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Other features
skeletal. The skeletal bite can be may deteriorate the esthetics and further
differentiated from dental deep bite by increase the interlabial gap.
cephalometric analysis.
In a clinical situation, if incisor-stomion
distance is large, ( the distance between
Postural position is also used in the the incisal edge of the maxillary central
differential diagnosis of deepbite cases: the incisor to the lower most border of the
freeway space will be larger than normal in upper lip is an average of 2 to 4 mm)
cases with inadequate vertical which is often associated with a high smile
development of the buccal segments and line or "gummy smile", the best method of
normal in cases of over-eruption of the treating a deep overbite may be by
incisor teeth intrusion of the upper incisors
In non skeletal deep bites a utility arch that In class II div I growing patients intrusion or
incorporates molar and incisor teeth can be prevention of excessive eruption of the
used during the mixed dentition to intrude, lower incisors is achieved by leveling out
tip, or reposition both molars and incisors. an excessive curve of Spee with the
Realistically, although bite depth changes continous arch wire mechanics from molar
can be made in the mixed dentition by to incisors.
intrusion of anterior teeth, intrusion is
difficult to retain-even in later phases of full In the absence of growth, absolute
appliance therapy. For this reason, intrusion intrusion is required and segmented arch
as a part of early treatment is seldom mechanics must be used to achieve this .
required. It is often better to defer this Eruption of the first molars can be aided by
treatment until the early permanent the use of a flat maxillary bite plane or a
monobloc and the incisors depressed with
utility archwire.
I. Removable appliances
b. Myofunctional appliance
a. Maxillary acrylic bite plate or
anterior bite plane ( fig 14 A and B) Deep bite due to developing class II div I
The most popular method for correcting a pattern can be intercepted with the
deep overbite is by or anterior bite plane. myofunctional appliances like activator and
The anterior bite plane is a modified bionator. Deep bite cases diagnosed to be
Hawleys appliance with a with a built-in due to infra-occlusion of molars can be
flat acrylic bite plate or inclined plane or treated by an activator designed and
platform lingual to the maxillary incisors . trimmed to allow the extrusion of these
The anterior bite plane consists of Adams teeth. The inter -oclusal acrylic is trimmed
clasps on the molars which help in gradually to encourage the eruption of the
retaining the appliance. A labial bow is posterior teeth. Bionator can also be used
also incorporated to counter any forward for a similar purpose. This is discussed in
component of force on the upper anteriors. chapter on myofunctional appliances
The bite plane may be extended labially
not to cover more than 1/3rds to produce
the same effect ie.., to prevent the c. Headgears
protusion of upper anteriors. When an extremely deep overbite is
present because of the overeruption of the
maxillary anterior teeth, a high pull
headgear can be attached to the anterior
segment of the arch wire in an attempt to
With this appliance in the mouth during the intrude these teeth.
mandibular closing movement, the
mandibular incisors come in contact with
Fig 14 A
The cervical headgear with its downward the wire is in place for a long enough
vector of force increases lower facial height period and vertical facial growth occurs,
by extruding the molars. The mechanics premolars extrude and, to a lesser degree
are discussed in detail in chapter on molars and incisors get intruded
myofunctional appliances
Use of utility arches ( fig 17): Utility arches
are arch wires that are bent is such a way
that they bypass the buccal segment and
are engaged on the incisors. These arches
II. Fixed orthodontic appliances( fig
can be used to perform a number of tooth
15, 16, 17, 18)
movements including intrusion of incisors,
Fixed orthodontic appliances can be used
protraction or even retraction of incisors.
to intrude the incisors or extrude the
They are activated by giving a V bend in
molars. They can also produce mild skeletal
the buccal segment of the wire so as to
effects . Appliances used for deep bite
produce a intrusive force on the anteriors
correction are generically
termed intrusion arches and variations
include base arches, utility arches,
Three piece segmental wires (fig 18) - This
Connecticut arch and reverse curve of Spee
type of wire is used in cases of absolute
wires etc..,.
deepbite where there is nor growth
potential. Simultaneous retraction and
Intrusion of anterior teeth can be
intrusion can be achieved.
obtained with the following methods
Extrusion of posterior teeth
Use of anchorage bends( fig 15) : Anchor
bends are given in the arch wire mesial to
Extrusion of posterior teeth can be
the molar tubes so that the anterior part of
obtained with the following methods
the arch wire lies gingival to the bracket
slot . Thus when these arch wires are
Use of archwires with reverse curve of
pulled occlusally and engaged into the
Spee The extrusion of posterior teeth can
brackets, a gingivally directed intrusive
be successfully attained by fixed
force is exerted on the incisors which
orthodontic appliances by using 0.16 in.
reduces the deep bite. When intrusion of
round wire with a reverse curve of Spee.
anterior teeth is the goal, light forces
The disadvantage of round wire is that it
should be used. Heavier forces are more
causes undesirable changes in the axial
likely to create a greater tendency for
inclination of the buccal teeth and flaring of
posterior teeth to erupt as a result of the
the incisors
equal and opposite extrusive force at the
molar. Recommended forces for intrusion of
Use of intermaxillary elastics ( fig
lower incisors are in the range of 12.5 g per
19)Extrusion of molars might be fortified by
tooth and for maxillary incisors about 15 to
means of elastics, which attempt to
20 g per tooth. The reactionary extrusive
overerupt the molars in both the upper and
force on molars is prevented by natural
lower jaws. Use of anchorage bend in the
interdigitating occlusion or in extreme
upper jaw as well as in the lower jaw in
cases by giving a posterior bite plane of
combination with Class II elastics may
minimum thickness
cause overeruption of the lower molars
and may help to correct a dental deep
bite.One of the draw backs of the class II
Use of archwires with reverse curve of
elastics is that it results in extrusion of the
Spee( fig 16): resilient arch wires that have
upper incisors, in an attempt to overerupt
been curved in a direction opposite to that
lower molars
of the curve of Spee can be used to intrude
lower anteriors. When these arch wires
are inserted into the molar tubes, the
Implants ( fig 20)
anterior segment curves gingivally. This
anterior segment is forced occusally into
Implants can be used as Temporary
the bracket slot resulting in an intrusive
anchoring devices for intrusion of upper
force on the incisors. A reverse curve of
anterior teeth. They are used along with
Spee wire on the lower arch acts mainly by
fixed appliances
tipping molars distally and incisors labially.
As the incisors flare labially, angular
changes contribute to overbite correction If
7. Salzmann. JA. Practice of Orthodontics.
Philadelphia and Montreal. B, Lippincott
Company; 1966.
XIV. References
1. Nanda R. The Differential Diagnosis and
Treatment of Excessive Overbite. In :
Nanda R .Symposium on Orthodontics;
1981;69:82.