The Effects of Intrusion of Anterior Teeth by Skeletal Anchorage in Deep Bite Patients; A Systematic Review and Meta-Analysis

Abstract

Background: Deep bite is known as one of the most common malocclusions, and its treatment and retention are often challenging. The use of mini-screws has been suggested as an ideal method for the intrusion of incisors in deep-bite patients. Still, there are conflicting reports regarding the superiority of this method compared to other common treatments. Aim: The aim of this systematic review and meta-analysis was to evaluate the effects of the intrusion of anterior teeth by skeletal anchorage in deep bite patients. Methods: From the beginning to 15 September 2022, articles on the topic of interest were searched in electronic databases including PubMed, Web of Science, Scopus, EMBASE, and Cochrane’s CENTRAL. Additionally, a hand search for pertinent studies and a search of the grey literature were carried out. After the selection of eligible studies, data extraction was performed using piloted forms. Inverse-variance random-effects meta-analyses were used to combine the outcome measures of dental indices, skeletal cephalometric indices, and dental cephalometric indices. Results: A total of 15 studies (6 RCT; 9 CCT) were included in the systematic review and 14 were used in the meta-analyses. The differences in overbite changes (MD = −0.45, p = 0.04), true incisor intrusion [u1-pp] (MD = −0.62, p = 0.003) and molar extrusion [u6-pp] (MD = −0.40, p = 0.01) were statistically significant and TADs showed better treatment results than other intrusion methods (segmented intrusion arch, utility arch, J hook headgear). No significant differences regarding overjet, molar and incisor tipping, and skeletal indices between mini-screw and other intrusion methods could be found. Conclusion: The use of mini-screws leads to lower overbite and higher true intrusion (about 0.45 and 0.62 mm, respectively) compared to the use of other methods for intruding upper incisors. Furthermore, the effect of TAD on extrusion of molar teeth is less (by 0.4 mm) than other methods.

Comprehensive Deciphering the Complexity of the Deep Bite: Insight from Animal Model to Human Subjects

“…Through the process of growth and development, the skeletodental and soft-tissue components structurally adapt to one another to create a functionally balanced condition [64]. A shift in the mandibular muscular balance takes place because widening the bite is typically performed via protrusion of posterior teeth [13]. If the correction is to stay stable, either the musculature must adjust in some way to its new functional resting length or the bone arrangement must alter.…”

“…Particularly in the lower portion of the face, the anterior facial height is frequently tiny in such circumstances. The incisors' supraocclusion (overeruption), on the other hand, is indicated by dental deep bites [13] or infraocclusion (undereruption) of the molars or a combination of the two [14]. Alterations to the tooth morphologies, early loss of permanent teeth leading to a lingual collapse of the maxillary or mandibular anterior teeth, mesiodistal breadth of anterior teeth, and age-related natural deepening of the bite are other factors that might have an impact on this condition.…”

Effectiveness of different intrusion modes of maxillary anterior teeth with mini-implants in clear aligner treatment: a three-dimensional finite element analysis

“…For those resulting from anterior dentoalveolar extrusion and vertical maxillary excess, it can be improved by the intrusion of maxillary anterior teeth [ 1 , 2 ]. Additionally, the deep overbite is a common malocclusion, which can affect facial aesthetics, occlusal function, and overall oral health [ 3 ]. In cases of skeletal Class II and vertical growth pattern with deep overbite, the intrusion of maxillary anterior teeth not only facilitates bite opening but also creates space for counterclockwise rotation of the mandible, which is crucial for the improvement of facial profile [ 1 , 4 ].…”

“…J-hook headgear causes strong discomfort and requires patient compliance [ 4 ]. Other methods are less effective and may lead to the extrusion of posterior teeth [ 3 ]. Researchers have confirmed that the application of mini-implants can effectively facilitate the intrusion of maxillary anterior teeth and achieve true intrusion [ 3 ].…”

“…Other methods are less effective and may lead to the extrusion of posterior teeth [ 3 ]. Researchers have confirmed that the application of mini-implants can effectively facilitate the intrusion of maxillary anterior teeth and achieve true intrusion [ 3 ]. Mini-implants have the advantages of immediate force application, clear biomechanics, and diversity of implantation site and force direction [ 3 , 5 ].…”