deepbite & open bite

7/27/2019 Deepbite & Open Bite

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bismillah


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FJDC

DEEP BITE & OPEN BITE


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overview DEEP BITE

Definition

measurement

Classification

Causes

Intraoral and extra oral features diagnosis

Treatment plan

OPEN BITE

Definition

Causes

Classification

Diagnosis

Treatment plan


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DEEP


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Deep Bite

A condition of excessive overbite, where

the vertical measurement between the

maxillary & mandibular incisal margins is

excessive when the mandible is broughtinto habitual or centric occlusion. (Graber)


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1-2mm overlap of

lower incisors is

normal and it isknown as Overbite

When overbite

becomes excessiveit is known as DeepBite


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Measure of Deepbite


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Causes

Hereditary

Dental

Muscular

Skeletal


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Hereditary

may follow a genetic pattern or familial

condition


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Dental causes Premature loss ofpermanent teeth causing

lingual collapse of anteriorteeth

Anterior tipping of posteriorteeth

Infraocclusion of posteriorteeth due to tonguethrusting

Supraocclusion of anteriorteeth usually seen in class IIdue to inc overjet

Large sized teeth


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Skeletal causesa.An overgrowth or undergrowth of one or more

alveolar segments.

b. An excess of growth of the ramus and

posterior cranial base permits the mandible to

rotate upward. Thus Long ramus and shortbody with decreased gonial angle is

characteristic feature

c. Convergent upper and lower jaw bases

d. Horizontal growth pattern or forward rotation or

anticlock wise rotation of the of the lower jaw

b

ca


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Muscular Causes

The posterior vertical chain ofmuscles (masseter,internalpterygoid, temporal) is strongand attached anteriorly on themandible and stretches in

nearly a straight line vertically.The molars are directly underthe impact of the masticatoryforces of this chain.

When the posterior verticalchain of muscles is strong andanteriorly positioned, a greaterdepressive action is transmittedto the dentition

F t d Eff t f


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Features and Effects of

deep Overbite

Extraoral features

1. Facial esthetics is impaired

(muscular face). Strongcontractions of the massetermuscle can be seen in the faceby clenching the teeth

2. Straight to Mild convex profile

3. curled appearance of the lips .


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4. Short anterior faceheight as measuredfrom nasion to gnathion

5. Diminished anterior

lower face height. Shortnose-chin distance.

6. Labiomental fold :deep


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Intra oral features

1. The maxillary dental arch is

broad, with often a maxillarybuccal cross-bite

2. May involve a group of teeth orwhole dentition.

3. In skeletal deep bites thepatient may exhibit gummy smile ifthere is clockwise rotation ofmaxilla . When the problem is in

the anterior maxillary region, thepatients often show excessivegingival tissue during smiling oreven while speaking even whenthe upper lip is of adequate length


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4. The palatal vault is flat.

The presence of deep bite

may cause palatal grooving

by the indentations causedby lower anteriors.

5. The dentition exhibits atendency to small teeth

prone to abrasion.


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Other features

1. The mandible cannot be openedto an appreciable degree in skeletalcases.

2. Temporomandibular jointdysfunction due to over closure ofthe mandible characterized byclicking sensation of the joint.

3. Periodontal conditions may befound as a result of such occlusion


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Diagnosis History

Clinical examination

study models

Lateral cephalogram:

The skeletal bite can be differentiated

from dental deep bite bycephalometric analysis.OPG


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Treatment plan

5 important factors to achieve stable

relationship:

1. lip relationship

2. Occlusal relationship

3. Age of patient

4. Vertical facial relationship

5. Interocclusal space


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lip relationship

Incompetent lips Competent lips

Intrusion of anterior teeth Extrusion of posterior teeth


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Vertical facial relationship

Extrusion of 1mm of posterior teeth

results in increase in anterior facial

height by 2mm

Increased anterior facial height

Intrusion of anterior teeth

Reduced anterior facial height

Extrusion mechanism


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Occlusal Plane

In deep bite there is deep

curve of spee in mandible and

reverse curve of spee in

maxilla.

Leveling of curve of spee can

be done by intrusion, extrusion

or relative intrusion


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AGE

Growing patientso Intrude anteriors

o Erupt posteriors

o Combination of posterior eruption

and anterior intrusion

Non growing patients (little or no growthexpected)

o Orthognathic surgeryo Intrusion of anteriors (posterior

extrusion invariably relapses)


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Removable appliances

Anterior bite plane

Myofunctional applianceactivator

Bionator (reverse)

Fixed appliance

Appliances used


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OPENBITE


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Open Bite

Open bite is descriptive ofa condition where a spaceexists between theocclusal or incisalsurfaces of maxillary &mandibular teeth in thebuccal or anteriorsegment, when the

mandible is brought intohabitual or centricocclusion. (graber)


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Causes Unfavorable growth pattern

digit-sucking habit

Tongue & orofacial muscle activity

Hereditary

Increased tongue size

Imbalances between jaw posture andgrowth, occlusal and eruptive forces.

Nasopharyngeal airway obstruction &associated mouth breathing

Failure in eruptive mechanism of tooth( especially in posterior open bite)


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Types of Open BiteBased on location

Based on dental & skeletal

component involved


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Diagnosis

History

Clinical Examination

Study models

Lateral cephalogram, OPG


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Treatment

l


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Simple anterior Openbite Stop thumb sucking

In mixed dentition:functional appliances

like activator,bionator(open) orfrankel

In late mixed & earlypermanent dentition:multibandedappliances are usedalong with habitbreaking appliance i.eTongue Spikes

l


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Simple Posterior openbite Bionator or activator

with lateral flanges is

used to prevent lateral

tongue thrust

Removal of ankylosedprimary tooth

l k l l


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Complex or skeletal openbite Early diagnosis is crucial-

since it helps to minimize theproblem.Bionator or frankel

Difficult to treatorthodontically

Adult skeletal open bite isbest treated by orthognathicsurgery


35/36Thank you


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deepbite & open bite

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