Clinical Assessment & Presentations
Extra-oral Features
Start your assessment by looking at the patient’s extra-oral features.
Brachyfacial appearance (skeletal deep bites)
Skeletal deep bite patients often present with a brachyfacial appearance (short facial height). The typical characteristics are seen below. A dental deep bite only malocclusion does not present with any abnormal facial features.
A low angle mandibular plane (border) is present.
A mild reduced lower facial third is present.
(Adapted from Valarelli et al. 2017)
Radiographic features (skeletal deep bites)
Skeletal deep bite malocclusions is visible on standard orthodontic radiographs. The typical characteristics are shown below.
A lateral cephalogram shows a low angle mandibular plane (green) and over-erupted lower incisors with palatal mucosa contact (red).
A panoramic radiograph shows the over-erupted lower incisors (curve of Spee).
Intra-oral Features
Clinical views of deep bites
The clinical presentation of a deep bite can be best viewed from a frontal perspective. A sagittal view can also assist with assessing how much incisors have overerupted.
Clinical appearance of a deep bite
Deep bite from a sagittal view. Upper incisors are usually retroclined whilst lower incisors can either be normal or retroclined.
Deep curve of Spee
A deep bite malocclusion will often present with overerupted incisors and a lack of molar and premolars eruption. This is seen in Class II div 2 malocclusions, however deep bites are not limited to these malocclusions.
In this Class II div 2 malocclusion there is a severe deep bite caused by the overeruption of the incisors (green arrows) and a lack of posterior eruption. A severe mandibular curve of Spee (red line) is also present and need to be levelled appropriately during orthodontic treatment.
Palatal mucosa trauma
A pathologic deep bite can result when lower incisors occlude the palatal mucosa. Mucosa stripping and eventual loss of the upper incisors make this a serious complication of a deep bite malocclusion and it will need to be treated urgently.
Palatal mucosa trauma at the gingival margins of the upper incisors.
(Adapted from Beddis et al. 2014)
