Deep Bite Malocclusion Research Articles

A 3D finite element analysis of biomechanical effects on teeth and bone during true intrusion of anteriors using miniscrews

The primary objective of this study was to investigate the biomechanical effects and stresses on bone, periodontal ligament (PDL), cementum and displacement along X-, Y- and Z-axis during true intrusion of incisors using mini-implants with Finite Element Analysis; the secondary objective of the study was to find out the best method for anterior intrusion in clinical practice to treat anterior deep bite malocclusions. A 3D finite element method was used to simulate true anterior intrusion with sliding mechanics using mini-implants. Two groups were modelled with mini-implants placed distal to lateral incisors for Model1, and below the anteriornasalspine (ANS) for Model2, to achieve intrusion. von Mises stress, principal stress on PDL and alveolar bone, displacements in all 3 planes were determined. Amongst the modalities compared in the present study, the stresses on bone and PDL were showing best behavior for mini-implants placed distal to lateral incisors (Model1). The teeth showed controlled tooth movement in Model1. Maximum stress was found in the cortical bone and in the PDL. Nature of the stress changed from compressive to tensile from cervical area to root apex, concentrating mainly at the apical area. Amongst the modalities compared, the best controlled tooth movements for anterior intrusion to treat anterior deep bite malocclusions, was for mini-implants placed distal to lateral incisors (Model1).

Evaluation of the Best Method for Orthodontic Correction of Skeletal Deep Bites in Growing Patients: A Systematic Review.

This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.

Exploring the Impact of Orthodontic Treatment on Temporomandibular Joint Health.

Currently, one of the most prevalent oral abnormalities is malocclusion. There is a rising percentage of patients who are willing to undertake orthodontic procedures. To evaluate the impact of orthodontic treatment on the morphology of temporomandibular joint (TMJ) in patients with malocclusion associated with TMJ abnormality such as skeletal class II deep bite malocclusion using CBCT. In total, 80 patients who underwent orthodontic treatment for skeletal class II deep bite malocclusion over a duration of 3 years were included. Parameters of the morphology of the condyle and glenoid fossa on CBCT scan both before and after orthodontic therapy were measured. The maximum cross-sectional area of the condyle decreased from 99.84 ± 18.89 mm2 to 81.32 ± 16.80 mm2 after orthodontic treatment. The anterior condyle oblique inclination increased from 34.14 ± 2.98° to 36.52 ± 3.41° after orthodontic therapy. The articular eminence to the FH plane angle increased from 29.65 ± 2.53° to 33.29 ± 4.18° after orthodontic therapy. Orthodontic treatment is significantly correlated with improvement in TMJ health in patients of malocclusion.

The Biomechanics of Clear Aligners associated with temporary skeletal anchorage devices (TSADs)

The treatment with aligners is challenging especially because the overall accuracy of tooth movement is reported to be below 50%. Moreover, dental anchorage provided by the CA is critical due to the third law of physics, where for every force action, there is an equal opposite reaction. CA associated with temporary skeletal anchorage devices (TSAD) are an effective treatment protocol for expanding the envelope of movement in complex cases. Extra-alveolar miniscrews associated with CA, are effective for retracting the maxillary (IZC) and mandibular dentition (MBS), while interradicular miniscrews provide excellent anchorage for incisor intrusion.Objective: The objective of the paper was to discuss the current biomechanics principles related to the use of CA associated with TSAD showcasing the treatment of complex cases, such as Class II, Class III, as well as deepbite malocclusions.

Unplanned tooth movement in deepbite correction with Invisalign: A retrospective study

This study aimed to investigate unplanned tooth movements in deepbite correction with Invisalign. The sample consisted of 34 adult patients with deepbite malocclusion treated with Invisalign. Pretreatment and predicted digital models were exported from ClinCheck software, while the post-treatment model was obtained from an intraoral scan taken at the end of the first set of aligners. Digital models' superimposition was done using the eModel "Compare" software. Frequency and percentage of occurrence of unplanned linear and angular movements, their magnitude, and direction were then determined. In addition, comparison of unplanned movements was performed between anterior and posterior teeth as well as between linear and angular measurements. The percentage of unplanned movements ranged from 1.68% to 25.63% in the maxilla and 3.36% to 23.95% in the mandible, being most evident in the first and second molars. Unplanned movements were statistically significantly more frequent in posterior teeth compared with the anterior teeth (P > 0.05). In addition, the frequency of angular movements was statistically significantly higher for each tooth than linear movement (P < 0.05) with a higher mean value. Unplanned mesiodistal movements were the least frequent. Unplanned linear as well as angular movements were evident in almost all teeth. Unplanned faciolingual inclination and mesiodistal angulation movements were the most frequently observed. Unplanned vertical movements can affect the predictability of deepbite correction and thus merit particular attention in those cases.

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.

Comprehensive Deciphering the Complexity of the Deep Bite: Insight from Animal Model to Human Subjects.

Deep bite is a malocclusion phenotype, defined as the misalignment in the vertical dimension of teeth and jaws and characterized by excessive overlap of the upper front teeth over the lower front teeth. Numerous factors, including genetics, environmental factors, and behavioral ones, might contribute to deep bite. In this study, we discuss the current clinical treatment strategies for deep bite, summarize the already published findings of genetic analysis associated with this complex phenotype, and their constraints. Finally, we propose a comprehensive roadmap to facilitate investigations for determining the genetic bases of this complex phenotype development. Initially, human deep bite phenotype, genetics of human deep bite, the prevalence of human deep bite, diagnosis, and treatment of human deep bite were the search terms for published publications. Here, we discuss these findings and their limitations and our view on future strategies for studying the genetic bases of this complex phenotype. New preventative and treatment methods for this widespread dental issue can be developed with the help of an understanding of the genetic and epigenetic variables that influence malocclusion. Additionally, malocclusion treatment may benefit from technological developments like 3D printing and computer-aided design and manufacture (CAD/CAM). These technologies enable the development of personalized surgical and orthodontic guidelines, enhancing the accuracy and effectiveness of treatment. Overall, the most significant results for the patient can only be achieved with a customized treatment plan created by an experienced orthodontic professional. To design a plan that meets the patient's specific requirements and expectations, open communication between the patient and the orthodontist is essential. Here, we propose to conduct a genome-wide association study (GWAS), RNAseq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro and small RNA, and long noncoding RNA analysis in tissues associated with deep bite malocclusion in human, and complement it by the same approaches in the collaborative cross (CC) mouse model which offer a novel platform for identifying genetic factors as a cause of deep bite in mice, and subsequently can then be translated to humans. An additional direct outcome of this study is discovering novel genetic elements to advance our knowledge of how this malocclusion phenotype develops and open the venue for early identification of patients carrying the susceptible genetic factors so that we can offer early prevention and treatment strategies, a step towards applying a personalized medicine approach.

Deep bite -An insight

Deep bite is one of the most common malocclusion which affects children and even adults leading to a number of oral health problems. Patients with deep bite encounter periodontal and temporomandibular problems. Deep overbite refers to the increase of overlap of maxillary incisors over mandibular incisors beyond normal coverage of 30-40%. There are many factors which lead to the development of deep bite like inherent and acquired factors. Inherent factors like tooth morphology, skeletal patterns, rotation of condyle affects the bite. Acquired factors like muscle habits, loss of posterior tooth support or lateral tongue thrust may affect the bite. Deep bite can be corrected by number of different methods which include intrusion of anterior teeth, extrusion of posterior teeth or a combination of both. In non-growing patients surgical treatment is a suitable option to achieve stable results.This article describes various appliances and their biomechanics involved for correcting deepbite malocclusion

DEEP BITE MALOCCLUSION: EXPLORATION OF THE SKELETAL AND DENTAL FACTORS

Background and objective: A deep bite malocclusion may be due to skeletal and dental factors. The analysis of the etiological factors may have an influence on the treatment plan. The aim of this study was to exploration the most common dental and skeletal factors that contribute to deep bite malocclusion in Yemeni individuals, as well as the correlations between them. Material and methods: a cross-sectional prospective study was conducted to evaluate 136 individuals with deep bites using study casts and lateral cephalometrics (62 males and 74 females), with ages ranging from 18 to 28 years, with the Onyx program used for analysis. The recorded data was collected, tabulated, and statistically analyzed by SPSS. Results: The Gonial angle and Jarabak index form the highest contribution to skeletal deep bite (59.3%), and the least contributing factors were the decreased saddle angle (3%), followed by decreases in the inclination angle) Pn line- PP) (11.1%). On the other hand, the most contributing dental factor to the deep bite was an exaggerated curve of spee (63.5%), followed by a decreased clinical crown length of the Lower first molar (52.6%), and the least contributing dental factor was an increased clinical crown length of the maxillary incisors. There was more correlation between skeletal factors than dental factors. Conclusion: Deep bite malocclusion was characterized mostly by counterclockwise rotation of the mandible and increased spee curve. Understanding the most common dental and skeletal contributors will help clinicians treat patients with deep malocclusions more successfully. Peer Review History: Received: 4 February 2023; Revised: 11 March; Accepted: 28 April 2023, Available online: 15 May 2023 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Dr. Khaled A AL-Haddad,Orthodontics, Pedodontics and Prevention Department Faculty of Dentistry, Sana'a University, Yemen, ya_haddadi@yahoo.com

Aşırı Derin Kapanış ve Alt Kesici Dişlerde Pulpa Nekrozu Birlikteliği: Olgu Serisi

In this article, a unique disease pattern in 9 patients involving the simultaneous presence of excessive deep-bite malocclusion (≥50% vertical overlap) and the necrosis of multiple mandibular incisor teeth with large periradicular radiolucency is described. The mandibular central incisors were always implicated and were sometimes joined by the lateral incisors. In the examination, no other significant factor that could contribute to the pathology was found. During centric occlusion, the incisal edges of the incisors either occluded into the palatal gingival crevices of the maxillary teeth (Akerly Class II) or abraded the palatal surfaces of maxillary incisors (Akerly Class IV). Additionally, during protrusive and lateral jaw movements, the necrotic mandibular incisors often contacted their antagonists. Mild to severe attrition was found in the affected mandibular incisors. Changes in the stomatognathic equilibrium, due to the deep-bite malocclusion and the elicited chronic trauma, are assumed to be the underlying factors in this pathology.

CLINICAL, SOCIO-DEMOGRAPHIC AND BEHAVIORAL FACTORS AFFECTING THE ORAL-HEALTH RELATED QUALITY OF LIFE IN PRE-SCHOOL CHILDREN WITH MALOCCLUSION

Amaç: Bu kesitsel çalışmanın amacı, maloklüzyonu olan okul öncesi çocukların ağız sağlığına bağlı yaşam kalitesini etkileyen sosyo-demografik, klinik ve davranışsal faktörlerin incelenmesidir. Gereç ve Yöntemler: Çalışmaya İstanbul Üniversitesi Diş Hekimliği Fakültesi Pedodonti Anabilim Dalı Kliniği’ne başvuran 113 çocuk (30-71 ay yaş aralığında) ve ebeveyni dahil edildi. Çalışma verileri, klinik muayeneler ile Erken Çocukluk Çağı Ağız Sağlığı Etki Ölçeği’nin (ECOHIS) Türkçe versiyonu, sosyo-demografik ve davranışsal faktörleri içeren bir anket aracılığı ile toplandı. Verilerin analizinde tanımlayıcı istatistik, Mann-Whitney-U testi, Spearman’ın sıralı korelasyon katsayısı ve çoklu doğrusal regresyon analizi kullanıldı. Bulgular: İkili analizlerde, çürük ve dolgulu diş sayısı ile ECOHIS-toplam, çocuk ve aile alt boyutları skorları arasında anlamlı pozitif korelasyonlar bulundu. Distal basamak ve derin örtülü kapanış maloklüzyon tipi olan çocuklar ile beslenme dışı emme alışkanlığı olanların ağız sağlığına bağlı yaşam kaliteleri olmayanlara göre daha iyi bulundu. Regresyon analizinde, maloklüzyonla alakalı bir alışkanlığın olması, diş çürüğünün olması ve çocuk yaşının artması çocuğa bağlı yaşam kalitesini azaltan ve toplam varyansın %17,1’ini açıklayan faktörler olarak saptandı. Sonuç: Çocuklarda periodontal durumun ve maloklüzyon tipinin ağız sağlığına bağlı yaşam kalitesini olumsuz etkilemediği saptandı. Diş çürükleri, dolgulu diş sayısı, parafonksiyonel alışkanlıklar, çocuğun yaşı ve eğitim kurumuna devamı ağız sağlığına bağlı yaşam kalitesini etkileyen önemli belirleyenler olarak tespit edildi.

Severe class II div 2 malocclusion with impacted canines- A case report

Non surgical correction of severe deep bite malocclusion always poses a challengeespecially when it is associated with a Class II skeletal base. Here a case with severe Class II div 2 malocclusion (&amp;#62;200% deep bite) with impacted canines is presented which was successfully treated non-surgically. Class II div 2 malocclusion, impacted canines, skeletal deep bite, gummy smile

Chewing Patterns and Muscular Activation in Deep Bite Malocclusion.

Background: Deep bite, a frequent malocclusion with a high relapse rate, is associated with craniofacial features that need to be considered in the course of orthodontic treatment. Methods: This study included 81 patients with deep bite malocclusion (11.4 ± 1.1 [yr.mo]; M = 32 and F = 49), and 14 age- and gender-matched controls (9.11 ± 1 [yr.mo]; M = 5 and F = 9). The patients with deep bite malocclusion were treated with functional therapy. The chewing cycles and masticatory muscle EMG activity were recorded concomitantly before treatment in both groups (n = 95). Following correction of the malocclusion, a second recording took place (n = 25). Results: The kinematic variables showed the same dependency on bolus hardness in those with deep bite and in the controls. The masticatory muscle EMG activity was increased in those with deep bite, but decreased as a result of functional treatment. The chewing patterns showed a tendency towards a reduced lateral component, which significantly increased after treatment, indicating that functional therapy impacts the neuromuscular coordination of mastication, as well as dental positioning. Conclusions: Deep bite is a complex malocclusion, involving alterations in chewing and masticatory muscle activity. Orthognathodontic treatment should not only consider and correct the teeth position, but should also address muscular hyperactivity.

Does Planas’ Equiplan really work in deep bite treatment?

Deep bite malocclusion impacts function of the stomatognathic system, patients’ quality of life and self-stem by compromising oral and facial esthetics. The malocclusion can involve teeth and facial skeleton, for such is one of the most challenging malocclusion treatments. The aim of this investigation is to check the clinical belief that Planas’ Equiplan is efficient to treat deep bite malocclusion. Dental overbite was measured in 21 patients submitting to Jaw Functional Orthopedics treatment at post-graduation course. The inclusion criteria were a vertical trespass of the incisal border of the upper incisors covering the vestibular face of the lower incisors more than 3 mm, treatment cooperation and a consent form signed by the patients, or their legal tutor, allowing the use of the data obtained for research and didactic purposes. The initial measurement (T0) and 15 months treatment (T1) was collected to study overbite behavior during treatment with Planas’ Equiplan. The mean overbite of the sample at T0 was 5,02 ± 1,311 mm, at T1 the mean overbite was 2,38 ± 1,026 mm. The difference T1-T0 is –2,65 ± 1,462 mm (p&lt; 0,01). The data presented here supports the efficacy of the use of Planas’ Equiplan in the treatment of Deep bite Malocclusion.

The Effect of Malocclusion on Kurdish Young Children’s Production of Dental, Labio-Dental and Alveolar Sounds: A Case study

The purpose of the present study is to investigate the effect of malocclusion on the production of dental, labio-dental, and alveolar fricative and stop consonants. To achieve this purpose, Fifteen Kurdish young children ranging in age from 8-12 years old were selected to participate in the current study. They were distributed over three groups according to their bite-block occlusions. The participants were asked to pronounce isolate fricative and stop sounds and words which include target sounds, and their voices were recorded. Later, the patricians’ audio-recordings were analyzed via a software praat analysis (wave form and sound spectrograph). The main conclusion of the study was that the children with malocclusions had difficulties in producing the inter-dental, labiodental, and alveolar sounds properly. In addition, distocclusion, open-bite and extra orally deep-bite malocclusions were more significant than other types of malocclusions in affecting target sounds production

Associated Factors For Deep Bite Malocclusion Among Adolescents In An Institutional Setup

Associated Factors For Deep Bite Malocclusion Among Adolescents In An Institutional Setup

English

BACKGROUND A deep overbite may be due to an underlying skeletal or dentoalveolar component that may influence the treatment plan. The purpose of this study was to evaluate and compare the different components of deep bite malocclusion and normal occlusion. METHODS This was a case control study. Lateral cephalograms and study casts of normal (N = 50) and deep overbite (N = 50) subjects were used to evaluate skeletal and dentoalveolar components. Data was analysed statistically by independent t - test. RESULTS The significant skeletal contributing factors were gonial angles, mandibular plane, maxillary plane angle &amp; ramus / Frankfort horizontal. An increased curve of Spee and decreased mandibular first molar height were predominant dental variables in the deep overbite group. The inclination of the upper incisors &amp; lower incisors height did not show a statistically significant difference between the two groups. CONCLUSIONS The counterclockwise rotation of the mandible and the increased curve of Spee were the dominant features of deep bite malocclusion. This analysis of deep overbite components could help clinicians design individualised mechanotherapy based on the underlying cause rather than being prejudiced toward conventional mechanics when correcting with a deep overbite malocclusion. KEY WORDS Skeletal and Dental Components, Deep Overbite, Ramus / Frankfort Horizontal

Evaluation of the efficiency of computerized algorithms to formulate a decision support system for deepbite treatment planning

This study aimed to evaluate the efficiency of a newly constructed computer-based decision support system (DSS) on the basis of artificial intelligence technology and designed to plan treatment for patients with a deep overbite. With the help of information technology, a DSS was developed specifically for treatment planning of deepbite malocclusion. The program inputs were the components and the contributing factors used commonly by the orthodontic clinicians in deepbite diagnosis. The program outputs were the treatment planning options for deepbite treatment. A total of 357 decisions made by the algorithm were evaluated for accuracy by comparing them to the actual treatment changes of 51 patients with a well-treated deepbite. The decisions made by the algorithm were precise, with 94.4% having a very good agreement with actual treatment changes determined using Cohen's kappa coefficient. The constructed DSS was shown to be an efficient tool for planning treatment of deep overbite malocclusion in the permanent dentition; thus, the artificial intelligence could be used to formulate a customized plan for orthodontic clinicians.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study.

Background Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders.Objective Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil.Methodology This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years’ schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle’s classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI).Results A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88).Conclusion Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Mechanical considerations for deep-bite correction with aligners

Correction of deep-bite malocclusions with aligners is challenging for orthodontists. This review is intended to help orthodontists improve their clinical success in treating deep-bite malocclusions with aligners. Virtual case setup, attachment design, elastics, and bite ramp utilization are discussed in order to better equip orthodontists with a new “best practices” paradigm.