classification, manifestations, and its early treatment of deep bit, in a nut shell. In this lecture, we also are going to discuss some cases.

1. Deep Bite
and its early tx.
Presented by: M.R. Vatankhah
Assistant professor: Dr. Heidarpour

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Deep bite problems; Preface
treatment is
difficult
strong
relapse
tendency
lack long-
term
stability..

3. MR Vatankhah - SBMU
First of All: What is a Normal Bite?
■ Overlapping of maxillary incisors over mandibular incisors with a range
of 2 to 3 mm.
■ Around 5% to 30% of overlap is accepted as normal overbite.
■ Range of 25% to 40% may be considered normal, provided that no
functional problems exist during various movements of the
temporomandibular joint.
■ Neff expressed overbite as a percentage of the mandibular incisor covered
by the corresponding maxillary incisor; he considered a 20% overbite to
be ideal.

4. MR Vatankhah - SBMU
Note that;
■ Deep bites are not always alike; deep bite may be associated
with a Class I, a Class II division 2, or a Class II division 1
malocclusion, and reverse overbite may be associated with a
Class III malocclusion;

5. MR Vatankhah - SBMU
The Etiology is complex: genetic and environment
■ Strang: Supereruption of the incisors, infraeruption of the posterior teeth,
or a combination.
■ Diamond: Lack of growth in the vertical height of the mandibular ramus.
■ Wylie: Rejected the idea of diamond in a cephalometric study.
■ Baume: degree of overbite in primary dentition, the forward growth of
the mandible relative to the maxilla, and the relative position of the
mandibular incisor edges to the maxillary incisor edges

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Dental deep bite; Etiology
– Diminished posterior dental height due to loss of posterior teeth and
mesial tipping of the posterior segment
– Early loss of primary molars and lingual tipping of permanent molars,
causing scissors bite (buccal bite) and collapse of the mandibular
arch
– Early loss of the primary canines, lingual collapse, and overeruption
of the mandibular anterior teeth
– Abrasion of molar teeth or molar cusps
– Bilateral undereruption of primary teeth due to ankylosis

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– Periodontal disease and pathologic mesial migration of the
posterior teeth that worsens the existing anterior deep bite
– Hypodontia or microdontia in one arch relative to the opposing arch
– Buccal bite and mandibular collapse
– Perioral neuromuscular imbalance
– Imbalance of the posterior vertical chain of orofacial muscles
– Abnormal oral habits such as lateral tongue thrust, bruxism,
clenching, lip dysfunction
Dental deep bite; Etiology

8. MR Vatankhah - SBMU
Skeletal dental deep bite
– Reduced lower facial height (brachycephalic)
– Excessive freeway space
– Increased ramus height and width
– Large coronoid process
– Two-step occlusion (incisors and canines at higher levels relative to
the premolars and molars)
– Strong temporalis and masseter muscles

9. MR Vatankhah - SBMU
– Small gonial angle
– Increased ramus height and posterior cranial base causing
counterclockwise rotation of the mandible
– Short and broad mandibular symphysis
– Deep nasion relative to frontal boss
– Small cranial base angle
– Convergent face (four facial planes of the face are horizontal)
– Straight or concave profile
Skeletal dental deep bite

10. MR Vatankhah - SBMU
Failure to correct deep bite problems, especially in the
permanent dentition, contributes to a variety of pathologic
conditions affecting the masticatory apparatus.
For example, a common problem associated with deep bite
is difficulty in proper restoration. The general
practitioner may refer a patient for orthodontic treatment
of excessive deep bite, which usually displays a
significant loss of vertical dimension.

11. MR Vatankhah - SBMU
• Long-term stability can be achieved.
• Treatment is readily established.
• Growth potential can produce better skeletal
relationships.
• Changes in the dentoskeletal relationships and environment
can bring more positive muscular adaptation.
• Less mass tooth movement and comprehensive mechanics
are needed.
Why early tx. is recommended?

12. MR Vatankhah - SBMU
Treatment options without surgical intervention
Intrusion of maxillary or
mandibular incisors or both
Extrusion of maxillary or
mandibular posterior teeth or both
A combination of intrusion and extrusion
of the anterior and posterior segments

13. MR Vatankhah - SBMU
Dental deep bite: Mesial migration of the posterior teeth
Distalization of the
mesial migrated tooth
Maintaining the
accomplished results
Bahreman: Use an ant. bite plate
to disocclude the post. teeth

14. MR Vatankhah - SBMU
Dental deep bite: Abnormal habits
Early diagnosis of
dental deep bite
Different protocols for
prevention of oral habits

15. MR Vatankhah - SBMU
Dental deep bite: Lower lip dysfunction
Hypertonicity of the lower lip or from overjet
that traps the lower lip behind the maxillary incisors
Application of a lip bumper to separate
the lip force from the mandibular incisors
Hawley bite plate to disocclude posterior segments
and facilitate overeruption of the posterior segment
Distalize and upright the molars

16. MR Vatankhah - SBMU
Dental deep bite: Early loss of the primary canines
Mandibular incisor retroclination and
extrusion
Immediate insertion of a lower holding
arch to maintain the dental arch

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Skeletal deep bite: Management during the primary dentition
Treatment of deep bite during the primary
dentition is indicated
only when a severe impinging deep bite is present
The presence of excessive bite during the primary
dentition indicates the presence of a skeletal
aberration.

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Skeletal deep bite: Management during the early mixed dentition
A removable bite plate appliance can
reduce overbite for patients who have
less than normal eruption of the
posterior teeth or in whom overbite is
associated with reduced facial height.
The anterior acrylic resin part is made in
such a way that the patient’s mandibular
incisors occlude with the plastic plane lingual
to the maxillary incisors and the posterior
teeth are disoccluded about 1.0 to 1.5 mm

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Skeletal deep bite: Management during the late mixed dentition
existence of rapid growth
changes during the growth spurt
that takes place at these ages.
Correction of the
curve of Spee or
two-step occlusion

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