March, 2011

A New Fixed Acrylic Bite Plane for Deep Bite Correction

1. Dr. Amit Prakash

Senior lecturer

Department of Orthodontics and Dentofacial Orthopedics

Darshan dental college and hospital, Loyara, Udaipur

2. Dr. Arundhati P. Tandur

Professor

Department of Orthodontics and Dentofacial Orthopedics

K.L.E.S Institute of Dental Sciences, Bangalore

3. Dr.Sri Chandana

Final year PG student

Department of Conservative dentistry

Government dental college, Hyderabad

4. Dr.pravin Murare

Final year PG student

Department of Orthodontics

K.L.E.S Institute of Dental Sciences, Bangalore

Corresponding address –

Dr. Amit Prakash

Department of Orthodontics and Dentofacial Orthopedics

Darshan dental college and hospital, Loyara, Udaipur

E-mail address- drprakash24@yahoo.co.in

amitprakash30@gmail.com

Mobile number – 09649671900

Abstract

A deep bite is one of the most common malocclusions seen in children and adults that can occur along with other associated malocclusions. A deep overbite can be corrected by different methods like intrusion of anteriors, extrusion of posteriors, combination of anterior intrusion and posterior extrusion, proclining anteriors or surgical correction. However, it should be decided which method will be more beneficial or which will improve the patient’s facial appearance and functional efficacy. In this paper a new fixed acrylic bite plane was used to correct the deep bite by extrusion of molars.


Graber1 ­­­­­­­­­­­­defined overbite as the distance, which the maxillary incisor margin closes vertically past the mandibular incisor margin, when the teeth are brought into habitual or centric occlusion.

Proffit 2defined overbite as the vertical overlap of the incisor teeth when the posterior teeth are in contact.

Different terms used for deep bite

Deep overbite

Cover bite

Close bite

Deckbiss

Posterior collapsed bite

Diagnosis

An anterior deep bite could be caused by supraeruption of upper and / or lower incisors or infraeruption of posterior teeth. To evaluate whether infraeruption or supraeruption is present, the orthodontist must use linear measurements from the base of the alveolar process. The amount of eruption anteriorly or posteriorly can be established by Cephalometric analysis.

Bite plane or bite plate

The bite plate was used in 1879 by Miller3 to permit the elongation of posterior teeth.  It has played an important part in the treatment of the deep overbite ever since. A bite plane can achieve vertical height without significantly changing the occlusal relationships. In bite plane therapy for the deep overbite the elongation of posterior segments depends on the growth of the alveolar bone. This new bone must be conditioned to withstand the stresses of mastication by gradual withdrawal of a bite plate. Many cases of failure of bite plate therapy have been caused by the abrupt removal of the bite plate before complete organization of the bone has taken place. A bite plane takes the form of a thickened platform of acrylic, palatal to the upper incisors, on which the lower incisors can occlude, leaving the posterior teeth out of occlusion.

Extrusion of posterior teeth

Extrusion of posterior teeth is commonly indicated in patients with decreased lower anterior facial height. It is also indicated in true deep bite cases.4 If the incisal edges of the maxillary anterior teeth are positioned above the inferior margin of the upper lip, in these cases extrusion of the posterior teeth is indicated. Extrusion of molars of an average of 1mm results in  2 to 2.5 mm of bite opening.  This is probably the most common and easiest, although not always the best method, of correcting deep overbites. Extrusion of posteriors can be done by myofunctional appliances, removable appliances and fixed appliance therapy. Extrusion of posterior teeth in growing patients is stable, but in adults it may result in relapse.

Clinical case 1

Patient name A.J. had a chief complaint of mal-alignment of teeth. On examination he had an Angle Class 1 molar relationship, severe crowding in the upper and lower arches and an impinging deep bite. The prescribed treatment plan:

  • Extraction of all the first premolars to relieve the crowding.
  • Fixed bite plane to allow extrusion of molars for correction of deep bite.
  • Prolonged retention with wrap around retainers with inclined plane in the upper arch for corrected deep bite retention.

Figure 1- Pre-treatment

Figure 2- Fixed bite plane

Figure 3- 0cclusal view

Figure 4- After fixed bite plane removal

Figure 5- Post-treatment

Clinical case 2

Patient name R.S. had a chief complaint of irregular teeth. On examination she had an Angle Class II, Division 2 malocclusion with impinging deep bite. The prescribed treatment plan:

  • Non-Extraction due to a pleasing profile.
  • Fixed bite plane to allow extrusion of molars for correction of a deep bite.
  • Prolonged retention including a wrap around retainer with inclined bite plane in the upper arch for corrected deep bite retention.

Figure 6- Pre-treatment

Figure 7- With fixed bite plane

Figure 8- Occlusal view

Figure 9- After fixed bite plane removal

Figure 10- Post-treatment

Conclusion

The correction of a deep bite is one of the primary objectives of orthodontic treatment. A deep bite has been considered one of the most common malocclusions and the most difficult to successfully treat. Therefore, the optimal treatment of deep bites requires a proper diagnosis, a careful treatment plan and an efficient appliance design. Because vertical growth continues into the late teens, a maxillary removable retainer with a bite plane is often is needed for several years after fixed appliance orthodontics is completed. Bite depth can be maintained by wearing the retainer only at night, after stability in other regards has been achieved.

Bibliography

1. Graber T.M. Orthodontics: Principles and Practice. 3rd Ed., W.B. Saunders, Philadelphia.

2.Proffit W.R., Field H.W., Ackerman J. L., Bailey L.T., Tulloch J.F.C. Contemporary Orthodontics 3rd, C.V. Mosby Co; 2000.

3. Geiger A, Hirshfeld L. Minor tooth movements in general practice 3rd Ed. Mosby Co.

4. Nanda R. Correction of deep overbite in adults. DCNA1997; 41: 67-87.

Comments 6 Responses

  1. beny

    14. May, 2011

    what happen with the 1st left lower incisor after treatment in the fig. 10 case 2 dan fig.5 case 1 ???

    Reply to this comment
  2. mari

    06. Jun, 2011

    what cement do you usually use to cement the fixed bite plane so as not to fracture the anteriors during removal?

    Reply to this comment
  3. belal

    10. Jan, 2012

    dramatic trauma from occlusion, a typical result from using fixed anterior biteplane, can’t believe reviewers passed this!! what a shame!!

    Reply to this comment
  4. Welcome

    22. Sep, 2012

    I think you’ve just captured the answer prefectly

    Reply to this comment
  5. selena

    05. Nov, 2012

    how much is a bite plane now if you have lost yours ?

    Reply to this comment
  6. selena

    05. Nov, 2012

    well this is a very good explanation

    Reply to this comment

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