CASE REPORT: Deep Bite

A 15-year-old male in the permanent dentition presented with a class II canine relationship, an increased overbite, upright incisors and crowding in both arches in the anterior segments.

3D dental scans showing deep overbite, crowded teeth and upright incisors before treatment

The aim for treatment is to both align his teeth and to correct his occlusion. However, this case report will mainly focus on the strategies used to correct his deep overbite with clear aligners.

3 key principles were used:

Relative intrusion via proclination
Planned overcorrection
Posterior anchorage with specific attachment design.

Given the difficulty of achieving pure absolute intrusion predictably, the presence of anterior crowding and upright incisors was used to advantage. Controlled proclination created space to alleviate crowding while producing relative intrusion as the incisal edges moved gingivally. This can be demonstrated in the diagram below

Diagram showing controlled incisor proclination reducing deep overbite through relative intrusion

Below shows the amount of proclination and buccal movement for the patient during alignment, blue being the initial stage.

Lower arch scan showing initial positions in blue and planned proclination and buccal movement

To improve the likelihood of clinical expression, overcorrection was deliberately incorporated into the digital setup, similar in concept to a reverse curve of speed wire in fixed appliances. The virtual plan accepted a slight anterior open bite with the expectation that full expression would not occur clinically.

Initial and digital setup views showing planned overcorrection and slight anterior open bite

Finally, horizontal rectangular attachments were placed on posterior teeth to serve as anchorage units, supporting anterior intrusion by improving aligner retention. Note the “active surface” for these supportive posterior attachments are on the gingival surface of these supportive attachments.

Posterior attachments with gingival active surfaces supporting aligner retention and anterior intrusion

It can also be seen the buccal cut-outs have been placed on the lower first molars to allow for button placement and subsequent elastic wear to aid in class II correction.

After 18 aligners, this patients’ deep bite has been corrected as shown below:

3D dental scans showing corrected deep bite and improved alignment after 18 clear aligners

After a further 8 and 9 more refinement aligners, we have been able to correct his occlusion and alignment.

3D dental scans showing corrected occlusion and alignment after clear aligner refinements

A total of 3 rounds of aligners were used – 18 initial aligners, followed by 2 rounds of refinement aligners of 8 aligners and 9 aligners respectively.

This case underscores the importance of planning beyond the digital simulation, using relative intrusion, overcorrection, and strategic attachment design to enhance clinical expression.

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