American Journal of ORTHODONTICS

Volume 72, Number 1, July, 1977

ORIGINAL

ARTICLES

Deep overbite correction by intrusion

Charles

R. Burstone

Farmington,

Conn.

ne of the major challenges of Class II treatment is the correction of

deep overbite. Unfortunately,
it is still common for the correction to be determined by the system of mechanics that an orthodontist will employ, rather than
the nature of the discrepancy. In most instances this correction is produced by
the extrusion of posterior teeth, with the greatest success associated with patients
who exhibit considerable mandibular growth.
Differential
treatment planning for the Class II patient requires that the
relative amount of anterior intrusion and posterior extrusion be determined before treatment and that differential mechanics be utilized to produce the desired
correction. The amount of intrusion required will vary from patient to patient;
however, some trends in treatment planning should be noted in the average Class
II situation. Many Class II cases are characterized either by an A-B (apical base)
discrepancy or by a greater-than-average
vertical dimension.
Lip length may be relatively short in relation to the vertical dimension. It is
not desirable to increase the vertical dimension, since it would tend to make the
A-B relationship more Class II and increase an abnormally large lower face. A
great deal has been written about the undesirability
of rotating a mandible open
in the steep mandibular
plane case ; the same precautions concerning rotation
should also be employed in a patient with a large A-B discrepancy. Fig. 1 shows
a patient in whom deep overbite was corrected by the extrusion of primarily
lower premolars and molars associated with leveling the curve of Spee in the
lower arch and the use of Class II elastics.
The bony Class II relationship measured at points A and B haa become more
severe as the mandible has swung downward and backward. The vertical dimension has increased, creating an even longer lower face and potential instability in
Department
of
Health
Center.

Orthodontics,

SchooI

of

DentaI

Medicine,

University

of

Connecticut

Bursto?le

Am.

J. Orthod.
J&y
1977

L
f---

P
-0
I
,< #,
,, ,
I .I
,.,
.;
,-:,,,
I,<,/ ,I ,/ -1 \ \
\\
1 --.[I4
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-._-

Fig. 1. Correction
of deep
overbite
by extrusion
of lower
first molars
and premolars
associated
with
Class
II elastics
and
leveling
of the lower
curve
of Spee.
An undersirable
increase
in vertical
and
facial
convexity
has .occurred.
(Solid
line-before;
dotted
lineafter
treatment.)

the overbite correction. Extrusive mechanics has worsened the skeletal pattern
since minimal mandibular growth has occurred during treatment. Patients J. Z.
and M. H. were treated with the intrusion mechanics which are described in this
article (Figs. 2 to 5). Even though these patients are characterized by minimal
mandibular growth, it should be noted that the mandible has not exhibited a
clockwise rotation during treatment; actually, the Y axis angle has been reduced.
This control of vertical dimension ensures that one has not encroached on the
interocclusal space during deep overbite correction and thus increases stability.
It makes it easier for the patient to close his lips and improves the A-B relationship.l If our objective in a high percentage of Class II cases is to reduce or hold
vertical dimension rather than to-increase it, correction of deep overbite becomes
more difficult for it requires genuine intrusion of the anterior teeth. Although
intrusion may complicate the mechanical treatment of the patient, it is necessary
for the achieving of an optimal result.
The decision as to the proper cant and level of the occlusal plane should not
be determined as an accident of mechanics but should be carefully evaluated at
the beginning of treatment. The usual factors that should be considered are the
natural plane of occlusion (the original axial inclinations and alignment of the
posterior teeth), anterior esthetics (the relationship of the incisor to the upper
lip), the amount of attached gingiva present in the mandibular incisor region,
and the A-B discrepancy. If one were to generalize, most Class II patients require

Deep overbite

\
\

1 \
1 \
\ .f
\
I 1

PI
\ I
\I

I.,

correction

4:
f \
\
\

<
:
1

\
\
.

04
Figs. 2 to 5. Correction

M. H. d

-\

--w_

--__

of deep
overbite
by intrusion
of incisors.
Anterior
cranial
base
superposition
and separate
maxillary
and mandibular
superpositions
are shown.
(Superposition
of maxilla
is on palatal
plane
at ANS;
mandible
is superposed
at symphysis
and anterior
third
of lower
border.)
Note
genuine
intrusion
of maxillary
incisors
and reduction
in facial
convexity.
[Solid black
teeth--after
treatment.)

Bursto7le

Am.

J. Orthod.
July
1977

a relatively flat occlusal plane that tends to coincide with the natural plane of
occlusion of the posterior teeth. The plane should not allow more than 3 mm. of
the incisors to show below the upper lip.
If WC accept this concept of an occlusal plane, it is apparent that more intrusion of the upper incisor than of the lower incisor is required. Once again, this
complicates treatment since it is much easier to intrude lower incisors because of
their smaller root mass and the common presence of a curve of Spee in the lower
arch. For optimal treatment, however, more intrusion is required in the upper
arch than in the lower. It should be noted that in Patients J. Z. and M. H.
genuine intrusion of the upper incisor is shown in the maxillary superposition
which is greater than the intrusion shown in the mandibular arch.
Every patient with deep overbite requires a comprehensive treatment plan
which establishes how the deep overbite should be corrected, either by extrusion
of posterior teeth or inhibition and genuine intrusion of anterior teeth. This
decision is based in part on where the clinician desires to place the occlusal plane,
the amount of mandibular growth anticipated, and the vertica1 dimension desired
at the end of treatment.
It is important to define intrusion, since the dental literature suggests ambiguity in its use. Intrusion refers to the apical movement of the geometric center
of the root (centroid) in respect to the occlusal plane or a plane based on the
long axis of the tooth. Labial tipping of an incisor around its centroid produces
pseudo-intrusion. Although this pseudo-intrusion would help correct a deep overbite in a Class II, Division 2 patient, it should not be confused with the genuine
intrusion discussed in this article. Incisal edges should therefore not be used to
evaluate intrusion, since they are easily affected by tipping movements of the
incisors. Ideally, a point should be selected in the center of the root (centroid)
and comparison should be based upon the movement of this point.
The

basic

intrusive

mechanism

In the 1950s I developed an approach to orthodontic therapy which did not

use continuous arches.2 The technique, known as the segmented arch, used different cross sections of wire within the same arch and wires that did not run
continuously from one bracket to the adjacent bracket.39 4 Segmented arch procedures have a number of advantages in space closure in extraction cases and in
producing tooth alignment with minimum side effects.5 In particular, segmentation allows for the genuine intrusive movement of the anterior teeth. One of the
limitations of traditional continuous arch therapy has been its inability to produce genuine intrusion.
The basic mechanism for intrusion consists of three parts: (1) a posterior
anchorage unit, (2) an anterior segment, and (3) an intrusive arch spring
(Fig. 6).
Early in treatment the posterior teeth are aligned and joined together with a
buccal stabilizing segment, Once a buccal stabilizing segment of at least 0.018 by
0.018 inch (0.457 by 0.457 mm.), with or without loops, can be placed, intrusive
mechanics can be begun. (The mechanics described are based upon a 0.022 inch
(0.559 mm.) slot edgewise bracket. Although the cross sections of wire will differ

Deep oz~erbite correction

Fig.

6.

four

incisors,

the

first

Fig.

7.

molars

Fig.

8.

9.

intrusive

for

intrusion;

intrusive

posterior

arch.

The

anchorage

intrusion

arch

unit,

anterior

is placed

segment

in the

auxiliary

in
tube

the
on

view

of

intrusive

arch.

Arch

lies

gingivai

to

incisors.

Canines

and

pre

bypassed.

Intrusive
from

Forces
and

an

attachment.

Anterior

arch

trusion

mechanism
and

molar

are

vents
Fig.

Basic

arch

has

being
acting

on

a negative

force

(FA)

been

placed

displaced

times

the
rotation
the

into

teeth

from

at

the

the
an

level

of

the

mucobuccal
intrusive

arch.

(crown-distal-root-mesial).
distance

(L) from

the

incisors.
fold

if
The

The
incisor

to

the

A double
a

tie

effect
moment
center

is

rope

tie

pre-

accidentally

on

the

(M)
of

molar
is equal

resistance

lost.
is exto

the

of

the

molar.

with each segment for an 0.018 inch (0.457 mm.) slot, the same basic principlc)s
can be used. The cross section and design of the intrusive springs are identical.)
the arch by means
Right and left posterior segments are joined together across
of a transpalatal
lingual arch in the maxilla. and a low lingual arch in the
mandible.
When alignment is completed in the posterior segment, the buccal stabilizing
segments and lingual arches remain in place and arc not continually adjusted as
in continuous arch therapy. Conceptually, one should not think of the posterior
teeth as a group of individual teeth but, rather, as a single multirooted tooth
composed of all the teeth on the right and left sides of the arch in the posterior
region.
To increase the stability of the posterior segment, wires that are 0.018 by
0.025 inch (0.457 by 0.635 mm.) or 0.021 by 0.025 inch (0.533 by 0.635 mm.)
can
be placed following initial alignment and thereafter
maintained in place
throughout treatment. A special bracket-tube or triple-tube combination is placed

Am

Table

I. Force

values

for

J. Cbthod.
July
1.977

intrusion*

Teeth

Force/Side

Total force
in midline

Moment/Side
(Gm.-mm.)

&w-r
incisors
and lateral incisors
Central and lateral incisors and canine
Central
Central

25

50

750

50
100

100
200

1,500
3,000$

Lower

Central and lateral incisors

20
40
600
Central and lateral incisors and canine
160
80
2.4OOf
*Averages only.
tMoment values based on 30 mm. distance from incisors to the center of resistance of posterior
segment.
tThis moment can efficiently tip back posterior teeth.

on the upper or lower first molar. The most lingual slot or tube is used for plaeement of the edgewise arch; the large round tube is used for headgear. An auxiliary tube placed gingivally
is the anchor point for intrusive springs. The
auxiliary tube on the first molar is standardized for an 0.018 by 0.025 inch (0.457
by 0.635 mm.) wire, regardless
of the slot dimension
of the strap-up.
It is
important to reiterate that during t,he overbite correction adjustments are not
made tooth to tooth in the buccal segment, except for purposes of minor tooth
alignment, and that the only adjust,ment to be found is between the auxiliary
tube on the first molar and the anterior segment.
The intrusive arch normally consists of an 0.018 by 0.022 inch (0.457 by 0.559
mm.) or 0.018 by 0.025 inch (0.457 by 0.635 mm.) edgewise wire with a 3 mm.
helix wound 21/2 times placed mesial to the auxiliary tube. Curvature is placed
in the intrusive arch, so that. the incisal portion lies gingival to the central
incisors (Fig. 7). When the arch is tied to the level of the incisors, an intrusive
force is developed (Fig. 8). In order that the arch does not increase its length
during the activation, a gentle curvature should be placed with the amount of
curvature increasing as one approaches the helix. In this way the activated arch
wire will appear relatively straight, and as it works out during intrusion arch
length will decrease and no anterior flaring is produced.
The intrusive spring is not directly tied into the incisor bracket. An anterior
alignment arch or anterior segment is placed in the central incisors or the four
incisors and the intrusive arch is tied either labially, incisally, or gingivally to
that wire.
It is true that almost any intrusive bend placed on an arch of this type could
produce dramatic leveling of the arch. However, where there is genuine intrusion, greater control of the force system is needed. For this reason, the six major
principles of intrusion will now be discussed.
Controlling

the

force

magnitude

and

constancy

It is important to use the lowest magnitude of force that is capable of intruding incisors. If the magnitudes of force are too great, the rate of intrusion will

Volume
Number

72
1

Deep overbite

comection

not increase and the rate of root resorption will increase. This has been demonstrated by Dellingers research on monkeys.j Even more significant is the reciProCal effect on the posterior segments of too great a force. The posterior teeth will
feel a vertical force which will tend to extrude the buccal segments and a moment
or torque which in the upper arch will steepen the plane of occlusion and in the
lower arch flatten it (Fig. 9). If only a single tooth, as a first molar, is attached
to an intrusive spring, the undesirable side effect is seen primarily as a tip-back
action, with the crown moving distally and the root mesially. Loss of anchorage
during intrusion is primarily produced by the moment rather than by the force,
since occlusal forces tend to negate the eruptive tendency. The moment is large
because the distance from the ihcisors to the posterior teeth is great.
The recommended forces for anterior intrusion
are given in Table I. It
should be noted that approximately
25 Gm. of force is delivered to an upper
incisor and approximately
half that amount to a lower incisor. A canine requires
about 50 Gm. of force, on the average, for intrusion. Fig. 10 gives the loaddeflection characteristics of typical 0.018 by 0.025 inch (0.0457 by 0.635 mm.)
intrusive arches. The length of the arch is measured from the mesial aspect of
the auxiliary tube on the molar to the midline of the dental arch parallel to the
midsagittal plane. If the orthodontist
desires to intrude four incisors, 100 Gm.
of force midline would be required (25 Gm. per tooth). For a 30 mm. arch, 16.5
mm. of activation is required. (The intrusive arch is then bent so that its anterior
portion lies 16.5 mm. below the level of incisor brackets.)
The suggested forces are averages based upon clinical experience. They can
be modified if root circumference and length vary from the average. Care should
be taken, however, not to increase the magnitudes significantly because of the
possibility of upsetting the posterior anchorage. It is important
to make sure
not only that an optimal magnitude of force is employed but that the force
operates relatively constantly.
Springs that deliver relatively constant force have low loa.d-deflection rates.
An intrusive arch with a 30 mm. arm (perpendicular
distance from the incisor
to the first molar) has a load-deflection rate of 6 Gm. per millimeter. If this
intrusive arch is activated 16.5 mm., 100 Gm. of force is produced in the midline,
50 Gm. per side. As the incisors intrude 1 mm., there is a change of force magnitude of only 6 Gm.; hence, the delivery of force is relatively constant.
By contrast, high load-deflection mechanisms, such as some of the loops that
are tried for intrusion, are activated only just a few millimeters; accordingly,
the drop off of force is very dramatic for every millimeter of tooth movement.
With a high load-deflection mechanism, it is not possible to deliver optimum
forces since the activations required to produce the desired forces are in tenths
of a millimeter and the orthodontist does not have the ability to carry out such
minute activation.8 Furthermore,
with a high load-deflection spring rate as the
tooth moves, a rapid drop in force magnitude occurs, so that the optimal force
may be only momentarily reached.
The clinician, therefore, learns that he must use greater than optimal forces
to achieve any appreciable tooth movement. In short, in order to accomplish
intrusion, it is necessary to deliver an optimal force constantly. A low load-

Am.

INTRUSIVE

BASE

J.

Orthod.

July

1977

ARCHES

WIRE SIZE: ,018 x.025

DIAMETER
OF HELIXz3mm.

21/z TURNS

320
1

L: 20mm

L-25mm

Lf30mm

z i__L=35mm
0

12

ACTIVAT!ON
Fig. 10 Load-deflection
from
the incisor
bracket
is given
on the vertical
determined

from

this

16

20

or a force

gauge

can

24

28

(mm)

characteristics
of the intrusive
arch
to the mesial
aspect
of the molar
axis.
Data
are based
on average
table,

be used

(1) is the perpendicular

distance
auxiliary
tube.
The total
force
arch forms.
Activation
can be
in the

mouth.

deflection rate spring makes it practical for the clinician to determine the magnitude of the force, since activation is not so critical and assures that as intrusion
proceeds there will not be a marked reduction in force magnitude.
Force magnitude can be measured either from a force-deflection graph (Fig.
10) based on average arch form or by directly measuring the intrusive arch in
the mouth with the use of a force gauge. The intrusive arch has certain characteristics which assure a low deflection rate and relative freedom from accidental
permanent deformation
under the forces of mastication. Although a wire of
relatively large cross section is used, either 0.018 by 0.025 inch (0.457 by 0.635
mm.) or 0.018 by 0.022 inch (0.457 by 0.559 mm.), the load deflection is reduced
by the long perpendicular length from the incisors to the auxiliary tube of the
first molar. In addition, a helix 3 mm. in diameter is placed at the critical section
immediately mesial to the auxiliary tube on the first molar in which 2.5 turns are
placed (Fig. 11). This spring is an example of how a large cross-sectional wire
can be used in proper design to deliver optimal and constant forces without being
so flimsy that permanent deformation can occur under accidental loading.
Anterior

single

point

contack

The intrusive arch is not placed directly into the brackets of the anterior
teeth. The major reason why one avoids bracket engagement of the intrusive

Deep overbite

Fig. 11. A helix

auxiliary
without

3 mm. in diameter
with
2.5 turns
is placed
immediately
tube on the first molar.
The helix lowers
the force and delivers
reducing
the archs
ability
to withstand
permanent
deformation.

Fig. 12. Intrusive

(0.254
by 0.508
Fig.

13.

SO that

arch
is placed
incisal
to brackets.
mm.] anterior
segment
joins the incisor.

If the intrusive
arch
no torque
is produced.

is placed

in two

incisors,

separate

it is necessary

correction

mesial
to the
it more constantly

0.010
to

by
round

0.020
the

inch
wire

spring is that, inadvertently,

anterior torque may be present in the arch. Even if
no torque is present, as the intrusive arch works out, torque can be introduced. If,
purposely or inadvertently,
labial root torque is placed into the incisors, t,he
intrusive forces are increased on the anterior teeth ; this added intrusive force is
not needed and can produce anchorage loss of the posterior teeth.
On the other hand, if lingual root torque is present, it will have the effect of
reducing the magnitude of intrusion on the incisors. In fact, if the lingual root
torque is large enough, the direction of the force could reverse and the incisors
could actually extrude.
The advantage of not tying an intrusive arch directly into the incisor brackets
is that it allows the clinician t,o know more positively the force system delivered.
By having a single point of force application on the incisors, one knows the full
force system acting at both the incisor point and the buccal tubes. A system of
this type is described as being statically determinant. Placing the intrusive arch
into the brackets
and statically e

Deep overbite

correctio7L

Fig. 14. As the intrusive

force
is applied
more anteriorly
to the center
of resistance
of
incisors,
a positive
moment
is created
which
tends
to move
the root lingually,
provided
incisor
is restrained
from
flaring
labially.
Fig. 15.
by 0.635
extension.

A posterior
extension
has been
placed
on
mm.)
anterior
segment.
Right and sectional

Fig. 16. Force system

of
Note
that
the posterior
resistance
of the incisor.
Fig.
The

17. A long posterior

hook
at the intrusive

appliance
extension
No incisor

shown
allows
tipping

extension
section

is used
is shown.

a lower
intrusive

0.018
by 0.025
inch
springs
are hooked

in Fig. 15. Only

forces
force
to be directed
will occur.
to

protrusive

lower

11

the
the

(0.457
on the

on the teeth
are shown.
through
the center
of
incisors

to

prevent

flaring.

on the incisors is the major key to success. This control includes delivering
optimal force magnitudes, delivering these forces constantly, delivering the intrusive force at a single point contact, and controlling the point of force application
with respect to the center of resistance of the anterior segment.
Selective

intrusion

Indiscriminate
leveling with a continuous arch or with sections can produce
undesirable side effects in a patient with deep overbite. In Fig. 18 a Class II,
Division 2 maxillary arch is depicted. Commonly one would like to intrude the
incisors to the level of the canines or perhaps produce some extrusion of the
posterior teeth without altering the plane of occlusion (line A). A straight arch

Deep overbite

correctio7L

Fig. 14. As the intrusive

force
is applied
more anteriorly
to the center
of resistance
of
incisors,
a positive
moment
is created
which
tends
to move
the root lingually,
provided
incisor
is restrained
from
flaring
labially.
Fig. 15.
by 0.635
extension.

A posterior
extension
has been
placed
on
mm.)
anterior
segment.
Right and sectional

Fig. 16. Force system

of
Note
that
the posterior
resistance
of the incisor.
Fig.
The

17. A long posterior

hook
at the intrusive

appliance
extension
No incisor

shown
allows
tipping

extension
section

is used
is shown.

a lower
intrusive

0.018
by 0.025
inch
springs
are hooked

in Fig. 15. Only

forces
force
to be directed
will occur.
to

protrusive

lower

11

the
the

(0.457
on the

on the teeth
are shown.
through
the center
of
incisors

to

prevent

flaring.

on the incisors is the major key to success. This control includes delivering
optimal force magnitudes, delivering these forces constantly, delivering the intrusive force at a single point contact, and controlling the point of force application
with respect to the center of resistance of the anterior segment.
Selective

intrusion

Indiscriminate
leveling with a continuous arch or with sections can produce
undesirable side effects in a patient with deep overbite. In Fig. 18 a Class II,
Division 2 maxillary arch is depicted. Commonly one would like to intrude the
incisors to the level of the canines or perhaps produce some extrusion of the
posterior teeth without altering the plane of occlusion (line A). A straight arch

12

Burstone

Fig. 18. A straight

wire
ducing
intrusion
(line A),

Am.

placed
in brackets
of a Class
II, Division
tends to steepen
the plane
of o9.lw 3nww July

2 case,

instead

J. Orthod.
July
1977

of

pro-

20

Burstone

Fig. 33.
position.
Fig.
tube

0.018

by

34. Canine-intrusion
of the canine.

Fig. 35.
auxiliary
available.

Fig. 36.
reduce

An

Am.

An 0.018
tube on
Active
unwanted

0.025
spring

by 0.018
the second

inch

(0.457

by

is activated
inch (0.457
premolar.

by
This

0.635
by

mm.)

placing

0.457
spring

state
of spring
shown
in Fig. 35.
negative
moments
on the canine.

canine-intrusion
its

anterior

J. Orthod.
Jzcly 1977

spring.
end

into

Passive

the

vertical

mm.)
intrusive
spring
attached
is used if molar
auxiliary
tube
Helices

lower

load-deflection

rate

to the
is not
and

the suggested force values, typically 100 Gm. of force on a side is required to
intrude the incisors and the canines. Table I shows that 100 Gm. would produce
a moment of 3,000 Gm.-mm. to the posterior segment if the perpendicular distance
from the incisors to the center of resistance of the posterior segment was 30 mm.
Since moments of this magnitude are most effective, tipping of the posterior teeth
will occur more rapidly than the intrusion, and since this tipping is not required,
intrusion mechanics will not be successful. If the posterior segment were backed
up with an occipital headgear in the maxillary arch, it is possible to eliminate
this undesirable moment as well as the eruptive force on the posterior teeth.
Without
excellent cooperation from the patient in the wearing of headgear,
intrusion of six anterior teeth simultaneously should not be attempted.
Two types of situation require separate canine intrusion. In the first the
canine lies bilaterally occlusal to the premolar and the canine must be intruded
separately following anterior intrusion. In the second, the canines have not
erupted symmetrically
and canine intrusion is required on only one side. In

Deep overbite correction

Fig. 37. Canine

simultaneously.

root

spring.

During

canine

root

movement

intrusion

can

be

carried

21

out

patients with deep overbite it is usually a mistake to level and extrude infraerupted canines. Many of these canines should be left in their original position
and the incisors should be intruded to their level.
Figs. 33 and 34 show a canine-intrusion
spring which is activated to produce
50 to 75 Gm. of force. It is fabricated from 0.018 by 0.025 inch wire inserted into
the auxiliary tube of the first molar and into the vertical tube of a canine
bracket. Since the intrusive force lies lateral to the center of resistance of the
canine, it is necessary to place a slight constrictive force in the spring to keep the
canine from flaring labially. To minimize the chance of producing an undesirable
moment in the canine tube, it is a good idea to round the wire in the portion of
the spring that is placed in the vertical tube of a canine. If the incisors have
already been intruded, it is necessary to join them to the posterior segments by
an anterior wire inserted in the auxiliary tubes of the premolars stepped either
occlusally or gingivally around the canine. This wire holds the incisors in place
and adds further anchorage for the intrusion of the canines.
If the auxiliary tube in the first molar is not available for an intrusive spring,
an 0.018 by 0.018 inch (0.457 by 0.457 mm.) spring can be constructed which
inserts into the auxiliary tube of the most anterior premolar (Figs. 35 and 36).
If no auxiliary tubes are available, a continuous segment from molar forward to
canine can be constructed of this design. The 0.018 by 0.018 inch (0.457 by 0.457
mm.) intrusive spring is a modified rectangular loop with helices placed mesial
to the brackets. This design reduces the load-deflection rate and, more important,
assures that as the spring works out a vertical force will be delivered without an
undesirable moment being produced on the canine. If a canine is flared, a moment
is produced which flares the canine more; hence, it is necessary to tie the canine
back on both the buccal and lingual aspects. A buccal tie alone could cause the
canine to rotate with its distal aspect toward the lingual.
In addition to specialized intrusive springs, separate canine intrusion can be
produced by canine-retraction
assemblies or root springs, In Fig, 37 a root spring
is being used to simultaneously retract the root and intrude the canine.

Deep overbite correction

Volume
Number

73

Fig. 31.
dibular

Patient
rotation

Fig. 32.
intruded

Patient
M. M. Maxillary
and mandibular
7 mm.,
measured
at their
apices.

M. M. Cranial
base superposition
or increase
in vertical
dimension

(Dotted
line-After
has occurred
during
superpositions.

Upper

19

treatment].
treatment.

No

man-

incisors

have

been

central incisors reached the level of the lateral incisors, and then all four incisors
were intruded as a unit. En masse space closure of the six anterior teeth was
effected by an 0.010 by 0.020 inch (0.254 by 0.508 mm.) anterior retraction assembly (Fig. 29). The finished result is shown in Fig. 30.
Because of the short upper lip, the curve of Spee was maintained in the lower
arch, with all of the intrusion occurring in the upper incisor region (Figs. 31
and 32). The skeletal pattern with its large vertical height anteriorly, facial
convexity, and steep mandibular plane required treatment that would maintain
the vertical dimension and correct the deep overbite by intrusion. If the Iower
curve of Spee had been leveled, the result would have been undesirable ; the
vertical dimension would have been increased, so that the patient would not close
her lips and too much upper incisor would have shown below the upper lip.
Indiscriminate
leveling of the lower arch should not be attempted in this type of
case.
Canine

inrtrusion

It is usually not possible to intrude all six anterior teeth at one time without
producing undesirable axial inclination change in the posterior segment. TJsing

20

Burstone

Fig. 33.
position.
Fig.
tube

0.018

by

34. Canine-intrusion
of the canine.

Fig. 35.
auxiliary
available.

Fig. 36.
reduce

An

Am.

An 0.018
tube on
Active
unwanted

0.025
spring

by 0.018
the second

inch

(0.457

by

is activated
inch (0.457
premolar.

by
This

0.635
by

mm.)

placing

0.457
spring

state
of spring
shown
in Fig. 35.
negative
moments
on the canine.

canine-intrusion
its

anterior

J. Orthod.
Jzcly 1977

spring.
end

into

Passive

the

vertical

mm.)
intrusive
spring
attached
is used if molar
auxiliary
tube
Helices

lower

load-deflection

rate

to the
is not
and

the suggested force values, typically 100 Gm. of force on a side is required to
intrude the incisors and the canines. Table I shows that 100 Gm. would produce
a moment of 3,000 Gm.-mm. to the posterior segment if the perpendicular distance
from the incisors to the center of resistance of the posterior segment was 30 mm.
Since moments of this magnitude are most effective, tipping of the posterior teeth
will occur more rapidly than the intrusion, and since this tipping is not required,
intrusion mechanics will not be successful. If the posterior segment were backed
up with an occipital headgear in the maxillary arch, it is possible to eliminate
this undesirable moment as well as the eruptive force on the posterior teeth.
Without
excellent cooperation from the patient in the wearing of headgear,
intrusion of six anterior teeth simultaneously should not be attempted.
Two types of situation require separate canine intrusion. In the first the
canine lies bilaterally occlusal to the premolar and the canine must be intruded
separately following anterior intrusion. In the second, the canines have not
erupted symmetrically
and canine intrusion is required on only one side. In

Deep overbite correction

Fig. 37. Canine

simultaneously.

root

spring.

During

canine

root

movement

intrusion

can

be

carried

21

out

patients with deep overbite it is usually a mistake to level and extrude infraerupted canines. Many of these canines should be left in their original position
and the incisors should be intruded to their level.
Figs. 33 and 34 show a canine-intrusion
spring which is activated to produce
50 to 75 Gm. of force. It is fabricated from 0.018 by 0.025 inch wire inserted into
the auxiliary tube of the first molar and into the vertical tube of a canine
bracket. Since the intrusive force lies lateral to the center of resistance of the
canine, it is necessary to place a slight constrictive force in the spring to keep the
canine from flaring labially. To minimize the chance of producing an undesirable
moment in the canine tube, it is a good idea to round the wire in the portion of
the spring that is placed in the vertical tube of a canine. If the incisors have
already been intruded, it is necessary to join them to the posterior segments by
an anterior wire inserted in the auxiliary tubes of the premolars stepped either
occlusally or gingivally around the canine. This wire holds the incisors in place
and adds further anchorage for the intrusion of the canines.
If the auxiliary tube in the first molar is not available for an intrusive spring,
an 0.018 by 0.018 inch (0.457 by 0.457 mm.) spring can be constructed which
inserts into the auxiliary tube of the most anterior premolar (Figs. 35 and 36).
If no auxiliary tubes are available, a continuous segment from molar forward to
canine can be constructed of this design. The 0.018 by 0.018 inch (0.457 by 0.457
mm.) intrusive spring is a modified rectangular loop with helices placed mesial
to the brackets. This design reduces the load-deflection rate and, more important,
assures that as the spring works out a vertical force will be delivered without an
undesirable moment being produced on the canine. If a canine is flared, a moment
is produced which flares the canine more; hence, it is necessary to tie the canine
back on both the buccal and lingual aspects. A buccal tie alone could cause the
canine to rotate with its distal aspect toward the lingual.
In addition to specialized intrusive springs, separate canine intrusion can be
produced by canine-retraction
assemblies or root springs, In Fig, 37 a root spring
is being used to simultaneously retract the root and intrude the canine.