1. Dr. Saba Basit
MCPS Resident
Orthodontics
03/2/2015 1Seminars 253 inOrthodontics,Vol19,No4(December)
2. ‘A condition of
excessive overbite
where the vertical
measurement between
the maxillary and
mandibular incisal
margins is excessive
when the mandible is
brought into habitual
or centric occlusion.’
(GRABER)
‘The amount and
percentage of overlap
of lower incisors by
the upper incisors .
The overbite may be
calculated as a
percentage of the
clinical crown height
of one of the
mandibular central
incisors.’ (NANDA)
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3. The prevalence of severe deep bite varies between racial
groups twice as common in Caucasian Americans compared
to African Americans and Hispanics.
03/2/2015 3Seminars 253 inOrthodontics,Vol19,No4(December)
10. Characterized by the absence of any skeletal complicating
features which are seen in skeletal deep bites.
Occurs due to:
Over-eruption of anteriors
Infra-occlusion of molars.
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11. Over-eruption of anteriors
Usually seen in class II
Increased overjet causing over eruption of lower
anteriors untill they meet palatal muosa.
Excessive curve of spee
03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 11
12. Infra-occlusion of molars:
Occurs due to
Partially erupted molars/reduced crown length
Large interocclusal clearance
Lateral tongue posture/thrust
(preventing molars erupting in normal
occlusion)
Premature loss of posteriors
03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 12
13. They are often associated with class II
malocclusion and hypodivergent facial patterns.
This tends to have:
1. Strong mandibular elevator muscle
2. High mentalis activity
3. Deep mento labial folds
4. Everted lower lip
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14. A. Clinical examination
B. Study cast
C. Lateral ceph
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15. 1. Mecahnaical consideration
▪ Intrusion of incisors
▪ Extrusion of moalrs
▪ Proclination of incisors
2. Considerations in growing individuals
3. Considerations in nongrowing patients
4. Esthetic considerations
5. Treatment challenges
6. Guidlines for stability
7. Conclusion
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16. Intrusion of incisors is indicated when:
1. Excessive distance between incisal edge and stomion
2. Large interlabial gap
3. More occlusal level of central incisor to lateral
incisor
Methods to intrude incisors
a) Continuous arches
b) Segmenal techniques
Adjunct applainces
High pull headgear
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17. Extrusion of posteriors:
1mm extrusion of posteriors teeth causes
1.5 to 2.5mm reduction in incisor overlap.
Indicated when
1. Short facial height
2. Increased curve of spee
3. Incisor display ranging from normal to
minimal.
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18. Proclinaion of incisors:
It decreases the amount of overbite and usually
occurs as a side effect of other treatment
modalities.
Indicated to include it separately in the treatment
plan when
Lingually tipped incisors in class II div 2
Class III
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19. Strategies to extrude molars:
1. Altering bracket height
2. Leveling dental arches by using RSC wire in
mandible and ECS wire in maxilla.
3. Including 2nd molars in fixed assembly.
4. Increasing step bends from anterior teeth to
posteriors.
5. Giving anterior bite plane
6. Using class II elastics
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20. AIM
Enhncement of posterior eruption
Maintaining height of posteriors(esp in hypodivergents)
What we can do?
1. Removable appliance with ant. bite plane
2. Fixed 2/4 appliance with appropriate
anchorage situations with intrusion arch wire.
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23. Orthognathic surgery is the treatment option in
malocclusion with severe skeletal problems.
Extractions are to be avoided in most of the cases
of deep bite avoiding worsening of deep bite.
However treatment with minimal intervention
leads to compromised results:
1. Lengthy treatment
2. Reduced esthetics
3. Periodontal compromise
4. Root resorption
5. Orthognatic surgery eventually
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25. Upper lip line in relation to maxillary incisors.
Depth of mental sulcus in realtion to
mandibular incisor.
Contraindication for intrusion:
1. Low lip line
2. Reduced lower anterior facial height
(hypodivergent)
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27. 1. Addressing limited objectives to resolve a specific
patient complaint,reduce treatment time, or avoid
surgery.
2. Giving more weight to esthetic considerations and
awareness, sometimes at the expense of evidence
available for occlusal stability.
3. Minimizing the side effects of treatment such as
a) root resorption
b) periodontal complications
c) temporomandibular joint dysfunction
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28. 1. Nature of the occlusion (missing teeth and mutilated
dentition).
2. Compromised dental health(existing restora-
tions/severe caries and root resorption).
3. Mechanical limitations (difficult space closure,
especially extraction spaces,and resistance to
intrusion—mainly in adults).
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29. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 29
SUCCESS
Compliance Growth direction
and amount1. a headgear
2. a functional appliance
3. removable bite plates
4. elastics
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Importance should be given in:
Posterior teeth extrusion in severe hypodivergent faces
with hyperactive musculature.
Proclanation of mandibular incisors and clockwise rotation
of mandible.
32. 1. Treat a developing deep overbite early.
2. Avoid extraction of premolars, particularly in
very deep bites.
3. Long-term retention.
4. Enhance sustainability of the correction such
as the use of a bite plate at least at night.
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33. Dental or skeletal deep bite
Esthetical considerations
Stability considerations
Long term retention
03/2/2015 33Seminars 253 inOrthodontics,Vol19,No4(December)
34. 03/2/2015 Seminars 253 inOrthodontics,Vol19,No4(December) 34
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