Deep Overbite Research Articles

Correction of Skeletal Class II Malocclusion using Functional-Fixed Appliance Therapy

Single-phase treatment started during late mixed dentition using functional followed by fixed appliance therapy has proven to be the most effective approach to achieve correction of Class II malocclusion. This case report demonstrates the use of this treatment approach in an 11-year-old girl with skeletal and dental Class II malocclusion, large overjet, deep overbite, increased incisor exposure and a gummy smile. She was given a functional appliance for 1 year which was immediately followed by fixed mechanotherapy for final finishing and detailing of the occlusion. The magnitude of skeletal and dental correction achieved, along with the dramatic improvement in facial appearance of the patient, provides a strong case for establishing the efficacy of this treatment modality.

Conservative treatment of a Class I malocclusion with 12 mm overjet, overbite and severe mandibular crowding

INTRODUCTION: A female patient aged 12 years and 2 months had molars and canines in Class II relationship, severe overjet (12 mm), deep overbite (100%), excessive retroclination and extrusion of the lower incisors, upper incisor proclination, with mild midline diastema. Both dental arches appeared constricted and a lower arch discrepancy of less than -6.5 mm. Facially, she had a significant upper incisors display at rest, interposition and eversion of the lower lip, acute nasolabial angle and convex profile. OBJECTIVE: To report a clinical case consisting of Angle Class I malocclusion with deep overbite and overjet in addition to severe crowding treated with a conservative approach. METHODS: Treatment consisted of slight retraction of the upper incisors and intrusion and protrusion of the lower incisors until all crowding was eliminated. RESULTS: Adequate overbite and overjet were achieved while maintaining the Angle Class I canine and molar relationships and coincident midlines. The facial features were improved, with the emergence of a slightly convex profile and lip competence, achieved through a slight retraction of the upper lip and protrusion of the lower lip, while improving the nasolabial and mentolabial sulcus. CONCLUSIONS: This conservative approach with no extractions proved effective and resulted in a significant improvement of the occlusal relationship as well as in the patient's dental and facial aesthetics.

Deep overbite malocclusion: Analysis of the underlying components

A deepbite malocclusion should not be approached as a disease entity; instead, it should be viewed as a clinical manifestation of underlying discrepancies. The aim of this study was to investigate the various skeletal and dental components of deep bite malocclusion, the significance of the contribution of each, and whether there are certain correlations between them. Dental and skeletal measurements were made on lateral cephalometric radiographs and study models of 124 patients with deepbite. These measurements were statistically analyzed. An exaggerated curve of Spee was the greatest shared dental component (78%), significantly higher than any other component (P = 0.0335). A decreased gonial angle was the greatest shared skeletal component (37.1%), highly significant compared with the other components (P = 0.0019). A strong positive correlation was found between the ramus/Frankfort horizontal angle and the gonial angle; weaker correlations were found between various components. An exaggerated curve of Spee and a decreased gonial angle were the greatest contributing components. This analysis of deepbite components could help clinicians design individualized mechanotherapies based on the underlying cause, rather than being biased toward predetermined mechanics when treating patients with a deepbite malocclusion.

구강 내 장치와 III급 고무줄을 이용한 유치열기 전치부 반대 교합 치료

III급 부정 교합과 전치부 반대 교합은 동양인에게서 더 빈번히 관찰되며 이 문제는 치과 의사뿐 아니라 부모도 쉽게 인지할 수 있다. 유치열기 반대 교합의 경우, 피개량이 깊어질수록 하악의 기능성 전방 변위가 현저해지는데 이를 방치하면 골격성 반대 교합으로 이행될 우려가 있다. 따라서 치료가 필요한 유치열기 반대 교합의 경우 조기에 정확히 진단하는 것이 중요하고 조기교정 치료를 통해 개입할 필요가 있다. 본 증례에서는 유치열기에 전치부 반대 교합을 주소로 내원하여 기능성 반대 교합으로 진단된 만 4세 어린이들에게 구강내 장치를 이용한 치료를 시행하여 정상적 상하악 치열 관계로 개선시켰다. 또한 본과에서 유치열기 반대 교합 치료를 받은 7명의 어린이들의 치료 기간과 사용된 장치를 고찰하고, 측방 두부 규격 방사선 사진 분석을 통해 치료 전후의 상하악의 위치적 관계의 변화, 악골 크기의 변화량 등을 분석하였다. 그 결과 구내 장치와 III급 고무줄을 이용한 치료에서 대부분의 어린이들은 1년 이내에 반대 교합의 개선을 보였고, 그 치료 결과는 전하안면 고경의 수직적 성장을 통한 하악의 후하방 회전에 의한 것으로 나타났다. Class III malocclusion or anterior crossbite is commonly seen in Asian. This problem is easily recognized by dentists and parents. During the primary dentition period, anterior crossbite with functional shift and deep overbite could develop to skeletal protrusive mandible. So, early and proper diagnosis of anterior crossbite which needs prompt treatment is important. These cases showed the early management of crossbite with functional shift in primary dentition using intraoral removable appliance resulting in improvement of intermaxillary relationship. And I analyzed the positional change and the dimensional change during treatment with lateral cephalometric x-ray analysis. Our patients showed vertical dimensional change of lower anterior facial height and clockwise rotation which results crossbite correction in 1 year of treatment period.

Serial extraction: 20 years of follow-up

This paper reports a case treated by a serial extraction program at the mixed dentition stage followed by a corrective orthodontic treatment, with a long-term follow-up period. Twenty years after the interceptive treatment, a harmonious face was observed along with treatment stability in the anterior posterior direction, deep overbite (which has been mentioned as a disadvantage of the serial extraction program), and a small relapse of anterior tooth crowding. All these conditions have been regarded as normal occurrences for most orthodontic treatments with a long-term follow-up period. This case report demonstrated that the establishment of a serial extraction protocol determined relevant esthetic changes that afforded an improvement of the patient's self-esteem, with a positive social impact. Furthermore, the low cost of this protocol permits the use of this therapy with underprivileged populations. It is important to emphasize that an early correction of tooth crowding by this protocol does not guarantee stability, but small relapses do not invalidate its accomplishment.

Nonsurgical treatment of an adult with a skeletal Class II Division 1 malocclusion and a severe overjet

This case report describes the treatment of an adult patient who had a Class II Division 1 malocclusion with a severe overjet (13.5 mm), a deep overbite (7 mm, 100%), and spacing between the maxillary anterior teeth. The purpose of this report is to demonstrate the importance of developing an individualized treatment plan, tailored to the patient's specific dental and skeletal problems, as well as to his or her needs and desires. Although all indications pointed to a surgical intervention for this patient, her reluctance to undergo orthognathic surgery led to an alternative treatment, which yielded a satisfactory result.

Dento-skeletal changes associated with treatment of deep overbite in class II malocclusion

The present study aimed to evaluate the treatment changes in class II patients with deep overbite. A total of 22 females (15-18 years) were treated with fixed orthodontic appliances divided into 2 groups; the first group comprised of 12 cases with class II division 1and the second group ten cases with class II division 2. All cases possessed over bite more than 4 mm, class II more than 4 degrees and had pre and post treatment lateral cephalometric x-ray films. Eleven angular and ten linear cephalometric measurements were recorded and analyzed before and after treatment. The differences in mean values of variables within each studied group were statistically analyzed using Wilcox on singed rank test. On the other hand the mean differences of overbite before and after intervention were compared between the two studied groups using Mann-Whitney test.Results: Bite depth improved an average of 5.6 mm in class II division1, and 2.6 mm in class II division2 with significant differences within and between the studied groups. All measurements showed changes that were statistically significant except SNB0 in both groups, ANB0, OP/MP0, U1-PP, ANS-Me in group 1, and L1-MP in group 2. Conclusion: Bite depth improved due to the changes in the axial inclination of incisor teeth that were decreased in class II division1, while increased in class II division 2, intrusion of lower incisor in class II division1, and intrusion of maxillary incisor in class II division 2 in addition to extrusion of upper and lower molars in both groups.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Treatment of a Class II Division 1 malocclusion with miniscrew anchorage

This case report describes the treatment of a 30-year-old woman with a Class II Division 1 malocclusion, characterized by a large overjet, a deep overbite, and a V-shaped maxillary dental arch. She had a convex profile with a retrognathic mandible and marked lip protrusion. Treatment involved extraction of 4 first premolars and miniscrew implant anchorage for space closure. The total treatment time was about 20 months. Ideal overjet and overbite relationships were established, and the facial profile was improved substantially. The 2-year follow-up records show a morphologically and functionally stable result.

Stress Appraisal with Simulation of en masse Absolute Intrusion of Maxillary Anteriors deploying Strategic Mini-implant Locations: A Finite Element Analysis

One of the major challenges of fixed clinical orthodontics is the correction of deep overbite. Mini screw implants are ideally suited for absolute intrusion because they make it possible to apply light continuous forces of known magnitudes without producing any reciprocal reactionary effect on posterior teeth. The purpose of this FEM study was to evaluate and compare the stresses generated in maxillary anterior region during absolute en masse intrusion of six maxillary teeth using mini-implants at strategic locations. Materials and methods: Finite element model was generated using FEM software ANSYS and, on the same model, two different analyses were carried out for two groups with different points of force application as Group I consisted of two bilateral implants for en masse intrusion of maxillary anteriors and Group II consisted of a single mid implant. Results: Soft and hard bones showed significantly high stress distribution in Group I as compared to Group II. The total tooth deformation was found to be more with single point of force application which produced oblique force vectors. Conclusion: Stresses on the teeth are higher and distributed more evenly, when the point of force application is bilateral rather than a single source. Bilateral implants generate less stresses which are evenly distributed with minimum detrimental effect on the teeth during absolute intrusion.

Relapse of orthodontically corrected deepbites in accordance with growth pattern

A common orthodontic problem is a deep overbite malocclusion. Because of its high relapse tendency, it is also one of the most challenging problems to treat. To minimize relapse, the morphologic characteristics of patients need to be considered. The aim of this study was to compare deepbite relapse in 3 groups of patients categorized by vertical growth type. The total sample included 60 patients treated at the University of Washington in Seattle, all with initial overbites greater than 50%. Data were collected from casts and cephalometric radiographs at 3 time points: pretreatment, posttreatment, and 10 years postretention. A mixed-effects model (analysis of variance) and post-hoc t tests were used for the statistical evaluations. The high-angle subjects showed the least deepbite relapse (0.1 ± 1.1 mm), whereas the low-angle (1.2 ± 0.9 mm) and the normal-angle (1.4 ± 1.3 mm) subjects had statistically significant relapses P <0.001. This overbite relapse might be partially due to changes in the mandibular and interincisal angles, which were also observed in these 2 groups. High-angle subjects tend to relapse less in overbite than do low-angle and normal-angle subjects in the long term.

Residents' journal review

Residents' journal review

Significance of curve of Spee: An orthodontic review.

Exaggerated curve of Spee is frequently observed in dental malocclusions with deep overbites. Such excessive curve of Spee alters the muscle imbalance, ultimately leading to the improper functional occlusion. It has been proposed that an imbalance between the anterior and the posterior components of occlusal force can cause the lower incisors to overerupt, the premolars to infraerupt, and the lower molars to be mesially inclined. This altered condition requires specialized skills for the practitioner. It would be useful if we have a thorough knowledge of how and when this curve of Spee develops, so that it will aid us in our treatment. The understanding of why the curve of Spee develops is limited in literature. The purpose of this article is to increase our knowledge regarding the development and its effect on dentition and its treatment in exaggerated cases.

Study of Stress Distribution in Maxillary Anterior Region during True Intrusion of Maxillary Incisors using Finite Element Methodology

ABSTRACT Introduction One of the major challenges of fixed clinical orthodontics is the correction of deep overbite. Miniscrew implants are ideally suited for absolute intrusion because they make it possible to apply light continuous forces of known magnitudes without producing any reciprocal reactionary effect on posterior teeth. The purpose of this finite element method (FEM) study was to evaluate and compare the stresses generated in maxillary anterior region during absolute en masse intrusion of six maxillary teeth using mini-implants at strategic locations. Materials and methods Finite element model was generated using FEM software and on the same model finite element analysis was carried out to study the stress distribution in maxillary anterior region during true incisor intrusion. Results Soft bone and hard bone showed significantly high stress distribution in maxillary anterior region. Conclusion Stresses on the teeth, soft bone and hard bone, were concentrated more on and near the central incisors as compared to lateral incisors. This was probably because the point of force application was between the central incisors and away from the lateral incisors. How to cite this article Padmawar SS, Belludi A, Bhardwaj A, Vadvadgi V, Saini R. Study of Stress Distribution in Maxillary Anterior Region during True Intrusion of Maxillary Incisors using Finite Element Methodology. Int J Experiment Dent Sci 2012;1(2):89-92.

A critical review of the management of deep overbite complicated by periodontal diseases

AbstractTraumatic deep overbite complicated with periodontal problems is a challenging problem for a periodontist as well as for an orthodontist. A thorough and systematic approach to periodontal and occlusal examination, etiological factors, diagnosis and treatment planning is essential for better treatment results. In such cases prevention of disease is better than its treatment therefore.

Management of skeletal deep overbite in an adult class II division 1 malocclusion by unconventional extraction pattern

The ideal treatment protocol for an adult patient with skeletal class II division 1 malocclusion and deep bite has beyond doubt been accepted as combined surgical and orthodontic management including upper and lower bicuspid extractions. Here, a case report has been presented where a similar problem has been managed with conventional orthodontics alone and selecting an unconventional extraction pattern taking into consideration certain key factors that aid in long-term retention. Instead of extraction approach of upper and lower bicuspids, extraction of two upper bicuspids and single incisor extraction was done in the mandibular arch.

Periodontal and Orthodontic Management of Malocclusion as a Result of Juvenile Periodontitis in Benin City: A Case Report

A case of severe malocclusion as a result of juvenile periodontitis is reported. An interdisciplinary approach involving the Periodontist and the Orthodontist was used to manage a 19-year-old boy who presented with a grade 2 mobility of the anterior teeth resulting in pathologic migration of those teeth and a severe anterior inclination of 14.5mm with a deep overbite. There was a pathological loss of the upper right canine, generalized anterior segment spacing, supra eruption of the lower right canine and extrusion of the upper premolars and molars. This case report emphasizes the importance of interdisciplinary collaboration and teamwork among Dental specialists in managing difficult cases, resulting in a favourable functional and aesthetically pleasing outcome.

P1-274 Prevalence and predisposing factors for malocclusion among Brazilian preschool children

IntroductionThe aim of this study was to assess the prevalence of malocclusion in primary teeth and its predisposing factors.MethodsA randomised representative cross-sectional study was carried out in Belo Horizonte, Brazil,...

Periodontal and orthodontic management of malocclusion as a result of juvenile periodontitis in Benin City: A Case Report

A case of severe malocclusion as a result of juvenile periodontitis is reported. An interdisciplinary approach involving the Periodontist and the Orthodontist was used to manage a 19-year-old boy who presented with a grade 2 mobility of the anterior teeth resulting in pathologic migration of those teeth and a severe anterior inclination of 14.5mm with a deep overbite. There was a pathological loss of the upper right canine, generalized anterior segment spacing, supra eruption of the lower right canine and extrusion of the upper premolars and molars. This case report emphasizes the importance of interdisciplinary collaboration and teamwork among Dental specialists in managing difficult cases, resulting in a favourable functional and aesthetically pleasing outcome.Key words: malocclusion, juvenile periodontitis, periodontal, orthodontic management

Orthodontic treatment for a patient with hypodontia involving the maxillary lateral incisors

Developmental absence of maxillary lateral incisors is not uncommon in orthodontic patients. Treatment depends on a number of factors, including skeletal pattern, type of malocclusion, overjet, and the shape and color of the canines. Management can be broadly divided into space closure, space opening or redistribution, and prosthetic replacement. The purpose of this article was to report the treatment of a girl with an Angle Class I malocclusion with missing maxillary lateral incisors and severe crowding in the mandibular labial segment. Treatment included preadjusted fixed appliances, extraction of the mandibular first premolars, and space closure of the maxillary labial segment space with the canines substituted for the maxillary lateral incisors.