An overbite, technically known as a deep bite or excessive vertical overlap, is a common type of malocclusion where the upper front teeth significantly cover the lower front teeth when the back teeth are closed. This misalignment can lead to functional issues, uneven wear on tooth surfaces, and potential jaw pain over time. Orthodontists use specialized diagnostic methods and mechanical forces to reposition the teeth and jaws, effectively correcting this issue.
Initial Assessment and Diagnosis
A thorough initial assessment determines the nature and severity of the overbite. The orthodontist conducts a detailed clinical examination, visually assessing the relationship between the upper and lower dental arches and the underlying skeletal structure. This step helps distinguish between a dental overbite, where only the teeth are misaligned, and a skeletal overbite, which involves an imbalance in jaw size or position.
Collecting comprehensive diagnostic records is the next step, often including specialized X-rays. A panoramic X-ray provides a broad view of all teeth and surrounding bone, while a cephalometric X-ray captures a profile view of the skull and jaw, allowing for precise angular measurements. These measurements help the clinician identify the exact cause of the excessive vertical overlap and plan precise treatment.
Modern practices incorporate three-dimensional digital scans to create accurate models of the dental arches. These digital records, along with the radiographic data, form the complete diagnostic package. This phase is important for determining whether the patient is a growing individual, eligible for orthopedic growth modification, or an adult requiring different corrective mechanics.
Corrective Treatments for Growing Patients
For growing patients, typically between the ages of 7 and 10, orthodontists recommend Phase I or interceptive treatment. This early intervention utilizes the child’s growth potential to modify the underlying skeletal discrepancy causing the overbite. The goal is to guide the development of the jaws into a more balanced relationship before the onset of the pubertal growth spurt.
Functional appliances are employed to encourage forward growth of a recessed lower jaw (mandible) or to restrict the growth of an overly prominent upper jaw (maxilla). The Herbst appliance, a fixed device, holds the lower jaw in a forward position, stimulating bone remodeling. This guided growth reduces the skeletal component of the overbite by correcting the front-to-back jaw relationship.
Other devices, such as removable palatal expanders, may be used if the upper jaw is too narrow, which can be a contributing factor to the deep bite. By widening the arch, space is created and the bite relationship improves. This type of treatment aims to achieve a better foundational structure before all permanent teeth erupt, often reducing the complexity and duration of the second phase of comprehensive treatment.
The timing of this early intervention is important because facial skeletal structures are pliable and responsive to orthopedic forces. Correcting the skeletal imbalance during this growth period can sometimes eliminate the need for more invasive procedures, such as jaw surgery, later. Phase I treatment typically lasts 12 to 18 months and sets the stage for future definitive tooth alignment.
Comprehensive Treatment for Adults and Teens
Once skeletal growth is complete, comprehensive orthodontic therapy begins, focusing on the movement and alignment of the teeth. This phase is common for older teens and adults, targeting the remaining dental component of the overbite and the final occlusion. Traditional braces, consisting of brackets and wires, exert continuous, controlled forces to reposition teeth within the alveolar bone.
Contemporary options include clear aligner systems, which use a series of custom-made, removable plastic trays to gradually move the teeth. Whether using braces or aligners, the orthodontist employs auxiliary mechanics to achieve the complex movements needed to correct the deep bite. This frequently involves interarch elastics, worn between the upper and lower arches to apply forces that pull the upper back teeth up and the lower back teeth down, opening the bite vertically.
For cases involving significant tooth intrusion or extrusion, temporary anchorage devices (TADs) may be used. These small, biocompatible screws are temporarily placed into the jaw bone to act as a fixed anchor point, allowing the orthodontist to apply precise, localized forces for moving specific groups of teeth. TADs can be effective in reducing a deep bite by intruding the upper or lower front teeth.
For severe skeletal overbite cases where growth modification is no longer possible, and dental correction alone is insufficient, the treatment plan may require orthognathic surgery. This procedure involves the surgical repositioning of the jaw bones to achieve a proper skeletal relationship, which is performed in conjunction with orthodontics to align the teeth on the newly positioned jaws. This combined approach offers the most dramatic correction for severe skeletal discrepancies in non-growing patients.
Maintaining the Correction: The Retention Phase
Achieving the correct bite relationship is only the first step; the next challenge is maintaining it through the retention phase. Teeth possess a natural tendency to shift back toward their original positions, a phenomenon known as relapse. This occurs because surrounding soft tissues, including the gingival fibers and periodontal ligaments, exert forces that attempt to pull the teeth back.
To counteract these forces, patients must diligently wear retainers. Retention devices fall into two main categories: fixed and removable. Fixed retainers are thin wires custom-bonded to the tongue-side surfaces of the front teeth, providing continuous, passive stabilization that cannot be removed by the patient.
Removable retainers, such as Hawley retainers or clear plastic aligner-style retainers (vacuum-formed retainers), are worn full-time initially and then typically transition to nighttime use indefinitely. The long-term commitment to wearing retainers is necessary to ensure the stability of the corrected overbite. Without consistent retention, the dental and skeletal improvements can gradually degrade.