Deep Bite Patients Research Articles

Compromised orthodontic treatment in severe deepbite patient: A case report

Compromised orthodontic treatment in severe deepbite patient: A case report

Does aligner refinement have the same efficiency in deep bite correction?: A retrospective study

BackgroundRefinements are very common in clear aligner treatments. The aim of this study is to assess whether the predictability of deep overbite correction is similar over several refinements using clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth.MethodsThis retrospective study included 20 deep bite patients (7M and 13F; 32.63 ± 11.88 years old; an initial overbite of 5.09 ± 0.98 mm), consecutively treated from September 2016 and March 2023, who completed at least two sets of aligners, including refinements. The initial, predicted, and achieved models were exported from ClinCheck or OrthoCAD (Cadent Inc, Carlstadt, NJ) and superimposed via best-fit surface-based registration using SlicerCMF (version 4.9.0; cmf.slicer.org). We also examined 15 out of 20 patients who completed treatments. The overbite correction and changes in vertical movement and inclination for individual teeth were measured. Descriptive statistics and a paired t-test or Wilcoxon signed-rank test were performed. P < 0.05 was considered statistically significant.ResultsThe mean accuracy of overbite correction was 37.63% after 1st set, followed by 11.19%, 6.32%, and 13.80% (2nd-4th sets), respectively. There were statistically significant differences between the predicted and achieved vertical movements and inclination changes for all teeth for the 1st and 2nd sets. For the completed cases, the mean overbite correction was 38.54% compared to the initially planned overbite correction, which is similar to one of the 1st set. Still, the vertical movements and inclination changes of all teeth present statistically significant differences between the initially planned and finally achieved movements except for maxillary lateral incisor torque.ConclusionsThe most overbite correction occurs during the 1st set of aligners, and refinement treatment does not significantly improve the deep bite correction.

The role of Function Generating Bite (FGB) devices on changes of chewing patterns and muscle activity in deep bite malocclusion

Background: A malocclusion known as a deep bite occurs when the mandibular incisors are covered by the maxillary incisors by more than the normal value of 30-40% or 2-4 mm. Deep bite is a type of malocclusion that is often found in children and adults, with a prevalence of 23.83% in the Asian population. Patients with a deep bite have a restricted masticatory pattern and have excess function of the mastication muscles. Active muscle training should be recommended to improve jaw bone morphology. Objective: This review aims to explain the role of the Function Generating Bite (FGB) device on changes in masticatory patterns and muscle activity in deep bite malocclusion. Methods: The search for literature reviews was conducted using the ScienceDirect, PubMed, and Google Scholar databases. The selected literature was published between 2010 - 2023 in English and Indonesian. Discussion: Treatment of deep bite in each patient varies depending on the etiology of the malocclusion. One of the functional therapies that can be used to correct malocclusion is FGB. The FGB device has an anchorage system on the muscles, which can regulate and exert pressure intermittently, so as to correct dental malocclusion and functional imbalance. Conclusion: Treatment with FGB has been shown to significantly improve the lateral component of the masticatory pattern and reduce muscle hyperactivity in deep bite patients during mastication.

The Effects of Intrusion of Anterior Teeth by Skeletal Anchorage in Deep Bite Patients; A Systematic Review and Meta-Analysis.

Deep bite is known as one of the most common malocclusions, and its treatment and retention are often challenging. The use of mini-screws has been suggested as an ideal method for the intrusion of incisors in deep-bite patients. Still, there are conflicting reports regarding the superiority of this method compared to other common treatments. The aim of this systematic review and meta-analysis was to evaluate the effects of the intrusion of anterior teeth by skeletal anchorage in deep bite patients. From the beginning to 15 September 2022, articles on the topic of interest were searched in electronic databases including PubMed, Web of Science, Scopus, EMBASE, and Cochrane's CENTRAL. Additionally, a hand search for pertinent studies and a search of the grey literature were carried out. After the selection of eligible studies, data extraction was performed using piloted forms. Inverse-variance random-effects meta-analyses were used to combine the outcome measures of dental indices, skeletal cephalometric indices, and dental cephalometric indices. A total of 15 studies (6 RCT; 9 CCT) were included in the systematic review and 14 were used in the meta-analyses. The differences in overbite changes (MD = -0.45, p = 0.04), true incisor intrusion [u1-pp] (MD = -0.62, p = 0.003) and molar extrusion [u6-pp] (MD = -0.40, p = 0.01) were statistically significant and TADs showed better treatment results than other intrusion methods (segmented intrusion arch, utility arch, J hook headgear). No significant differences regarding overjet, molar and incisor tipping, and skeletal indices between mini-screw and other intrusion methods could be found. The use of mini-screws leads to lower overbite and higher true intrusion (about 0.45 and 0.62 mm, respectively) compared to the use of other methods for intruding upper incisors. Furthermore, the effect of TAD on extrusion of molar teeth is less (by 0.4 mm) than other methods.

Predictability of the deep overbite correction using clear aligners

The objective of this study was to investigate the predictability of overbite correction in patients with deepbite using the clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth. This retrospective study included 24 deepbite patients (10 males and 14 females; aged 32.8 ± 11.9 years; an initial overbite of 5.20 ± 0.95 mm; an average treatment period of 11.04 ± 4.14 months) consecutively treated from September 2016 and completed before August 2021. SmartTrack materials were used for all patients. The initial, predicted, and achieved final models were exported from ClinCheck and superimposed via best-fit surface-based registration using Slicer CMF (version 4.9.0; cmf.slicer.org). The overbite correction, changes in vertical movement, and inclination for individual teeth were measured. Descriptive statistics and a paired t test or Wilcoxon signed-rank test were performed. P<0.05 was considered statistically significant. Mean overbite correction was 33%, with a 1.15 mm improvement after the first set of aligners. All teeth demonstrated statistically significant differences between planned and achieved amounts in vertical movement and inclination change, with the largest difference in maxillary central incisors. Mandibular incisor intrusion and mandibular premolar extrusion had similar accuracies. Regarding inclination change, maxillary central incisors showed the lowest accuracy of 13.3%. Clear aligner treatment showed an average of 33% overbite correction. Overcorrection and additional refinement treatments are needed in most patients with a deepbite.

Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study

The aim of this study was to assess the changes in occlusal patterns during combined surgical and orthodontic therapy in patients with vertical jaw malformations. Twenty-six orthognathic patients (18 female, eight male; median age 25 years, interquartile range 11.5 years) and 10 control patients (five female, five male; median age 29.8 years, interquartile range 13.5 years) recruited from neutral configured patients attending the Department of Orthodontics, were investigated. Based on cephalometry, the patients were grouped into vertical skeletal configurations of either open, deep, or natural bite cases. Registrations of the occlusal contacts were taken using a digital occlusal sensor immediately before surgery and at 9 months after the surgical intervention. Before the intervention, open and deep bite patients showed significantly less efficient occlusal patterns than the untreated controls regarding total tooth contact (P < 0.001), time of occlusion (P = 0.002), occlusal asymmetry (P = 0.001), anterior tooth contact (P < 0.001), and posterior tooth contact (P < 0.001). After surgery, the parameters in the deep bite patients were similar to those in the controls; however, in open bite patients, total tooth contact (P = 0.003), occlusal asymmetry (P = 0.011), and posterior tooth contact (P = 0.035) differed significantly. In conclusion, combined orthodontic and surgical correction of vertical malocclusions was found to improve occlusal function in patients with deep bite to the level of controls.

A comparitive evaluation of changes in marginal alveolar bone in anterior maxilla caused by maxillary incisors intrusion using miniscrews and utility arch: A 3-dimensional study

Objective: This study was performed to investigate the changes in alveolar bone after maxillary incisor intrusion and to determine the related factors in deep-bite patients. Material and Methods: 20 maxillary central incisors of 20 patients were evaluated. The maxillary incisors in Group I (20 patients; mean age, 22±1.32 years) were intruded with a Utility-arch, while those in Group II (10 patients; mean age, 20±2.71 years) were intruded with miniscrews. Changes in the alveolar envelope were assessed using pre-intrusion and post-intrusion CBCT. Labial, palatal, and total bone thicknesses were evaluated at the crestal (3 mm) and mid-root (6 mm) levels. BACH, PACH, and BBH was evaluated. Paired t test was performed for quantitative variables. Results: Upper incisor inclination and intrusion changes were significantly greater in Group II than in Group I. Conclusions: Change in the labial inclination and the amount of intrusion should be considered during upper incisor intrusion, as these factors increase the risk of alveolar bone loss.

English

BACKGROUND Self-satisfaction can be influenced by malocclusion resulting in impairment of psychology, associated with low self-esteem (SE) and quality of life issues (QOL). Certain malocclusions and orthodontic treatment needs are related to QOL and they can affect the psychological development and social skills of adolescents and young adults, who are the most common orthodontic patients. This study was done to assess the self-esteem and Orthognathic Quality of Life (OQL) among female participants with different types of malocclusion in private orthodontic clinics in Jeddah. METHODS This questionnaire-based study evaluated the effect of orthodontic malocclusion on SE and QOL in female orthodontic patients with Class I, Class II, Class III malocclusion, crowded anterior teeth, proclined anterior teeth, open bite, and deep bite patients. Patients were evaluated before starting orthodontic treatment with Rosenberg’s SelfEsteem Scale and the Orthognathic Quality of Life Questionnaire (OQLQ) to find any correlation with malocclusion severity. RESULTS The results indicated that females who had Class II proclination and Class II deep bite type of malocclusion had significantly higher negative SE compared to other types. In the oral function component of the OQLQ, Class II malocclusion had statistically significant higher OQLQ scores than Class I Open bite (mean difference = 6.11, P = 0.004) and Class II Deep bite (mean difference = 4.88, P = 0.015). CONCLUSIONS The results suggest that female orthodontic patients with severe Class II and / or severely protrusive lip profile, deep bite may have lower SE and QOL than those with crowding, open bite, and Class III malocclusion. KEY WORDS Self-esteem, Orthodontic Malocclusion, Female Adult Orthodontic Patients, Quality of Life

Effects of Invisalign (G5) with virtual bite ramps for skeletal deep overbite malocclusion correction in adults.

To investigate the skeletal and dentoalveolar effects of Invisalign's G5 protocol with virtual bite ramps in the treatment of adults with skeletal deep bites. This retrospective study was conducted on consecutively treated adults presenting with skeletal deep bites as defined by the Overbite Depth Indicator (ODI). Subjects were divided into 2 groups: Invisalign group (n = 24) treated with the Invisalign G5 protocol and a full fixed appliance (FFA) group (n = 24) treated with edgewise FFAs and matched to the Invisalign group by ODI, sex, type of malocclusion, and non-extraction treatment. Pretreatment (T1) and post-comprehensive treatment (T2) lateral cephalograms were obtained and analyzed. Both the Invisalign and FFA groups showed significant changes from T1 to T2 in ODI and other skeletal and dentoalveolar measurements. The mean change in ODI was -1.5° (P < .001) for the Invisalign group and -2.0° (P < .001) for the FFA group. The mean decrease in overbite was 1.3 mm (P < .001) and 2.0 mm (P < .001) for the Invisalign and FFA groups, respectively. The mean increase in mandibular plane angle (Sn-GoGn) was 0.65° (P = .003) for the Invisalign group and 1.15° (P < .001) for the FFA group. When the groups were compared with each other, both ODI (P = .03) and overbite (P = .003) were significantly different in addition to other measurements. Although FFA treatment had more apparent skeletal changes for deep bite adult patients when compared with Invisalign, both systems were effective in opening deep bites at dentoalveolar and skeletal levels.

Evaluation of the Effect of Fixed Anterior Biteplane Treatment on Temporomandibular Joint in Patients with Deep Bite.

To investigate the effects of fixed anterior biteplane treatment on temporomandibular joint in deep bite patients. The sample comprised 17 Class II patients with deep bite and decreased lower anterior facial height. The average patient age was 9.9±0.9 years. Transcranial temporomandibular joint radiographs were obtained from the subjects before (T0) and after fixed anterior biteplane treatment (T1). Anterior joint space, posterior joint space, superior joint space, anteroposterior thickness of the condylar head, vertical height of the articular fossa, and the articular fossa slope were measured on temporomandibular joint radiographs to evaluate the position of the mandibular condyles in the glenoid fossa. The average treatment duration was 8.5±2.1 months. Slope of the articular fossa, vertical height of the articular fossa, anteroposterior thickness of the condyle, posterior joint space, superior joint space, and anterior joint space showed no statistically significant difference between T0 and T1 (p>0.05). Fixed anterior biteplane appliance treatment did not change the condyle fossa relationship in Class II deep bite patients at the time of appliance removal.

Treatment of a Class II Deep Bite Malocclusion Using Orthodontic Mini-Implants: Case Report

Deep bite is due to various dental and skeletal etiologies. The treatment of deep bite includes growth modification, orthodontic treatment (intrusion of the anterior teeth or extrusion of the posterior teeth or combination of the two) and orthognathic surgery. During treatment planning, the orthodontists should consider patient’s growth potential, skeletal pattern, vertical positions of the maxillary incisors relative to the upper lip, occlusal plane, and gummy smile, etc. In the case of Class II patient with mandible deficiency, counterclockwise rotation of the mandible by intrusion of the posterior teeth could improve the facial profile. However, in a Class II deep bite patient, the counterclockwise rotation of the mandible could worsen the deep bite. This clinical case report presents the vertical control of a Class II deep bite malocclusion by distalization of the whole maxillary dentition and intrusion of the anterior teeth using orthodontic mini-implants (OMIs).

Rapid Maxillary Expander and Eruption Guidance Appliance therapy in skeletal Class II: cephalometric considerations.

The use of rapid maxillary expander (RME) combined with eruption guidance appliances (EGA) represents a valid method in the treatment of skeletal Class II deep bite patients. In this paper a retrospective cephalometric study of the effects of RME and EGA therapy in Class II deep bite patients is described and compared with the treatment effects of patients with the same malocclusion treated only by RME. Pre and post treatment cephalometric radiographs of 47 Class II division 1 deep bite growing patients treated with RME followed by EGA (mean age 9.65 years) (Group 1) were compared with those obtained from a control group (Group 2) of 44 patients (mean age 9.34 years) treated with RME only. The following cephalometric values were analized: SNA; SNB; ANB; SN-PNS.ANS; SN-Go.GN; N-Me; S-Go. Improvement in maxillo-mandibular relationship was observed in both groups with significantly higher decrease of SNA and ANB in group 1. The cranio-maxillary relation shows a tendency to grow downward and backward in both groups. Both anterior and posterior total facial heights showed a significant increase in group 1. RME followed by EGA therapy in Class II skeletal deep bite patients has shown better results compared with RME therapy without functional appliance.

Mesiodistal angulation of posterior teeth in orthodontic patients with different facial growth patterns.

Background. Mesiodistal and buccolingual angulations of teeth are variable in different malocclusion classes. This study aimed to assess the mesiodistal angulation of posterior teeth in orthodontic patients with vertical, normal, and horizontal facial growth patterns. Methods. This descriptive, cross-sectional study evaluated 150 lateral cephalograms of orthodontic patients. According to cephalometric analysis, facial growth patterns were divided into three groups of normal, horizontal, and vertical (n=50). The angulation of maxillary and mandibular posterior teeth was then measured. Data were analyzed using SPSS 22. Results. The results showed an increase in the mean angle of maxillary and mandibular posterior teeth relative to palatal and mandibular planes in patients with a vertical facial growth pattern. Conversely, their angulation decreased relative to the bisected occlusal plane (BOP). The angulation of posterior teeth decreased relative to palatal and mandibular planes and increased relative to the occlusal plane with an increase in overbite. The mean angle of all maxillary teeth relative to the palatal plane was significantly greater in open bite patients compared to normal and deep bite patients. This value in patients with normal bite was significantly greater than that in deep bite patients (P<0.05). Conclusion. The current results revealed that in patients with a vertical growth pattern, all the posterior teeth had a forward inclination. Conversely, in patients with a horizontal growth pattern, the teeth had a backward inclination.

Effectiveness of Orthodontic Mini-Screw Implants in Adult Deep Bite Patients during Incisor Intrusion: A Systematic Review.

Aims:The aim of this systematic review was to compare the effectiveness of temporary anchorage devices (TADs) and conventional segmented arches (CSAs) during incisor intrusion in adult patients with a deep bite and their adverse effects.Settings and Design:Four electronic databases were searched. In addition, articles were manually searched for using the reference lists of relevant articles, grey literature, and peer-reviewed orthodontic journals.Subjects and Methods:Data from the retrieved articles were selected and evaluated by two independent reviewers using a new systematic review software program, DistillerSR. A meta-analysis of raw mean differences was performed.Results:Initially, we retrieved 9600 articles, but the selection process resulted in six articles. The included studies ranged from low to high in quality. Meta-analysis showed that TADs enabled 0.78 mm more upper incisor intrusion than the conventional method (95% confidence interval [CI] = 0.28–1.29). There was no significant anchorage loss difference in the CSA group compared to the TAD group (mean difference [MD] −3.68; 95% CI −7.41–0.05). Furthermore, a significant molar tipping of 1.03° was observed in the CSA group (P = 0.008) compared to the TAD group (MD −1.03; 95% CI −1.79–−0.27).Conclusions:The results of this meta-analysis showed that patients receiving TADs had 0.78 mm greater upper incisor intrusion than patients receiving the conventional treatment. This was statistically significant, but not clinically relevant. No clinical difference was found between TADs and the conventional method of anchorage loss.

Effects of short-term acupuncture treatment on occlusal force and mandibular movement in patients with deep-bite malocclusion

Background/purposeAcupuncture is well known to be effective for pain relief and muscle relaxation, and hence it is feasible that acupuncture treatment could change the occlusal forces and mandibular movements in subjects with deep-bite malocclusion. The purpose of this research was to determine the distribution of occlusal force and the border movement of the mandible in patients with deep-bite malocclusion before and after acupuncture treatment. Materials and methodsThis study involved 17 volunteers with deep-bite malocclusion and aged 20–30 years. Before and after acupuncture treatment, the distribution of the occlusal-force percentage at each tooth was measured and the percentage biting force in the first molar area during maximal clenching was recorded. Additionally, the mandibular movements including the maximum mouth opening and maximum lateral border movement were also evaluated. All of the data were analyzed statistically using the Wilcoxon signed-rank test. ResultsThe percentage biting force at the first molar differed significantly between before and after the acupuncture treatments (P = 0.017). However, no treatment effects were seen for the maximum mouth opening and the maximum lateral border movement. Conclusion: Although the mandibular border movements did not change significantly, this study has confirmed that acupuncture treatment may become an alternative choice on improving the occlusal force of deep-bite patients.

A THREE-DIMENSIONAL EVALUATION OF THE EFFECTS OF DIFFERENT INCISOR INTRUSION MECHANICS TO THE PERMANENT MAXILLARY FIRST MOLAR TEETH BY USING CONE BEAM COMPUTED TOMOGRAPHY

Objective: The present study aims to evaluate the impacts of the upper incisor teeth intrusion in deepbite patients by two different techniques to the permanent maxillary first molar tooth using the three-dimensional cephalometric analysis in the individuals. Materials and Methods: The population of this study consists of 34 patients with >4 mm overbite and a ≥2 mm gummy smile during post-pubertal period. Patients who underwent intrusion of upper incisor teeth were randomized to receive Connecticut intrusion arch (CTA) or miniscrew anchorage intrusion system (MAIS) to compare the impacts on permanent maxillary first molar teeth. Cone Beam Computed Tomography (CBCT) data obtained before (T1) and after (T2) intrusion were evaluated through three-dimensional (3D) cephalometric analysis. Intragroup assessment of treatment-related variables were performed via “t-test in dependent samples” and intergroup comparisons were assessed by “t-test in independent samples”. Results: In patients who underwent intrusion of upper incisors, permanent maxillary first molar teeth became deviated distally (1.48 mm/7.63 degree) only in CTA group, a statistically significant difference was found between two groups (p<0.05). The distance between resistance centers of maxillary first molar teeth was only increased in CTA group (0.31 mm), which also statistically differed from MAIS group. Conclusion: CTA and MAIS techniques resulted in similar intrusive effects overall at the end of the treatment. While MAIS is recommended when anchorage from posterior region is not desired in patients with deep overbite, we believe that CTA may serve a suitable treatment alternative where miniscrew technique could not be performed.

Management of overbite with the Invisalign appliance.

Most of the published literature on the management of overbite with the Invisalign appliance (Align Technology, Santa Clara, Calif) consists of case reports and case series. In this retrospective study of 120 patients, we sought to assess the nature of overbite changes with the Invisalign appliance. Records were collected from 3 practitioners, all experienced with the Invisalign technique. The patients were consecutively treated adults (>18years old) who underwent orthodontic treatment only with the Invisalign appliance. Patients with major transverse or anteroposterior changes or extraction treatment plans were excluded. The study sample included 68 patients with normal overbites, 40 with deepbites, and 12 with open bites. Their median age was 33years, and 70% of the patients were women. Cephalometric analyses indicated that the deepbite patients had a median overbite opening of 1.5mm, whereas the open bite patients had a median deepening of 1.5mm. The median change for the normal overbite patients was 0.3mm. Changes in incisor position were responsible for most of the improvements in the deepbite and open bite groups. Minimal changes in molar vertical position and mandibular plane angle were noted. The Invisalign appliance appears to manage the vertical dimension relatively well, and the primary mechanism is via incisor movements.

Full-mouth rehabilitation of partial edentulism in a deep bite patient

과도한 수직피개를 가진 과개교합 환자에서 안정적인 유지접촉이 없는 경우 연조직 외상, 치질 파괴, 대합치 정출의 문제가 일어날 수 있고 이는 결과적으로 교합평면의 붕괴와 기능적, 심미적 문제로 이어진다. 치아의 상실과 마모가 발생된 환자에 대한 치료계획 수립 시 올바른 교합수직고경 설정을 통해 환자의 안정적...

Complete oral rehabilitation of a deep bite patient with Ewing’s sarcoma; surgical and prosthetic phases: A clinical report

Introduction: Ewings sarcoma (ES) is an unusual, aggressive malignant neoplasm occurring primarily in the long bones of the lower and upper extremities followed by pelvis, ribs, vertebrae, skull, and jaws-bones. Patients with ES tumor need long-term complete oral reconstruction. The location of the primary tumor in the face is predominantly in the mandible, and usually in the posterior mandible. Case Report: Here, both surgical procedures and prosthetic reconstruction in three stages of a 10-year-old childs life presented. Definitive prosthetic reconstruction is extremely challenging in such patients after previous excessive surgical resection, especially when the patient has complex dental abnormality. Fixed dental prostheses and implant-supported fixed restorations have been selected as the preferred treatment option in this case after increasing occlusal vertical dimension (OVD) to create sufficient interocclusal space (IOS). Discussion: In this case, ES patient treated in three phases. In the first-stage, only surgical resection of tumor and bone graft reconstruction with titanium plate fixation was performed. In the second-stage, Lefort I surgery for maxilla with dental implants insertion in mandible was done simultaneously. For definitive restorations fabrication, it was mandatory to increase occlusal vertical dimension (OVD) to create sufficient inter-occlusal space (IOS) for the restorations. OVD has been altered to achieve more stable relationship of mandibular teeth with maxillary teeth, and to obtain an optimum esthetic and functional result. Several factors should be considered as determinants for increasing the OVD such as remaining tooth structure, the space available for the restorations such as the current situation, occlusal variables, and esthetics.

Botulinum toxin as a therapeutic agent to prevent relapse in deep bite patients.

The etiology of deep bite is multifactorial. One of the causes is increased muscular activity. This makes the treatment of deep bite malocclusions difficult and often results in relapse in many cases. In this work we compared patients with surgical orthognathic treatment only and surgical orthognathic treatment with additional injections of botulinum toxin after mandibular advancement for class II division 2 malocclusion. This is a prospective study. Adult patients were assessed pretreatment (T1), posttreatment (T2), and long-term after 1 year (T3). In total, 32 patients (mean age, 30.7 years; 23 women and 9 men) reached the study end point (T3); 24 patients were treated without botulinum toxin and 8 patients received preoperative injections of botulinum toxin. Significant differences between both groups were observed, with a more stable result for the experimental group treated with botulinum toxin. In a selective group of adult patients with a class II division II incisor relationship and with a class II skeletal base, botulinum toxin injections can effectively prevent relapse. This may present an alternative to a conventional myotomy.