Jaw Deformity Nomenclature PDF

# Jaw Deformity Nomenclature ## Category Aspect Names ### Size * **Too big**: Hyperplasia, macrognathia, macrogenia * **Too small**: Hypoplasia, micrognathia, microgenia ### Position * **Anteroposterior**: Prognathism, retrognathism * **Transverse**: Laterognathia * **Vertical**: Excessive downw...

# Jaw Deformity Nomenclature ## Category Aspect Names ### Size * **Too big**: Hyperplasia, macrognathia, macrogenia * **Too small**: Hypoplasia, micrognathia, microgenia ### Position * **Anteroposterior**: Prognathism, retrognathism * **Transverse**: Laterognathia * **Vertical**: Excessive downward displacement, insufficient downward displacement ### Shape * **Completeness Distortion**: Agenesis, cleft, Symmetry Defect ## Geometric Classification of Jaw Deformities * **Deformities of size**: occur when a jaw is either too large or too small. * **Hyperplasia**: indicates pathological enlargement. * **Hypoplasia**: signifies the failure to attain normal size. * **Micrognathia**: is a synonym for mandibular hypoplasia. * **Macrognathia**: corresponds to mandibular hyperplasia. * **Macrogenia**: indicates a large chin. * **Microgenia**: indicates a small chin. * **Abnormal jaw positions**: occur in all cardinal directions. * **Prognathism**: occurs when a jaw is too far forward. * **Retrognathism**: occurs when a jaw is too far backward. * **Transverse**: direction a jaw can be displaced, in either direction, away from the median plane. ## Dental Arch Deformities * **Curve of Spee**: is deep when the cusps of the teeth trace a plane with sharp upward curvature. The curve is reversed when the curvature of the plane has downward concavity. * **Spacing**: is abnormal when diastemas are present or when the arch cannot accommodate the teeth. * **Excessive dental spacing**: first condition. * **Dental crowding**: second condition. * **Harmonized arches**: for normal occlusion to occur, the upper and lower arches must also be coordinated: in position, shape, and tooth size. * **Discordant dental arch positions**: cause malocclusion. This lack of concordance can occur among all cardinal planes: anteroposterior, vertical, and transverse. ## Angle's Molar Relationship Angle's molar relationship assesses the position of the buccal groove of the lower first molar in relation to the mesiobuccal cusp of the upper. * **Class I molar relationship**: these landmarks coincide. * **Class II relationship**: the lower molar groove is behind the upper cusp. * **Class III relationship**: the lower molar groove is in front of the upper cusp. **Canine region**: a similar assessment is done. * **Class I canine relationship**: the lower-canine-first- premolar embrasure coincides with the cusp of the upper canine. * **Class II relationship**: the embrasure is behind the upper canine cusp. * **Class III relationship**: the embrasure is in front of the upper canine cusp. **Overjet**: is the horizontal distance between the incisal edges of the upper and lower central incisors. * **Zero overjet**: the lower incisal edge coincides with the upper. * **Positive overjet**: the lower incisal edge is behind the upper. * **Negative overjet**: lower incisal edge is in front the upper. ## Jaw Deformities * **Laterognathia**: a jaw can be too far down (excessive downward displacement) or too far up (deficient downward displacement). * **Malrotations**: are classified according to the axis on which the abnormal rotation occurs. * **Abnormal pitch**: jaw is malrotated around the transverse facial axis. * **Abnormal roll**: jaw is malrotated around the anteroposterior axis, also known as cant. * **Abnormal yaw**: jaw is malrotated around the vertical axis. * **Shape**: refers to figure, the geometric characteristic of an object that is not size, position, or orientation. A jaw with abnormal shape is said be distorted. * **Symmetry**: the human face has reflection symmetry around one plane, the median. * **Object symmetry**: each of the units comprising the face must be symmetrical * **Symmetric alignment**: each of the units must be symmetrically aligned to the median plane. * **Asymmetry**: jaws can have deformities of symmetry, either because of object asymmetry or because of misalignment. * **Mandibular and maxillary asymmetry**: refer to abnormalities in object symmetry. * **Asymmetric alignment**: used to denote abnormal alignment causing asymmetry. * **Completeness**: refers the wholeness of the jaw. A jaw can be incomplete because one of its processes did not fully develop; for example, agenesis of the condylar process of the mandible, which may be seen in hemifacial microsomia. Completeness can also fail to occur because some of the jaw's embryologic processes failed to fuse (e.g., cleft), or because of an acquired defect. ## Occlusion * **Overjet**: Ideal range is +2mm. * **Types of occlusion**: * **Neutrocclusion**: The molar and canine relationships are Class I and the overjet is normal. * **Distocclusion**: The molar and canine relationships are Class II and the overjet is either greater than normal (Division 1) or normal (Division 2). * **Mesiocclusion**: The molar and canine relationships are Class III and the overjet is smaller than normal, usually negative. * **Position discordance**: between the upper and lower dental arches also occurs in the vertical direction. * **Open bite**: absence of vertical overlap between the upper and lower teeth. * **Deep bite**: excessive vertical-overlap of the anterior teeth. * **Posterior bite collapse**: excessive vertical-overlap of the posterior teeth. * **Discordance between the maxillary and mandibular dental arches**: can also occur in the transverse dimension. * **Posterior crossbite**: When the reverse occurs, we encounter a posterior crossbite. In extreme cases, all the lower teeth can be inside the upper, a condition known as Brodie bite. * **Scissor bite**: Conversely, the upper teeth can be inside the lower, a condition known as scissor bite. * **Arch shape-discordance**: abnormally because they have different shapes. For example, a "U" shaped lower arch does not fit a "V" shaped upper. The lack of shape congruency between the upper and lower teeth results in arch shape-discordance. ## Dental Arch * **Teeth paradontium and alveolar ridge**: form the whole functional entirety -dental arch. * **Dental arch consists of**: * **Extra-parts**: crowns of teeth. * **Intra-alveolar parts**: teeth roots. * **Deciduous bite**: the dental arch is semi-circle shape. * **Permanent bite**: the upper dental arch is elliptic and the lower one is parable. * **Anomalies of entire dental arch**: can be considered in three perpendicular planes: * **Sagittal**: arch length discrepancies. * **Transversal**: narrowing/widening. * **Vertical**: infra/supra anomaly. ## Causes of Dental Arch Elongation * **Pathologies of upper respiratory ways**: characterized with breathing through open mouth, macrodentia, supernumerary teeth in the dental arch, swallowing problems, incorrect tongue articulation, bad habits (sucking of finger, tongue, pencil, prolonged use of pacifier) * **Elongation of the dental arch**: frequently occur with sagittal, transversal occlusion and open disocclusion. ## Treatment of Dental Arch Elongation * **Deciduous bite**: elimination of risk factory, massage, myotherapy. * **Temporary bite**: prevention of arch growth with the intra- and extra-oral removable appliances. * **Permanent bite**: treatment is provided with fixed and removable intra-oral removable appliances, teeth extraction, if indicated (first or second premolars) ## Causes of Dental Arch Shortening * **Adentia**: Shortening of the dental arch is mostly caused by adentia, retention, incorrect location of the buds or their eruption out of the arch, early extraction of deciduous teeth, microdentia, abnormal jaw size, bad habits (sucking of the lips, tongue etc). * **Distal occlusion**: Shortening of the dental arch is frequent in combination with distal (mandibular dental arch) and mesial (maxillary dental arch) occlusion. ## Treatment of Dental Arch Shortening * **Deciduous bite period**: elimination of risk factors, normalization of functions, massage, myotherapeutic exercises, in case of different types of jaw deformities (size, position, orientation, shape, symmetry, and completeness) are frequently correlated. ## Alignment, Leveling and Spacing * **Alignment**: refers to the arrangement of teeth in an arch. In ideal alignment, the incisal edges of the incisors and the buccal- cuspal ridges of the canines, premolars, and molars form an arch. * **Misalignment**: can occur because of dental displacement, dental tipping, or dental rotations. * **Displacement**: a tooth is bodily moved outside the arch. * **Tipping**: a tooth is abnormally inclined. * **Rotations**: a tooth is misaligned because of abnormal rotation around its long axis. * **Leveling**: refers to the vertical arrangement of teeth. Abnormal leveling can affect a single tooth or the whole arch. * **Measurement**: one measures the vertical positions of the lower teeth in relation to the mandibular occlusal plane and the vertical positions of the upper teeth in relation to the maxillary occlusal plane. * **Infraocclusion and supraocclusion**: an individual tooth is in infraocclusion or supraocclusion when it is located below or above its ascribed occlusal plane. ## Alignment, Leveling and Spacing * **Curve of Spee**: for the entire dental arch, one judges dental leveling by gauging the curve of Spee. From the central incisor backward to the last molar, the cusps of all teeth should inscribe either a flat plane or a curved plane of slightly upward concavity. Dental deformity can create a deep or a temporary bite-stimulation of jaw growth by removable appliances. In case of permanent bite: removable and fixed intra-oral appliances, in certain cases extraction are indicated (first, second premolar, first molar) ## Dental Arch Anomalies * **Vertical plane**: dental arch anomalies include extrusion and intrusion. * **Measurement**: of the dental arch height is provided in relation to the occlusion curve. * **Extrusion**: is frequently combined with open disocclusion, distal and mesial occlusion. * **Transversal plane**: abnormalities include: * **Imbalance**: between the masticatory, mimic and tongue muscles, impairment of swallowing, speech, respiration functions, bad habits (permanently open mouth, thumb sucking). * **Incorrect location of the tongue**: carious damages of the teeth and their early extraction. * **Narrowing**: can be symmetric, asymmetric. On one or both jaws, without occlusion problems or in combination with mesial occlusion. ## Treatment of Dental Arch Anomalies * **Deciduous and temporary bite**: elimination of the risk factors, restoration of the oral cavity functions, timely treatment of caries and its complications. * **Adentia**: providing reasonable prostheses. ## Treatment of Dental Arch Anomalies * **Deciduous teeth**: includes identification and elimination of risk factors, myotherapy, Dental arch growth stimulation. * **Pronounced abnormality**: in the period of formed temporary bite it is reasonable to use removable appliances. * **Variable bite**: treatment with appliances. * **Permanent bite**: treatment with the fixed and removable appliances. * **Widening**: is the rarest anomaly among the dental arch abnormalities. * **Causes**: incorrect location of the buds, delayed change of deciduous teeth, macrognathia, tumors. * **Symmetric or asymmetric**: on one or both jaws; it can be in combination with neutral, mesial ,distal occlusions or open disocclusion. ## Treatment of Dental Arch Anomalies * **Deciduous bite**: includes elimination of risk factors, suspension of jaw growth, massage, myotherapy, in the period of variable bite- use of removable appliances and in the period of permanent bite-treatment with fixed and removable appliances. * **Surgical intervention**: in some cases surgical intervention, plastic surgery is required. ## Front Teeth Anomalies * **Protrusion**: is characterized with vestibular inclination of the front teeth, together with the alveolar ridge, in most cases there are space between them. * **Causes**: pathologies of respiratory airways, muscle disfunction, bad habits (sucking of the lower lip, fist). * **Combination**: frequently it is in combination with distal occlusion. * **Treatment**: in the period of deciduous and variable bite includes measures against risk factors, restriction of growth of the front part of alveolar ridge with extra-oral appliance and in the period of permanent bite- correction with fixed and removable appliances. * **Retrusion**: is characterized with oral inclination of the front teeth together with alveolar ridge, in most cases this abnormality is in combination with deep occlusion and distal occlusion. * **Crowding**: of the front teeth, there is indicated palatal or labial location of the teeth or rotation of teeth. * **Causes**: disproportion between the jaw and teeth sizes, macrodentia, impairment of breathing through the nose, early loss of deciduous molars. * **Combination**: Crowding of the front teeth mostly occurs in combination with all types of abnormalities. ## Treatment of Front Teeth Anomalies * **Deciduous dentition**: treatment includes elimination of risk factors, extraction, while in case of permanent bite treatment includes fixed and removable appliances, extraction, as indicated (mostly premolars). * **Articulation impairment**: can take place, as well as biting and chewing disorders. ## Etiological Factors (Cross-bite) * **Skeletal form**: can be caused by the small maxilla, overgrown mandible or combination of both. * **Other causes**: maxillary cleft, calcium metabolism disorders, trauma, jaw growth disorders caused by the inflammatory processes, temporomandibular joint ankylosis. * **Dental arch**: can be caused by the dental anomalies: crowding, teeth eruption timing anomalies (retention, delayed second dentition, anomaly of teeth eruption sequence), teeth number anomaly(presence of supernumerary teeth), bad habits (sucking of finger, chick, prolonged use of pacifier), upper respiratory pathologies(deviated nasal septum, adenoid and tonsil hypertrophies, chronic diseases of upper respiratory airways resulting in open mouth and hence, narrowing of the maxillary dental arch). ## Diagnostics (Cross-bite) * **Basic and supplementary methods**: are applied for orthodontic diagnosing of cross bite. * **Basic methods**: include medical history and clinical examination of the patient. * **Supplementary method**: biometrical analysis of the gypsum models, study of the x-ray (panoramic radiograph, cephalogram) and photo images. ## Treatment (Cross-bite) * **Goal**: of orthodontic treatment of the cross bite malocclusion is ensuring desired contact between the occluding surfaces of the teeth, improvement of the face esthetics and, as far as possible, obtaining stable outcomes. * **Considerations**: When selecting the orthodontic treatment plan, it is necessary to take into consideration the patient's age, face proportions and type of scull growing. It may include orthodontic treatment method only or in combination of orthodontic and surgical (tooth extraction, jaw plastics, surgical widening of maxilla etc.). * **Timely and proper treatment**: yields positive outcomes. ## Treatment (Cross-bite) * **Deciduous bite**: mostly preventive measures are applied. * **Factors preventing normal growth**: should be eliminated; for example, giving up the harmful habits such as sucking of tongue, finger, pacifier. * **Pathologies of the upper respiratory airway**: timely treatment of pathologies of the upper respiratory airway is necessary as well, to prevent permanently open mouth and breathing through mouth. * **Exercises**: are prescribed to train the pterygoid muscle. * **Unworn cusps**: of the deciduous canines must be removed if they restrict transversal movement. * **Preventive appliance**: may be required. * **Mastication and facial muscle reduction**: the special exercises of the muscles are prescribed to the patient. * **Mixed and Permanent Dentition**: Orthodontic appliances are prescribed in the period of mixed and permanent dentition periods. * **Narrowed maxilla**: it is necessary to widen it by means of removable fixed appliances with the screws. * **Palatine suture**: in case of timely expanding of maxilla (up to 12-14 years in girls and up to 16 years in boys) the palatine suture is opened. Activation of the screw lasts for 1-2 months and further it is left in mouth in passive state for 3-4 months after widening is ended, to stimulate growing if the new bone tissue in the area of open suture and hence obtaining stable outcomes of treatment. * **Transversal grow of scull**: when transversal grow of scull is completed, the palatine raphe becomes bony and its opening would be impossible by orthodontic methods only (weakening of the palatine raphe surgically is required). * **Cross bite**: in treatment of cross bite, simultaneously with the widening of maxilla, it is necessary to improve teeth, dental arches or other accompanying occlusion anomalies by means of the fixed appliances -braces or other appliances. If cross bite is caused by the skeletal deformations, surgery is required for its proper treatment. ## Definition of Cross-bite * **Transversal plane occlusion anomaly**: where a tooth or group of teeth is displaced closer to the cheek or tongue or lip. In orthognathic occlusion, when the upper and lower teeth are in central occlusion position, the upper teeth overlap the lower ones, i.e. the maxillary teeth are located bucally, in relation to the mandibular ones. The palatal cusps of the maxillary premolars and molars enter the longitudinal fissures of the antagonist teeth. Cross bite occur in the front or buccal teeth areas. It can be unilateral or bilateral. Cross bite can be skeletal, dental or combined. ## Types of Cross-bite * **Buccal cusps of the maxillary premolars and molars**: are located into the longitudinal fissures of the antagonist teeth. This can be unilateral or bilateral. This anomaly is called unilateral or bilateral palatino-occlusion. * **Palatal cusps of the maxillary premolars and molars**: touch the mandibular premolar and molar buccal cusps unilaterally or bilaterally. Such alignment is called unilateral or bilateral maxillary vestibule-occlusion. * **Buccal and palatal cusps of the maxillary premolars and molars**: touch similar cusps of antagonist teeth, i.e. there is "cusp of cusp contact". Such anomaly is accompanied with shift of mandible to one site at a time of chewing, either to the right or to the left. Such anomaly is called unilateral functional cross bite. Hence, on the side there will take place palatino-occlusion of the maxilla and on the other-vestibulo-occlusion. ## Temporomandibular Joint Changes With Cross-bite * **Change with palatino-occlusion**: the mandibular articular process is shifted buccally and hence the glenoid fossa is narrowed on that side, while the lingually glenoid fossa is widened. ## Cross-bite and its Relationship with Other Anomalies * **Can occur separately**: or in combination with distal, mesial, deep or open bite. * **Esthetic and functional disorder**: cross-bite is characterized with esthetic and functional disorder. * **Changes**: in the facial esthetics is changed, in particular, the face is asymmetric, midline between upper and lower front teeth does not coincide with the face midline, chin is shifted to one side. ## Open Bite Malocclusion * **Vertical plane anomaly**: Its morphological sign is vertical gap (space) between the teeth in the central occlusion position and absence of contact between them. * **Occurs**: in the area of Arteriors or buccal teeth. * **Contact**: begins from the cuspidates, premolars or molars. * **Rarer**: Open bite of teeth is rarer and can be both, symmetric and two-sided. ## Esthetic and Functional Disorders with Open Bite * **Elongated lower third**: of the face, mouth is opened, naso-labial fold is smoothened. * **Macroglossia**: In case of macroglossia (tongue enlargement) the front third of the tongues is between the anterior teeth and because of tension of the facial muscles at a time of closing of mouth the lips are strained. * **Disorders of speech**: Open bite results in disorder of the speech, biting and chewing functions, it can also result into the breathing through the mouth. * **Paradontium**: Frequently, in case of this anomaly, the paradontium in the area of open bite is not properly loaded and frequently results in development of parodontitis. ## Types of Open Bite * **Dental-alveolar**: can be three types: * **Excessively developed alveolar ridge**: in the area of premolars and molars. * **Underdeveloped alveolar ridge**: in the area of anteriors, on the upper jaw or lower jaw only or on both, simultaneously. * **Underdeveloped alveolar ridge**: in the front teeth area while in the area of side teeth is excessively developed (elongated). ## TMJ Changes with Open Bite * **Widening of the upper part**: of the articular cavity and narrowing of the lower area. ## Etiological Factors (Open Bite) * **Genetic factor**: should be admitted. * **Mother's diseases**: at a time of pregnancy, birth trauma etc. * **Dental-alveolar form**: of the open bite can be caused by the bad habits, e.g. sucking of the tongue, lip, digit, pacifier use for long period etc., it can develop also as a result of macroglossia, pathologies of the upper respiratory airways, hypoplasia of Arteriors, neurological problems. * **Upper respiratory pathologies**: In case of upper respiratory pathologies (deviated nasal septum, allergy, adenoid and tonsil hypertrophies etc.) is characterized with difficulty of breathing through the nose, tongue is on the bottom of the oral cavity and at a time of swallowing it is placed between the front teeth infantile swallow causing disorder of contact between the teeth and formation of open bite malocclusion. * **Skeletal form**: of open bite is caused by disorders of growing of the anatomical parts of the maxilla and mandible, e.g. it can develop in case of craniofacial dysplasia (improper development). In case of craniofacial dysplasia, rotation of the palatal cusps counterclockwise takes place. This causes elongation of the lower third of the face, in such case the ascending ramus of the mandible is shortened and gonial angle is obtuse. Open bite of front teeth can develop at a time of upper lip, alveolar ridge, hard palate, soft palate cleft, as it such case maxilla growth disorder takes place. Such patients have asymmetric open bite malocclusion with localisation on the cleft side. ## Diagnostics (Open Bite) * **Basic and supplementary methods**: are applied for orthodontic diagnosing of open bite. Basic methods include medical history and clinical examination of the patient and the supplementary method is biometrical analysis of the plaster models, study of the x-ray (panoramic radiograph, cephalogram,) and photo images. ## Treatment (Open Bite) * **Goal**: of orthodontic treatment of the open bite malocclusion is ensuring desired contact between the occluding surfaces of the teeth, improvement of the face esthetics and, as far as possible, obtaining stable outcomes. * **Considerations**: When selecting the orthodontic treatment plan, it is necessary to take into consideration the patient's age, face proportions and type of scull growing. It may include orthodontic treatment method only or in combination of orthodontic and surgical (tooth extraction, jaw plastics, surgical widening of maxilla etc.). * **Timely and proper treatment**: yields positive outcomes. ## Treatment (Open Bite) * **Deciduous bite**: mostly preventive measures are applied. * **Factors preventing normal growth**: should be eliminated; for example, giving up the harmful habits such as sucking of tongue, finger, pacifier. * **Pathologies of the upper respiratory airway**: timely treatment of pathologies of the upper respiratory airway is necessary as well, to prevent permanently open mouth and breathing through mouth. * **Exercises**: are prescribed to train the pterygoid muscle. * **Unworn cusps**: of the deciduous canines must be removed if they restrict transversal movement. * **Preventive appliance**: may be required. * **Mastication and facial muscle reduction**: the special exercises of the muscles are prescribed to the patient. * **Mixed and Permanent Dentition**: Orthodontic appliances are prescribed in the period of mixed and permanent dentition periods. * **Narrowed maxilla**: it is necessary to widen it by means of removable fixed appliances with the screws. * **Palatine suture**: in case of timely expanding of maxilla (up to 12-14 years in girls and up to 16 years in boys) the palatine suture is opened. Activation of the screw lasts for 1-2 months and further it is left in mouth in passive state for 3-4 months after widening is ended, to stimulate growing if the new bone tissue in the area of open suture and hence obtaining stable outcomes of treatment. * **Transversal grow of scull**: when transversal grow of scull is completed, the palatine raphe becomes bony and its opening would be impossible by orthodontic methods only (weakening of the palatine raphe surgically is required). * **Cross bite**: in treatment of cross bite, simultaneously with the widening of maxilla, it is necessary to improve teeth, dental arches or other accompanying occlusion anomalies by means of the fixed appliances -braces or other appliances. If cross bite is caused by the skeletal deformations, surgery is required for its proper treatment. ## Definition of Deep Bite * **Vertical plane anomaly**: where the crowns of maxillary anterior teeth overlap the crowns of mandibular anterior teeth at more than one third of their length. * **Ranges**: Upper anteriors can overlap the lower anteriors from 1/3 to 2/3, from 2/3 to 3/3 and over 3/3, lower anteriors can touch the cingulum areas of the upper anteriors, maxillary alveolar ridge or palatal mucosa and traumatize the palate. * **Rare cases**: In rare cases the upper dentition can fully overlap the inferior arch and in such case the upper teeth hurt lower transitory fold while the lower teeth traumatize the palatal mucuous. ## Deep Bite and Other Anomalies * **Can occur in combination**: with distal, mesial and cross bite. * **Clinical manifestations**: depend on the anomaly in combination with which it takes place. And changes of facial esthetics depend on the latter as well. * **Changes**: The lower third of the face can be diminished and mento labial fold- particularly pronounced. ## Functional Disorders with Deep Bite * **Excess load**: Mention impairment of food nipping and masticatory functions ecessive load on the front teeth paradontium and in many case-mucuous tunic traumatizing that causes development of periodontitis and wearing of the teet. * **Temporomandibular joint disfunction**: due to excessive load of certain groups of masseter muscles takes place as well. * **Exaggerated curve of Spee**: In case of deep bite the sagittal occlusion curve- Curve of Spree is exaggerated and in heavy cases it can reach 9mm (in normal case the curve of Spee is 2mm) ## Types of Deep Bite * **Dentoalveolar**: can be three types: * **Underdeveloped alveolar ridge**: in the area of premolars and molars. * **Vertically overdeveloped alveolar ridge**: in the area of anteriors. * **Overdeveloped alveolar ridge**: in the area of anteriors and underdeveloped in the areas of buccal teeth. ## Treatment of Deep Bite * **Deciduous bite**: mostly preventive measures are applied. * **Factors preventing shortening**: shortening of the dento alveolar ridge in the buccal areas and elongation of the dentoalveolar ridge in the area of front teeth. * **Harmful habits**: For example, giving up the harmful habits such as sucking of tongue, finger, pacifier. * **Pathologies of the upper respiratory airway**: Timely treatment of the pathologies of the upper respiratory airway is necessary as well, to prevent permanently open mouth and breathing through mouth. In the event of special exercises of the muscles are prescribed to the patient. * **Chewing**: In the period of given bite, it is recommended to make a child to chew hard food product, such as raw fruits and vegetables etc. consumption of such products provide stimulation of the normal growth of dentofacial system. * **Appliances**: In the event of early loss of deciduous teeth, it is recommended to use the appliances of various structures maintaining the space or prosthetics * **Removable partials**: for the purpose of bite improvement and restoration of the mastication function, it is recommended to use removable partials. * **Mixed and Permanent Dentition**: Orthodontic appliances are prescribed in the period of mixed and permanent dentition perids. * **Curve of Spee**: The main purpose of appliances use is improvement of the sagittal occlusion curve( curve of Spee) so that it was no more than 2mm. this can be archieved by means of both, removable and fixed appliances. * **Space**: Where the removable appliances are applied, the space is created between the buccal teeth(their "disconnecting"). * **Vertical growth**: Absence of contact between the buccal teeth the dentoalveolar ridges grow vertically. * **Improve curve of Spee**: Will braces it is easy to improve curve of Spee by means of the stainless steel arches. ## Etiological Factors (Deep Bite) * **Developmental factors**: genetic factors, mother's diseases in the pregnancy period, birth trauma etc. * **Dentoalveolar form**: the most widespread include reduction of the height of the buccal teeth crowns due to caries or non-caries damage of the hard tisues of the teeth, uneven wearing of the side teeth cusps, early loss of the deciduous teeth, adentia of permanent teeth, causing bite deepening in anteriors area. * **Absence of contact**: Attention should be also paid to absence of contact between the anteriors. * **Control of vertical growth**: in orthognatic occlusion the lower central incisor edges touch the lingul surfaces of the upper antagonist crowns and the latter control vertical rowth of the lower incisors. * **Lost contact**: Where the contact between the lower and upper teeth I lost and the teeth do not touch one another, the teeth start to grow vertically and hence the bite becomes deeper. * **Bad habits**: Loss of contact between the upper and lower teeth can be caused by the bad habits (finger, lip sucking) with shortening of the lower dentition(adentia, microdentia, teeth crowding) and elongation of the upper dentition (diasthema, tremes, macrodentia) * **Skeletal form**: of deep bite is caused by disorder of growing of the anatomical parts of the maxilla and mandible. ## Diagnostics (Deep Bite) * **Basic and supplementary methods**: are applied for orthodontic diagnosing of deep bite. Basic method include medical history and clinical examination of the patient and the supplementary method is biometrical analysis of the gypsum models, study of the x-ray (panoramic radiograp, cephalogram) ad photo images. ## Treatment (Deep Bite) * **Goal**: of orthodontic treatment of the deep bite malocclusion is ensuring desired contact between the occluding surfaces of the teeth, improvement of the face esthetics and, as far as possible, obtaining stable outcomes. * **Considerations**: When selecting the orthodontic treatment olan, it is necessary to take into consideration the patient's age, face proportions and type of scull growing. It may include orthodontic treatment method only or in combination of orthodontic * **Timely and proper treatment**: yields positive outcomes. ## Treatment (Deep Bite) * **Deciduous bite**: mostly preventive measures are applied. * **Factors preventing shortening**: shortening of the dento alveolar ridge in the buccal areas and elongation of the dentoalveolar ridge in the area of front teeth. * **Harmful habits**: For example, giving up the harmful habits such as sucking of tongue, finger, pacifier. * **Pathologies of the upper respiratory airway**: Timely treatment of the pathologies of the upper respiratory airway is necessary as well, to prevent permanently open mouth and breathing through mouth. In the event of special exercises of the muscles are prescribed to the patient. * **Chewing**: In the period of given bite, it is recommended to make a child to chew hard food product, such as raw fruits and vegetables etc. consumption of such products provide stimulation of the normal growth of dentofacial system. * **Appliances**: In the event of early loss of deciduous teeth, it is recommended to use the appliances of various structures maintaining the space or prosthetics * **Removable partials**: for the purpose of bite improvement and restoration of the mastication function, it is recommended to use removable partials. * **Mixed and Permanent Dentition**: Orthodontic appliances are prescribed in the period of mixed and permanent dentition perids. * **Curve of Spee**: The main purpose of appliances use is improvement of the sagittal occlusion curve( curve of Spee) so that it was no more than 2mm. this can be archieved by means of both, removable and fixed appliances. * **Space**: Where the removable appliances are applied, the space is created between the buccal teeth(their "disconnecting"). * **Vertical growth**: Absence of contact between the buccal teeth the dentoalveolar ridges grow vertically. * **Improve curve of Spee**: Will braces it is easy to improve curve of Spee by means of the stainless steel arches. ## Definition of Mesial Bite * **Sagittal plane bite anomaly**: According to Angle's classification, it is class III anomaly, where the mesiobuccal cusp of maxillary first molar lies on the distal cusp of the mandibular first molar or between the first and second molars. * **Lower front teeth**: may touch the upper front teeth or be in reverse bite (under-bite). * **Sagittal space**: If the mandibular front teeth are in reverse bite and do not touch the antagonist, the sagittal space exists. * **Mandibular prognathism**: Mesial occlusion is called mandibular prognathism. This originates from Greek: pro-forward, gnathos -jaw. ## Types of Mesial Bite * **Skeletal**: can be caused by underdevelopment of the maxilla, excessive development of mandible or their combination. * **Dentoalveolar**: is characterized with the arterior location of the lower teeth in relation to the maxillary teeth, elongation of the lower dental arch, shortening of the maxillary dental arch or their combination. * **Combination**: of the skeletal, excessive development of the mandible or their combination. ## TMJ Considerations with Mesial Bite * **Changes in temporomandibular joint**: in particular, mesial narrowing and distal widening of the articular cavity. ## Mesial Bite and Other Anomalies * **Open bite and cross bite**: Mesial occlusion can occur in combination with open bite and cross bite. ## Esthtic and Functional Disorders with Mesial Bite * **Elongation of the lower third**: of the face, the chin is massive(prominent), mentolabial fold is smoothened, nasolabial fold is apparent, the upper lip is sunken and middle third of the face is flattened (area of check-bones), mandibular body is elongated, ascending line is shortened and the angle of mandible is obtuse. * **Functional disorders**: characteristic for mesial occlusion are as follows: disorder of articulation, disorders of biting and chewing. ## Etiological Factors (Mesial Bite) * **Genetic predisposition**: mother's diseases in the pregnancy period, birth trauma, macroglossia, lingual frenulum anomalies, upper respiratory airways pathologies, bad habits: sucking of finger, upper lip, check and tongue, incorrect location of head at a time of sleeping or sitting, open mouth etc. ## Development of Mesial Bite * **Uneven wearing of deciduous cusps**: Mesial occlusion can develop also as a result of uneven wearing of the temporary teeth cusps (deciduous cusps are implied), causing protruding of the mandible. ## Definition of Distal Occlusion * **Angle's class II bite anomaly**: is called distal occlusion (i.e. prognathism, in Greek pro - forward, gnathos - jaw). * **Sagittal bite anomaly**: In distal occlusion buccal medial cusp of maxillary first molar is located anterior to inter-cusp fissure of matching molar on the medial cusp of the mandibular molar or between the mandibular second premolar and first molar. Upper front teeth do not touch the lower teeth and there is sagittal space between them. ## Early Signs of Distal Occlusion * **Deciduous bite**: the early sign of