An overbite, often called a deep bite, is a common form of malocclusion where the upper front teeth excessively overlap the lower front teeth vertically. While some overlap is normal, an excessive overbite can lead to functional problems, including premature wear on the lower teeth and potential soft tissue damage to the roof of the mouth. Correcting this condition is a frequent goal of orthodontic treatment. The appropriate method depends entirely on the underlying cause and the patient’s age, drawing on techniques from growth modification to surgery.
Understanding the Underlying Cause: Dental vs. Skeletal Overbites
Successful correction of an overbite begins with identifying whether the issue is dental, skeletal, or a combination of both. A dental overbite is primarily a problem of tooth position, often resulting from the over-eruption of the front teeth or the under-eruption of the back teeth. This type of malocclusion exists even when the underlying jawbones are correctly aligned.
In contrast, a skeletal overbite, frequently classified as a Class II malocclusion, involves a structural misalignment of the jawbones themselves. This occurs when the lower jaw (mandible) is positioned too far back relative to the upper jaw (maxilla). The resulting discrepancy in jaw size or position is a more significant challenge to correct and dictates a more involved treatment plan.
Interceptive Treatment for Growing Patients
For children whose jaws are still actively developing, interceptive orthodontics offers an opportunity to correct a skeletal overbite. This treatment phase, often called Phase I, typically begins around ages 7 to 14, taking advantage of the pubertal growth spurt. The goal is to modify the growth pattern of the jaws to improve their relationship before the permanent teeth fully erupt.
Functional appliances are the basis of this approach, designed to hold the lower jaw forward to stimulate its growth. Devices like the Herbst appliance are fixed to the back teeth and use telescopic rods to posture the mandible forward. Because the Herbst appliance is fixed, it works constantly, overcoming compliance issues associated with removable appliances like the Bionator or Twin Block. These appliances aim for skeletal correction to reduce the jaw discrepancy, creating a balanced foundation for permanent teeth alignment.
Comprehensive Orthodontic Solutions for Alignment
When jaw growth is complete or the overbite is primarily dental, the focus shifts to comprehensive orthodontic solutions aimed at moving the teeth within the jawbone. Traditional fixed braces utilize a system of brackets, archwires, and elastics to apply continuous forces for deep bite correction. The archwires are shaped to intrude (push up) the front teeth while simultaneously extruding (pulling down) the back teeth to open the bite.
Clear aligner therapy, such as Invisalign, is effective for mild to moderate overbites but often requires auxiliary components. Attachments, which are small, tooth-colored composite bumps bonded to the teeth, provide the necessary grip for complex movements like intrusion. For deep bite cases, orthodontists incorporate bite turbos or bite ramps, which are small pads placed behind the upper front teeth or on the back molars. These temporary bumpers prevent the patient from biting all the way down, allowing the back teeth to erupt slightly and shallow the overbite.
Surgical Correction for Severe Skeletal Discrepancies
For adults with a severe skeletal overbite that cannot be corrected by tooth movement, orthognathic surgery (jaw surgery) may be necessary. This approach is reserved for pronounced Class II cases where the lower jaw is significantly underdeveloped or retruded. The procedure aims to physically reposition the jawbones to achieve proper bite alignment and improve facial aesthetics.
The process begins with pre-surgical orthodontics, lasting an average of 6 to 18 months, to align the teeth within their respective jaws. The most common surgical procedure is the Bilateral Sagittal Split Osteotomy (BSSO), which involves making cuts behind the lower molars to allow the lower jaw segment to be moved forward. After the new position is secured with small titanium plates and screws, post-surgical orthodontics follows to fine-tune the final bite relationship.
Maintaining the Results: The Retention Phase
Once the active movement phase of treatment is complete, the retention phase begins to prevent orthodontic relapse. The tissues and fibers surrounding the newly moved teeth require time to stabilize in their corrected positions. The long-term stability of a deep bite correction is susceptible to recurrence unless properly retained.
Retention devices fall into two main categories: fixed and removable. Fixed retainers consist of a thin, braided wire bonded to the tongue-side surface of the front teeth, typically canine-to-canine on the lower arch. Removable retainers include Hawley retainers (made of acrylic and wire) or vacuum-formed clear retainers (Essix retainers). Consistent wear of a removable retainer, initially full-time and then transitioning to night-time only, is a commitment necessary to ensure the corrected bite remains stable.