Treatment of vertical malocclusions
DEEP BITE
Increased Overbite
o Incisors have erupted past each other.
o > 4mm or 1/3 of the lower incisor is covered by
the upper incisor
o Often associated with reduced vertical
facial proportions.
Increased Overbite
o Associated to any other type of posterior
occlusion.
o One of the most frequent MO
o Problem when it:
o Alters the masticatory function.
o Alters the condylar function.
o Esthetic implications
Etiopathology & Diagnosis
o Strong genetic influence
o Short face pattern
o Skeletal mandibular deficiency
o Incidence varies depending on race.
o Difficult to identify environmental factors
o Maxillary compression?
o Muscle hypertonicity?
Etiopathology & Diagnosis
FACE ANALYSIS
Etiopathology & Diagnosis
FACE ANALYSIS
o Chin well developed, despite the possible
Mn deficiency.
o Everted lower lip,
o Hypertonic lips
o Decreased AFH
Etiopathology & Diagnosis
CEPHALOMETRIC ANALYSIS
Etiopathology & Diagnosis
CEPHALOMETRIC ANALYSIS
o Low mandibular plane
o Long ramus
o Counterclockwise rotation
o Reduced eruption of M
o Excessive eruption of I
Etiopathology & Diagnosis
CLINICAL EXPLORATION
o Tendency to present class II M & C
o Increased overjet
o Camouflaged by crowding!
o Excessive curve of Spee in the lower arch.
o Tendency to produce crowding.
Etiopathology & Diagnosis
FUNCTIONAL PROBLEMS
o Irritation of the gingival tissues
o Palatal gingiva upper incisors
o Buccal gingiva lower incisors
o Abbrasion of enamel
o TMJ problems
o Excessively retruded position of the condyles?
Treatment
Objectives
o Correct/control over-eruption of incisors.
o Stimulate eruption of posterior teeth.
o Level the curve of Spee.
o Increase AFH (when possible).
Treatment
Growing patient
o Growth of condyles compensates for posterior
dental extrusion.
o Correction of the inter-incisal angle is
important for the stability of overbite
reduction
o Prevent the incisors from erupting past each other
and the overbite increasing again.
o Especially relevant for class II-1 cases associated
with proclined upper incisors
Treatment
Growing patient
o Cases with a low maxillary–mandibular
planes angle is easier with a non-extraction
approach.
o Extraction treatment ! reduction of
vertical dimension
Mechanotherapy
Deep overbite associated with an increased
curve of Spee in the lower arch:
o Relative incisor intrusion
Mechanotherapy
Relative incisor intrusion
o Extrusion of the lower buccal segments whilst
maintaining lower incisor eruptive position.
o Very effective way of reducing an increased
overbite, particularly in a growing patient
o Vertical growth condyle compensates for any increase
in the vertical dimension induced by the molar
extrusion
Mechanotherapy
Deep overbite associated with an increased
curve of Spee in the lower arch:
o Buccal segment extrusion
Mechanotherapy
Buccal segment extrusion
o No growth potential at the condyle
o Buccal segment extrusion
o Clockwise rotation of the mandible,
o Steepening of the occlusal plane,
o Increase in the lower face height.
Mechanotherapy
Buccal segment extrusion
o Worsens any underlying skeletal class II
o Prone to relapse following treatment.
o Overbite reduction can be more difficult in adult
patients.
Mechanotherapy
Relative incisor intrusion / Buccal segment
extrusion
o Removable appliance + anterior bite plane
o Level C. Spee
o Reduce overbite
o Functional appliance
Mechanotherapy
Relative incisor intrusion / Buccal segment
extrusion
o Fixed appliances:
o Buccal segment extrusion
o Incisor intrusion
o Tendency for the lower incisors to procline, but
may not be desirable or stable.
Mechanotherapy
Deep overbite associated with an increased
curve of Spee in the lower arch:
o Incisor intrusion
Mechanotherapy
True intrusion of the incisors
o In cases with a long face tendency and a class
II malocclusion
o Molar extrusion ! undesirable clockwise rotation of
the mandible.
o Absolute intrusion of the incisors is
mechanically difficult to achieve ! fixed
appliances.
Mechanotherapy
True intrusion of the incisors
o Anchorage unit in the buccal segments
o Intrude the incisors with a utility or bypass arch
pitched against the buccal teeth
Mechanotherapy
True intrusion of the incisors
o Miniscrews
Mechanotherapy
True intrusion of the incisors
o Segmental surgery
Mechanotherapy
Deep overbite associated with an increased
curve of Spee in the lower arch:
o Incisor proclination
Mechanotherapy
Proclination of the Incisors
o Associated reduction in the inter-incisal
angle.
o Lower incisor proclination = UNSTABLE
o Unless originally markedly retroclined
