A malocclusion, or a “bad bite,” describes a misalignment of the teeth and jaws, and one of the most common forms is an overbite. This condition is characterized by an excessive vertical overlap of the upper front teeth over the lower front teeth. While a slight overlap is normal, a deep overbite can compromise dental health and function. Correcting this misalignment involves a range of orthodontic treatments that vary depending on the patient’s age and the severity of the bite problem.
Defining the Overbite and Its Effects
An overbite, technically known as a deep bite, measures the vertical relationship between the upper and lower teeth. A healthy bite involves the upper teeth covering about 25% of the lower teeth when biting down; exceeding this is considered an excessive overbite. The overbite is often confused with an overjet, which refers to the horizontal protrusion of the upper front teeth. Both are Class II malocclusions, but overbite is vertical, while overjet is horizontal.
Causes of an overbite are typically a combination of skeletal factors, such as a disproportionate size or position of the upper and lower jaws, and dental factors, including the position of the teeth themselves. Early childhood habits, such as prolonged thumb-sucking or pacifier use, can also contribute to the development of this issue.
Uncorrected overbites can lead to several long-term problems. A deep bite causes uneven wear on the lower front teeth due to excessive force. In severe cases, the lower front teeth can bite directly into the gum tissue behind the upper teeth, causing trauma and gum recession. This misalignment can also strain the temporomandibular joints (TMJ), potentially leading to jaw joint pain, headaches, and difficulty chewing.
Optimizing the Timing of Intervention
The timing of orthodontic intervention is a major factor in determining the type and duration of treatment required. For children, the American Association of Orthodontists recommends an initial evaluation around age seven to identify developing skeletal discrepancies while the child is still growing.
Intervention at a young age typically falls under Phase I, or interceptive, treatment (ages seven to ten). The primary goal of Phase I is to modify jaw growth and guide the eruption of permanent teeth, utilizing the body’s natural growth potential. Early correction can often simplify or shorten the second phase of treatment.
Phase II, or comprehensive treatment, generally begins during adolescence (ages 11 to 15) once most permanent teeth have erupted. For adolescents and adults whose growth is complete, treatment focuses primarily on moving the teeth within the jawbone to achieve the correct alignment and bite. Adult treatment is highly effective, but it cannot modify skeletal structure to the same degree as treatment during childhood.
Active Treatment Modalities
The correction of an overbite involves a range of appliances, selected based on whether the problem is primarily dental (misaligned teeth) or skeletal (misaligned jaws). Traditional metal or ceramic braces are a common and highly effective method. They use brackets bonded to the teeth and connected by archwires, applying continuous, gentle forces to reposition the teeth and correct the vertical bite plane.
Clear aligners, such as those made of thin, transparent plastic, offer a less noticeable alternative for tooth movement. They can effectively correct mild to moderate overbites by gradually adjusting the position of the teeth. However, complex overbite cases often require the mechanical advantage of traditional fixed appliances or auxiliary attachments to achieve the necessary vertical control.
When the overbite is caused by a skeletal discrepancy (lower jaw positioned too far back), functional appliances are used, primarily in growing patients during Phase I treatment. Devices like the Herbst appliance or the Mandibular Anterior Repositioning Appliance (MARA) encourage the forward growth of the lower jaw while simultaneously moving the upper molars backward. These fixed appliances utilize the child’s growth spurt to correct the jaw relationship and reduce the severity of the malocclusion.
Orthodontic treatment often incorporates auxiliary tools to assist with deep bite correction. Bite plates or turbos are small acrylic or resin ramps placed behind the upper front teeth or on the back teeth. These devices temporarily prevent full contact, allowing the back teeth to emerge slightly and reducing the vertical overlap of the front teeth. In cases of severe skeletal discrepancies that cannot be corrected by orthodontics alone, orthognathic surgery may be necessary. This involves surgically repositioning the upper or lower jaw to achieve a balanced skeletal relationship, typically performed in conjunction with comprehensive orthodontic treatment.
Maintaining Correction Post-Treatment
Once the active phase of treatment is complete, the final stage is retention. This phase is crucial because teeth have a natural tendency to shift back toward their original positions, a phenomenon known as relapse. Consistent retainer wear is necessary to stabilize the new tooth and jaw positions until the surrounding bone and ligaments fully adapt.
Retention is achieved through various types of retainers. Removable retainers include the Hawley retainer (metal wire and acrylic base) and clear vacuum-formed retainers (thin, transparent trays). The Hawley design is often more adjustable and durable, while the clear retainers are more discreet.
Fixed retainers consist of a thin wire bonded directly to the back surface of the front teeth, most commonly on the lower arch. This type of retainer provides continuous, non-removable stabilization, eliminating the need for patient compliance. Long-term or lifelong retention, often involving nighttime wear, is recommended to ensure the corrected bite remains stable against the forces of muscle memory and natural aging.