Management of Deep Bite -Orthodontics

Summary

This video from Boundless Dentistry educates viewers on deep bite treatment and management. It begins by defining deep bite as an excessive vertical overlap of the maxillary and mandibular incisors, beyond the normal 2-4mm range. The video then differentiates between incomplete and complete deep bites, and discusses the use of cover bite and closed bite terms. It explores the classification of deep bite into skeletal and dental abnormalities, highlighting diagnostic tools like clinical examination and cephalometric analysis. The treatment section covers various appliances, both removable and fixed, used to correct deep bite by either intruding incisors or extruding molars, depending on the patient's specific condition.

Takeaways

• 😀 Deep bite is characterized by an excessive vertical overlap of the maxillary incisor over the mandibular incisor, beyond the normal range of 2-4 mm.
• 🔍 Deep bite is classified into two types: incomplete (where the mandibular incisor does not touch the palatal mucosa) and complete (where it does).
• 🦷 The causes of deep bite can be skeletal, involving abnormalities in the maxilla or mandible, or dental, related to over eruption of anteriors or infra occlusion of molars.
• 👩‍⚕️ Diagnosis of deep bite involves clinical examination and cephalometric analysis to assess the relationship between the maxilla, mandible, and incisors.
• 📏 Treatment considerations for deep bite include determining whether intrusion or extrusion is needed, evaluating lip relations, and considering the patient's growth phase.
• 🛠️ Removable appliances like the modified Holley's appliance are used for molar extrusion, while myofascial appliances like activators and bionators also aid in treatment.
• 🔧 Fixed appliances, including anchorage bands, reverse curve of speed wires, intrusion arches, and utility arches, are used to intrude incisors or extrude molars.
• 🏥 Fixed anterior bite planes, similar to removable ones but cemented to the teeth, are used to extrude posterior teeth and correct deep bite.
• 📈 Early treatment of deep bite in growing patients is often more effective due to the potential for optimal treatment outcomes and reduced risk of relapse.
• 📚 The video provides a comprehensive overview of deep bite, its classification, causes, diagnosis, and various treatment options using both removable and fixed appliances.

Q & A

What is a deep bite in dentistry?

A deep bite, also known as excessive overbite, occurs when the vertical overlap between the maxillary incisor and the mandibular incisor exceeds the normal range of 2 to 4 mm or 30%. This condition is not normal and can be challenging to treat, especially in adults.

How is deep bite classified?

Deep bite can be classified into two types: incomplete and complete. In an incomplete deep bite, the maxillary incisor does not fully cover the mandibular incisor, meaning the mandibular incisor does not touch the palatal mucosa. In a complete deep bite, the mandibular central incisor touches the palatal mucosa and is fully covered by the maxillary incisor.

What are the additional terms used to describe deep bite?

Two additional terms used in deep bite are cover bite and closed bite. Cover bite refers to a situation where the mandibular incisors are completely covered by the maxillary incisors, often seen in class 2 division 2 malocclusion. Closed bite is similar to cover bite but is characterized by a loss of posterior teeth, leading the mandibular incisors to be covered by the maxillary incisors.

What causes deep bite and how is it diagnosed?

Deep bite can be caused by either skeletal abnormalities, such as issues with the maxilla or mandible, or dental abnormalities like overeruption of anteriors or infraocclusion of molars. Diagnosis involves clinical examination and cephalometric analysis to assess the relationship between the maxillary and mandibular incisors and the overall facial structure.

What are the features of a skeletal deep bite?

Features of a skeletal deep bite include a horizontal growth pattern, decreased anterior facial height, decreased interocclusal space (also known as freeway space), and certain cephalometric measurements where the Frankfurt horizontal plane, mandibular plane, and SN planes are almost parallel to each other.

How is deep bite treated in growing patients versus adults?

Deep bite is generally easier to treat in growing patients due to the potential for natural growth and development to assist in correction. In adults, treatment is more complex and may involve more invasive procedures due to the lack of growth potential.

What are the factors to consider before treating deep bite?

Before treating deep bite, factors to consider include determining whether intrusion or extrusion is needed, assessing lip relations and smile aesthetics, considering the patient's age and growth potential, evaluating the interocclusal space, and the presence of any dental abnormalities.

What are the different types of appliances used to treat deep bite?

Appliances used to treat deep bite include removable appliances like the modified Holley's appliance, myofascial appliances like activators and bionators, and fixed appliances such as anchorage bands, archwires with reverse curve of Spee, intrusion arches, utility arches, and fixed anterior bite planes.

How does the modified Holley's appliance work in treating deep bite?

The modified Holley's appliance works by creating space in the posterior region when the patient bites down on the acrylic plate, allowing for the extrusion of molars. The labial bow counteracts forward forces to prevent accidental proclination of incisors, and the appliance aims to create 1.5 to 2 mm of space for optimal molar extrusion.

What is the role of fixed anterior bite planes in treating deep bite?

Fixed anterior bite planes are used to extrude posterior teeth. They can be fixed via bands on molars or as biplanes bonded on the lingual surfaces of maxillary incisors. The main purpose is to correct deep bite by altering the vertical dimension and promoting the eruption of molars.