Extrusion Of Posterior Teeth Research Articles

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

INTRUSION ARC IN ORTHODONTIC:

The intrusion arch is a device for orthodontic anterior teeth intrusion, having been introduced by Burstone in 1977 for the treatment of deep bite, especially in the case of Class II division 2. But they are based on the origin of malocclusion and the patient's clinical characteristics, such as smile line, vertical dimension, predicted growth, among others. Use of this arc is governed by the principles of mechanical intrusion, which include obtaining a pure no intrusion proclination movements, therefore, necessary for successful treatment. Among these we can highlight to get a constant magnitude of force and the choice of point of application of force in the anterior segment, which would determine whether the motion would be pure intrusion or intrusion inclined. The mechanical stability of this is making it more advantageous in the treatment of deep bite in relation to treatment with extrusion of posterior teeth, which is notoriously prone to relapse. Thus, based on the principles of mechanics and its stability, several authors have developed some type of intrusion arches, using the original biomechanics, but differing mainly in the type of alloy wire and the point of application of force to the center of resistance to achieve the goals of the treatment

Noninvasive Orthodontic Treatment for Class II Division 2 Adult Patient with 100% Deep Bite by Continuous Wire Mechanism

A characteristic of Class II Division 2 malocclusion is severe deep overbite and lingual inclination of the incisors. Deep overbite can be corrected by intrusion of anterior teeth, extrusion of posterior teeth, or a combination of both. Intrusion of the incisors should be the preferred treatment in nongrowing patients with anterior deep bites.

Using the Invisalign® system in conjunction with extraction for the treatment of Class II malocclusion with severe anterior crowding

Clear aligners are a well-established alternative to conventional fixed orthodontic appliances for treating mild-to-moderate malocclusion. This case report details the successful treatment of a 14-year-old female patient with Class II malocclusion, crowding, and dental crossbite using extraction and the Invisalign® system. Achieving satisfactory anterior guidance by correcting the anterior crossbite and reducing the overjet and overbite was the primary treatment goal. Secondary treatment objectives included upper and lower midline alignment, leveling and alignment of arches, and achieving a Class I canine relationship for adequate canine guidance. Two sets of clear aligners were chosen; the first for alignment and the second for refinement. Extraction of teeth 14 and 24 were performed during the first aligner treatment phase, with space closure achieved by the distal movement of canine and posterior teeth mesialization. The second set of aligners refined the dentition by correcting the posterior open bite and extrusion of posterior teeth. Treatment duration was 13.5 months. By the end of treatment, the Invisalign system in conjunction with tooth extraction established an ideal overbite and overjet, corrected the crossbite, and achieved a Class I canine relationship with minimal disruption to the patient’s esthetic appearance. In addition, root axes were parallel and well controlled, despite extractions and space closure. Awareness of the dental biomechanics when clear aligners and extraction are used may be imperative for yielding successful outcomes for patients with Class II malocclusion and extractions.

MYOFUNCTIONAL THERAPY IN ANTERIOR DEEP BITE AND TMD PATIENT-CASE REPORT

Deep bite is perhaps one of the most common dental malocclusions seen in children as well as in adults and is very demanding to be treated successfully. A skeletal or dental overbite is caused by genetic or environmental factors, or a combination of both. The ideal overbite in a normal occlusion may range from 2 to 4 mm. Mild deep bite typically requires no correction, unless correction for aesthetic reasons. Severe overbite, considered as a clinical problem may affect the temporomandibular joint, causes periodontal problems and tooth wearing, as well as traumatizing the incisive papilla or interfering with mastication function. Anterior deep bite could be caused by overeruption of upper and/or lower incisors or undereruption of posterior teeth. Correction of deep overbite has always been challenging to orthodontists, especially in adult cases. There are different modalities in orthodontic treatment of this malocclusion. Deep bite correction can be treated with intrusion of incisors, extrusion of posterior teeth, combination of both, and orthognathic surgical modality. The aim of this case report was to present treatment protocol for an adult patient with skeletal deep bite, Class II Division 1 malocclusion and temporomandibular disorder (TMD) managed with conventional orthodontics therapy combined with orofacial myofunctional exercises. The modality of exercise therapy included improvement of proprioception, tonicity and mobility, working with the facial and cervical musculature, as well as with stomatognathic functions - respiration, mastication, deglutition and speech. The most important thing is to aid long-term retention. Keywords: anterior deep bite, TMD, myofunctional therapy.

Segmental intrusion and retraction with tads for the correction of gummy smile -A case report

The intrusion of the maxillary anteriors with Temporary Anchorage Devices (TADs) is one of the most common and effective treatment methods for the correction of gummy smile, but the main disadvantage of this method is the extrusion of posterior teeth, especially when used in conjunction with a continuous arch wire leading to an increase in the lower anterior facial height. The objective of this case report is to demonstrate the true intrusion of the maxillary anterior segment without causing extrusion of the posterior segment using a segmented arch wire rather than the routine continuous arch wire with the assistance of TADs in a patient diagnosed with a 5 mm gummy smile. After the initial leveling and alignment, a 0.019×0.025 stainless steel posted arch wire was sectioned distal to the canines. The TADs were positioned bilaterally mesial to upper first molars and an intrusive force of 250gm was applied per side using elastomeric chains attached to the miniscrews. At the end of the treatment, complete correction of the gummy smile was achieved by the intrusion of maxillary anteriors without any significant extrusion of the posteriors. The TAD assisted segmented arch wire for intrusion and retraction of maxillary anteriors is an excellent method for the successful correction of the gummy smile rather than using regular continous arch wire as we can avoid the unwanted extrusion of posteriors. Keywords: Gummysmile, TADS, Segmental mechanics, Intrusion, Gummysmile, TADS, Segmental mechanics, Intrusion.

Deep Bite Its Etiology, Diagnosis and Management: A Review

Deep bite is one of the most common malocclusion seen in children as well as adults and is most difficult to treat successfully. Unfavorable sequel of this malocclusion predisposes a patient to periodontal involvement, functional problems, and temporomandibular joint disturbance. Deep bite anteriorly could be caused by supraeruption of upper and/or lower incisors or infraeruption of posterior teeth. Methods of deep bite correction are extrusion of posterior teeth, intrusion of anterior teeth, combination of both, proclination of incisors and orthognathic surgical modality. This article will describe various appliances, their indication and contraindication and also with the biomechanics involved.

Rate of intrusion of maxillary incisors in Class II Div 1 malocclusion using skeletal anchorage device and Connecticut intrusion arch

BackgroundNonsurgical correction of deep bite involves either extrusion of posterior teeth, intrusion of incisors, or combination of both. The introduction of skeletal anchorage device with microimplant provides near absolute anchorage without producing any untoward effects on anchor unit. Connecticut Intrusion Arch (CIA) provided an efficient system of intruding anterior segment without producing much adverse affects on anchor teeth. MethodsThe study comprised of 30 patients of Class II Div 1 malocclusion with overbite of >6mm and required therapeutic extractions of all first premolars, randomly distributed into two groups. Group 1 was treated using orthodontic microimplants, while Group 2 treated with CIA. Lateral cephalograms were taken pre-intrusion (T1) and post-intrusion at the end of six months (T2). ResultsThe rate of intrusion was 0.51 and 0.34mm/month for Group 1 and Group 2 respectively. The average amount of change in centroid point to PP distance and U1-SN angle was significantly higher in Group 1 compared to Group 2 (P<0.001). The average amount of change in U6 to PP distance did not differ significantly between two study groups (P>0.05). ConclusionThe amount of intrusion is significantly higher in SAD group. Although vertical molar positional change was higher in CIA group than the SAD group, it was not changed significantly in both treatment modalities. SAD group overall had better results and was easier in handling during intrusion.

Intrusión del segmento anterior superior con miniimplantes para eliminar la mordida profunda anterior en maloclusión clase II con compromiso periodontal. Reporte de un caso

The use of miniimplants has revolutioned biomechanics in orthodontics with better results as far as anchorage is concerned. We have no limits when using these attachments depending only on our imagination. Anterior deep bites in severe class II malocclusion patients are a common problem that causes orthodontists to focus therapy in biomechanics to eliminate the problem by extrusion of posterior teeth or intrusion of the anterior. In this case, we decided to correct the anterior deep bite by intruding the incisors using as anchorage two miniimplants. The case was compromised by periodontal disease with moderated loss of alveolar bone so we had to choose biomechanics with a stable anchorage to achieve our goals. In the end, the patient exhibited collateral effects that were solved successfully and the deep bite was eliminated with great results and stable periodontal health.

Upper anterior intrusion with mini-implants to correct anterior deep bite in a periodontally compromised class II malocclusion. Case report

The use of mini-implants has revolutioned biomechanics in orthodontics with better results as far as anchorage is concerned. We have no limits when using these attachments depending only on our imagination. Anterior deep bites in severe class II malocclusion patients are a common problem that causes orthodontists to focus therapy in biomechanics to eliminate the problem by extrusion of posterior teeth or intrusion of the anterior. In this case, we decided to correct the anterior deep bite by intruding the incisors using as anchorage two mini-implants. The case was compromised by periodontal disease with moderated loss of alveolar bone so we had to choose biomechanics with a stable anchorage to achieve our goals. In the end, the patient exhibited collateral effects that were solved successfully and the deep bite was eliminated with great results and stable periodontal health.

Soldered Power Arm: An Easy and Effective Method for Intrusion and Retraction of Anterior Teeth

The orthodontic correction of deep overbite can be achieved with several mechanisms that will result in true intrusion of anterior teeth, extrusion of posterior teeth, or a combination of both. For the orthodontic correction of bimaxillary dentoalveolar protrusion with deep bite, there are several treatment modalities like segmented arch approach, retraction and intrusion utility arches, temporary anchorage devices. Though not a novel therapeutic concept, the use of miniscrew implants to obtain absolute anchorage has recently become very popular in clinical orthodontic approaches. To allow the use of sliding mechanics for bodily retraction with intrusion of anterior teeth, we devised a soldered power arm (SPA) on standard molar tube. It is simple, stable, precise and effective in cases where anterior teeth need to be simultaneously retracted and intruded. A power arm can be readily fabricated from 20 gauge stainless steel wire and soldered on the molar buccal tube so as to avoid any distortion or loosening of power arm from molar tube during the course of the treatment. The SPA works efficiently with the molar being stabilized in all three planes of space. The resultant force vector is directed more apically toward the center of resistance of the anchor unit, which resulted in the treatment outcome of retraction and intrusion of the anterior teeth and correction of the deep bite.

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.

Early orthodontic treatment of skeletal open-bite malocclusion with the open-bite bionator: A cephalometric study

This study was designed to evaluate the effectiveness of the open-bite bionator in growing subjects with increased vertical dimensions. The records of 20 subjects with high-angle skeletal relationships (MPA > or =25 degrees) were examined. Cephalometric measurements were compared with those obtained from 23 sets of records of an untreated group matched according to age, sex, vertical skeletal relationships, and time intervals between records. Lateral cephalograms were analyzed before the start of treatment (mean age; 8.3 years) and after therapy and retention, with a mean period of observation of 2.5 years. The treated group had a significantly smaller palatal plane-mandibular plane angle (-1.9 degrees) and a greater overbite (+1.5 mm) associated with a significantly smaller overjet when compared with the control group. Based on the analysis of this sample, early treatment of skeletal open bite with the open-bite bionator appears to produce a modest effect that mainly consists of significant improvement in intermaxillary divergence. No favorable effects on the extrusion of posterior teeth were found.

Nonsurgical correction of skeletal deep overbite and class II division 2 malocclusion in an adult patient

Treatment modalities for Class II Division 2 malocclusion include growth modification, dental compensation, and surgical-orthodontic therapy; which treatment is chosen depends on the patient's age and growth potential. Deep overbite can be corrected by intrusion of anterior teeth, extrusion of posterior teeth, or a combination of both. Treatment considerations include the patient's facial profile, skeletal pattern, growth potential, and severity of dental malocclusion. Here, we present the nonsurgical orthodontic treatment of an adult patient with deep overbite and underlying skeletal Class II discrepancy. He had a hypodivergent facial pattern, Class II Division 2 malocclusion, and traumatic deep overbite due to supereruption of the mandibular anterior teeth. He refused orthognathic surgery but would accept orthodontic treatment alone, with the understanding that the treatment results could be compromised. We corrected the deep overbite by proclining the mandibular incisors; this helped to level the exaggerated curve of Spee. The posttreatment occlusion was significantly improved, both functionally and esthetically, with stable interincisal contacts. However, the improvement in occlusion and esthetics was achieved at the expense of reduced periodontal support for the mandibular anterior teeth.

Biomechanics of deep overbite correction

Correction of deep overbite can be accomplished in different ways depending on the treatment goals chosen for individual patients. The 2 primary methods of correction are intrusion of anterior teeth or extrusion of posterior teeth. Successful intrusion of the incisors depends on careful control of the force system used. Low force magnitude, force constancy, a properly selected single point of force application, and control of force direction are all important factors to consider. The design of the intrusion arch may be continuous, or a 3-piece intrusion arch may be selected depending on the needs of the patient. Alternatively, extrusion of posterior teeth may be indicated in patients who are still actively growing and who have short vertical facial dimensions.

CORRECTION OF DEEP OVERBITE IN ADULTS

Deep overbite is one of the most common features of adult malocclusions. Treatment of deep overbites involves a careful diagnosis, treatment plan, and mechanics plan. Pure intrusion of upper or lower incisors alone or in combination with flaring and extrusion of posterior teeth are common methods to correct deep overbites. This article describes appliance systems and biomechanical considerations necessary for intrusion of incisors.

Correction of skeletal class II malocclusions with deep bite by rapid extrusion of posterior teeth

Correction of skeletal class II malocclusions with deep bite by rapid extrusion of posterior teeth

Reference charts for controlled extraoral force application to maxillary molars

A lthough headgear appliances were originally designed by Norman William Kingsley in 1892, half a century elapsed before orthodontists began to employ extraoral force extensively. 1 Kloehn’$ results with the cervical neckstrap actually provided the impetus to preserve extraoral traction from near obliteration. Subsequently, a va-riety of methods have been developed to employ extraoral force in conjunction with almost every type of orthodontic appliance. Yet extraoral force is primarily used for two purposes: (1) to correct dental arch relationships and (2) as anchorage to support teeth that would be displaced while other movements are being carried out. The most commonly used extraoral devices are the neckstrap for cervical pull and headcaps for straight pull and for higher pull. Force delivery to the teeth is usually accomplished by means of a face-bow attached to an intraoral bow which is inserted into buccal tubes on the maxillary molar ba.nds or by direct attachment of the headgear arms to hooks on the maxillary arch wire itself. Extraoral traction has many advantages when used properly, but it may produce unfavorable tooth movements and treatment results when basic biomechanical principles governing the direction of the applied force are disregarded. The most common adverse effects are extrusion and tipping of molar teeth. Furthermore, Schudy3 stressed that molar elongation must be avoided in persons with retrognathic facial profiles since extrusion of posterior teeth tends to rotate the mandible dorsally, thereby aggravating their facial disfigurement. Poulton* warned particularly against the indiscriminate use of the cervical neckstrap because it harbors a considerable vertical force component. Kuhn5 considered the control of posterior tooth eruption a major factor in attempts to modify or maintain lower face height. Whatever the merits of these concepts and critiques may be, an understand-