Orthodontics/Hello

Advertisement


Question
Bite
Bite  
I have a deep bite. I've been told that I can get braces for upper and lower or just lower teeth. The front lower teeth touch the gums behind my upper teeth. My question is when having braces if I were to only straighten the lower part how do they straighten such teeth? Do they pull the lower back teeth up to match the front lower or do they push the front lower teeth down? I found a photo online that looks similar to my situation. Also, my top teeth are straight.

Answer
Hello Alex!

I have been mulling over your question and thinking of the various solutions to help address your deep anterior vertical overbite. First the normal legal mumbo-jumbo preamble,  namely that what I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise, or any form of treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Unfortunately I do not have any lateral cephalometric X-rays to allow me to better assess if your deep vertical overbite problem is primarily dental or skeletal in nature. In other words, a poor bite relationship can be due to the poor alignment of the teeth (dental in nature), or due to a mismatch in the skeletal architecture of the upper and lower jaws (skeletal in nature). In practical terms, it is often a combination of both, particularly because a skeletal imbalance will influence the manner in which the teeth erupt.  

Let me go through your que4stion step by step.  Your wrote :
  
“I have a deep bite. I've been told that I can get braces for upper and lower or just lower teeth. The front lower teeth touch the gums behind my upper teeth.”

This comment may indicate that not only do you have a deep anterior vertical overbite,  but you may also have an anterior-posterior bite disharmony known as “horizontal overjet”. A vertical overbite is an up-down vertical disharmony of the bite. An overjet is a horizontal discrepancy of the bite whereby the upper and lower front incisors do not properly meet, rather there is a significant anterior-posterior horizontal gap.

Such gaps, if large can affect chewing as well as speech.  A person with a strong horizontal overjet may often have over-erupted lower front incisors. Normally upper and lower adult teeth, including incisors erupt into the mouth and finally contact each other, forming  a “bite relationship”.  In the case of a patient with a skeletal discrepancy, such as an oversized upper jaw and a small short lower jaw, the upper and lower front incisors erupt and “miss one another, erupting and ending up unopposed by any teeth. Such teeth can in fact “over erupt” causing a “skeletal overbite” to be even further accentuated by a “dental component”.  It seems Alex that you may have a combination of skeletal and dental. This is important in terms of selecting treatment.

You also wrote:

“My question is when having braces if I were to only straighten  the lower part how do they straighten such teeth? Do they pull the lower back teeth up to match the front lower or do they push the front lower teeth down?  

Actually a little of both. Previously I mentioned the possibility of a horizontal discrepancy component to your bite. If this is indeed the case, then lower treatment alone might only be able to address the vertical aspect of the dental bite problem. If your upper and lower teeth look straight, and the deep bite is resolved, maybe this is enough to satisfy your needs.

Orthodontics though is not just about improving aesthetics. Improvement of function is also important. If due to a horizontal gap, you are biting only on your back molars and premolars, and you are continuing to possibly experience premature wear of the back teeth. In such a case, a night guard should be employed to minimize such accelerated wear of the enamel.

In terms of how to treat your overbite, there are many options. Let us assume that the horizontal component, if any,  of the problem is minimal. Moreover, let us assume that you are primarily interested in treatment of only the lower teeth.

I will not go into great detail of each treatment option. Let me mention them in brief bullet fashion.

Wearing an upper removable bite plate.  This appliance will basically very slightly prop open your bite, and allow the posterior teeth to passively erupt. It is worn on the upper teeth and removable.  Imagine propping a pencil transversely in your mouth  and biting down on it with your back molars. The pencil props open the mouth. Likewise, if instead of a pencil, the further vertical eruption of the posterior lower molars can prop open the bite naturally, the deep overbite of the front incisors can be improved. It is removed when brushing the teeth or eating.

Wearing a fixed upper bite plate.  This is similar to the removable appliance described above. It has the advantage of being in the mouth continuously, and is used when compliance by the patient is problematic. A removable bite plate that is not worn and left in its case serves no purpose.  The fixed upper bite plate is usually attached via bands to the upper adult first molars.

Using Lower braces. This approach can be used alone, or in conjunction with either the fixed or removable bite plate appliance. Brackets are attached to all the lower teeth spanning from the lower left to the lower right first molar. A horse shoe shaped wire is then attached and it will in effect “move the teeth “.  Some teeth will be moved vertically down (the front incisors and canines), while others will be moved up, namely the more posterior premolars and molars.  A variety of wires can be used, including some with not only the planar horse shoe shape that is in the horizontal plane, but have an additional vertical curvature throughout and have a “ Curve of Spee” . A nickel titanium wire with a Reverse Curve of Spee can help the reverse your current dental tooth alignment. This wire, alone, or possibly in conjunction with one of the two styles of bite plate, can help address a deep anterior vertical over bite.

Finally you wrote:

“I found a photo online that looks similar to my situation. Also, my top teeth are straight.”

As I said a lateral cephalometric X-ray would be very helpful in addition to the reference image you submitted. So Alex at this point the question is what to do.

I would recommend that you consider:

1)   Make an appointment with an Orthodontist and make sure that he/she properly diagnoses the horizontal and vertical aspects of you bite, and investigates the skeletal vs dental components contributing to the problem.
2)   Minimally, a removable bite plate can be used to achieve some improvement.
3)   If you have the inclination and the resources, I would recommend considering the “ Full Monte “ so to speak, namely an appliance and lower braces.
4)   I can offer no time estimate of treatment duration without more data. Even then, your Orthodontist will likely offer you a treatment time with a broad range. Eruption treatment to correct a deep anterior vertical overbite can be extremely variable.
5)   If a horizontal component continues to exist after treatment, the use of a retainer and or night guard long term should be considered.

I hope that this has been helpful Alex. Sometimes my answers seem very long and “fuzzy” but that is actually the most truthful way to answer inquiries like yours. Easy quick direct short answers are often a misleading.  Woody Allen one said that he had used speed reading to read Tolstoy’s classic novel  “War and Peace”  in 15 minutes. “ It’s about Russia “ he said.  Uhh…   yeah....  it is, but ...   

Alex, please feel free to submit a follow up question  if you like after you have had an Orthodontic  consultation.  Please consider submitting an X-ray if you do.  Thank you for submitting this question. I think it is a common enough condition that many readers will benefit from your question.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. I also will sometimes consult with other doctors on complex questions. This of course takes time.  Your understanding is appreciated.

Orthodontics

All Answers


Answers by Expert:


Ask Experts

Volunteer


Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

©2016 About.com. All rights reserved.