Deepbite Malocclusion: Analysis of Underlying Components in Different Facial Growth Patterns

Research Article

J Dent App. 2015;2(3): 183-187.

Deepbite Malocclusion: Analysis of Underlying Components in Different Facial Growth Patterns

Jhalani A1, Golchha V2, Paul R3 and Sharma P4*

1Department of Orthodontics, Inderprastha Dental College and Hospital, India

2Department of Orthodontics, Inderprastha Dental College and Hospital, India

3Department of Orthodontics, Inderprastha Dental College and Hospital, India

4Sharma P, Amity institute of Physiotherapy, Amity University, India

*Corresponding author: Prof. Bahar GUCIZ DOGAN, Hacettepe University Faculty of Medicine, Dept. of Public Health, 06100, Ankara-Turkey

Received: December 01, 2014; Accepted: February 03, 2015; Published: February 05 , 2015


Background: Deep bite malocclusion should not be approached as a disease entity; instead, it should be viewed as clinical manifestation of underlying discrepancies. The present study aim to evaluate parameters of deepbite in various growth patterns.

Materials and Methods: Sample of 90 patients divided into groups of varying growth patterns: Vertical (FMA=27°), Horizontal (FMA=22°), Normal (FMA 22°-27°), were studied for cephalometric and dental measurements.

Results:Curve of spee was major contributor to deep bite in all growth patterns. Gonialangle, and maxilla mandibular alveolar base heights were correlated with deep bite in horizontal growers. Inclination of maxillary and mandibular incisors was responsible for deep bite in vertical growth pattern.

Conclusion: This analysis of deep bite components could help clinicians design individualized mechanotherapies based on underlying cause, rather than being biased toward predetermined mechanics when treating deep bite malocclusion. Hence, orthodontists should look for not just leveling of curve of spee but also the growth pattern of patient.

Keywords: Deep bite; Growth patterns;Curve of spee


A deep overbite is a common malocclusion encountered in an orthodontic practice.Severe deepbites (overbite 5 mm) are found in nearly 20% of children and 13% of adults, representing about 95.2% of vertical occlusal problems[1].A deep bite malocclusion overlies a multitude of hidden skeletal or dental discrepancies. Accordingly, a deep bite should not be approached as a disease entity; instead, it is a clinical manifestation of an underlying skeletal or dental discrepancy. Previous studies addressing deep overbite focused on detecting the changes in the dentoalveolar morphology[2,3] accompanying the changes in overbite.Other studies aimed to evaluate the effect of age on the change in overbite4and relate the increase in bite depth to other malocclusions[5].

Ceylan and Eroz[2]studied some components of deep overbite in 4 groups of patients (20 patients in each group) with variable bite depths. Among their significant findings was that the gonial angle was the largest in the open-bite group and smallest in the deepbite group. Baydaset al[4]studied the effect of the depth of the curve of Spee on bite depth in a sample of 137 subjects. They were divided into 3 groups; normal, flat, and deep curves of Spee, and the groups were compared. The results showed statistically significant correlations between the depth of the curve of Spee and overjet and overbite.

Certain components were deemed to share in a developing deepbite malocclusion, thus classifying deepbite into dental and skeletal deepbite according to the causative factor. Various dental and skeletal components of deepbite have been studied by many investigators.

Regarding dental deepbite, a deep curve of Spee[3,6]and an increased buccal root torque[7]of the maxillaryincisorswere proven to be correlated with deepbitemalocclusions. The overerupted maxillary and mandibularanterior alveolar basal heightsand the undereruptionof the maxillary and mandibular posteriorsegmentswere also shown to have positive correlationswith deepbite malocclusions[2]. Extraction of the mandibular incisors leads to a collapse of that arch with consequent deepening of the bite[8].

A skeletal deepbite could result from a discrepancy in the vertical position of the maxilla, the mandible, or their cant9.Few studies10, 11 have dealt with the components of skeletal deepbite; it was shown that the vertical component of mandibular growth has a more remarkable effect than the rotational component,and that the mandibular skeletal changes were twice as important as the mandibular dental changes and about 2.5 times as important as the maxillary changes in inducing overbite changes11.These parameters have a strong influence on the treatment planning. As a result it is important to understand the role of all dento skeletal components in occurrence of deep overbite in patients with different growth patterns.

The aim of our study is to study the parameters of deep overbite in vertical, horizontal and normal growth patterns.

Materials and Method

This is a retrospective study with sample comprising of pre Treatment lateral cephalograms and study models of 90 patients with deepbite, selected from approximately 400 patient records at the outpatient clinic of the Department of Orthodontics. The study was approved by the ethical committee as it involved the analysis of previous model and cephalometric data of the patients.

All the selected cases in the study fulfilled the following criteria: (1) Age ranged from 12 to 26 years, (2) deep overbite more than 5 mm, (3) complete eruption of the second molars, (4) no history of orthodontic treatment, (5) no severe craniofacial disorders, and (6) no missing teeth.

The records for each case enrolled into the sample included panoramic, lateral cephalometric radiographs and a well trimmed study model. Records of 400 pateints were then screened to identify cases with deep bite from which 90 patients were randomly selected for cephalometric analysis. Lateral cephalometric radiographs of the 90 cases were traced and analyzed to identify underlying skeletal pattern.

The 90 patients were broadly divided into 3 groups:

GROUP I: Vertical Growth pattern (FMA = 27°) n=30

GROUP II: Horizontal Growth patternFMA = 22°) n=30

GROUP III: Normal Growth pattern (FMA 22° -27°) n=30

The groups were studied for the following cephalometric parameter (Figure: 1,2)

    1. Vertical
      • Gonial angle
        1. Upper gonial angle(UGA)
        2. Lower gonial angle(LGA)
      • SellaNasion - mandibular plane angle (SN-MP angle)
      • Basal plane angle(BPA)
      • Mandibular plane angle(MPA)
      • Palatal plane - Frankfort plane(PP-FH)
      • Posterior/anterior facial height(PAFH)
      • Lower anterior facial height(LAFH)
      • Maxillary anterior alveolar basal height(MxABH)
      • Maxillary posterior alveolar basal height(MxPBH)
      • Mandibular anterior alveolar basal height(MnABH)
      • Mandibular posterior alveolar basal height(MnPBH)
    2. Anteroposterior
      • SellaNasion A Point( SNA)
      • SellaNasion B Point ( SNB)
      • A Nasion B Point( ANB)
      • Y axis
      • Wits appraisal
  2. DENTAL:
    • Upper Incisor - SellaNasion Angle (U1-SN)
    • Lower Incisor - Mandibular Plane Angle (L1-MP)
    • Upper Incisor - Nasion A Point Angle( U1-NA)
    • Lower Incisor -Nasion B Point Angle (L1-NB)
    • Overbite
    • Curve of spee

Statistical Analysis

Descriptive statistics were calculated, including the mean standard deviation and coefficient of variation of each dental and skeletal component of deepbite malocclusion, with the contribution of each component.

The Pearson correlation coefficient was used to correlate thevarious deepbite components.

All statistical analysis was done by SPSS 16.0 software.


The statistical analysis of the measurements showed the following results.

The means, standard deviations, and percentages of contribution of the dental and skeletal components ofdeep overbite are given (Table 1).The skeletal and dental parameters were correlated to deep over bite using the Pearson correlation coefficient test.

Citation: Dogan BG and Gokalp S. Oral Health Knowledge and Practices of Children in a Primary School in Turkey. J Dent App. 2015;2(3): 178-182. ISSN:2381-9049