Vertical Discrepancies and Their Treatment
Vertical Discrepancies and Their Treatment
Vertical Discrepancies and Their Treatment
1. INTRODUCTION
The orthodontic literature and the orthodontic lecture circuit are replete with
publications and much discussion pertaining to treatment of the anteroposterior dimension
and to a lesser extent the transverse dimension of the dentition. However, there has been
very little discussion and much less compilation of the work on development or treatment
of the vertical dimension.
Probably no discipline in medicine and certainly none in dentistry devote more time
to growth research than orthodontics. The amazing benefits of this growth to the clinician
have been well-documented by researchers since the 18th century. Yet equally conspicuous
is the fact that this fantastic wealth of information is still consigned to the laboratory and
for the most part is ignored by the clinician. How else can one explain the continued
rampant use of extraction therapy in growing children, serial extraction in children with
great growth potential, the increasing use of orthognathic surgery in younger patients and
the prevalent notion that the vertical dimension is one of orthodontics’ greatest challenges.1
In reality the vertical dimension should be the easiest of the three dimensions for
the orthodontist to deal with. It grows the most in magnitude and for the longest period of
time. It would seem that the greater the potential for a structure to increase in size, the
greater the opportunity to effect a change in that structure. And the longer potential for
change, the longer the opportunity to make that change.
Why has the vertical dimension been such an enigma? It would seem that the
answer is also to be found in the literature. A perusal of same would indicate that, for the
most part in the past and still to a large extent in the present, traditionally the vertical
dimension has been largely ignored! And when finally discovered, the most commonly
used mechanics are frequently totally contrary to biological needs.
This work will unravel the classification, diagnosis and how to manage the vertical
discrepancies at different ages and dentition in Orthodontics.
According to Thomas Rakosi1, there are various factors, which give importance to
a malocclusion with a vertical discrepancy. While treating a case of Open bite or Deep bite,
it is not only the vertical dimensions that need to be addressed, but also the sagittal
relationship, i.e., anteroposteriorly, if it is a Class I, Class II, or Class III malocclusion. The
direction & amount of growth completed, and growth expected in the patient during the
course of the treatment and in the post-treatment period is to be considered as well.
The vertical dimension is unique in that the growth rate is highest and lasts the
longest in this direction. Since growth tends to increase the vertical distance between the
maxillary and mandibular jaw bases, performing treatment during this period is most
advantageous, as stated by Rakosi.1
However, he also states that vertical dimension is not stable. Even in adults who
have never had any orthodontic treatment, significant changes can occur in the vertical
dimension. Abrasion or loss of teeth can close down the vertical dimension leading to a
deep bite. Tooth elongation or over-eruption also can occur, increasing the vertical
dimension and opening the bite. The stability of tooth position depends on the eruption or
elongation tendency of the teeth and on the opposing forces. If the occlusal forces are
altered, the equilibrium is disturbed and the teeth migrate in the direction of the occlusal
plane.1
Late growth of the mandible may increase an already existing increase in vertical
dimension, accentuating the malocclusion thus occurring due to the discrepancy.
Now talking about the vertical dental relationships its important to understand the
normal relationship i.e. normal overbite and then understand its discrepancy i.e. Open bite
and deep bite.
According to Profitt2, Overbite is defined as the vertical overlap of the incisors
(Fig-1.1)
Normally the lower incisor edges contact the lingual surface of the upper incisors
at or above the cingulum. i.e., normally there is 1-2mm overbite. (Fig-1.2)
Deep bite
Definition-According to Moyers3, a deep-bite exists when the mandibular incisors
impinge on the palatal mucosa. In (Fig-1.3), the circled area shows excessive impingement
of the mandibular incisal edge on the palatal mucosa. This malocclusion is restricted to the
anterior teeth alone.
Open bite
Definition-According to Subtelney and Sakuda4, open bite is defined as an open
vertical dimension between the incisal edges of the maxillary and mandibular anterior
teeth. In a case of openbite, there will not be any vertical overlap. To measure the amount
of bite opening-the vertical separation is measured. To diagnose-the vertical distance
between the maxillary and the mandibular incisor edges are measured. In Fig-1.4, there is
no overlap of incisal edges, showing a bite that has opened up.