Deep overbite—A review

Annals and Essences of Dentistry

Vol I issue 1 July – September 2009 -8-

Deep overbite—A review

(Deep bite, Deep overbite, Excessive overbite)

*Cvvr sreedhar**Sreenivas Baratam

*Professor,Mythrei Dental college, Durg, ChattisGarh**Reader, Department of orthodontics, Kalinga institute of Dental sciences, Orissa.

Abstract :- Deep overbite or Deep bite is one of the common malocclusion which has a varied of etiologies. Theetiology may be present at different levels of structures, Viz. dental skeletal, combination of skeletal and dentaletc..,The treatment plan depends upon the severity and the age of the patient. A review of deep bite in generalwith due reference to some treated cases is done in this article

Key words:- Deep bite, skeletal, Dental, Treatment.

Introduction

Deep bite is one of the frequently seenmalocclusions next to crowding. It can occur alongwith other associated malocclusions. It is said to beone of the most perpetuating and damagingmalocclusions . It may jeopardize the periodontalsupport, occlusion itself or TMJ . The excessiveoverbite is a complex orthodontic problem that mayinvolve a group of teeth or whole dentition, alveolarbone, of maxillary and mandibular basal bones,and/or soft tissue of the face. The management ofthis problem demands a careful diagnostic analysis,treatment plan, and selection of appropriatetreatment therapy

The term "overbite" applies to the distancewhich the maxillary incisal margin closes verticallypast the mandibular incisal margin . In the conceptof normal occlusion, the maxillary central incisorsslightly overlap the mandibular incisors. Normallythe lower incisal edges contact the lingual surface ofthe upper incisors at or slightly above the cingulum(i.e.,normally there is 1 to 2 mm overbite). Thisvertical overlap is either described in millimeters oras the percentage of mandibular incisor crownlength overlapped by maxillary central incisors.Since the crown length of the lower incisorssignificantly varies in individual, a notation of theoverbite in percentage is more descriptive anddesirable . When the teeth are brought into habitualor centric occlusion. Usually normal overbite is 2-

3mm or 30% percent or 1/3 rd the clinical crownheight of the mandibular incisors( Fig 1)

Definition

The deep over bite or deep bite can be definedby the excess amount or percentage of overlap ofthe lower incisors by the upper incisors. Graber hasdefined ‘Deep bite’ as a condition of excessiveoverbite, where the vertical measurement betweenthe maxillary and mandibular incisal margins isexcessive when the mandible is brought intohabitual or centric occlusion’. It is customary todiagnose deep bite when the incisors' overlapexceeds one third of the crown height of the lowerincisors . Deep bite (or deep overbite) is presentwhen the mandibular incisors' occlusal edgesocclude apical to the cingulum of the maxillaryincisors. This may be due to overeruption of eitherthe maxillary or mandibular anteriors.

The term "closed bite" describes condition ofexcessive overbite, where the verticalmeasurement between the maxillary andmandibular incisal margins is excessive when themandible brought into habitual or centric occlusion.Closed bite is excessive overbite resulting from lossof posterior teeth. It is rarely seen in young children,must not be confused with deep bite.

Excessive overbite is most prevalent in the mixeddentition and is a self correcting transientmalocclusion. Open bite is comparatively more



prevalent in the deciduous dentition and tend todisappear in the later mixed dentition.

Classification

1. According to its origin;

a) Dental deep bites (Simple).

b) Skeletal deep bite (Complex).

2. According to functional classification ;

a) True deep bite.

b) Pseudo deep bite.

3. Depending on the extent of deep bite

incomplete over bite

complete over bite

4. According to dentition;

a) Primary dentition deep bite.

b) Mixed dentition deep bite.

c) Permanent dentition deep bite.

1. Dental and skeletal deep bitea. Simple (dental) deep bite(Fig 1, 2 and 3)

A simple deep bite is localized to the teeth andalveolar processes. In this type of deep overbite, theproblem lies mainly within the dentition. Dental deepbites occur due to over-eruption of anteriors or infra-occlusion of molars. The result may be labialversion of the upper incisors and impingement ofthe lowers into the palatal mucosa

A majority of the problems in this category arecreated by the loss of permanent teeth causing alingual collapse of maxillary or mandibular anteriorteeth. The denial of a skeletal contribution to thecondition is critical to the diagnosis. This kind ofdeep bite is characterized by the absence of anyskeletal complicating features which are seen inskeletal deep bites .In the mandibular dentition, itmay manifest as a deep curve of Spee or a reversecurve of Spee in the maxillary dentition. Thesepatients frequently show temporomandibulardysfunction and a limited range of functionalocclusal movements.

b. Complex (skeletal) deep bite ( Fig 2, 3 and 4.)

Complex deep bite is a deep bite associated withbasic skeletal features with which the alveolarprocess cannot cope.

A skeletal type of overbite may be due either tomalrelationship of alveolar bones and/or underlyingmandibular or maxillary bones or to an overgrowthor undergrowth of one or more alveolar segments

The dimished anterior vertical height of the face isalso an important criterion for diagnosis of skeletaldeep overbites.

Complex deep bite is frequently associated withclass II div 2 and occasionally with Class III.

2. True and pseudo-deep overbite

True deep overbite Pseudo-deepoverbite

This is caused byinfraocclusion of theposterior segmentsie..molars

is caused byovereruption of theanterior teeth thatalready has normaleruption of theposterior segmentteeth

Seen in class II div II Seen in class II div Imalocclusions

It is often the resultof a lateral tongueposture of tonguethrust . Theinterposition oftongue prevents theeruption of theposterior teeth. Itcan also occur dueto premature loss ofposterior teeth

It is the result ofovereruption of theincisors. Due to thepresence of theincreased overjet, thelower incisors toover-erupt until theymeet the palatalmucosa.

These patients havenear flat curve ofspee.

These patients henceexhibit an excessivecurve of Spee

There is a largeinterocclusalclearance

The inter-occlusalclearance is usuallynormal or small asthe molars are fullyerupted.



Some Class II,division II,malocclusion withadequate lip linerelationships aregood examples

Some Class IIdivision I,malocclusions with a"gummy" smile and apoor lip line relationcan fall into thiscategory

Treatment in themixed dentitionperiod requires theelimination ofenvironmentalfactors that areinhibiting eruption ofthe posterior teeth.Ideal for functionalappliance therapy

Incisors cannot beintruded effectivelyusing functionalmethods duringmixed dentition .

Extrusive mechanicsof molars possible

All possible intrusivemechanics on theincisor teeth withfixed appliances isusually indicated .extrusion of molars ispossible only to alimited extent

3. Incomplete and complete deep bite ( Fig 5)

Incomplete over bite is an incisor relationship inwhich the lower incisors fail to occlude with eitherthe upper incisors or the mucous of the palate whenthe teeth are occluded

Complete over bite on the other hand is arelationship in which the lower incisors contact thepalatal surface of the upper incisors or the palataltissue when the teeth are in centric occlusion . Thiskind of deep bite often results in trauma of themucous palatal to the maxillary incisors

IV. Etiology of deep bite

The etiology of deep overbite is a complex problemand may include one or more of the following;

1. Hereditary and may follow a genetic pattern orfamilial condition

2. Skeletal ( Fig 6)

a. An overgrowth or undergrowth of one or morealveolar segments.

b. An excess of growth of the ramus andposterior cranial base permits the mandible torotate upward. Thus Long ramus and shortbody with decreased gonial angle ischaracterstic feature

c. Convergent upper and lower jaw bases ( fig 3)d. Horizontal growth pattern or forward rotation or

anticlock wise rotation of the of the lower jaw( Fig 4)

e. The four planes of the face (inraorbital ( FHPlane), palatal, occlusal, and mandibular) asseen from lateral roentgenograms arehorizontal and nearly parallel to each other.

3. Dental

a. Loss and/or mesial tipping of posterior teeth. Inother words diminished posterior dental height

b. Early loss of teeth and lingual collapse of theanterior teeth

c. Overeruption of the incisor teeth, infraocclusionof the buccal segment or a combination of both.

d. Overbite may because or accentuated by anaberration in the tooth morphology.

e. Periodontal disease. Bite may deepen if theposterior tooth drift mesially during thepathological migration and worsen the existingcondition

f. When the teeth are reduced in size andnumber, the dental arches oppose lessresistance against mandibular closure.

4. Muscular

The posterior vertical chain of muscles (masseter,internal pterygoid, temporal) is strong and attachedanteriorly on the mandible and stretches in nearly astraight line vertically. The molars are directly underthe impact of the masticatory forces of this chain.When the posterior vertical chain of muscles isstrong and anteriorly positioned, a greaterdepressive action is transmitted to the dentition

5. Habitsa. lateral Tongue thrust swallowb. Finger sucking,c. Lip sucking



V. Features and Effect of deep over biteExtraoral features ( Fig 7 and 8)1. Brachycephalic and europroscopic face. Facial

esthetics is impaired (muscular face). Strongcontractions of the masseter muscle can beseen in the face by clenching the teeth

2. Straight to Mild convex profile3. Short anterior face height as measured from

nasion to gnathion (fig 6)4. Diminished anterior lower face height. Short

nose-chin distance.5. Normal distance from the chin to the incisal

edge.6. The lips are thin and with an excess of lip height

relative to face height. This gives a curledappearance of the lips .

7. Mento labial sulcus :There is usually deepfurrow, or sulcus, between the prominent chinand the lower lip

8. Mandibular deficiency characterized by longmandibular ramus and short body, Squaregonial angle, flat mandibular plane, prominentzygoma and prominent chin. Many of thesefeatures are common to class II div II

Intra oral features( Fig. 9)1. The maxillary dental arch is broad, with often a

maxillary bucccal cross-bite2. May involve a group of teeth or whole dentition.3. In skeletal deepbites the patient may exhibit

gummy smile if there is clockwise rotation ofmaxilla . When the problem is in the anteriormaxillary region, the patients often showexcessive gingival tissue during smiling or eventwhile speaking even when the upper lip is ofadequate length ( fig 8)

4. The palatal vault is flat. The presence of deepbite may cause palatal grooving by theindentations caused by lower anteriors.

5. The dentition exhibits a tendency to small teethprone to abrasion and a high increasedpercentage of congenitally missing teeth.

6. Although teeth tend to spaced, a crowding oflower incisors may be present as a result of thedeep bite.

7. A deep curve of Spee in lower arch or areverse curve of Spee in the maxillary dentition(Fig 2)

8. Occlusal functions become impaired.9. Often the maxillary incisors are tipped lingually

in Angle's Class II, division 2 pattern ( Fig 7)

Other features

1. The mandible cannot be opened to anappreciable degree in skeletal cases.

2. Temporomandibular joint dysfunction due tooverclosure of the mandible characterized byclicking sensation of the joint.

3. Periodontal conditions may be found as a resultof such occlusion.

VI. Diagnosis

Excessive overbite is not to be viewed as anisolated entity: it must be seen as a part of the totalmalocclusion. The routine diagnostic aids such asclinical examination, study models and lateralcephalogram are used of the diagnostic exercise .The factors contributing to excessive overbite varywith the type of occlusion and skeletal pattern.Their determination is the most important step indiagnosis and Treatment planning. Excessiveoverbite is not being viewed as an isolated entity. Itmust seen as a part of the total malocclusion. Theprimary diagnostic problem in both deep bite andopen bite is to ascertain the site of the dysplasiaswhether dental or skeletal. The skeletal bite can bedifferentiated from dental deep bite bycephalometric analysis.







Postural position is also used in the differentialdiagnosis of deep bite cases: the freeway space willbe larger than normal in cases with inadequatevertical development of the buccal segments andnormal in cases of over-eruption of the incisor teeth

VII Management of deep overbite

The extent of the intermaxillary distance "freewayspace" is an important factor in treatment planning.When the freeway space is minimal or even absentthe problem is more severe

1.Treatment modalities in growing and nongrowing patients.

Growing patients

o Intrude anteriorso Erupt posteriorso Combination of posterior eruption

and anterior intrusionNon growing patients (little or no growth expected)

o Orthognathic surgeryo Intrusion of anteriors (posterior

extrusion invariably relapses)whatever the treatment modality the management ofdeep bite is by intrusion of anteriors, extrusion ofposteriors or combination of the both

2. Factors to be considered before intrusion orextrusion

Interlabial gap Growth pattern whether vertical or

Horizontal Presence of adequate free way space or

interocclusal clearance

Intrusion of anteriors

Intrusive mechanics is considered in the followingsituations

Deep bite with large interlabial gap(In a relaxedmandibular position, an individual has normal of 2to 4 mm) , intrusion is the ideal choice. Extrusion ofposteriors may deteriorate the esthetics and furtherincrease the interlabial gap.

In a clinical situation, if incisor-stomion distance islarge, ( the distance between the incisal edge of themaxillary central incisor to the lower most border ofthe upper lip is an average of 2 to 4 mm) which isoften associated with a high smile line or "gummysmile", the best method of treating a deep overbitemay be by intrusion of the upper incisors.

In a Class II, division 1 type of malocclusion withlarge vertical facial height, extrusion of posteriorteeth may cause serious functional, esthetic, andstability problems. Extrusion of molar furtherscauses the downward and backward rotation of themandible worsening the condition. In those casesthe intrusion of anteriors is the treatment option.

Intrusion mechanics are considered if there isinadequate or normal freeway space.Encroachment of this space by extrusion ofposterior teeth is determinant and bound to relapse.It results in fatigue of the muscles of masticationwhich get stretched and predispose to relapse. Italso strains the TMJ.

Extrusion of molars

In deep bite with redundant upper and /or lowerlips, or no interlabial gap, posterior extrusivemechanics may be desirable (if other considerationspermit).

If a patient with deep overbite exhibits normalincision-stomion distance, the choice of correctionof deep bite by an intrusion of maxillary incisors isoften contraindicated since it will give the patientan edentulous appearance. Extrusion of posteriorsis the treatment option

In patients having excessive overbite with Class II,division 2 type of skeletal malocclusion, anextrusion of the posterior teeth met be the treatmentof choice ( if other considerations permit). Extrusionmechanics are considered if there is adequateinterocclusal space.

Intrusion of incisors Extrusion of molars

Deep bite with largeinterlabial gap

Deep bite with nointerlabial gap

If gummy smile ispresent

Normal incisor-stomiondistance



In class II div I patientswith large verticalfacial height

In class II div II patientswith short vertical facialheight

Considered ifInadequete free wayspace is there

Considered if adequatefree way space is there

3. Planning Treatment in different age groups

1) Treatment planning in primary dentition Bothdeep bite and open bite malocclusion occur in theprimary dentition. Open bite is more common.Anterior deep bites in the primary dentition are fairlycommon but are rarely treated. When an excessiveoverbite is seen in the primary dentition, it is likely tohave a skeletal basis with the presence ofdeveloping Class II malocclusions. Activator typeappliance may he used to direct differential alveolargrowth, reduce the interocclusal distance, andimprove skeletal morphology. As with Class IImalocclusions, treatment decisions are typicallypostponed until the mixed dentition when the childattains maturity to wear the appliance. Indicationsfor treatment in the primary dentition includeimpingement on the palatal mucosa, excessivegrinding, clenching, and headaches if they arebelieved to be secondary to the deep bite

2) Treatment planning for mixed dentition (Fig12)

The overbite is greater just after eruption of theprominent incisors and decreases with eruption ofthe posterior teeth. If the skeletal bases are class Iwith normal incisor angulation, it is better to waitand watch till the eruption of the posterior teethwhich results in resolution of deep bite.

In non skeletal deep bites a utility arch thatincorporates molar and incisor teeth can be usedduring the mixed dentition to intrude, tip, orreposition both molars and incisors. Realistically,although bite depth changes can be made in themixed dentition by intrusion of anterior teeth,intrusion is difficult to retain-even in later phases offull appliance therapy. For this reason, intrusion asa part of early treatment is seldom required. It isoften better to defer this treatment until the earlypermanent dentition, using an intrusion arch during

the first stage of comprehensive fixed appliancetherapy

Early childhood is the best time to treat complexdeep bite. Functional jaw orthopedic appliancescan then guide the eruption of the permanentdentition upper molars, while eruption can bemanipulated with and help control vertical skeletalgrowth .Cervical headgear produces more eruptionof the upper molars and with functional applianceeither the upper or lower molars erupt more.

Deepbites with anterior vertical maxillary excessshowing gummy smiles can be intercepted by highpull headgears.

Class I skeletal deepbites with horizontal growthpattern can also be intercepted with themyofunctional appliances .

3) Treatment planning for early permanentdentition comprehensive orthodontic treatment isusually required to treat the cases of deep bite.Leveling of the teeth tends to elevate the posteriorteeth and depress the anterior teeth while improvingincisal stops and reducing the depth of bite

Several factors such as the growth pattern,thepattern of the rotation of the mandible type of dentalmalocclusion, deleterious habits, relationship ofintraoral and extra oral musculature should beconsidered. The treatment becomes morecomplicated if there is, in addition, an excessiveoverjet, reverse overjet , crowding in either anteriorregion or excessive alveolar bone loss.

In cases of simple dental deep bites and whenthere is a normal interocclusal distance in themandibular postural position, treatment by archleveling mechanics alone may be possible.

In class II div I growing patients intrusion orprevention of excessive eruption of the lowerincisors is achieved by leveling out an excessivecurve of Spee with the continuous arch wiremechanics from molar to incisors.

In the absence of growth, absolute intrusion isrequired and segmented arch mechanics must beused to achieve this . Eruption of the first molarscan be aided by the use of a flat maxillary bite planeor a monobloc and the incisors depressed withutility archwire.



Mild cases of skeletal deepbites in adolescent aretreated with full-banded or bracketed appliances. Inmoderate cases a flat maxillary bite plane is used inconjunction with full-banded therapy. Severe casesof complex deep bite may require orthognathicsurgery later. Even in the most severe problems, itis preferable to attempt treatment in adolescenceand force the decision toward surgery by theinadequate response to conservative therapy.Adolescent treatment of moderately severe casesusually more successful in boys then girls sinceboys normally have more remaining growth to utilizethe treatment

4) Treatment planning in adults (Fig 13)

In adult patient showing excessive deep overbite of100 per cent or more, with accompanying;

1. High smile line. 2. decreased Vertical facialheight. 3. Alveolar problems, the length of treatmentmay be very long. In this instance, the patientshould be given a choice for an Orthognathiccorrection of the problem. In these patients, thetreatment plan to correct the excessive overbiteshould be done in conjunction with anoromaxillofacial surgeon.

Maxillary surgery The maxilla can be moved upquite successfully with Lefort I. Surgicallyrepositioning of maxilla in superior direction can bedone by complete maxillary osteotomy. Thecorrection of deep bites resulting from verticalmaxillary excess can be effectively corrected by thismethod.

Mandibular surgery Patients with a short face(skeletal deep bite) problem are characterized by along mandibular ramus, square gonial angle andshort nose-chin distance. They are treated mostpredictably and successfully by mandibular ramussurgery that allows the mandible to move downwardonly at the chin, increasing the mandibular planeangle. They are treated best by sagital splitmandibular ramus surgery to rotate the mandibleslightly forward and down and the gonial angle openup.The deep bites in the anterior mandibular alveolarregion can be corrected by subapical osteotomy.Appliances and methods used in the treatmentof deep bite

Deep bites can be treated using removable, fixed ormyofunctional appliances.

I. Removable appliances

a. Maxillary acrylic bite plate or anterior biteplane ( Fig 14 A and B)

The most popular method for correcting a deepoverbite is by or anterior bite plane. The anteriorbite plane is a modified Hawley’s appliance with awith a built-in flat acrylic bite plate or inclined planeor platform lingual to the maxillary incisors . Theanterior bite plane consists of Adam’s clasps on themolars which help in retaining the appliance. Alabial bow is also incorporated to counter anyforward component of force on the upper anteriors.The bite plane may be extended labially not to covermore than 1/3rds to produce the same effect ie.., toprevent the protusion of upper anteriors.

With this appliance in the mouth during themandibular closing movement, the mandibularincisors come in contact with the acrylic platform,which causes a disocclusion of the posterior teeth.The disocclusion leaves the molars free to erupt.The disocclusion of the bite accelerates thepassive eruption of the posterior teeth, which stopswhen one or more opposing teeth come in contact .It is advisable not to disocclude the posterior teethmore than 2 mm. If bite opening in the anteriorregion is not sufficient, the acrylic platform can beaugmented in small increments several times duringthe treatment.

Small increments also apparently do not cause asudden temporomandibular joint or myofunctionalchange. If used with a correct treatment plan, thebite plate can also help in minor labiolingual andmesiodistal movements of teeth with the help of alabial bow or auxiliary springs

The patient wears this appliance almost 24 hours aday. The use of bite plates, at the time of attainingthe desired overbite, should not be suddenlystopped, the bite plate itself should be used as aretainer and its discontinuance should be gradual.

















A bite plate increases lower facial height bypermitting posterior dentoalveolar eruption but tendsto rotate the mandible in a down-and backdirection, this diminishing mandibular projection.This is a advantage in horizontal growth pattern buta disadvantage in vertical growth pattern.

b. Myofunctional appliance

Deep bite due to developing class II div I patterncan be intercepted with the myofunctionalappliances like activator and bionator. Deep bitecases diagnosed to be due to infra-occlusion ofmolars can be treated by an activator designed andtrimmed to allow the extrusion of these teeth. Theinter -oclusal acrylic is trimmed gradually toencourage the eruption of the posterior teeth.Bionator can also be used for a similar purpose.This is discussed in chapter on myofunctionalappliances

c. HeadgearsWhen an extremely deep overbite is presentbecause of the overeruption of the maxillaryanterior teeth, a high pull headgear can be attachedto the anterior segment of the arch wire in anattempt to intrude these teeth.

The cervical headgear with its downward vector offorce increases lower facial height by extruding themolars. The mechanics are discussed in detail inchapter on myofunctional appliances

II. Fixed orthodontic appliances( Fig 15--18)Fixed orthodontic appliances can be used to intrudethe incisors or extrude the molars. They can alsoproduce mild skeletal effects . Appliances used fordeep bite correction are genericallytermed intrusion arches and variations include basearches, utility arches, Connecticut arch and reversecurve of Spee wires etc..,.

Intrusion of anterior teeth can be obtained withthe following methods

Use of anchorage bends( Fig 15) : Anchor bendsare given in the arch wire mesial to the molar tubesso that the anterior part of the arch wire lies gingivalto the bracket slot . Thus when these arch wires arepulled occlusally and engaged into the brackets, agingivally directed intrusive force is exerted on the

incisors which reduces the deep bite. Whenintrusion of anterior teeth is the goal, light forcesshould be used. Heavier forces are more likely tocreate a greater tendency for posterior teeth toerupt as a result of the equal and opposite extrusiveforce at the molar. Recommended forces forintrusion of lower incisors are in the range of 12.5 gper tooth and for maxillary incisors about 15 to 20 gper tooth. The reactionary extrusive force on molarsis prevented by natural interdigitating occlusion orin extreme cases by giving a posterior bite plane ofminimum thickness

Use of archwires with reverse curve of Spee( Fig16): resilient arch wires that have been curved in adirection opposite to that of the curve of Spee canbe used to intrude lower anteriors. When thesearch wires are inserted into the molar tubes, theanterior segment curves gingivally. This anteriorsegment is forced occusally into the bracket slotresulting in an intrusive force on the incisors. Areverse curve of Spee wire on the lower arch actsmainly by tipping molars distally and incisorslabially. As the incisors flare labially, angularchanges contribute to overbite correction If the wireis in place for a long enough period and verticalfacial growth occurs, premolars extrude and, to alesser degree molars and incisors get intruded

Use of utility arches ( Fig 17): Utility arches arearch wires that are bent is such a way that theybypass the buccal segment and are engaged on theincisors. These arches can be used to perform anumber of tooth movements including intrusion ofincisors, protraction or even retraction of incisors.They are activated by giving a V bend in the buccalsegment of the wire so as to produce a intrusiveforce on the anteriors

Three piece segmental wires (Fig 18) - This type ofwire is used in cases of absolute deepbite wherethere is nor growth potential. Simultaneousretraction and intrusion can be achieved.

Extrusion of posterior teeth

Extrusion of posterior teeth can be obtained withthe following methods



Use of archwires with reverse curve of Spee Theextrusion of posterior teeth can be successfullyattained by fixed orthodontic appliances by using0.16 in. round wire with a reverse curve of Spee.The disadvantage of round wire is that it causesundesirable changes in the axial inclination of thebuccal teeth and flaring of the incisors

Use of intermaxillary elastics ( Fig. 19)Extrusionof molars might be fortified by means of elastics,which attempt to overerupt the molars in both theupper and lower jaws. Use of anchorage bend in theupper jaw as well as in the lower jaw in combinationwith Class II elastics may cause overeruption of thelower molars and may help to correct a dental deepbite.One of the draw backs of the class II elastics isthat it results in extrusion of the upper incisors, inan attempt to overerupt lower molars

Implants ( Fig 20)

Implants can be used as Temporary anchoringdevices for intrusion of upper anterior teeth. Theyare used along with fixed appliances

Retention (Fig 21 )Corrected deep overbites in either Class I or

Class II malocclusions usually require retention in avertical plane (moderate retention). If anterior teethwere depressed to achieve overbite correction, abite plate on a maxillary retainer is desirable. It isworn continuously for perhaps the first 4 to 6months. Often the incisal edges of the anterior teethare unworn and require spot grinding and adjustingin some class II Div I cases.

If cases of skeletal deepbite correction is achievedas a result of bite opening. In these cases the

mandible is forced away from the maxilla and thevertical dimensions should be held until growth (i.e.,mandibular ramal height) can catch up. Thechanges of the mandibular plane angle suggestproper retention.

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Deep overbite—A review

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