Research progress on the three-dimensional finite element analysis of bite opening / 口腔疾病防治

@#Deep bite is a common clinical malocclusion that has a great impact on patients’ facial aesthetics and oral function. Bite opening is the key step in the treatment of deep bite, playing a decisive role in the development of mandible and the progress of orthodontic treatment. Torque and tip control during the correction of deep bites is a hot topic in orthodontics. The three-dimensional finite element method can accurately simulate clinical processes and conduct dynamic stress analysis, which provides the basis of the biomechanical mechanism. This paper reviewed the finite element analysis of various orthodontic systems for bite opening to provide a reference for clinical application. The emergence of mini-implants provided a new idea for anchorage control in bite opening. Finite element studies found that high-positioned mini-implants are beneficial for bodily tooth intrusion and proposed the ideal position for force application. For the finite element simulation of the reverse curve archwire, it was found that the intrusion and inclination of the anterior teeth increased with the curve depth of the archwire. The application of clear aligners has also been flourishing, but these forces are still difficult to effectively control. Finite element studies on their attachment design and corresponding tooth movement may be helpful to open the bite quickly and effectively. However, the existing studies still have modeling limitations. The structural simplification, linearization and nonstandard parameter definition of the model reduce model accuracy. Additionally, the existing research mostly focused on initial tooth movement, and studies on long-term tooth movement after bone remodeling are lacking. These studies are needed in the future.

Full mouth rehabilitation on the patient with deep bite and posterior bite collapse using re-establishment of occlusal vertical dimension / 대한치과보철학회지

The loss of posterior support and the abnormal jaw relation can cause pathologic findings. If deep bite patients with multiple missing teeth, can not have the stable posterior contact, the mandible moves posteriorly, and consequently the overjet and overbite get worse. And when the mandibular irregular occlusal plane is corrected, it is easier to have the bilateral balanced occlusion with the maxilla. So the treatment goal is to give proper posetrior support and establish appropriate anterior guidance, and ultimately provide improved mastication and esthetics recovery. In this case, a 68 year old man, having deep bite without posterior support was evaluated by the vertical dimesion decision flow-chart. An available prosthetic height, anterior occlusal relation such as overjet, overbite and the esthetic part such as facial height and the cephalometric analysis are the factors to be considered.

Orthodontic traction of impacted canines: Concepts and clinical application

ABSTRACT Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.

RESUMO O tracionamento de caninos impactados representa um dos grandes desafios da Ortodontia. Trata-se de um problema clínico relativamente frequente, cujo tratamento muitas vezes requer uma abordagem multidisciplinar. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente na respectiva arcada podem, com frequência, levar a complicações nos tecidos de suporte, sem mencionar o longo tempo de tratamento e os custos elevados para o paciente. Por isso, vale a pena ressaltar a importância dos diagnósticos precoces, para que a interceptação do problema seja feita o mais cedo possível e de maneira eficaz. O presente trabalho apresenta uma revisão dos principais conceitos envolvendo a prevalência, etiologia e classificação dos caninos impactados, e descreve os vários tipos de abordagem clínica para a resolução do problema. Ao final, ilustra o tema com a apresentação de um tratamento realizado em um paciente de 13 anos e 7 meses de idade, portador de má oclusão de Classe II, divisão 2, subdivisão esquerda, associado a mordida profunda, que apresentava retenção prolongada de um canino superior decíduo, devido à impacção de seu sucessor permanente. O tratamento ortodôntico corretivo foi associado à expansão rápida de maxila e ao uso de aparelho extrabucal de tração cervical. O canino impactado foi tracionado ortodonticamente e posicionado corretamente na arcada. Essa abordagem foi eficiente para atingir as metas funcionais e estéticas propostas.

Full mouth rehabilitation in patient with loss of vertical dimension and deep bite due to tooth wear / 대한치과보철학회지

Excessive tooth wear can cause irreversible damage to the occlusal surface and can alter the anterior occlusal relationship by destroying the structure of the anterior teeth needed for esthetics and proper anterior guidance. The anterior deep bite is not a morbid occlusion by itself, but it may cause problems such as soft tissue trauma, opposing tooth eruption, tooth wear, and occlusal trauma if there are no stable occlusal contacts between the lower incisal edge against its upper lingual surface. The most important goal of treatment is to form stable occlusal contact in centric relation. In this case report, patients with decrease in vertical dimension and anterior deep bite due to maxillary posterior tooth loss and excessive tooth wear were treated full mouth rehabilitation with increased vertical dimension to regain the space for restoration and improve anterior occlusal relationship and esthetics. The functional and aesthetic problems of the patient could be solved by the equal intensity contact of all the teeth in centic relation (CR), anterior guidance in harmony with the functional movement, and restoration of the wear surface beyond the enamel range.

Interdisciplinary planning as a landmark for treatment: Case report with a 2-years follow-up

Abstract Case report: young adult woman with esthetic complaints regarding her smile and frontal teeth aspect. At first glance, the problem seemed to be only the shape of the lateral upper incisors and a small diastema between the central incisors. The diagnosis shared between the orthodontist and the prosthetist led us to consider some other important aspects, such as the deep bite, the teeth inclination and the lips support. All these findings led us to consider that the right way to improve the esthetics of the patient's smile was to plan an orthodontic treatment. This would serve not only for the distribution of the spaces, but mostly it would improve all other problems, before the restoration of the upper lateral teeth with two ceramic veneers. Results: the treatment plan achieved the right distribution of spaces for upper lateral incisors, significant correction of the incisors inclination with important reduction of overbite and better lip support, upper laterals restorations with ceramic feldspathic veneers, obtaining a good integration with natural teeth satisfying patient complaint. Conclusion: in cases which involve interdisciplinary approach, the fundamental step comes from the beginning, when only an initial diagnosis shared among the team of specialists can define the patient problems from different points of view. In this way, we can better understand the competency fields and plan the right treatment and time sequence.

Resumo Relato de caso: paciente adulta jovem, sexo feminino, buscou tratamento devido à queixa com a estética do sorriso e o aspecto dos dentes anteriores. À primeira vista, o problema parecia ser apenas o formato dos incisivos laterais superiores e um pequeno diastema entre os incisivos centrais. O diagnóstico conjunto do ortodontista e do protesista fez com que considerássemos outros aspectos importantes, tais como mordida profunda, inclinação dentária e suporte labial. A partir de todas essas constatações, consideramos que a maneira mais adequada de melhorar a estética do sorriso seria planejar o tratamento ortodôntico. Assim, o tratamento serviria não apenas para melhor distribuição dos espaços, mas também melhoraria todos os outros problemas antes da restauração dos dentes laterais superiores ser realizada com duas facetas de cerâmica. Resultados: o tratamento planejado levou à correta distribuição dos espaços nos incisivos laterais superiores, com correção significativa da inclinação dos incisivos, importante redução da sobremordida e um melhor suporte labial, com restauração dos laterais superiores usando facetas de cerâmica feldspática, obtendo-se uma integração ideal com os dentes naturais, resolvendo as reclamações da paciente. Conclusão: em casos envolvendo abordagem multidisciplinar, as etapas iniciais são fundamentais, e apenas um diagnóstico inicial discutido entre a equipe de especialistas pode determinar os problemas do paciente sob diferentes perspectivas. Dessa forma, podemos compreender melhor os campos de competência e planejar a sequência e o tempo de tratamento mais adequados.

A case of full mouth rehabilitation in patient with loss of vertical dimension and deep bite due to tooth wear / 대한치과보철학회지

The collapse of the posterior occlusion destroys the normal occlusal plane and causes excessive wear reducing the vertical dimension. Reduced vertical dimension of occlusion causes not only aesthetic and functional problems but also overloading on the temporomandibular joints and abnormalities of muscle nerve system. In order to improve the collapsed occlusal relationship, it is necessary to consider the change of the vertical dimension. It is necessary to make a precise diagnosis and analysis before the treatment and to evaluate the adaption of patient to the new vertical dimension of occlusion. A patient with excessive overbite often has occlusal problems of tooth wear and tooth eruption. Considering these considerations, overall prosthodontic restoration is required to solve the problem. A patient of 68 year old man in this case who suffered major tooth wear and maxillary posterior teeth loss was treated with elevation of vertical dimension of occlusion by maxillary removable dental prosthesis and mandibular fixed prosthesis.

Full-mouth rehabilitation of partial edentulism in a deep bite patient / 대한치과보철학회지

Deep overbite patients who do not have proper occlusal relationship may cause problems such as teeth wear and antagonist extrusion. These lead to the collapse of occlusal plane and esthetic problem. Increasing vertical dimension is frequently essential to resolve those problems. This case report demonstrates a full-mouth rehabilitation for a patient with severe deep bite that contacts surface to surface by increasing vertical dimension. Treatment procedures included diagnosis, treatment planning, implant surgery, and prosthodontic rehabilitation. Satisfactory results were obtained in functional and esthetic aspects.

Full mouth rehabilitation in patient with loss of vertical dimension and deep bite due to worn dentition / 대한치과보철학회지

Gradual occlusal attrition is a normal process of aging. However, severe attrition causes pathogenic pulp, occlusal disharmony, functional disorder and esthetic problems. Alteration of vertical dimension should be considered for space regaining for tooth restoration, esthetic improvement or correction of occlusal relationship. Vertical dimension should be determined within the range of minimal invasive process satisfying patient's esthetic requirements and operator's functional goal. And patient's adaptation to newly determined vertical dimension should be assessed simultaneously. Deep overbite is not a simple problem of overbite, instead it is an usually complicated problem with anterior-posterior occlusal relationship. Considering these facts, appropriate restoration of edentulous part as well as improvement of anterior-posterior relationship should be performed to solve this fundamental problems. In this study, a 67 year-old male patient with many worn teeth and loss of posterior teeth was treated with removable partial denture at edentulous mandibular area to increase vertical dimension and fixed prostheses at dentulous maxillary and mandibular area. With these treatments, we attained a satisfactory result in functional and esthetic aspects as a report case.

Full mouth rehabilitation of deep bite patient with segmental osteotomy and orthodontic treatment / 대한치과보철학회지

Teeth wear and extrusion of antagonist are commonly observed in deep bite patient having severe vertical and horizontal overlap. These problems cause collapse of occlusal plane and abnormal anterior guidance. Without restoring harmonious occlusion, loss of multiple teeth and decreased masticatory function could not be prevented. To resolve problems associated with deep bite, multidisciplinary treatment including oral surgical, orthodontic and prosthetic treatment should be performed. This clinical report describes the results of increasing occlusal vertical dimension with a full-mouth restoration procedure. The treatment procedures include extraoral and intraoral examination, diagnosis, treatment planning, diagnostic wax-up, segmental osteotomy, orthodontic intrusion and prosthodontic rehabilitation. Full mouth rehabilitation with increasing occlusal vertical dimension can solve esthetic and functional problems.

A Cephalometric Evaluation of Anterior Deep Bite in Class II Malocclusions.

Background & objectives: Vertical malocclusions of the incisor teeth namely, anterior openbite and deep overbite present a challenge to the orthodontic clinicians. Determining the etiology of these is utmost important for further treatment planning and prognosis. Present study was carried out to understand the dentofacial skeletal pattern of the deep overbite in two types of deformities, Angle's Class II Div.l & Class II Div.2 (study group) and comparing them with normal occlusion (control group). Methods: Lateral cephalogram of total 60 pts, 20 in each of the above mentioned groups were analysed using 19 linear and 8 angular parameters and results of each group were compared with other two groups and conclusions were drawn. Result and conclusion: Larger posterior facial height, lower anterior facial height, lower gonial angle, larger Jaraback’s ratio & reduced lower molar height together contribute to horizontal growth pattern. It was concluded that there is more horizontal growth pattern in class II div. 2 cases hence the deepbite is more severe in class II div.2 cases compared to div.1 cases.

Efectividad del Equiplán en el tratamiento de la mordida profunda / Effectiveness of the Equiplan in the deep bite treatment

Introducción: la mordida profunda es una maloclusión que se caracteriza por el excesivo sobrepase de los incisivos superiores respecto a los inferiores, siendo causa directa de alteraciones funcionales en otras partes del sistema estomatognático. Varias son las opciones terapéuticas para su corrección, entre ellas, el uso del Equiplán, que ha sido empleado a lo largo de cinco décadas en la recuperación del equilibrio oclusal perdido por esta entidad. Objetivo: valorar la efectividad del Equiplán en el tratamiento de la mordida profunda. Material y Método: se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos: MEDLINE, PubMed y Scielo, con la utilización de descriptores como Equiplán, mordida profunda, rehabilitación neuroclusal. Resultados: el Equiplán mejora la sobremordida por extrusión de los dientes posteriores sin modificar notablemente la posición vertical de los incisivos, y reduce el tiempo de tratamiento en los pacientes según su biotipo facial. Conclusiones: considerando los fundamentos de la Rehabilitación Neuroclusal sobre los que se sustenta su uso, y la experiencia favorable de otros autores, se concluye que el Equiplán es efectivo en el tratamiento de la mordida profunda, al provocar cambios sustanciales del sobrepase en un período de 4 meses.

Introduction: the deep bite is a malocclusion characterized by the excessive overbite of the upper incisors related to the lowers, being the main cause of functional disorders. There are several options to treat it and the use of Equiplan is one of them. For five decades, this appliance has been proved to be effective recovering the occlusal balance. Objective: to reflect the effectiveness of the Equiplan in the deep bite treatment. Materials and Methods: reference systems such as MEDLINE, PUBMED, SCIELO were consulted. It was also made a revision of descriptors like Equiplan, deep bite, treatment, neuro-occlusal rehabilitation. Results: equiplan improves the overbite due to the extrussion of posterior teeth without remarkable changing in the vertical position of incisors, which reduces the treatment period, according to the biofacial type of the patient. Conclusions: considering the fundamentals of neuro - occlusal rehabilitation, a substantial change in the remission of the deep bite has been found in a four month period with the use of Equiplan.

Application of lingual bonding apparatus on anterior teeth in patients with deep overbite / 中国基层医药

Objective To introduce a new method to open bite.Methods Compound resin materials were used to make a bonding type deep-bite opening device on the lingual side of anterior teeth in 21 patients.Results 21 patients with deep overbite treatment by this method achieved satisfactory results.Average time in Ⅱ°deep bite pa tients was(3.5 ± 1.4)months,and(5.4 ± 1.2)months in Ⅲ°deep bite patients.Conclusion This device is favorable for rapidly opening deep-bite and is simple and effective.

Deep overbite—A review.

Abstract :- Deep overbite or Deep bite is one of the common malocclusion which has a varied of etiologies. The etiology may be present at different levels of structures, Viz. dental skeletal, combination of skeletal and dental etc..,The treatment plan depends upon the severity and the age of the patient. A review of deep bite in general with due reference to some treated cases is done in this article

Relato de caso de tratamento de sobremordida com placa de mordida / Treatment of deep bite with bite plate: a case report

Determinados aspectos da má oclusão, particularmente a mordida profunda, podem ser relacionados com a saúde do periodonto e das articulações temporomandibulares (ATM). Na Ortodontia, a mordida profunda foi considerada sempre como uma anomalia difícil de corrigir, mas também como o primeiro passo para poder prosseguir o tratamento ortodôntico. Um relato de caso de mordida profunda e mordida cruzada do incisivo lateral esquerdo superior permanente em uma má oclusão em dentição permanente classe I ilustra os princípios de tratamento do caso. A redução da mordida profunda utilizando placa da mordida (Equi-Plan) mostrou-se eficiente em um curto período de tempo (4 meses). O padrão mesofacial do paciente favoreceu o tratamento rápido da mordida profunda, da mesma maneira que um tipo dolicofacial é também propício pelo fato de o padrão de crescimento facial vertical ser mais favorável. No contraste, o tipo braquifacial exige mais tempo na hora de tratar a mordida profunda

Certain aspects of malocclusion, particularly deep bite, can be related to periodontal pathology and the healthy of temporomandibular joints (TMJ). In orthodontics, deep bite has always been considered as a difficult anomaly to correct, but also as the one most hindering to solving the problems resulting from other associated malpositions. A case report of deep bite and crossed bite of permanent upper left lateral incisor in a Class I malocclusion and permanent dentition illustrates the principles of case management. The reduction of deep bite using bite plate (Equi-Plan) showed quick and short time in permanent dentition (within 4 months). The mesofacial type of the patient favored the fast treatment of the deep bite, in the same way that a dolicofacial type also is favorable because of the facial vertical growth pattern. In contrast, the braquifacial type demands greater time to treat the deep bite

Efectos musculares de las pistas directas planas en pacientes de 3 a 5 años con mordida profunda / Muscular effects of Planas Direct Tracks in patients from 3 to 5 years with deep bite

Se realizó un estudio piloto con el propósito de evaluar los cambios electromiográficos producidos por la adaptación de Pistas Directas de Planas (PDP) en una muestra de 7 niños entre los 3 y los 5 años de edad en quienes se había diagnosticado mordida profunda. Para el efecto antes de colocar las Pistas de Planas se efectuó un primer registro electromiográfico de los músculos temporal anterior y masetero derechos mientras el paciente masticaba una goma de mascar sin edulcorantes. Luego de 1 mes de la adaptación de las PDP se llevo a cabo un segundo registro del funcionamiento de los mismos haces musculares con las mismas condiciones y a continuación se realizaron las comparaciones de los dos registros obtenidos. Aunque se presentó una tendencia a la disminución de la actividad electromiográfica, los cambios no fueron estadísticamente significativos.

A pilot study in a sample of 7 children with deep bite and between 3 and 5 years old was carried out to evaluate the electromyographic changes after Planas Direct Tracks (PDT) adaptation. An initial electromyographic register of the masseter and anterior temporal right muscles was made while the children chewed gum. A month after the PDT adaptation, a second electromyographic register was taken and comparisons were made. Although an electromyographic activity decrease tendency was presented, the changes were not statistically significant.

A cephalometric study on mesiodistal axial inclination of posterior teeth in open bite and deep bite / 대한치과교정학회지

For the purpose of investigating mesiodistal axial inclination of posterior teeth in normal occlusion group, open bite and deep bite group and investigating the correlationship between the axial inclination of posterior teeth and overbite of anterior teeth, a cephalometric study was performed on the subjects consisted of normal occlusion group(40), open bite group(71 : Angle's Class I 21, Class II, division 1 25, Class III 25) and deep bite group(64 : Angle's Class I 23, Class II, division 1 21, Class III 20). Mesiodistal axial inclination of posterior teeth to occlusal, mandibular and palatal plane were measured. The findings of this study were as follows: 1. Upper and lower posterior teeth were more mesially inclined to occlusal plane in open bite group than in deep bite group. 2. Lower posterior teeth were more mesially inclined in deep bite group than in open bite group in Angle's Class II, division 1 malocclusion but there were no significant differences in Angle's Class I and Class III malocclusion. 3. There was no significant correlationship between the axial inclination of posterior teeth to each plane and overbite of anterior teeth in open bite group. 4. There was a significant correlationship between the axial inclination of upper and lower second premolar to occlusal plane and overbite of anterior teeth in Angle's Class I, Class II, division 1 and Class III malocclusion.