ages 4 to 20
years. For this patient there was -19 degrees internal rotation but only
-3 degrees change in the mandibular plane angle. Note how the
dramatic remodeling (external rotation) compensates for and conceals
the extent of the internal rotation. (From Bjork A, Skieller V: Eur J
Orthod 5:1-46, 1983.)

It is less easy to divide the maxilla into a core of bone and
a series of functional processes. The alveolar process is
certainly a functional process in the classic sense, but there
are no areas of muscle attachment analogous to those of the
mandible. The parts of the bone surrounding the air
passages serve the function of respiration, and the form
function relationships involved are poorly understood.
If implants are placed above the maxillary alveolar
process, however, one can observe a core of the maxilla
that undergoes a small and variable degree of rotation,
forward or backward.

Superimposition on implants in the
maxilla reveals that this patient
experienced a small amount of
backward internal rotation of the
maxilla (i.e., down anteriorly). A
small amount of forward rotation is
the more usual pattern, but
backward rotation occurs
frequently. (From Bjork A, Skieller
V: Am J Orthod 62:357,1972.)

Matrix rotation, as defined for the mandible, is not possible
for the maxilla. At the same time that internal rotation of the
maxilla is occurring, there also are varying degrees of
resorption of bone on the nasal side and apposition of bone
on the palatal side in the anterior and posterior parts of the
palate.
For most patients, the external rotation is opposite in
direction and equal in magnitude to the internal rotation, so
that the two rotations cancel and the net change in jaw
orientation (as evaluated by the palatal plane) is zero. Until
the implant studies were done, rotation of the maxilla
during normal growth had not been suspected.

Both internal and external rotation occur in everybody,
but variations from the average pattern are common.
Greater or lesser degrees of both internal and external
rotation often occur, altering the extent to which external
changes compensate for the internal rotation.
The result is moderate variation in jaw orientation, even
in individuals with normal facial proportions.
In addition, the rotational patterns of growth are quite
different for individuals who have what are called the
short face and long face types of vertical facial
development.

Short anterior lower face height,
have excessive forward rotation of the
mandible during growth, resulting
from both an increase in the normal
internal rotation and a decrease in
external compensation. The result is a
nearly horizontal palatal plane and
mandibular morphology of the
"square jaw" type, with a low
mandibular plane angle and a square
gonial angle. A deep bite
malocclusion and crowded incisors
usually accompany this type of
rotation. (From Bjork A, Skieller
V:Am J Orthod 62:344,1972.)
Short face type,

The pattern of jaw rotation in an individual with the
"long face" pattern of growth (cranial base
superimposi-tion). As the mandible rotates
backward, anterior face height increases, there is
a tendency toward anterior open bite, and the
incisors are thrust forward relative to the mandible.
(From Bjork A, Skieller V: EurJ Orthod 5:29,
1983.)
Long face type, who have excessive lower anterior
face height, the palatal plane rotates down posteriorly,
often creating a negative rather than the normal positive
inclination to the true horizontal. The mandible shows an
opposite, backward rotation, with an increase in the
mandibular plane angle. The mandibular changes result
primarily from a lack of the normal forward internal
rotation or even a backward internal rota-tion.

The internal rotation, in turn, is primarily matrix rotation
(centered at the condyle), not intramatrix rotation.
This type of rotation is associated with anterior open bite
malocclusion and mandibular deficiency (because the chin
rotates back as well as down).
Backward rotation of the mandible also occurs in patients
with abnormalities or pathologic changes affecting the
temperomandibular joints. In these individuals, growth at
the condyle is restricted.

Mutual relationship of the rotating jaw bases:
Dentoalveolar occlusion or malocclusion depends on the
combination of these rotations. (Lavergne and Gasson (1982) in
human implant studies)
1. Convergent rotation of the jaw bases - creates a
severe, deep overbite that is difficult to manage using
functional methods.
2. Divergent rotation of the jaw bases - cause marked
open-bite problems. In severe cases, orthognathic surgery is
required for correction

3. Cranial rotation of both bases—In this horizontal
growth pattern a relatively harmonious rotation of both
jaws occurs in an upward and forward direction. This
rotation of the maxilla compensates for upward and
forward mandibular rotation, offsetting a deep bite. The
result is a normal overbite.
4. Caudal, or down and back, rotation of both bases —
This rotation occurs in a relatively harmonious manner.
The down and back maxillary rotation offsets the open
bite created by down and back mandibular rotation.

Interaction between Jaw Rotation and Tooth Eruption:
Influences the magnitude of tooth eruption, direction of
eruption and the ultimate anteroposterior position of the
incisor teeth.
Movement of the teeth relative to the cranial base obviously
could be produced by a combination of translocation as the
tooth moved along with the jaw in which it was embedded
and true eruption, movement of the tooth within its jaw..

Maxillary teeth: downward and somewhat forward. In
normal growth, the maxilla usually rotates a few degrees
forward but frequently rotates slightly backward.
Forward rotation would tend to tip the incisors forward,
increasing their prominence, while backward rotation
directs the anterior teeth more posteriorly than would have
been the case without the rotation, relatively uprighting
them and decreasing their prominence.

Superimposition on mandibular
implants shows the lingual
positioning of the mandibular
incisors relative to the mandible
that often accompanies forward
rotation during growth.
(FromBjorkA, SMeller
V:AmJOrthod62:357, 1972.)
Mandibular teeth: upward and somewhat forward. The
normal internal rotation of the mandible carries the jaw
upward in front. This rotation alters the eruption path of
the incisors, tending to direct them more posteriorly
than would otherwise have been the case.

Because the internal jaw rotation tends to upright the
incisors, the molars migrate farther mesially during growth
than do the incisors, and this migration is reflected in the
decrease in arch length that normally occurs.
When excessive rotation occurs in the short face type of
development, the incisors tend to be carried into an
overlapping position even if they erupt very little; hence the
tendencies for deep bite malocclusion in short face
individuals. The rotation also progressively uprights the
incisors, displacing them lingually and causing a tendency
toward crowding.

Cranial base superimpositon for a
patient with the short face pattern of
growth. As the mandible rotates
upward and forward, the vertical
overlap of the teeth tends to increase,
creating a deep bite malocclusion. In
addition, even though both the upper
and lower teeth do move forward
relative to cranial base, lingual
displacement of incisors relative to the
maxilla and mandible increases the
tendency toward crowding. (From
Bjork A, Steelier V: Am
JOrthod62:355, 1972.)

In the long face growth pattern, on the other hand, an
anterior open bite will develop as anterior face height
increases unless the incisors erupt for an extreme distance.
The rotation of the jaws also carries the incisors forward,
creating dental protrusion.
Mandibular rotation is caused by both growth-dependent
and functional influences. Functional orthodontic and
orthopedic methods alter function and guide the growth
process. For this reason the rotation of the mandible may be
moderately influenced therapeutically.

Environmental influences such as neuromuscular
dysfunction, occlusal forces, gravity and nasorespiratory
malfunction (according to Linder, Lowe, and Woodside
[1986]) can modify this inclination.

Three diagnostic exercises are recommended:
1. Determination of the postural rest position (mandible
and interposed freeway space or interocclusal clearance).
2. Examination of temperomandibular joint (TMJ)
function or dysfunction and condylar movement and
3. Assessment of the functional status of the lips, and
tongue, with particular attention to the roles they play in
dentofacial abnormalities
Diagnosis:

Determination of the Postural Rest Position and
Interocclusal Clearance:
• A major determinant of adult shape is the functional
pattern (originating from postural rest position of the
mandible) - registration is a priority.
• Muscular components are in dynamic equilibrium and
their balance is maintained with muscle tonus that
responds only to the permanent exogenous force
affecting the orofacial system (i.e., gravity).
• Rest position depends on and alters with the position of
the head. Thus natural head position (NHP) must be
determined for each patient.

The regimen for the examination is as follows:
1. Determination of the postural rest position with the
head in NHP
2. Registration and measurement of the postural rest
position
3. Evaluation of the relationship of rest position to
occlusal position in the following dimensions:
• Sagittal
• Vertical
• Transverse

Assessment of the postural rest position:
The patient is seated upright, preferably with the back
unsupported.
The head is oriented with the patient looking ahead at eye
level. (mirror)
If this position seems too variable or the patient is not
relaxed, the head can be positioned with the eye-ear plane
(Frankfort) horizontal.

Several methods are available to determine the postural
rest position of the mandible:
• Phonetic exercises
• Command methods
• Non-command methods
• Combined methods

Phonetic exercises.
Asked to repeat selected consonants.
The letter m is repeated 5 to 10 times. C also can be used.
Repeating or spelling the word Mississippi also is a good
exer-cise.
After the phonetic exercise the patient is instructed not to
move the lips or tongue at this time, even while the dentist
gently parts the lips to observe the interocclusal space and
tongue position.
Less satisfactory for children. In the mixed dentition,
language habits vary and are not yet stabilized.

Command methods.
Asked to perform selected functions; having the patient
lick the lips and then swallow produces the desired
relationship because the mandible returns to postural
rest within 2 seconds after the exercise.
Non-command methods.
Patient has no idea of the parameter being examined.
Careful observations are made as the patient talks,
swallows, and turns the head while being questioned on
a number of unrelated subjects.

Combined method.
Provides the best reproduction in the mixed dentition.
Asked to perform a prescribed function (e.g., swallowing,
to lick the lips, swallow, and then hold still. ) and then
relax.
After instructing the patient not to move, the clinician
gently palpates the submental muscles to assess whether
they are relaxed and parts the lips to observe the
relationship of the canines.
Normally the lower canine should be 3 mm below the
upper in comparison with the occlusal position. An
interocclusal space of 4 mm may be normal.www.indiandentalacademy.com

Registration of the postural rest position of the
mandible.
Various methods are recommended for producing the best
record:
• Direct intraoral method
• Indirect extraoral method
• Direct extraoral method

Direct intraoral method.
• A plaster core registration similar to that sometimes
used in prosthodontics.
• Measuring is difficult, although millimetric calipers
can be used to record the interocclusal space in the
canine or incisor area.
Indirect extraoral method.
The indirect extraoral method is the most common one
used, and various techniques are available:
roentgenography, cephalometry, electromyography,
cinefluorography, and kinesiography

Direct extraoral method.
Direct caliper measurements can be made on the patient's
profile by measuring the distance from soft tissue nasion (at
the bridge of the nose) or point A to menton (on the lowest
curvature of the chin).
Done in both postural rest and habitual occlusion.
The difference between the two measurements constitutes
interocclusal clearance. (soft tissues reduce reliability and
no record of the saggital relationship is produced.)

Evaluation of the path of closure from postural rest to
occlusion in the saggital plane:
Condylar movement from postural rest to occlusion can
consist of pure hinge movement, hinge and anterior
translatory displacement, and hinge and posterior superior
translatory displacement.
In Class II malocclusions without functional disturbance
the path of closure from rest to occlusion is straight up and
forward, with a hinge movement of the condyle in the fossa.
These are true Class II malocclusions.

In Class II malocclusions with functional disturbances
(deepbite) a rotary action of the condyle in the fossa from
postural rest to occlusion is evident.
From initial contact to full occlusion, condylar action is
both rotary and translatory up and backward (posterior
shift). Thus the movement combines rotary and sliding
components
Posterior translation or sliding into
the occlusal position in an abnormal
functional pattern with a deviated
path of closure.

Evaluation of the path of closure from postural rest to
habitual occlusion in the vertical plane:
This evaluation is of special interest in the assessment of
deep overbite cases. Two types of deep overbite can be
differentiated.
True deep overbite with a large interocclusal clearance is
caused by infraocclusion of the posterior segments. (lateral
tongue posture or tongue thrust habit.)Eg: Class II, division
2 malocclusions.

Pseudo-deepbite with a small interocclusal space already
has normal eruption of the posterior segment teeth.
The deep overbite is combined with overeruption of the
incisors.
Eg: Class II, division 2 malocclusions that produce a
"gummy" smile and poor lip line relation.
The amount of interocclusal clearance is a distinguishing
criterion.

Examination of the Temperomandibular Joint and
Condylar Movement:
The objective is to assess whether incipient symptoms of
TMJ dysfunction are present.
• Clicking and crepitus
• Sensitivity in the condylar region and masticatory
muscles
• Functional disturbances (e.g., hypermobility, limitation of
movement, deviation)
• Radiographic evidence of morphologic and positional
abnormalities

Clicking is seldom noted at the initial examination.
Crepitus can sometimes be observed during the opening
movement (initial, intermediate, or terminal).
Terminal clicking or crepitation - hypermobility or
too-wide opening. Sign of peripheral irregularity of the
articular disk or unevenness of the condylar surface; this
type of crepitus is amenable to correction. Crepitation
during chewing is occasionally seen, especially in children
with deep overbites.
Deviation was most frequently accompanied by
crepitus or clicking.

Tenderness to palpation in the condylar region is the most
characteristic symptom of initial functional disturbance of
the TMJ. The palpatory tenderness of the temporalis and
masseter muscles.
The lateral pterygoid muscle (LPM) is probably
implicated.
Hypermobility: an opening of more than 45 mm in 6 to
8year) old children and more than 49 mm in 10 to 12-year
old children.
The problem is mostly habitual, but it can indicate a
disposition to later temperomandibular dysfunction (TMD).

Neuromuscular involvement in TMJ problems was also
observed in the lip and tongue areas.
In children without TMJ dysfunction, 20.5% of the
sample showed abnormal perioral activity; the percentages
were significantly higher in children with TMJ symptoms
(43 %).
Tongue dysfunction was seen in 12.4% of the
sample without TMJ problems, compared with 21% in the
TMJ problem group.

Clinical functional examination for the
temperomandibular joint area:
• Auscultation
• Palpation
• Functional analysis

Auscultation:
A stethoscope is used to check for signs
of clicking and crepitus. The examinations are
performed by having the patient open and close the jaw
into full occlusion.
If clicking or crepitus is noted, the patient
is instructed to bite forward into incision and then repeat
the opening and closing movements. These movements
are checked for any sounds with the stethoscope. Most
often, sounds disappear in the protruded position.

Palpation.
• The condyle and fossa are palpated with the index finger
during opening and closing maneuvers.
The posterior surface can be palpated by inserting
the little finger in the external auditory meatus and can
be checked for tenderness, synchrony of action, and
coordination of relative position in the fossae.
• In TMJ patients, palpation of the muscles of the face,
head, and neck is essential.
Tenderness in the superior head of the LPM is an
important diagnostic clue because it may indicate
abnormal functional loading of the joint.www.indiandentalacademy.com

Palpation of LPM. can be approximated by
placing the forefinger behind the maxillary tuberosity,
right above the occlusal plane, with the palmar surface of
the finger directed medially toward the pterygoid hamulus
In patients with early TMJ symptoms, unilateral
tenderness commonly occurs. If hypersensitivity or pain
is present on both sides, palpation of other associated
muscles is indicated.

Functional analysis.
Dislocation of the condyles and discoordination of
movements are early symptoms of functional disturbance.
Functional movements of the mandible and
condyles are carefully assessed.
The extent of maximum opening is measured
between the upper and lower incisors with a Boley gauge.
In overbite - added to the measurement, whereas in open
bite - must be subtracted.
The direction of opening and closing movements
should be registered graphically with curves. Premature
contacts and deviations in sagittal and transverse
directions are assessed.www.indiandentalacademy.com

Characteristic findings of Deepbite:
Dentoalveolar Deep Overbite:
The growth pattern usually is average or tends toward the
vertical. The deep overbite caused by the infraocclusion
of molars has the following symptoms:
1. The molars are partially erupted.
2. The interocclusal space is large.
3. A lateral tongue posture and thrust are present.
4. The distances between the maxillary and mandibular
basal planes and occlusal plane are short.

The deep overbite caused by over eruption of the
incisors has the following characteristics:
1. The incisal margins of the incisors extend beyond
the functional occlusal plane.
2. The molars are fully erupted.
3. The curve of Spee (compensating curve) is
excessive.
4. The interocclusal space is small.

Skeletal Deep Overbite
• Horizontal type of growth pattern.
• The AFH is short, particularly the lower facial third,
whereas the posterior facial height is long.
• Ratio of U/L anterior facial height is reduced in the
skeletal deep overbite to a ratio of 2:2.5 or 2:2.8
(normal- 2:3).
• The horizontal cephalometric planes (sella-nasion,
palatal, occlusal, and mandibular) are approximately
parallel to each other.

• The interocclusal clearance is usually small.
• An extreme horizontal growth pattern can be at least
partially compensated by an up and forward inclination
of the maxillary base (anteinclination).
• On the other hand, the combination of a horizontal
growth pattern with a down and forward inclination
(retroclination) of the maxillary base results in a more
severe skeletal deep overbite.

Conclusion:

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Development and diagnosis of deepbite

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