Orthodontic treatment of deep bite part 1

Orthodontic treatment of deep bite
Part 1
Dr Maher Fouda
Mansoura Egypt

Zones of
overbite: 5% to
25% is normal
(yellow), 25% to
40% is increased
overbite
(orange), and
>40% excessive
(deep) overbite
(red)

Classification
1. According to its origin;
a) Dental deep bites (Simple).
b) Skeletal deep bite (Complex).
2. According to functional classification;
a) True deep bite.
b) Pseudo deep bite.
3. Depending on the extent of deep bite
incomplete over bite
complete over bite
4. According to dentition;
a) Primary dentition deep bite.
b) Mixed dentition deep bite.
c) Permanent dentition deep bite.

A 4-year, 6-month old boy WITH
CLASS II division 1 with deep
overbite

Class II division 1 with deep overbite in the
mixed dentition with deep overbite

Class II
division2 in
the mixed
dentition
with deep
overbite

Example of cover bite
malocclusion. Note that the
lower incisors are completely
concealed by the upper
incisors

The treatment
of deep bite
can be
performed in
the late mixed
dentition, in
the
permanent
dentition, and
in adulthood.
Class II div 1
CLASS II DIV 2

Functional
orthodontic
therapy with
bimaxillary
appliances and/or
two-by-four
appliances is of
paramount
importance when
treating
young patients.
2 BY 4 FIXED
APPLIANCE AND
LOW PULL FACE
BOW
DEEP BITE

Correction of class II division 1 DEEP BITE IN THE
PERMANENT DENTITION WITH HIGH PULL HEADGEAR

Ten-year-old boy with
6 mm deep overbite,
headaches,
Temporomandibular
Dysfunction. B, Deep
overbite, Class II
malocclusion, condyles
posteriorly displaced,
overjet 4 mm. C, Normal
overbite, normal
overjet, Rick-A-Nator,
composite buildups,
eliminate TM
dysfunction.

D, Rick-A-
Nator, fixed
appliance to
correct deep
overbite and
move lower jaw
forward. Two
molar bands,
.045 S.S
connector wires,
incisal ramp
(indexed).

F, Normal overbite, normal
overjet, Rick-A-Nator,
composite buildups, eliminate
TM dysfunction. G, Lower jaw
comes forward because of
Rick-A-Nator. The patient
occludes in front of the incisal
ramp. Composite buildups are
created on lower primary
molars to help patient chew.
Lower first molars passively
erupted to correct deep
overbite, 3 mm in 3 months.

. H, Class II skeletal
malocclusion, normal
maxilla, retrognathic
mandible, TMD
headaches,
retrognathic
profile. I, Rick-A-Nator
after 6 months. Class I
skeletal malocclusion,
normal maxilla, normal
mandible, no
headaches, straight
profil

whereas specific
orthodontic
intrusion
mechanics
And /or
orthognathic
surgery is the
treatment method
adopted for the
permanent
dentition and
during adulthood.

Intrusion
mechanics in
the permanent
dentition of
the young
patient
differ from
those applied
in adulthood.

Sweep archwires,
base arches, and NiTi
intrusion mechanics
can be used for the
young permanent
dentition in the
maxilla and mandible,
but
segmented intrusion
mechanics come to
the fore in adulthood.

In
this group of
patients,
aesthetic
aspects such
as the smile,
the
visibility of the
maxillary
incisors, and
biological
factors gain in
importance.

Intrusion of
maxillary
incisors with
2 by four
fixed
appliance
and base
archwire

force
system
delivered
by an
intrusion
arch

In patients who
are growing,
deep bite can
be treated with
removable
appliances
such as
occlusal plates
and bimaxillary
appliances
Bite Plane to Correct deep Overbite
(Transverse Expansion 1 - 2 Turns a Week)

. (A–C) Pretreatment intraoral
photographs of a 9-year-old girl.
Note severe depth of overbite and
severe overjet. Imprint of
mandibular incisors on palatal
mucosa because of impinging
incisors. (D and E) Frontal and lateral
view of maxillary removable retainer
with anterior bite plate disocclusing
the posterior teeth to allow their
eruption. Note hooks on labial bow
used by the patient to stretch
elastics for retraction of maxillary
incisors and overjet reduction.

(F) Occlusal view illustrates
amount of retraction of
incisors in one month,
between the prior anterior
position of the labial bow and
the facial surfaces of the
incisors. The acrylic touching
the incisors was cut to allow
their retraction. (G) Frontal
occlusal view at the end of
early treatment (phase 1). The
retainer was worn
subsequently for retention.

The natural growth
of the alveolar
process can be
specifically
managed at this
stage. This is
usually done by
managing
the vertical
eruption of the
teeth.
three-piece base arch delivering
simultaneous intrusion and
retraction of the maxillary anterior
segment of teeth.

A decisive
factor for
successful
therapy is
eruption
management
during the
growth
phase.

The effectiveness
of removable
devices can be
increased
by combining the
removable
appliance with fixed
elements such
as headgear and /
or two-by-four
mechanics.

Low pull headgear adjusted for class II treatment: a) en face view:
position of face bow: it does not lean against lips, b) lateral view -
external arms of the face bow bent up, c) external arms of the
face bow bent down; note the direction of force line ( ) and
moment (M) rotating molar.

Typical course of comprehensive mixed dentition treatment. (A) cervical
headgear; (B and C) maxillary 2 3 4 appliance; (D and E) before and 6 months after
placing a mandibular lingual arch after extracting the primary first molar

Headgear combined with fixed appliances: intermaxillary class
III traction forces lower canine distally

Dental
deep bite
in
adulthood
is treated
by
orthodonti
c methods.

Various fixed
mechanics
are used for the
orthodontic
correction of dental
deep
bite : sweep
archwires. overlay
technique, two-by-
four mechanics,
tip-back mechanics,
and segmented
intrusion mechanics

In
addition, the
aforementione
d orthodontic
effects can be
further
reinforced by
the additional
application of
extraoral
appliances
such as low-
pull headgear.

Bite blocks play an
important role in
the orthodontic
treatment of deep
bite. They provide
targeted
support for the
desired effects :
intrusion of the
anterior teeth
and/or extrusion of
the posterior teeth.

278 Deep bite with
traumatic bite
pattern
Deep bite with
traumatic bite
pattern can be of
dental or skeletal
origin . Depending
on the etiology of
this anomaly, there
are various
therapeutic
approaches.

278 Deep bite with
traumatic bite
pattern
Intrusion of the
anterior teeth and/or
extrusion of
the posterior teeth can be
performed
using orthodontics. Skeletal
deep bite can be partially
compensated;
in severe cases,
orthognathic
surgery is indicated .

Orthodontic Problems of
Deep Bite
In the treatment of
deep bite, an
etiological
distinction must be
drawn between
dental deep bite,
skeletal deep bite,
and a combination
of dental and
skeletal deep bite.

Orthodontic Problems of
Deep Bite
Depending on the
additional
functional diagnosis, dental
deep bite can be treated in
both the mixed dentition
and adulthood. The major
advantage of
treatment in the mixed
dentition is undoubtedly
the broader
range of treatment options.

Functionally, however,
it is essential to note
the position of the
incisal edge in
relation to the lip or
lip closure line.
Patients with
a pronounced deep
bite often display
hypertonicity of the
perioral
musculature .

When the position
of the
upper lip to the
lower lip in
relation to the
incisors is correct,
the
incisal edge of the
maxillary incisors
should lie in the
region of
the lip closure line

In this
configuration,
there is a
balanced
relationship
between the
anterior teeth
and
the lip
musculature.

In patients
with a deep
bite, there is
frequently a
deviation in
the position
of the
maxillary and
mandibular
incisors.

In this group of
patients, the
incisal edge of
the maxillary
incisors
is well below the
lip closure line
with the mouth
closed and
relaxed
closure of the
lips.

The clinician
can simply
measure the
patient's lip
closure line
with a probe
during the
clinical
examination.

When the
overbite is
correct, the
incisal edge is
in the area of
the lip closure
line when the
lips are closed
in a
relaxed manner
and a rest
position is
adopted .

Maxillary and
mandibula r
incisors are in a
harmonious sagittal
relationship to the
musculature, soft
tissue, and position
of the tongue.
This position must
be achieved for
reasons of stability
in the treatment
of deep bite.

Position of the
incisal edge in
patients with deep
bite
The position of the
incisal edge of
the maxillary
incisors is often
below
the lip closure line
in patients with a
deep bite.

Position of the incisal
edge in
patients with deep bite
As a result, an additional
unfavorable force vector
is applied to
the incisors via the
sagittal pressure
of the lower lip , in
particular when
there is hypertonicity in
the perioral
musculature.

To do this, the patient
closes the lips
in a relaxed manner
and adopts a rest
position. The
clinician
marks the patient's
lip closure line on the
labial surface of the
maxillary incisors
with a probe.

The patient
opens the
mouth
and the
measured
distance of
the
functionally
required
intrusion
path can be
recorded.

Orthodontic
intrusion of the
incisors results
in a more
favorable
relationship
between function
and the
position of the
teeth in relation to
musculature and
soft tissue.
(a) intrusion with mini-implants. (b)
intrusion with mandibular utility arch

In
addition to
vertical
correction of
the incisors,
axial
correction is
also
required in
many
patients.

Apart from
orthodontic intrusion,
the application of
torque is also
available for axial
improvement
in deep bite patients.
As a rule, this
involves a palatal root
torque of the
maxillary incisors.

Definition of Deep Bite
Deep bite is classified
by the degree of
overbite. We refer to
deep
bite when the overbite
is 􀃙 3 mm . Aesthetics
and masticatory
function may be
impaired as a result.
(a) A Class I incisor relationship with a
normal overbite. (b) The maxillary
incisors overlap the incisal third of the
mandibular incisor crowns. (c) A deep
anterior overbite with the maxillary
incisors covering 100% of the
mandibular incisor crowns

If
deep bite is combined
with retroclination of
the maxillary incisors,
a retral forced bite may
also be present in
functional terms.
In adulthood, this can
lead to a compressed
joint and the associated
problems .

In addition, a
deep bite with
gingival and/or
gingival trauma-
related
impingement
may be present
and this may result
in periodontal
problems.
(a) Mandibular incisors impinging
on the palatal mucosa. (b)
Maxillary incisors impinging on
the mandibular labial gingivae

According to
Hotz ( 1 954), a
deep bite must
be divided
diagnostically
into a true deep
bite and a
pseudo deep
bite . true deep bite

A true deep bite
exists when there
is large
interocclusal
clearance in the
rest position. In
such cases, the
posterior
teeth are in a so-
called infraposition.

A pseudo deep bite
exists in the case of
limited and/or normal
interocclusal
clearance.
The anterior teeth are
consequently in a
supraocclusion
and are the cause of
the deep bite.

A
differential
diagnosis is
made based
on the
functional
diagnosis .

Definition of deep bite
Left: A correct
overbite exists when
the incisal edges of
the maxillary
and mandbulra
nterior teeth overlap
by 2 mm .
A deep bite can be
diagnosed when
the overbite is <! 3
mm.

The deep
bite m ay be
dentally
supported
(center) or
gingivally
traumatized
( right). A true
deep bite must
be distinguished
from a pseudo
deep bite.

True deep bite
A true deep bite is caused
by the infra
position of the posterior
teeth.
The incisors a re correctly
positioned.
This can be diagnosed by
determining
the freeway space in the
functional
analysis.

True deep bite
The posterior alveolar
process is not sufficiently
developed
vertically. The freeway space is
enlarged
(4 mm ) . The therapeutic
approach
is to promote development
of the alveolar process by
managing
eruption of the teeth .

Pseudo deep bite
The cause of
pseudo deep bite
is the
supraocclusion
of the incisors.
These
project vertically
over the occlusal
plane.

Pseudo deep bite
The posterior relation
is vertically
correct and the
freeway space is
within the normal
range (2 mm ) .
The required treatment
involves vertical
reduction of the
anterior alveolar
process.

Therapy of Deep Bite
Bite raising
and
correction
of overbite
are the
aims of
deep bite
therapy.

Therapy of Deep Bite
Intrusion of the
incisors in the
maxilla and
mandible,
extrusion of the
premolars, and/or
extrusion of the
molars can be
performed to correct
the deep bite.

(A and B)Pretreatment
extraoral and intraoral
photographs.Note
severe depth of overbite,
despite normal lower
face height. The lip line
during smile under
scores indication for
extrusion of posterior
teeth
Class II division 2

(C)In the first step, only the
maxillary arch and
mandibular posterior teeth
were banded/bonded . An
anterior bite plate
disoccluded the posterior
teeth while vertical elastics
helped extrude the
mandibular teeth, which were
joined with segmental
archwires. (D and
E)Posttreatment smile and
occlusal photographs

(F) Another alternative of
bite opening by extrusion
of posterior teeth: the “bite
plate” is provided through
platforms bonded on the
palatal surfaces of the
maxillary incisors. Elatics
between the maxillary and
mandibular posterior teeth
facilitate their extrusion.

A 9-year-old
girl .Note
severe depth
of overbite and
severe overjet.
Imprint of mandibular
incisors on palatal
mucosa because of
impinging incisors.

Maxillary removable
retainer with anterior
bite plate
disocclusing the
posterior teeth to
allow their eruption.
Note hooks on labial
bow used by the
patient to stretch
elastics for retraction
of maxillary incisors
and overjet reduction.

The acrylic
touching the
incisors was
cut to allow
their
retraction.

At the end of early
treatment(phase 1)
retainer was worn
subsequently for
retention.

(A) Class II, division 2
malocclusion with
supracluded maxillary
central incisors.(B)
Intrusive archwire
anchored in the permanent
first molars resulted in
intrusion of the central
incisors (note change in
cervical level of central
versus lateral incisors and
in amount of overbite).

Correction of a deep
curve of Spee during
alignment using the early
vertical correction (EVC).
A, B, C) The flattening of
the curve of Spee is
managed with two 0.017 x
0.025-in stainless steel
cantilevers while the
flexible 0.014-in NiTi
archwire allows proper
alignment.

D, E, F) Two-month
progress photographs of
the improved vertical
relationship. The
correction of the curve of
Spee occurred faster than
the alignment of the teeth,
which is still incomplete.
The absence of change in
the AP relationship points
towards no extrusion of
the molars.

A base archwire
can be tied over the
main archwire
instead of being
inserted to the
brackets. In this
case, the force
system is
determined and
more predictable.

Two 0.017 x
0.025-in beta-
titanium
intrusion base
archwires can be
inserted into the
slots of the
brackets over a
flexible archwire
to assist
leveling.

Because the force
system in
indeterminate, they
might not produce
intrusion if an
incorrect activation is
placed, e.g., an
anterior bend
intending to cause
intrusion of the
incisors might
actually cause
extrusion.

The rationale
of a reversde
curve NiTi
archwire used
for vertical
correction.
The green
line depicts
an estimated
3-mm placed,
activation
when a flat
archwire is
placed

whereas the
yellow line shows
the increased
vertical activation
caused if a
reverse curve is
placed to the
archwire. The
reverse curve
would produce
twice the
intrusive force of
the flat wire.

The upper
and lower
anterior
teeth were
intruded by
0.016X0.022"
SSW lever
arm for
opening the
deep bite
and
leveling the
Cos.

Utility arch on 2 x 4 fixed appliance

TRUE DEEP BITE
This type of deep
bite is caused by
an infraocclusion
of posterior
segments. It is
usually seen in
class II division 2
malocclusions.

PSEUDO DEEP BITE
Pseudo deep bite is
caused by over
eruption of the
anterior teeth in
relation to the
normally erupted
posterior segment of
teeth. It is
usually seen in class II
division I
malocclusions.

Intrusion of the
incisors is the
main focus of
orthodontic
treatment
for a pseudo
deep bite
caused by
supraocclusion
of the
anterior teeth.
Pseudo Deep Bite

As a result of
vertically reduced
attachment,
intrusion
mechanics vary i
n adults and
young patients.
NiTi intrusion
mechanics can be
employed i n both
adults and
Young people .
Pseudo Deep Bite

If, in addition to
intrusion, palatal root
torque is
necessary, intrusion
may also be
performed with a
pretorqued
archwire ( compound
archwire ).

In adult patients,
we use
segmented
intrusion
mechanics to
correct the deep
bite. This is
particularly
indicated for
greater intrusion
distances.

All in all,
the
orthodontic
treatment of
deep bite in
adult
patients is
limited
as the lower
face cannot
be
enlarged.
Two middle-aged cases of deep overbite without molar
support treated by orthognathic surgery
International Journal of Surgery Case Reports

In these
cases,
orthognathic
surgery is
indicated for
larger
skeletal
deviations
and for
better
aesthetics.

Therapy of
deep bite is
dependent
on etiology,
type (true
or pseudo
deep bite),
and the age
of the
patient.

For intrusion of the
incisors, NTi
intrusion
mechanics or
overlay techniques
are used in young
patients
and segmented
intrusion
mechanics
with segmented
archwires in adult
patients.

Class II division 2
Overlay intrusive arch on 2 x 4 fixed
appliance

When
treating a
pronounced
skeletal deep
bite,
differential
diagnosis will
determine
whether
orthognathic
surgery is
indicated.

The extrusion of
molars and
premolars
is mainly
performed in
young
patients.
Removable or
fixed
orthodontic
appliances can
be used for this.

True Deep Bite
If a true deep bite with
infraposition of the
posterior teeth is
present, an extrusion
movement of
premolars and molars
in the
maxilla and mandible
is indicated.

A limiting factor here is
that
patients with a
horizontal skull
structure exhibit strong
masticatory
forces and patients with
a vertical skull structure
exhibit
rather weaker
masticatory forces.

The risk of a
recurrence is therefore
likely to be
higher in patients with
deep bite and
simultaneous skeletal
components
( horizontal skull
structure ) because of
muscular function
and masticatory force.

Hence, the
extrusion of
premolars
and molars is
contraindicated
in more than
90% of adult
patients
who undergo
orthodontic
therapy.

To correct the incisor
relationship, the
overbite should first
be reduced. An
effective way of doing
this in a growing
patient is the use of an
anterior bite plane. A
removable appliance
incorporating a flat
anterior bite plane was
therefore placed
initially.

Treatment Plan
•Use of headgear and
removable appliance to correct
the buccal segment
relationship to class I while
commencing overbite
reduction
•Upper and lower pre-adjusted
edgewise fixed appliances to
level and align arches and
correct the incisor relationship
•Exposure and bonding of the
UR3 to allow mechanical
traction to align UR3
•Long-term retention

The removable appliance
also had palatal finger
springs placed mesial to
the maxillary first molars
to aid in their
distalization. A Southend
clasp on the upper
central incisors was also
added for retention. The
design is a modification
of the Acrylic Cervical-
Occipital (ACCO)
appliance popularized by
Cetlin and Ten Hoeve
(1983)

What Are the Principles
of Providing a Patient
with Headgear?
As well as
direction of pull,
the other
important
principles when
using headgear
are duration of
wear, level of force
and safety.

of Providing a Patient
with Headgear?
For anchorage
support when no
movement of the
molars is desirable,
the patient should be
instructed to wear
the headgear for 10–
12 hours a day with a
force of between 250
and 350 g applied
bilaterally.

What Are the Principles of
Providing a Patient with
Headgear?
To distalize upper molars,
as in this case, or to
restrict maxillary growth,
the force should be
increased above 400 g and
the headgear worn for at
least 14 hours a day. As
such, the main limitation
of headgear is
compliance, as success is
reliant on a highly co-
operative patient.

The class II maxillary
protrusive patient is best
treated by headgear
therapy to restrict or
redirect maxillary
growth. A, This patient is
being treated with cervical
headgear that places a
distal and extrusive force
on both maxillary skeletal
and dental structures. The
force is provided by a neck
strap attached to the outer
bows of the headgear.

B, The molar relationship
is beginning to approach a
class III dental
position. C, Space is
beginning to open up
between the second
primary molar and the first
permanent molar. This type
of change is not apparent
for every patient because
the amount of growth and
the amount of cooperation
can vary from patient to
patient

What Are the
Principles of Overbite
Reduction in Class II
Division 2
Malocclusions?
Class II division 2
malocclusions
require a reduction
of the inter-incisal
angle, to achieve a
class I incisor
relationship and
stable overbite
reduction..

of Overbite Reduction
in Class II Division 2
Malocclusions?
A key element in this
is the relationship
between the lower
incisor tip and what
is known as the
centroid of the upper
incisor root (a
constructed point
half-way along the
root)..

What Are the
Principles of
Overbite Reduction
in Class II Division 2
Malocclusions?
If the lower
incisor tip is
placed anteriorly
to the centroid of
the upper incisor,
it should lead to
greater stability of
overbite reduction
(Houston, 1989).

What Are the Principles of
Overbite Reduction in Class
II Division 2 Malocclusions?
To achieve this, the
maxillary incisor roots
require palatal root torque,
necessitating fixed
appliances and space as
retroclined teeth result in a
shorter arch length than
teeth with appropriate
torque. In this case, space
was created with headgear
and distal movement of the
maxillary buccal segments.

Activator therapy is
particularly
suitable for the treatment
of true deep bite in the
early
mixed dentition and the
transition to late mixed
dentition because
adaptation of the
musculature can still be
achieved by
functional orthodontic
treatment.
Utility arch for uprighting
the incisors in Class II,
Division 2 cases. The
fixed appliance is used in
conjunction with the
skeletonized activator
for posturing the
mandible forward and
downward in the Class II,
Division 2 malocclusion.
Lingual view of the
skeletonized
activator used with
the utility arch for
functional therapy
of the condylar
fracture and of the
Class II, Division 2
malocclusion.

Modified,
horizontally
positioned
transpalatal
bar for
retention of
the
uprighted
incisors.

(a–k) A classic Class II division 2 type
malocclusion with increased overbite and
proclined
maxillary lateral incisors with half unit
Class II molar relationship in the mixed
dentition
(a–c). A ten Hoeve-type appliance was
fitted for full-time wear with a flat anterior
bite plane.
Retention was provided by anterior
clasping with a Southend clasp as well as
an Adams’ crib on
the maxillary first premolars (d, e).
Diligent wear resulted in overbite
reduction allied to distal
movement of the first permanent molars
producing molar correction over a 6-
month period (f–h).

A removable appliance
(nudger appliance) can
be used for maxillary
molar distalization.
Either palatal finger
springs (0.6 mm wire)
or screws can be used
as the active
component. A
Southend clasp on the
incisors and Adams
clasps for the molars
and premolars aid with
appliance fixation.

A removable appliance (nudger
appliance) can be used for maxillary
molar distalization. Either palatal
finger springs (0.6 mm wire) or
screws can be used as the active
component. A Southend clasp on
the incisors and Adams clasps for
the molars and premolars aid with
appliance fixation. An anterior or
posterior biteplate may be required
to disengage the occlusion and
permit uprighting of the tilted
permanent molar (as well
as reduction of an increased overbite).
Anchorage loss normally manifests as an
increase in the overjet.

An upper removable appliance
(nudger appliance) with two
screws to distalize the upper
right buccal segment and to
counteract the potential
crossbite
A nudger appliance and headgear in
combination can be used for maxillary
molar distalization to achieve bodily tooth
movement. The combination system
consists of an upper removable appliance
(URA) with palatal finger springs
(activation of 2−3 mm) that act to tip the
crown of the molar distally. High-pull
headgear worn at night, directed above
the centre of rotation of the molar, acts to
distalize the root and hold the crown
movement achieved during the daytime
wear of the URA.24 In addition, the
headgear provides a method of reinforcing
the anchorage during subsequent
retraction of the anterior teeth.

Activation: the
palatal finger
springs are
activated 1–2
mm.
Nudger
appliance for
unilateral
movement of
the upper right
first permanent
molar.

This capacity
for adaptation
only exists to a
limited degree
in adult
patients. Thus,
mechanics
such as
sweeps in NiTi
or steel
archwires can
be used in the
orthodontic
treatment of
young patients.
(a–e) A 0.019 × 0.025-in. reverse curve NiTi wire. The magnitude of the
reverse curve is
clear (a–e). The latter complicates engagement slightly. The wire can be
introduced into the first
molar tube using the fingers in the usual way; however, insertion in the
second molar tubes requires
use of a pliers such as a Weingarts (b, c) with stabilisation of the wire
anteriorly in order to facilitate
anterior engagement minimising soft tissue trauma (b)

These
orthodontic
mechanics
are only
indicated to
a limited
extent for
adult
patients .
(a–f) A 0.019 × 0.025-in.
stainless steel wire (a, b)
with reverse curve of Spee
of 3–4 mm
in depth in the premolar
region (c–e). The depth of
curve can be estimated
from the incisal tips to
the distal of the occlusal
surface of the first molars.
The wire is inserted in a
similar manner to the
reverse curve NiTi with
anterior engagement
initially to afford sufficient
flexibility (f)

Therapy of Deep Bite in M ixed Dentition
Deep bite therapy in the
mixed dentition should
take place before
eruption of the support
zones, between the age of
8 and 9
years. At this stage of
development, there is
usually still enough
orthopaedically useable
potential for growth.

At the same time,
dental use can be made of
the vertical development
of the posterior
alveolar process by
managing the eruption of
the posterior
teeth . Orthopaedic deep
bite therapy is therefore
indicated for
true deep bite with large
interocclusal clearance in
the posterior
region.

The aim is to influence the
mandible vertically in a
clockwise
direction, where possible,
and at the same time, to
establish
a new vertical position by
means of eruption
management in the
region of the support zones
and the molars.

Extrusion of the posterior
teeth and vertical development
of the lower face can be
achieved
very well with Angle Class I and
Angle Class 11/2 (Table 285 )
since
grinding measures with the
activator specifically move the
teeth
into the desired position. This
can only be done to this
extent
with bimaxillary appliances.

The bionator is not used to
correct deep bite as
grinding can
only take place selectively.
Another option is to
further enhance
the vertical effect of the
activator in the region of
the first molar
by the nighttime use of
headgear.
Standard Bionator.
activator

Treatment in the
mixed dentition is
successful only if
the support zones
have been
retained. The aim of
functional
orthodontic therapy
is enlargement,
especially of the
lower face.

Therapy of Deep Bite in
Mixed Dentition
In addition,
the effect of
the
activator with
respect to
retroclination
of the maxilla
is
counteracted.

Therapy of Deep Bite in
Mixed Dentition
An occlusal
plate with an
anterior bite
block and low-
pull
headgear can be
used as an
alternative to the
activator.
Occlusal view of the
upper plate (ACCO)
Activation of distalizing arms of
upper plate (first molar area).

The modified Teuscher
appliance is a
monobloc attached to
the upper jaw by the
acrylic
edentations and by a
facebow fitted into
tubes that are placed in
the region of second
bicuspid
or second deciduous
molar. A highpull
headgear is attached to
the outer facebow.

Therapy of Deep Bite in Mixed Dentition
The headgear
brings about dental
extrusion of the molar
and consequently
clockwise rotation of
the mandible. This
effect is enhanced by
the anterior bite block
and results in
enlargement of the
lower
face.
The Activator

Depending on
the angulation
and external
arm length of
the
headgear, a
vertical
orthopaedic
impact on the
maxilla can be
achieved.

When treating Angle
Class I combined with a
deep bite in the
late mixed dentition, a
two-by-four appliance is
preferable as the
effects of functional
orthodontic and
removable therapy are
too
limited.

Maxillary splint headgear: A, occlusal aspect; B, arrow
indicates the direction of high-pull extraoral traction

Deep bite in the mixed dentition can
be treated using functional orthodontic
appliances shortly before the
s u p port zones change. With a true
deep bite, a good clinical effect can
be achieved by extruding the posterior
teeth.

In this situation, the activator
is the appliance of choice. In
view of the possibility of influencing
the maxillary basal plane vertically
( N L) , the Sander II appliance is particularly suitable for
correction of a
skeletal deep bite.

Through additional use of the headgear, this
orthopaedic
effect can be enhanced by
counterclockwise rotation of the
maxilla . In contrast, correction of
deep bite with Angle Class Ill is done
with fixed a ppllances.

Angle Class I
If a deep bite is
combined with an
Angle Class I,
eruption of the
teeth and their
vertical
development can
be managed via the
activator
before the support
zones change .

Angle Class I
Extrusion and
vertical
development of
the alveolar
process
can be achieved,
especially in the
premolar region,
by specific
grinding
measures .

For an extrusive movement,
the guide planes of the
activator are ground out so
that there is only one contact
line belowthe tooth
equaterand the occlusal
direction of movement
remains clear (a)
Dental arch expansion
takes place via the tooth
guide planes contoured as
inclined planes ,an
occlusion rim remains
occlusally (b)

Early
correction of
Class II div 1
BY HIGH PULL
HEADGEAR
ATTACHED TO
ACTIVATOR

Orthodontic treatment of deep bite part 1

Orthodontic treatment of deep bite part 1

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Orthodontic treatment of deep bite part 1