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DEEP BITE & OPEN BITE

DEEP BITE & OPEN BITE FJDC
DEEP BITE & OPEN BITE FJDC

FJDC

overview

  • DEEP BITE

    • Definition

    • measurement

    • Classification

    • Causes

    • Intraoral and extra oral features

    • diagnosis

    • Treatment plan

      • OPEN BITE

        • Definition

        • Causes

        • Classification

        • Diagnosis

        • Treatment plan

overview  DEEP BITE  Definition  measurement  Classification  Causes  Intraoral and extra
DEEP
DEEP

BITE

Deep Bite

A condition of excessive overbite, where

the vertical measurement between the

maxillary & mandibular incisal margins is excessive when the mandible is brought

into habitual or centric occlusion. (Graber)

Deep Bite A condition of excessive overbite, where the vertical measurement between the maxillary & mandibular
  • 1-2mm overlap of lower incisors is normal and it is known as Overbite

  • When overbite becomes excessive it is known as Deep

Bite

 1-2mm overlap of lower incisors is normal and it is known as Overbite  When
 1-2mm overlap of lower incisors is normal and it is known as Overbite  When

Measure of Deep

bite

Measure of Deep bite
Hereditary Skeletal Causes Dental Muscular
Hereditary
Skeletal
Causes
Dental
Muscular

Hereditary

  • may follow a genetic pattern or familial condition

Hereditary  may follow a genetic pattern or familial condition

Dental causes

  • Premature loss of permanent teeth causing lingual collapse of anterior

teeth

  • Anterior tipping of posterior teeth

  • Infraocclusion of posterior

teeth due to tongue thrusting

  • Supraocclusion of anterior teeth usually seen in class II due to inc overjet

  • Large sized teeth

Dental causes  Premature loss of permanent teeth causing lingual collapse of anterior teeth  Anterior

Skeletal causes

a.An overgrowth or undergrowth of one or more alveolar segments.

b c a
b
c
a
  • b. An excess of growth of the ramus and

posterior cranial base permits the mandible to rotate upward. Thus Long ramus and short body with decreased gonial angle is

characteristic feature

  • c. Convergent upper and lower jaw bases

  • d. Horizontal growth pattern or forward rotation or

anticlock wise rotation of the of the lower jaw

Muscular Causes

The posterior vertical chain of

muscles (masseter,internal

pterygoid, temporal) is strong and attached anteriorly on the mandible and stretches in nearly a straight line vertically.

The molars are directly under

the impact of the masticatory forces of this chain.

When the posterior vertical

chain of muscles is strong and

anteriorly positioned, a greater depressive action is transmitted to the dentition

Muscular Causes The posterior vertical chain of muscles (masseter,internal pterygoid, temporal) is strong and attached anteriorly

Features and Effects of deep Over bite

Extraoral features

1. Facial esthetics is impaired (muscular face). Strong

contractions of the masseter

muscle can be seen in the face by clenching the teeth

  • 2. Straight to Mild convex profile

  • 3. curled appearance of the lips .

Features and Effects of deep Over bite Extraoral features 1. Facial esthetics is impaired (muscular face).
Features and Effects of deep Over bite Extraoral features 1. Facial esthetics is impaired (muscular face).
  • 4. Short anterior face

height as measured from nasion to gnathion

  • 5. Diminished anterior

lower face height. Short

nose-chin distance.

  • 6. Labiomental fold :

deep

4. Short anterior face height as measured from nasion to gnathion 5. Diminished anterior lower face
4. Short anterior face height as measured from nasion to gnathion 5. Diminished anterior lower face
4. Short anterior face height as measured from nasion to gnathion 5. Diminished anterior lower face

Intra oral features

1. The maxillary dental arch is broad, with often a maxillary buccal cross-bite

2. May involve a group of teeth or whole dentition.

3. In skeletal deep bites the

patient may exhibit gummy smile if there is clockwise rotation of maxilla . When the problem is in the anterior maxillary region, the

patients often show excessive

gingival tissue during smiling or even while speaking even when the upper lip is of adequate length

Intra oral features 1. The maxillary dental arch is broad, with often a maxillary buccal cross-bite

4. The palatal vault is flat.

The presence of deep bite

may cause palatal grooving by the indentations caused

by lower anteriors.

5. The dentition exhibits a

tendency to small teeth

prone to abrasion.

Other features

1. The mandible cannot be opened to an appreciable degree in skeletal

cases.

2. Temporomandibular joint

dysfunction due to over closure of

the mandible characterized by clicking sensation of the joint.

3. Periodontal conditions may be

found as a result of such occlusion

Diagnosis

  • History

  • Clinical examination

  • study models

  • Lateral cephalogram:

The skeletal bite can be differentiated from dental deep bite by

cephalometric analysis.

OPG

Diagnosis  History  Clinical examination  study models  Lateral cephalogram: The skeletal bite can
Diagnosis  History  Clinical examination  study models  Lateral cephalogram: The skeletal bite can
Diagnosis  History  Clinical examination  study models  Lateral cephalogram: The skeletal bite can

Treatment plan

5 important factors to achieve stable

relationship:

  • 1. lip relationship

  • 2. Occlusal relationship

  • 3. Age of patient

  • 4. Vertical facial relationship

  • 5. Interocclusal space

lip relationship

lip relationship Incompetent lips Competent lips  Extrusion of posterior teeth

Incompetent lips

lip relationship Incompetent lips Competent lips  Extrusion of posterior teeth

Competent lips

  • Intrusion of anterior teeth

Extrusion of posterior teeth

Vertical facial relationship

  • Extrusion of 1mm of posterior teeth results in increase in anterior facial height by 2mm

Increased anterior facial height

Intrusion of anterior teeth

Reduced anterior facial height

Extrusion mechanism

Occlusal Plane

  • In deep bite there is deep

curve of spee in mandible and

reverse curve of spee in maxilla.

Leveling of curve of spee can be done by intrusion, extrusion

or relative intrusion

AGE

Growing patients

o Intrude anteriors

o Erupt posteriors o Combination of posterior eruption and anterior intrusion

Non growing patients (little or no growth expected)

o Orthognathic surgery o Intrusion of anteriors (posterior extrusion invariably relapses)

AGE Growing patients o Intrude anteriors o Erupt posteriors o Combination of posterior eruption and anterior
AGE Growing patients o Intrude anteriors o Erupt posteriors o Combination of posterior eruption and anterior

Appliances used

Appliances used  Removable appliances Anterior bite plane  Myofunctional appliance activator  Bionator (reverse) 
  • Removable appliances

Anterior bite plane

  • Myofunctional appliance

activator

  • Bionator (reverse)

  • Fixed appliance

Appliances used  Removable appliances Anterior bite plane  Myofunctional appliance activator  Bionator (reverse) 

OPEN

BITE

Open Bite

  • Open bite is descriptive of a condition where a space exists between the occlusal or incisal surfaces of maxillary & mandibular teeth in the buccal or anterior segment, when the mandible is brought into habitual or centric occlusion. (graber)

Open Bite  Open bite is descriptive of a condition where a space exists between the

Causes

  • Unfavorable growth pattern

  • digit-sucking habit

  • Tongue & orofacial muscle activity

  • Hereditary

  • Increased tongue size

  • Imbalances between jaw posture and growth, occlusal and eruptive forces.

  • Nasopharyngeal airway obstruction & associated mouth breathing

  • Failure in eruptive mechanism of tooth ( especially in posterior open bite)

Causes  Unfavorable growth pattern  digit-sucking habit  Tongue & orofacial muscle activity  Hereditary
Causes  Unfavorable growth pattern  digit-sucking habit  Tongue & orofacial muscle activity  Hereditary
Causes  Unfavorable growth pattern  digit-sucking habit  Tongue & orofacial muscle activity  Hereditary

Types of Open Bite

Based on location

Types of Open Bite Based on location Based on dental & skeletal component involved

Based on dental & skeletal component involved

Types of Open Bite Based on location Based on dental & skeletal component involved

Diagnosis

  • History

  • Clinical Examination

  • Study models

Diagnosis  History  Clinical Examination  Study models  Lateral cephalogram, OPG
Diagnosis  History  Clinical Examination  Study models  Lateral cephalogram, OPG
  • Lateral cephalogram, OPG

Treatment

Treatment

Treatment
Treatment

Simple anterior Open

bite

  • Stop thumb sucking

Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,
Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,
  • In mixed dentition:

functional appliances like activator, bionator(open) or frankel

Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,
Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,
  • In late mixed & early permanent dentition:

multibanded appliances are used along with habit breaking appliance i.e Tongue Spikes

Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,
Simple anterior Open bite  Stop thumb sucking  In mixed dentition: functional appliances like activator,

Simple Posterior open

bite

  • Bionator or activator

with lateral flanges is

used to prevent lateral tongue thrust

  • Removal of ankylosed primary tooth

Simple Posterior open bite  Bionator or activator with lateral flanges is used to prevent lateral
Simple Posterior open bite  Bionator or activator with lateral flanges is used to prevent lateral

Complex or skeletal open

bite

  • Early diagnosis is crucial-

since it helps to minimize the

problem. Bionator or frankel

  • Difficult to treat

orthodontically

  • Adult skeletal open bite is

best treated by orthognathic

surgery

Complex or skeletal open bite  Early diagnosis is crucial- since it helps to minimize the

Thank you

Questions

Questions