الرحمن الله بسمالرحيم

VERTICAL MALOCCLUSION

Gaidaa Bushra. Supervised By Dr. Altohami

DEF. MalocclusionVariation from ideal occlusion which has

dental health and/or psychological implications for the individual.

Malocclusion can occur in three plans of spaces i.e

Sagittal Transverse vertical

VERTICAL MALOCCLUSION

OPEN BITEDEF.o Open bite is a malocclusion that occur in

the vertical planeo Characterized by lack of vertical overlap

between the maxillary and mandibular dentition.

o Open bites can occur in the anterior or posterior region and are called anterior open bite and posterior open bite.

ANTERIOR OPEN BITEo Def. is the condition where there is no

vertical overlap between the upper and lower anteriors.

o Anterior open bites are esthetically unattractive particularly during speech when the tongue is pressed between the teeth and lips.

o AOB can be classified as; Skeletal open bite Dental open bite

o Etiology of AOB is multifactorial. Prolonged thumb-sucking habit. (most,

posture, position, intensity, frequency, etc).

Tongue thrusting. (some cases) Mouth breathing. (associated with

nasopharyngeal airway obstruction ) Inherited factors. (large tongue size,

abnormal skeletal growth, etc)

FEATURES! SKELETAL DENTAL

FEARTURES!

SKELETAL DENTAL

a. Increased lower anterior facial height.

b. Decreased upper anterior facial height.

c. A steep mandibular plane angle.

d. Small mandibular body and ramus.

a. Proclined upper teeth.

b. The upper and lower anteriors fail to overlap each other.

c. The patient may have a narrow maxillary arch duo to lowered tongue posture duo to a habit.

TREATMENT REMOVAL OF THE CAUSE! Habits, by passive habit breaking

appliance. Habit breaker appliance can be either

fixed or removable. Persistence of all the causes will offer a

sever limitation in the corrective procedures!!

Myofunctional therapy! Functional appliance, e.g. head gear

with chin cup for pt exhibiting a downward and backward rotation of the mandible with increased vertical growth (if treated during mixed dentition period).

ORTHODONTIC THERAPY! Mild to moderate open bite can be

successfully managed using fixed appliance with box elastics.

Elastic that is stretched to extend between the upper and lower anteriors.

this brings extrusion of the upper and lower anteriors.

SURGICAL CORRECTION!! Skeletal open bites in adults are best

treated by surgical procedure involving the maxilla and the mandible.

POSTERIOR OPEN BITE DEF. is a condition characterized by lack

of contact between the posteriors when the teeth are in centric occlusion.

CAUSES:o Mechanical interference with eruption,

either before or after the tooth emerges from the alveolar bone.

o Failure of the eruptive mechanism of the tooth so that the expected amount of eruption does not occur.

NB. Mechanical interference with eruption

may be caused by ankylosis of the tooth to the alveolar bone, which can occur spontaneously or as a result of trauma, or by an obstacles in the path of the erupting tooth.

Such as supernumerary teeth and nonresorbing deciduous tooth roots or alveolar bone.

After the tooth emerges from the bone, pressure from soft tissue interposed between teeth (cheek, tongue, finger) can be an obstacle to eruption.

Infraocclusion by ankylosed teeth.

The second possible cause of eruption failure is a disturbance of eruption mechanism itself! Without any recognizable cause or disorder, which does not respond to orthodontic treatment.

TREATMENT

Remove the cause. Lateral tongue spikes (to avoid tongue

thrust). Extrusion of the posteriors forcefully. Infraocclusion by crowns to restore

normal occlusal level.

VERTICAL MALOCCLUSION

DEEP BITE DEF.o Vertical overlap of the upper and lower

anteriors.o One third – one half coverage is normal,

greater will be increased, thus termed overbite.

This overlapping of the mandibular teeth occurs both the horizontal as well as vertical direction.

The horizontal overjet The vertical overbite

Overbite can be : Incomplete overbite Complete overbite.

Deep bite can be broadly classified into :

1. Skeletal2. dental

SKELETAL DEEP BITE Genetic origin. Caused by upward and forward rotation

of the mandible, which can be worsen by a downward and forward inclination of the maxilla!!!

SKELETAL DEEP BITE Features:1. Pt exhibit horizontal growth pattern2. The anterior facial height is reduced3. A reduced inter-occlusal clearance

(freeway space)

DENTAL DEEP BITE This kind of deep bite is characterized

by the absence of any skeletal complicating features that are seen in skeletal deep bites.

Dental deep bite occur duo to over-eruption of anteriors OR infra-occlusion of posterior.

Deep bite duo to over-eruption of anteriors: is usually seen in class II malocclusion. The presence of an overjet allows the lower incisors to over-erupt, until they meet the palatal mucosa.

The pt hence exhibit an excessive curve of spee.

Deep bite duo to infra-occlusion of molars : the presence of a large tongue posture or lateral tongue thrust may prevent the molars from erupting to their normal occlusal level.

It can also occur due to premature loss of posterior teeth.

Lip relationship:Pts with deep bite who exhibit a short lip or a gummy

smile should be treated by intrusion of the anteriors.

In pts exhibiting normal upper lip with only 2-3 mm of maxillary incisal edge exposed, it is ideal to extrude the molars.

TREATMENT By removable, fixed or myofunctional

appliance.

Removable Hawley’s appliance

+ Adam’s clasps on the molars for retention.

Myofunctional activator desinged and trimmed to allow the extrusion.

Bionator can also be used.

Fixed to intrude the anteriors.

FIXED ANTERIOR BITE PLANE CAN BE USE IN CONJUNCTION WITHTHE FIXED APPLIANCE.

THANK YOU