a brief description of the various diagnostic methods used to classify deep bite and open bite and various treatment modalities used at various stages of it.

1. Good Afternoon
DR. KAPIL SAROHA
BDS, MDS
ORTHODONTICS AND DENTOFACIAL
ORTHOPAEDICS
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2. Overbite
Deep bite Open bite
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3. CONTENTS
 Introduction
 Definition and Classification of open bite
 Development of normal over bite
 Etiology
Epigenetic / hereditary factors
Skeletal factors
Environmental factors
Thumb/finger sucking
Mouth breathing
Tongue dysfunction
Role of Musculature
 Characteristics of Anterior open bite
(Skeletal)
Anterior open
bite
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4.  Treatment of open bite
Early mixed dentition period
Habit reminders
Rx Tongue thrust swallow
Rx Lip sucking
Oral screen
Mixed / early permanent dentition period
 Myofunctional appliances
Activatior and its modifications
Bionator
Frankel regulator (FR IV)
Twin block
 Orthopaedic appliance
High Pull Head Gear
Vertical Chincap
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5.  Molar intrusion
Bite blocks
Active Vertical Corrector (AVC)
MAD IV (Magnetic Activator Device)
Molar Intruder (MI) appliance
Rapid molar intruder (RMI)
Late permanent dentition
Extractions
Fixed appliance therapy
MEAW (Multiloop Edgewise Archwire)
Microscrew implant
Titanium Miniplates
Glossectomies
Orthognathic surgery
 Conclusion www.drdentiste.comSaturday, February 11, 2017 5

6. Esthetics primarily
responsible for orthodontics
Appearance the most
important factor for treatment
Physically attractive people achieve higher levels of
success in life than unattractive people
Breece and Neilberg JCO 1986
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7. Facial appearance is the most important
characteristic in relation to self image and self esteem
People dissatisfied with facial appearance
express more dissatisfaction with teeth than any
other feature Herchan etal AJO 1980
OULD YOU LIKE TO HAVE
A SMILE LIKE THIS ?
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8. Open bite
By Graber
 A condition where a space exists
between the occlusal or incisal
surfaces of maxillary and
mandibular teeth in buccal or
anterior segments when the
mandible is brought into habitual or
centric occlusion
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9. Moyer'sMoyer's
 Simple or DentoalveolarSimple or Dentoalveolar
AnteriorAnterior
PosteriorPosterior
 Complex or SkeletalComplex or Skeletal
LocationLocation
 AnteriorAnterior
 PosteriorPosterior
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10. Orthodontic equation
Causes
Times
Tissues
Results
Act at
on
producing
TREAT
THE
CAUSE
DOCKRELL R 1952
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11. Etiology
Epigenetic / hereditary factors
 Skeletal growth pattern of maxilla
and mandible
 Vertical relationship of jaws
 Morphology and size of tongue
 Muscle dysfunction
 Neurological disturbances
 Epigenetic / hereditary factors
 Environmental factors
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12. Environmental factors
 Tongue dysfunction
 Thumb/finger sucking
 Mouth breathing
 Foreign body in mouth
 Trauma or pathology of condyles
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13. Establishment of
Normal Over
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14. ENLOWS COUNTERPART PRINCIPLE
 Growth of any given facial or
cranial part relates specifically to
other structural and geometric
"counterparts" in the face and
cranium.
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15. Balanced growth
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16. Upward and
backward growth of
condyle
Downward and forward
displacement
xpansion of Middle cranial fossa
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17. Tongue
 Morphology,size
 Tongue thrust , posture
 MACROGLOSSIA
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18. TONGUE THRUST AND POSTURE
Swienheart(1942) Straub(1960)
 Tongue thrust primary cause
 Mouth seal difficult in open bite
 Physiological adaptation tongue
Thrust swallow is always seen in open bite
but reverse is not true
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19. Respiratory pattern
 Primary determinant of posture of jaws and
tongue
Mouth breathing
 Nasal inflamation
 Nasal polyps
 Deviated nasal septum
 Mechanical obstruction
 Inflamed tonsils or adenoids
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20. Postural changes
 Lowering of mandible
 Downward and forward positioning
of tongue
 Tipping back of head
 Adenoid facies
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21. Thumb sucking
29 week IU
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22. www.drdentiste.comSaturday, February 11, 2017 22

23. Role of Musculature
Facial muscles affect jaw growth
 Formation of bone at point of
muscle attachment
 Growth of muscle carries jaws
downward and forward
 Loss of musculature can result in
underdevelopment of that part of
face
 Excessive muscle contraction can
restrict growth
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24. Characteristics of Anterior open bite
(Skeletal)
 Hyperdivergent face (long Face)
 Vertical growth pattern
 Discrepancy in vertical proportions
> AFH restricted to lower third , < PFH
 No contact of teeth in anterior region
 Retruded Mandible
 Short ramus
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25.  > eruption of posterior teeth
 Clockwise rotation of mandible
 > gonial angle
 Antegonial notching
 Open mouth posture
 Proclination of upper incisors / retroclination of
lower incisors
 Lip incompetence
 Forward tongue posture
 Defective speech (s,f,z,l,r)
(Munim 1966)
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26. Treatment of open bite
Observation
Simple habit control
Complex surgical procedures
Vertical growth last
dimension to be
TREAT THE CAUSE
ETIOLOG
Y
completed
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27. Moyers
 Self correction of open bite can
occur if habit is corrected
Johson , Larson
Benefit should outweigh the risks
Treatment in early mixed dentition period
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28. Treatment of sucking habits
Sucking habit
Communication with patient
Meaningful Empty
Psychological approach Dental approach
Diagnose and
resolve the problem
Habit reminders
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29. Habit reminders
Thumb sucking
Extraoral
 Thumb guard (Allen 1991)
 Chemical method
Intraoral ( removable / fixed )
 To remind the patient
 To make the habit a non-pleasurable one.
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30. Palatal Cribs
Rakes
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31.  Thumb sucking
 Tongue thrusting
 Lip sucking
 Mouth breathing
 Flaccid hypo tonic orofacial musculature
 Open bites
Oral screen ( Newell 1912 )
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32. Oral screen
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33. Treatment in mixed / early
permanent dentition period
 Myofunctional appliances
 Orthopaedic appliance
 Combination
 Fixed appliance therapy
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34. Myofunctional
appliances
 Activatior and its modifications
 Bionator
 Frankel regulator (FR IV)
 Twin block
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35. Activator
Palate free activator
(Metzelder)
Elastic open activator
(Klammt)
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36. Bionator
 Open bite appliance
 Maxillary acrylic portion is modified with acrylic
extending up behind the maxillary incisors
 It does not contact the teeth or the alveolus
 Prevent tongue from thrusting between teeth
 Thin layer of acrylic between all posterior teeth to
exert a depressing force
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37. FR IV
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Twin block
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38. Intra oral elastics - Dr Christine Mills
 To maintain occlusal contact on the appliances
 Reinforcement of intrusive force on the bite
blocks to close the bite.
Repelling magnets
Intraoral traction
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39. Orthopaedic appliance
High Pull Head Gear
 Restrict maxillary sutural growth and vertical
dentoalveolar development
 Mandibular rotation
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40.  12 –14 hrs/day force 10 –16 oz (400 –450 gms)
per side
 Head gear with Maxillary occlusal splint
Bite blocks
Functional appliances
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41. Active Vertical Corrector (AVC)
 Dellinger AJO-DO 1986
 Removable or fixed
orthodontic appliance that
intrudes the posterior teeth
in both the maxilla and
mandible by reciprocal
forces.
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42. Treatment of late permanent
dentition (adult)
Extractions
Fixed appliance therapy
MEAW (Multiloop Edgewise Archwire)
Microscrew implant
Titanium Miniplates
Glossectomies
Orthognathic surgery
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43. Premolar extractions
 Mesial movement of the molar teeth.
 Retraction of incisors
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44. Fixed appliance therapy
 Leveling of arches (mild open bites)
 Elastics
 Incisor and canine brackets placed 0.5 mm
more gingival
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45. MEAW
Young H Kim Angle (1987)
 Multiloop Edgewise Archwire
 L shaped loops
 0.016 ×0.022 inch SS wire
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46. Objective
 Correction of occlusal plane
 Alignment of maxillary incisors
 Uprighting of axial inclinations of
posterior teeth
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47.  Enacar etal (JCO 1996)
 0.016 ×0.022 inch upper accentuated Niti
lower reverse curve Niti
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48. Advantages
 Simpler
 Hygienic
 Reduced chair side time
 Did not irritate soft tissues
 Results similar
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49. Microscrew implant anchorage for intrusion
Hyo Sang Park etal AJO 2004
Maxillary II premolars and I molars
 Anchorage for anterior retraction
 Posterior intrusion
Mandibular I and II molars
 Anchorage for uprighting
 Counteract mesial tipping during space closure
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50. Advantages
 Prevents mesial tipping of premolars
 Eliminate need of intermaxillary elastics
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51. www.drdentiste.comSaturday, February 11, 2017 51

52. Titanium Miniplates as Skeletal
anchorage for Intrusion .
 Keith H AJO Dec 2002
 L-, Y-, or T-shaped plates
Miniplate size and shape were based on
 Length of the roots of adjacent molars
 Contour and density of underlying bone.
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53.  Positioned so that only the last loop on the vertical (most
occlusal) leg of the plate projected through the mucosal
incision into the oral cavity
 Several millimeters apical to the brackets on the molars
and adjacent to the teeth requiring intrusion
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54.  A elastic thread passed through the exposed loop of the
implanted miniplate and tied tightly to the bracket of the
closest molar or molars to create a directly vertical
intrusive force.
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55. Orthognathic surgery
 Superior repositioning of maxilla as
a whole or as apart
 Mandibular surgery to bring lower
jaw forward and upward by tilting
the body of mandible upward
 Superior repositioning of chin by
lower border osteotomy
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56. Osteotomies
Maxilla
 Lefort I osteotomy
 Posterior Maxillary osteotomy
 Anterior Maxillary subapical osteotomy
Mandible
 Anterior Mandibular subapical osteotomy
 Mandibular body V osteotomy
 Sagittal split of Mandibular body
Hullihen(1849)
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57. Lefort I osteotomy
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58. Posterior Maxillary osteotomy
Schuchard , Kufner
 High palatal vault
 > Curvature of maxillary plane
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59. Anterior Maxillary and Mandibular
Subapical osteotomy
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60. Mandibular body V / Y osteotomy
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61. Sagittal split of Mandibular Body
 Obwegesser,Dalport
 Preserves integrity of inferior aspect of body of
mandible
 No bone grafting
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62. Conclusion
Open Bite is one of the most challenging
malocclusions to treat
Are we ready for this
challenge ???
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63. DEEP OVER BITE
DR.KAPIL SAROHA
BDS, MDS
ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
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64. Contents
 Introduction
 Definition
 Classification
 Diagnosis
 Clinical features
 Treatment in functional appliance
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65. Introduction
 Deep overbite presents an
orthodontist with challenge in any
of its many forms.
 Diagnosis ,treatment planning and
appropriate mechanics form an
backbone of successful orthodontic
treatment.
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66. Etiological Consideration
 According to etiological stand point over bite can
be differentiate into developmental deep bite
and acquired deep bite.
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67. Developmental ( Genetic) Deep Bite
 Skeletal deep bite with a
horizontal growth pattern is a
common malocclusion.
 Dentoalveolar deep bite caused by
supra occlusion of the incisors,
these cases the interocclusal
clearance is usually small meaning
the over bite is functionally a
pseudodeep bite.
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68. Acquired Deep Bite
 A lateral tongue thrust or postural
position frequently can produce
acquired deep bite this type of
function produce a infra-occlusion
of the posterior teeth which intern
leads to a deep over bite, the
freeway space is large which is
favorable for dentofacial
orthopedics functional appliance
treatment.
 E.g. class II div. II.
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69.  The wearing away of the occlusal
surface or teeth abrasion can
produce an acquired secondary
deep over bite in some patients.
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70.  Deep over bite can be localized
in either
1. Dentoalveolar
2. skeletal.
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71. Dentoalveolar deep over
bite
Deep overbite caused by infraocclusion molars has
the following symptoms.
1. Molars are partially erupted.
2. Interocclusal space is large.
3. A lateral tongue thrust and posture are present.
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72.  Deep over bite caused by over eruption of the
incisors has the following symptoms:
1. Molars are fully erupted.
2. Curve of spee is excessive(compensating
curve).
3. Interocclusal space is small.
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73. Skeletal Deep Over Bite
 Is characterized by a horizontal type of growth
pattern.
 Anterior facial height is short, particularly the lower
facial third, where as posterior facial height is long.
 Interocclusal clearance is usually small
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74. Vertical Malocclusion – Deep
Bite
Excessive over bite – deciduous dentition.
 Over bite is the considered to be excessive when
the incisors overlap by more than half.
 Genuine deep bite in a deciduous dentition where
the lower anterior teeth are covered completely as
result of an increased in the height of the upper
anterior alveolar process.
 An excessive overbite may be encountered during
any developmental period of dentition.
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76. Deep bite with class III malocclusion
 Deep bite conjunction with mandibular
prognathism and inverted over bite.
 This vertical deviation can be related with any
anteroposterior or transverse malocclusion.
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77. Closed bite caused by loss of posterior teeth
 Gingivally supported closed bite resulting from
premature extraction of teeth in the mixed
dentition.
 Pathologically the closed bite is caused by an
increased forward and upward rotation of the
mandible, resulting form lack of posterior dental
support.
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78. Functional classification
True deep over bite
1. Infraocclusion of molars.
2. Large freeway space.
 The prognosis for
successful therapy with
functional method is
favorable.
Pseudo deep over bite
1. Molars are fully
erupted.
2. Over eruption of the
incisors.
 The prognosis for
successfully therapy
with functional
method is
unfavorable.
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79. ABSOLUTE INTRUSION
RELATIVE INTRUSION
EXTRUSION
THREE POSSIBLE WAYS FOR INTRUSION
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80. Dentoalveolar Deep
Over Bite
True Deep Over Bite
1. In true deep bite the choice of
treatment is extrusion of posterior
teeth.
2. If a lateral tongue thrust is
present, a lateral tongue crib is
added to the palatal plate.
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81. Treatment of acquired deep bite
 Treatment being carried out during
eruption levelling of the curve of
spee can be carried out by the use
of an activator.
 Anterior bite plane can be used.
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82.  Anterior bite plane
 In growing patients anterior bite
plane inhibits the vertical
development of the lower incisors
and allows differential eruption of
the posterior teeth to take place.
 The posterior teeth will be
occlusion and the over bite will
reduced with in about 2 months.
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84. Tip back springs
 Indicated:
Deep over bite
deep curve of spee
Growing patients with forward growth
rotation.
the anchor molars are
reinforced with TPA
In the upper and lingual holding arch
in the lower arch.
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85. Correction of deep bite with activator
correction of deep bite with bionator
correction of deep bite with frankel
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86. Conclusion
 All these various modalities
described for the correction of the
deep overbite have been time
proven to be successful provided
the right method of treatment is
selected as per the demands if a
particular case
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87. Thank you
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