Vertical malocclusions /certified fixed orthodontic courses by Indian dental academy

VERTICAL MALOCCLUSIONS:
etiology, development, diagnosis
and some aspects of treatment
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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INTRODUCTION
DEVOLOPMENT OF MALOCCLUSIONS
MADIBULAR GROWTH & VERTICAL
MALOCCLUSIONS
GROWTH ROTATIONS & MALOCCLUSIONS
GROWTH PREDICTION
TREATMENT ASPECTS
SUMMARY
CROSS-REFRENCES

CONTENTS

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Vertical malocclusions result from
interplay of many etiological factors
during growth.
◦ Growth of maxilla and mandible
◦ Function of lips
◦ Tongue & dentoalveolar development

◦ Eruption of teeth

INTRODUCTION



Important factor in development of deep
bite and open bite is the pattern of growth
of the mandible.

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In this article, we discuss
 The role of facial growth as an
etiological factor in the development of
vertical malocclusions,
 possible association between functional
factors and malocclusions,
 diagnostic considerations and treatment
aspects.

VERTICAL MALOCCLUSIONS
DENTOALVEOLAR
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SKELETAL

Based on growth patterns of the jaws.


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In studies using metallic implant
technique, by Bjork an Bjork & Skieler,
direction of growth of lower jaw varies
greatly in normal population.

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Most common direction of condyle is
vertical, with some anterior component.

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Posterior growth is less frequently
observed.

MANDIBULAR GROWTH

Patients with upward and anterior growth
of mandibular condyle often have reduced
anterior facial height.
 They develop mostly deep bite.
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In extreme upward and forward
movement of condyle, a Class II div 2
malocclusion in combination with skeletal
deep bite is common.


Subject with skeletal deep bite.
Pronounced anterior rotation of both maxilla and mandible

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In this cases, mesial migration of max.&
mand. teeth with some degree of
proclination of mand. Incisors occurs.

In patients with pronounced increase in
lower facial height, have a more
posteriorly directed growth pattern of
mandibular condyle.
 Termed as long-face syndrome.
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Malocclusion seen in these patients is
mostly anterior open bite often in
combination with Class I or Class II.

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The dental eruption pattern of posterior
teeth is mostly vertical. Anterior teeth
may be more retroclined.

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Crowding is seen lately.


Vertical growth pattern

mandible rotated posteriorly during growth

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Differences in height development lead to
positional changes of the mandible.

AFH-eruption of maxillary mandibular
teeth.
 PFH-lowering of temporomandibular
fossae and condylar growth.


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Risk of development deep bite is more
during active growth.

GROWTH ROTATIONS

Development of deepbite depends on
relationship of max.&mand. Incisors.
 Acc. To Bjork, fulcruming point for forward
mandibular growth rotation is located at
incisors.
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If incisal contact is lacking due to:
Lip dysfunction
Finger sucking
deepbite
Skeletal discrepancy
•Treated early.
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Posterior condylar growth-similar AFH &
PFH

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If AFH > PFH

post. Condylar growth

openbite
 If treatment is done, Increased risk of
extrusion.
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Fulcrum at incisors- stable occlusion
overbite remains unchanged during growth


lack of ant. occlusal contact – fulcrum shifted to
occlusal plane
bite deepens during growth

Vertical growth – fulcrum at condyles


In a study by Isaacson et al, 3 groups
 Low angle
 Average
 High angle
 In high angle cases,
1. posterior dental development is greater
Moller & Ingervall-due to weaker
musculature.
2. lower facial height is more.
3. Openbite- less biting force.


FACIAL MORPHOLOGY

8yrs1mon patient with increased AFH convex profile &
incompetant lips.
Facial growth downwards & forwards

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Treatment consisted of 2 bands on
maxillary central incisors, & spurs to
prevent fingersucking & tongue
dysfunction.

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She was instructed to chew sugerless gum
for 2hrs daily.

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In mandible, lingual arch was placed to
maintain archlength during transition of
dentition.

Patient at 14yrs 6mon.
Maxilla rotated posterior. Mandible rotated in anterior
direction.

2nd phase: extraction of 1st PM.
 Use of high pull headgear in combination
with transpalatal arch.
 After2yrs of retention, occlusion is good
with harmonious soft tissue profile.
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11yrs 3mons patient with class II div2 malocclusion,deepbite
& concave profile

Begg appliance was tried for 1yr with little
success.
 Mandible was advanced surgically &
rotated vertically to increase AFH.
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Post-treatment, occlusion was class I,
with straighter profile.


Increase in lower facial height.
Corrected sagittal jaw discrepancy

EXTREME VARIATIONS IN VERTICAL FACIAL
GROWTH & VARIATION IN SKELETAL AND
DENTAL RELATIONS
JOHN R. ISAACSON,DDS.,MSD
ROBERT J. ISAACSON,DDS.,PhD
T. MICHAEL SPEIDEL,DDS.,MSD
FRANK W. WORMS,DDS.,MSD
Angle orthodondist vol41,no:3
July 1971

Cross references

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3groups of 20 each, randomly selected
cases of MP-SN,
Low MP-SN(260) – 13.34yrs
Average MP-SN(320) – 13.26yrs
High MP-SN(380) – 14.20yrs

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Cephalometric tracings were studied.


Overbite became deeper when MP-SN
angle decreased.
 In high angle group, there was openbite,
(mean= -0.65mm)
 Avg. angle mean=3.38
 Low group mean=5.25
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Actual values ranged from 9.5mm–4mm.


PATTERNS OF VERTICAL GROWTH IN
THE FACE
SURENDER K.NANDA DMD,MS

AJODO 1988 FEB 103-116


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Longitudinal data based on lateral
cephalometric radiographs of 16 male and
16 female subjects, ages 3 to 18 years,
were used.

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Curves of absolute and incremental growth
for total anterior face height, upper
anterior face height, lower anterior face
height, posterior face height, and ramal
length were analyzed statistically and
graphically.

Deep-bite subjects are characterized by
increased upper anterior face heights,
while increased lower anterior face
heights are observed in open-bite
persons.
2. Posterior face height and ramal height
do not significantly differ.
3. The pattern of development is
established before the eruption of the
first permanent molars and long before
the adolescent growth spurt.
1.


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