Deep bite

[julieh]

What methods are used to correct a deep bite? My orthodontist said that he is putting together a treatment plan to address this. In terms of severity, he said that I am a 9 on a scale of 1-10. My paranoia is getting the best of me. What am I in for?

[ArchWired28]

Well, if 10 is the most severe and you are a 9, I would think a deep bite that severe should be fixed with surgery. Perhaps you are looking at the 4 premolars removal at the very least, possibly with a functional appliance aka forsus and/or elastics, and of course braces... Please keep us updated!

[DrBill]

It really depends on where the deep bite is coming from. Most commonly it's from an exagerrated curve of Spee in the lower arch (the arch isn't level - lower front teeth swoop up under upper front teeth). In this case leveling that curve through a "relative intrusion" with braces - intruding the lower incisors and extruding the premolars - is most common. Other causes can be over-erupted upper front teeth (in which case intrusion of the upper front teeth is required) or severe skeletal issues (very short facial height/flat mandibular plane requiring surgery). Sorry if that's too technical! I'm sure your orthodontist will explain things in detail depending on the reason for your deep bite.

Clearing up some misinformation (sorry Archwired 28!) premolar extraction tends to DEEPEN a bite, so we generally try to treat deep bites non-extraction (of course there are always exceptions). Functional appliances primarily address front-to-back issues, not vertical issues.

If you are a 9 out of 10 surgery could be an option, but fortunately we can most often treat deepbites non-surgically with just braces (leveling the arches).

[julieh]

thanks. he said that my uppers are over erupted, my gum line is flat, and that he can fix the problems without surgery. what am i looking at?

[ArchWired28]

Clearing up some misinformation (sorry Archwired 28!) premolar extraction tends to DEEPEN a bite, so we generally try to treat deep bites non-extraction (of course there are always exceptions). Functional appliances primarily address front-to-back issues, not vertical issues.

Now I am confused. Isn't the deep bite synonymous to a class II bite or an overbite? I though premolar removal is a standard of care for treatment of a class II bite, especially class II division I with protruding front teeth.
If they are not the same, can you please explain the difference?

[DrBill]

A deep bite is synonymous with deep overbite, but NOT Class II malocclusion.

The bite can be looked at in 3 dimensions:

1) Vertical (Up-and-down) - Openbite, deepbite, etc

2) Anteroposterior (Front-to-back) diagnosed from the molars and/or canine relationship- ex Class II (which can lead to overjet, not overbite) or Class III (ex underbite)

3) Transverse (sideways) - ex crossbite

The mixup arises in that while most people call protruding upper incisors "overbite", we in orthodontics made a purposeful decision to confuse patients and call it "overjet" In orthodontics, overbite is a vertical issue. A deep bite (or overbite) means that the upper incisors are covering an excessive amount of the lower incisors. It does not refer to the anteroposterior or front-to-back. For example, you can have a Class II openbite, which may present itself as protrusive upper incisors that have no vertical overlap with the lower incisors. Likewise, you can have a Class I deepbite, where there is no incisor protrusion but the upper incisors cover an excessive amount of the lower incisors.

I wouldn't say premolar removal is standard of care for a Class II malocclusion. There are certainly cases where it's appropriate, but many others where it's not. Patient age, facial characteristics, skeletal relationships, crowding/spacing, incisor angulation, tooth display, etc all play a role in the most appropriate way to treat a Class II malocclusion.

[ArchWired28]

Thanks for the detailed explanation, DrBill! I certainly appreciate it, very informative. Now I know that I used to have (well, seems like I still have it now) a class I deep bite.