Deep bite is a vertical occlusion anomaly characterized by an increase in the overlap of the lower incisors by the upper ones by more than a third of the height of their crowns and a violation of the cutting–tubercle contact. Pathology is accompanied by a violation of facial aesthetics, difficulty chewing, speech defects, chronic traumatization of the mucous membrane of the palate and gums, increased tooth erasability, TMJ dysfunction. Disease is diagnosed by analyzing diagnostic models of the jaws, TRG, orthopantomograms, and photographs of the face. The treatment is carried out using orthodontic structures (vestibular plates, functional devices, trainers, braces, etc.).
Meaning
Deep bite is a type of malocclusion in which, during the closing of the jaws, there is a significant vertical overlap of the incisors of the lower row with the incisors of the upper row. Disease is one of the most common malocclusion that an orthodontist encounters in his daily practice. According to various data, the population frequency of deep bite ranges from 6 to 51%. In the structure of occlusion anomalies, deep bite is about 20%. In dentistry, a deep bite is sometimes referred to by the terms “traumatic bite”, “declining bite”, “deep incisor or frontal overlap”, “deep incisor occlusion or dysocclusion”.
Causes
The formation of a deep bite can be caused by genetic, intrauterine and postpartum factors (general diseases, dental and maxillofacial pathology, bad habits).
Most often, a deep bite is inherited from parents along with the structural features of the dental system and the facial skeleton. Congenital deformities of the face (such as “cleft palate” and “harelip”) they also contribute to the development of malocclusion. Among prenatal factors, the most important are diseases of the pregnant woman, toxicosis, intrauterine infections, mechanical injuries, fetal hypoxia, multiple pregnancy, intrauterine development delay, etc.
The formation of deep occlusion in the postpartum period may be associated with hypotrophy, rickets and rickets-like diseases that negatively affect the growth and development of the child’s bones; violation of the timing of eruption and change of baby teeth; diseases of the gastrointestinal tract and ENT organs, etc. Pathology often accompanies congenital and acquired defects of the musculoskeletal system: abnormalities of the spine, congenital muscular torticollis, posture disorders, systemic diseases of the skeleton.
In some cases, disease has an etiological connection with the early removal of milk or permanent molars, anomalies of teeth: their size (macrodentia) and number (supercomplete teeth), anomalies of attachment of the bridles of the tongue and lips, the presence of diastema, multiple caries, partial adentia, pathological tooth erasure, injuries and osteomyelitis of the jaws, ankylosis of the TMJ, etc.
The number of bad habits that contribute to the occurrence of malocclusion in children may include prolonged sucking of a pacifier, sucking of a finger and various objects, biting of the lip, etc.
Classification
The criterion for distinguishing deep incisor overlap, deep bite and deep traumatic bite is the localization of cutting-tubercle contact.
While maintaining the contact of the cutting edges of the lower teeth with the palatine tubercles of the upper ones (that is, the cutting-tubercle contact), they speak of excessive (deep) incisor overlap. The deep bite itself is characterized by a significant overlap of the lower incisors with the upper ones and the absence of cutting-tubercle contact between them. In the presence of contact of the cutting edges of the lower incisors with the palate or gum, the bite is regarded as deeply traumatic. These forms of bite can be considered as stages of a single pathological process, i.e. under certain conditions (tooth extraction, their pathological erasability), excessive incisor overlap can transform into a deep bite, and the latter into a deep traumatic bite.
According to the overlap of the crowns of the central incisors in orthodontics, there are 3 degrees of malocclusion:
- I – overlap from 1/3 to 2/3 of the height (3-5 mm)
- II – overlap from 2/3 of the height to the whole crown (5-9 mm)
- III – the overlap exceeds the size of the crown (more than 9 mm).
Depending on the position of the anterior upper teeth (vestibular or oral character of the relationship of the frontal teeth), there are roof-shaped and blocking forms of deep bite. The latter form is combined with prognathia. According to the nature of the interaction of the lateral teeth, a deep distal and a deep neutral bite are differentiated.
Symptoms
Deep bite is accompanied by aesthetic defects and serious functional disorders.
The external manifestations of a deep bite are characteristic facial and oral signs. Facial manifestations include shortening of the lower third of the face, pronounced supramental fold, inversion of the lower lip outward. In general, the patient’s face is sometimes characterized as “bird-like”. The oral signs include the overlap of the lower frontal teeth with the upper ones by the size of the crown, the predominance of the upper jaw over the lower one, and a decrease in the depth of the vestibule of the oral cavity. Chronic traumatization of the oral mucosa and periodontal overload of the frontal teeth contribute to the development of stomatitis, gingivitis, periodontitis and periodontal disease, increased tooth abrasion.
Functional changes in deep bite are represented by difficulties with biting and chewing food, speech defects (the patient talks “through his teeth”), respiratory disorders. A deep bite is often accompanied by a violation of the tone of the masticatory muscles, leading to the development of dysfunction and arthrosis of the TMJ: aching pains, crunching, clicking in the joint area, bruxism, headache.
Diagnostics
The presence of a deep bite, the causes of its occurrence and ways of correction are determined at an appointment with an orthodontist in the process of a thorough examination of complaints and examination of the oral cavity.
For a more detailed assessment of the nature of the relationship of the dentition, an impression is taken with an alginate mass and the production of diagnostic models with their subsequent careful measurement; the study of face photos in full face and profile, obtaining an occludogram.
Orthopantomography and telerentgenography data (calculation and analysis of TRG), electromyography are important for the diagnosis of deep bite.
Treatment
Treatment of deep bite in children should be started as early as possible. During the period of milk bite (up to 5-6 years), it is recommended to teach the child to chew solid food, fight bad habits (sucking a finger and toys, biting the lip or cheek, etc.), perform myogymnastics. It is necessary to eliminate the factors contributing to the formation of a deep bite, such as the treatment of caries, plastic surgery of the frenulum of the lip and tongue, preventive prosthetics.
At the stage of changing milk teeth permanent (from 6 to 12-13 years) removable plates, trainers, activators (Andrezen-Goypl, LM-activator), Frenkel apparatus, Bruckl apparatus, Bynin kappa, etc. can be used to separate the bite.
Starting from the age of 12-16, fixed orthodontic devices – braces – become the main method of treating deep bite. In adults, orthodontic treatment can be combined with surgical (compactosteotomy).
With persistent speech disorders, the patient may need the help of a speech therapist.
Prognosis and prevention
Treatment of a deep bite is a long, complex process that requires significant financial and time costs. The duration of correction of deep bite is variable and depends on the age of the beginning of orthodontic treatment, the degree of incisor overlap, the presence of concomitant deformities, etc. Properly planned orthodontic treatment allows you to completely eliminate aesthetic and functional disorders. Otherwise, disease will inevitably contribute to the development of periodontal and TMJ pathology, early tooth loss.
The key to the prevention of deep bite is the safe course of pregnancy, the fight against harmful oral habits in the child, regular visits to the dentist, the prevention of rickets, scoliosis and other diseases that adversely affect the formation of the dental system.
Literature
- Singhvi H.R., Malik A., Chaturvedi P. The Role of Chronic Mucosal Trauma in Oral Cancer: A Review of Literature // Indian J Med Paediatr Oncol. — 2017; 38(1): 44-50.link
- Trezubov V.N., Shcherbakov A.S., Fadeev R.A. Orthodontics. — M: Medical book, N. Novgorod: Publishing house of NGMA. — 2001. — 148 p.
- Bending Orthodontic wire: a practical guide / Eihiro Nakajima; per. A. Ostrovsky; scientific ed. per. D. Gladilin. — M.: ABC, 2011. — 87 p.
- Evidence-based orthodontics. Selected articles based on reliable data. Collection of articles. / Kevin O’brien; translated from English — Moscow: TARKOMM, 2019.