Evaluation of Changes on Maxillo-Facial Skeleton of Class II Patients with Deep Bite Treated with Anterior Bite Plane as a Functional Appliance


  • Ibtisam Briek Senussi Lecturer, Department of Oral Pathology, Oral Medicine, Radiology and Diagnosis, Faculty of Dentistry, University of Misurata, Libya. https://orcid.org/0000-0002-0828-5616
  • Iman Abdelgader Associate Professor, Department of Orthodontics, Faculty of Dentistry, Benghazi University, Libya.


Background: Class II division 1 malocclusion can be produced by protrusion of upper anterior teeth with normal maxillary basis relationship, that can be as a result of mandibular deficiency with normal dental position or posterior rotation of the mandible due to the excessive vertical growth of the maxilla. Deep bite usually associated with class II malocclusion, in which the mandibular incisor crowns are excessively overlapped vertically by the maxillary incisors where the teeth are in centric occlusion, which can be seen in children as well as in adults. So that for the successful treatment of Class II/ 1 required controlling the deep bite before starting the virtual treatment of this malocclusion to get better retention.

Aim: The aim of this study was to investigate the morphological changes in maxillary and mandibular bones relationship after using the anterior bite plane appliance.

Material and Methods: Evaluative analysis of cephalograms by superimposing two lateral cephalograms before and after the treatment of 27 patients (12 girls and 15 boys) class II division 1 malocclusion with mean age 11.7 years old. They treated by utilization of anterior bite plane while the period of fixed orthodontic therapy. Cephalometric data were analyzed with the following methods: Delaire, Danguy and classical and the morphological changes were evaluated.

Results: The results of superposition of every patient before and after treatment showed a significant (P<0.05) reduction of deep bite and the facial convexity reduced in an average of 2.49°, anterior-posterior discrepancy reduced also very significantly (P=0.001), with a mean value of 1.81° and increasing in total mandibular length with a mean value of 2.95 mm. The decrease of the overbite can be due especially to the mandibular rotation and also supra-eruption of posterior teeth. Change in the mandibular length and the maxillary position improved facial profile but did not correct it completely as the mandible moved forward and also downward due to vertical and horizontal ramus growth and condylar remodeling.

Conclusion: It can be concluded that the use of an anterior bite plane in conjunction with a straight wire and edgewise orthodontic techniques improved the overbite. Further research is recommended to support the result.

How to cite this article:
Senussi IB, Abdelgader I. Evaluation of Changeson Maxillo-Facial Skeleton of Class II Patients with Deep Bite Treated with Anterior Bite Plane as a Functional Appliance. J Adv Res Dent Oral Health 2019; 4(1): 1-9.


Jones G, Buschang PH, Kim KB et al. Class II nonextraction patients treated with the forsus fatigue resistant device versus intermaxillary elastics. Angle Orthod 2008; 78(2): 332-338.

Proffit WR, Fields HW Jr, Sarver DM. Contemporary orthodontics. Mosby, Elsevier, St. Louis, 2007; 160, 207-17.

Bishara SE. Text book of orthodontics. Ed W. B. Saunders Company, a Harcout Health Sciences Company, 2001. 176.

Daokar S, Agrawal G. Deep bite its etiology, diagnosis and management: a review. J Orthod Endod 2016; 2(4): 1-4.

Bench RW, Gugino CF, Hilgers JJ. Biopragressive therapy Part- 2, 7, 10 and 11. J Clin Orthod 1977; 12(3): 192-521.

Baccetti T, Stahl F, McNamara JA Jr. Dentofacial growth changes in subjects with untreated Class II malocclusion from late puberty through young adulthood. Am J Orthod Dentofacial Orthop 2009; 135(2): 148-154.

Pangrazio-Kulbersh V, Berger JL, Chermak DS et al. Treatment effects of the mandibular anterior repositioning appliance on patients with class II malocclusion. Am J Orthod Dentofacial Orthop 2003; 123(3): 286-295.

Güney V, Akeam MO. Treatment timing for functional treatment of class II division 1 malocclusions. Abstract Book 82nd EOS Congress, 2006. 102.

McNamara JA Jr, Bryan FA. Long-term mandibular adaptations to protrusive function: An experimental study in Macaca mulatta. Am J Orthod Dentofacial Orthop 1987; 92(2): 98-108.

Stahl F, Baccetti T, Franchi L et al. Longitudinal growth changes in untreated subjects with Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop 2008; 134(1): 125-37.

Jr KF, Faltin RM, Baccetti T. Long-term Effectiveness and Treatment Timing for Bionator Therapy. Angle Orthod 2003; 73(3): 221-230.

Franchi L, Pavoni C, Faltin K et al. Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion. Angle Orthod 2013; 83(2): 334-340.

Mills JR. The effect of functional appliances on the skeletal pattern. Br J Orthod 1991; 18(4): 267-275.

Gomes AS, Lima EM. Mandibular growth during adolescence. Angle Orthod 2006; 76(5): 786-790.

Hägg U, Pancherz H. Dentofacial orthopaedics in relation to chronological age, growth period and skeletal development: an analysis of 72 male patients with Class II, division 1 malocclusion treated with the Herbst appliance. Eur J Orthod 1988; 10(3): 169-176.

Pancherz H. Treatment of class II malocclusions by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod 1979; 76(4): 423-442.

Ruf S, Pancherz S. Temporo-mandibular joint remodeling in adolescents and young adults during Herbst treatment: A prospective longitudinal magneticresonance imaging and cephalometric radiographic investigation. Am J Orthod Dentofacial Orthop 1999;

(6): 607-618.

Owen AH. Morphologic changes in the sagittal dimension using the Fränkel appliance. Am J Orthod 1981; 80: 573-603.

Collett AR. Current concepts on functional appliances and mandibular growth stimulation. Aust Dent J 2000; 45(3): 173-178.

Marsan G. Effects of activator and high-pull headgear combination therapy: Skeletal, dentoalveolar and soft tissue profile changes. Eur J Orthod 2007; 29(2): 140-148.

Perillo L, Padricelli G, Isola G et al. Class II malocclusion division 1: a new classification method by cephalometric analysis. European Journal of Paediatric Dentistry 2012;

(3): 192-196.

Kucukkeles N, Orgun A. Correction of Class II malocclusions with a Jasper Jumper in growing patients. Eur J Orthod 1995; 17: 445.

Valant JR, Sinclair PM. Treatment effects of the Herbst appliance. Am J Orthod Dentofacial Orthop 1989; 95(2): 138-147.

Blackwood HO. Clinical management of the Jasper Jumper. J Clin Orthod 1991; 25(12) :755-760.

Tabe H, Ueda HM, Kato M et al. Influence of Functional Appliances on Masticatory Muscle Activity. Angle Orthod 2005; 75(4): 616-624.

Miralles R, Berger B, Bull R et al. Influence of the activator on electromyographic activity of mandibular elevator. American Journal of Orthodontics and Dentofacial Orthopedics 1988; 94(2): 97-103.

Pancherz H. The effect of continuous bite jumping on the dentofacial complex: A follow-up study after Herbst appliance treatment of Class II malocclusions. Eur J Orthod 1981; 3(1): 49-60.

Pancherz H, Anehus-Pancherz M. The headgear effect of the Herbst appliance: A cephalometric long-term study. Am J Orthod Dentofacial Orthop 1993; 103(6): 510-520.

McNamara JA Jr, Howe RP, Dischinger TG. A comparison of the Herbst and Fränkel appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop

; 98(2): 134-144.

Weiland FJ, Bantleon HP. Treatment of Class II malocclusions with the Jasper Jumper appliance. A preliminary report. Am J Orthod Dentofacial Orthop 1995; 108(4): 341-350.