the subject deals with types of turbo and application of turbos in orthodontics

1. Use of a Bite Ramp or bite
turbo in Orthodontic Treatment
by
DR. MAHER FOUDA
PROFESSOR OF ORTHODONTICS

2. CLASS II DEEP OVERBITE; BONDING BRACKETS
ON THE LOWER ANTERIORS IS IMPOSSIBLE

5. The Bite Ramps are easy to make and use.
Etch and prime the palatal of the maxillary centrals.
Fill the Bite Ramp mold with MiniMold cure light material.
With light pressure, place and hold the filled mold against the tooth
with the flat edge of the mold parallel to the incisal edge of the
central then cure.
To ensure that the ramps are equal on both teeth use a bracket
gauge to mark the lingual incisal edge where the flat edge of the
mold will be placed.
Note:
If your ramp does not extend far enough lingually to
engage the lower anterior teeth, refill the ramp mold
halfway, place the mold over the original ramp and cure.
Curing time depends on the light and curing material used
but should not exceed 15 seconds.

7. The bite ramp is a very useful orthodontic device to
correct deep overbite and curve of Spee which
prevent bonding of the mandibular incisors in the
beginning of orthodontic treatment.

9. 1. Upper 2X6 and posterior bite openers, 2.6 months Xbow followed by compensatory
maxillary expansion, now hold expansion and test Cl II correction for 5 months.
Higgins XBOW® Class II Corrector

10. The Higgins XBOW® Class II Corrector is an alternative to the Herbst®* appliance for
treatment of Class II malocclusions in children and adolescents. The Phase I
appliance allows simultaneous anteroposterior and transverse correction.
The XBOW pits the entire mandibular arch against the maxillary bicuspids and molars,
which opens space for the erupting canines. Used in conjunction with the Forsus™ Fatigue
Resistant Device from 3M Unitek, the XBOW appliance allows overcorrection of the molars
into a Class III relationship.
The Higgins XBOW Appliance consists of:
• Maxillary expansion appliance
• Triple "L" Arch® (lower labial lingual arch)
• Forsus Fatigue Resistant Device (25mm Direct Push Rod) and Gurin Locks (allow for easy
activation). Forsus Device & Gurin Locks available from your 3M Unitek representative.
Higgins XBOW® Class II
Corrector

11. Maxillary Expansion Appliance with Headgear
Tubes on the First Molars and Bonded Occlusal
Rests on the Second Molars
Triple “L” Arch™ with Bonded Rests
on the First Bicuspids
Xbow™ with Forsus™ Fatigue Resistant Device EZ Module and end caps from Comfort
Solutions, Inc. (Gurin locks rotated 90 degrees for comfort)
Higgins XBOW® Class II Corrector

12. In the past, Class II correction meant the use of headgear for several hours a day
or wearing rubber bands consistently for many months. Other appliances also
worked completely inside the mouth, but were bulky and had to be fabricated by
an outside dental laboratory after impressions of your teeth were taken.

13. 3M Unitek has developed the Forsus™ Fatigue Resistant Device to address this specific
treatment need. The appliance consists of a metal spring and rod that connect to parts of your
braces, hidden away by your cheeks and lips. Because the spring actively applies a light,
continuous force, treatment goals can be achieved quickly and without the need for patient
compliance with rubber bands or other external appliances. It only takes one appointment to
install the 3M Forsus appliance and requires no special adjustments by the patient. The length
of time the appliance is worn depends on the severity of the problem and varies on a case-by-
case basis
Higgins XBOW® Class II Corrector

14. Day of bite opener switch from posterior to anterior (bite-turbo) 5 months into full braces

15. We begin most cases with posterior bite openers. They remove occlusal
interferences to prevent debonds as well as allowing lower alignment with
the lightest forces

16. _____________________bite turbo placed_____________________Class
II elastics to erupt lower molars and correct overjet from bite opening
This is where patient cooperation is needed. Class II springs cannot open
the bite. Over-correct to incisal edge to edge

17. 9 months progress with full brace

18. 12 months braces

19. One of the most important things we do in our practice is the treatment of TMJ (Temporomandibular joint
disorders, TMD) These problems can cause the mandible to lock closed and the joint to click and pop. This
can cause extreme pain and suffering. The TMJ is the most complicated joint in the entire body. When you
open about half way the joint acts like a ball and socket joint, just like your knee or elbow. Then when you
open past halfway your lower jaw has to actually slide forward. The lower jaw moves "out of the
socket". This is the only joint in the body that does that. It also has three areas of articulation: 1. the right
joint 2. the left joint 3. the bite and the teeth. If any of these three are out of balance then the whole system
is out of balance and then the problems begin. When we start orthodontic treatment in our office we place
mounds of blue glue on the biting surfaces of the lower first molar teeth to separate the teeth. This removes
this third part of the chewing system so that the TMJs can move into their ideal positions without the
interference of the bad bite. As the bite comes together we remove these splints so that we can make the
bite as perfect as possible. These are a very annoying part of the treatment, but is probably one of the most
important things we can do for the health of the jaws and bite
Bryan P. S
Nelson DDS M

21. OCCLUSAL BUILD UP TO RAISE THE BITE IN CASESS OF ANTERIOR CROSSBITE

22. Bite Turbos
Bite turbos (BTs) have come to mean any occlusal stops on teeth that unlock the
malocclusion for greater freedom of tooth movement
Bite-turbos made of type II glass
ionomer cement were attached to the
occlusal surfaces of the lower first
molars to prevent bracket interference
during the initial alignment phase
Anterior BTs provided an incisal stop
that allowed the posterior segments to
extrude and level to correct the lower
curve of Spee. In addition, the mandible
was free to move anteriorly for a more
comfortable occlusion with the maxilla.
Anterior BTs can be quite versatile. In
addition to the present application on
the lingual surfaces of maxillary
incisors , they can be bonded on the
lingual surface of lower incisors to
assist in anterior cross bite correction
According to where they are positioned, BTs are classified as anterior and/or posterior.

24. Anterior BTs for deep bite cases are bonded more gingivally for big
overjet cases
Weak teeth, such as endodontically treated maxillary incisors, are a
contraindication for BTs because they are prone to fracture
glass ionomer bite turbos are bonded on the lingual surface of upper central incisors to provide an intrusive
force on the upper and lower incisors, in addition to opening the posterior bite to facilitate crossbite correction

25. After the initial alignment of the maxillary arch, anterior bite
turbos are bonded on both upper central incisors to correct the
deep bite
Anterior bite turbos are excellent tools for the correction of deep
bite if opening the bite and posterior mandibular rotation are
acceptable mechanics. They are easy to use and decrease the
treatment time for many patients.

26. Anterior bite turbos on maxillary incisors tend to intrude
lower incisors, and furthermore serve as effective vertical
stops for the overbite.

27. The axial inclination of the maxillary incisors must be
considered. If they are upright or retroclined, it may
be necessary to correct the inclination prior to
installing BTs
It is important to check the axial
inclination of the maxillary
incisors before bonding BTs.
Occlusal force from lower incisors
can produce an undesirable
moment, so partial correction of
maxillary incisor inclination is
necessary before bonding lingual
BTs on maxillary incisors.

28. However, for lingually tipped upper central incisors, the line of
occlusal force may be lingual to the center of resistance (CR) which
can result in more lingual tipping.
Thavarungkul suggests bonding the anterior bite turbos after both central
incisors have been proclined slightly. This allows the force vector to pass in
anterior of CR in order to correct the deep bite

29. If anterior bite turbos are applied before the initial alignment
of the incisors, the line of occlusal force may be distal to the
center of resistance (CR) resulting in more lingual tipping .

30. After some labial movement of the maxillary central incisor crowns,
the line of force (green) is labial to CR which is a preferable force
system

31. For open bites, posterior BTs can be combined
with squeeze exercises to intrude molars

38. Inverting brackets changes torque from positive to negative or vice versa (in this case, on the upper right
lateral incisor from +10º to -10º), which expands torque options and generates early root torque movement
in the desired direction upon insertion of the rectangular wire. Case photos courtesy of Dr. Bill Thomas,
Poway, CA

39. This case is an example of the most commonly
employed use for reverse torque. As
the light round wire aligns in such a case,
the crown of the upper right lateral incisor
will come forward, leaving the root in its
palatal position. To combat this “pseudotorque,”
place an inverted +10º upper right
lateral incisor bracket (now with reverse
torque) to create a -10º torque bracket. Upon
engaging the first rectangular wire, the root
will begin to detorque and move
labially toward its ideal position. With
this protocol, you no longer need to
await the major mechanics phase of
treatment to correct the palatally
positioned root. Once the root is in
ideal
position in relation to the crown, flip
the bracket to its normal position and
rebond (now with +10º) to ensure that
the root does not continue to move
labially.

40. When inverting brackets for reverse torque, keep
the brackets on the same side of the arch so the
root tip remains the same mesiodistal. For example,
when inverting an upper lateral bracket with
9º of distal root tip in the same arch (A), the distal
root tip remains the same (B).

41. Note: When inverting brackets for reverse torque, be sure to keep
the brackets on the same side of the arch so the root tip remains the same
mesiodistal. See illustrations A and B. Placing them on the opposite side
of the arch will change the intended root tip (mesial to distal and vice
versa). By the way, we use the term "reverse torque" when discussing
inverting brackets to minimize a patient's fear that we're placing a bracket
upside down.

42. – Unlock the
Malocclusion: Disarticulate the Arches
with Bite Turbos
Clinicians who use bite turbos normally place them on
the lingual surfaces of upper anterior teeth in deep-bite
cases to bond both arches at once (Figure 3). As we’re all
aware, bite turbos benefit treatment in numerous ways:
1. Protect the enamel from bracket wear / debonding.
2. Improve the effect of light wires on arch
development.
3. Improve the effect of early light elastics for A/P,
vertical and transverse corrections. See
Essential #3.
4. May have an impact on correction of excessively
low or high mandibular plane angles (brachyfacial
or dolichofacial patients).

43. In my practice, a bite turbo has come to mean any
resin bump that unlocks the malocclusion for
greater freedom of movement. Using bite turbos
more creatively, however, can have far-reaching
treatment implications
Bite turbos can also assist directionally in Class III
cases. For such cases, I often form bite turbos
(Mini-Mold starter kit, Ortho Arch, Schaumberg,
IL) on the lingual surfaces of the lower incisors in
such a way that they have an incline designed to
allow the upper incisors to slide down it toward a
Class I position. For all anterior bite turbos, I use
Blugloo™ two-way color change adhesive, which
turns from clear to blue during bonding and
debonding, making it easy to see during placement
and removal. If the turbo debonds during treatment,
the adhesive will turn blue, easing the
patient’s mind that it is not a tooth fragment.

44. I try to select bite turbo locations to enhance the
direction of the treatment goals. While this is an
admittedly simplistic approach, I generally choose
posterior bite turbos for high-angle cases and anterior
bite turbos for low-angle cases. For example, in
high-angle cases, using bite turbos in the posterior
can cause intrusion of the posterior teeth that helps
close down the high-angle. In low-angle cases,
anterior bite turbos in conjunction with early
light posterior vertical elastics will extrude posterior
teeth and correct a low-angle deep bite by
posterior eruption.
Flowing resin
into the occlusal grooves
of lower first molars to
make a flat plane fosters
directional crossbite
correction

45. Dr. Stuart Frost shared his idea of using flowable
resin to correct posterior crossbites when placing
bite turbos in the anteriors is difficult (Figure 4).
He flows a transparent pink resin (Triad® Gel
Flowable, Dentsply, York, PA) into the occlusal
grooves of lower first molars to make a flat plane,
which fosters crossbite correction in conjunction
with early light crossbite elastics by allowing freedom
of interarch movement. The pink color of the
resin makes the bite turbo easy to see during
placement
and removal and its transparency shows the
occlusal surface through the turbo. Note: It may be
necessary to air cool the Triad Gel because it warms
up during the curing process.
Early light elastics in this Class III case were
worn from bonding day to improve the efficiency of
treatment
Light Elastics for Early Dental Base
Movement

46. For cross bites, unlocking the inter-digitation with
contralateral BTs is effective for facilitating
transalveolar correction
Glass ionomer bite turbos are placed in the palatal cusps of
the first molars in order to open the bite and allow the
second molars to move.
Scissors bite of upper second molars

47. Glass ionomer bite turbos were
placed in the palatal cusps of the
first molars in order to open the bite
and allow the second molars to
move.
Scissors bite of upper
second molars .

48. Scissors bite of upper second molars

49. TREATING AN ASYMMETRIC CLASS II CASE WITH
suresmile

51. Biteplanes can be used in Class I and Class II, division 1 and 2
cases for the correction of deep bite with
moderate overjet and their shape was inspired by the lingual
orthodontic brackets. Biteplanes are often used
when bracket interference makes it difficult to bond the mand
ibular anterior or even the mandibular posterior
teeth at the start of treatment.

52. 1. Biteplanes can be fixed or removable. Removable biteplanes depen
d on patient cooperation what
unfortunately makes treatment less effective because the appliance
s are often worn only part time, lost or
broken. Besides, removable appliances can also produce mucosal tr
auma and, if oral hygiene is poor, chronic
candidal infection of the entire palatal mucosa can result. Many of t
hese problems can be overcome by using
a fixed biteplane, which is worn fulltime and is more hygienic

53. Bite opening in the anterior was due to switching turbos to lower 6s.
At 8 weeks, the
crossbite had
sufficiently
resolved so
crossbite elastics
begun at bonding
were
discontinued as
.018” Copper Ni-
Ti archwires were
engaged. Note: A
calculus bridge
scaled at this
appointment has
been preventing
lower anterior
alignment.

54. At 7 months, the .018” x .025”
Copper Ni-Ti wires had just been
engaged after 2.5 months in .014” x
.025” Copper Ni-Ti wires
At 13 months, the .018” x
.025” Copper Ni-Ti wires had
been engaged for 6 month
At 18 months, the upper .018” x .025”
Copper Ni-Ti wires had been engaged for
11 months. The case would now
transition to a TMA finishing wire in the
upper arch and Reverse Curve wires in
the lower arch before finishing in .018”

55. Fixed biteplanes can be fixed to orthodontic bands on the
upper first molars

56. Fixed bite
plane can be constructed with glass ionomer cement, composite resins or self-
curing acrylic resins. In this
second case, they are generally bonded on lingual surface of maxillary incisors

57. Palatal composite bite block
The bite blocks are used when bracket interference makes it difficult to bond
the mandibular anterior and posterior teeth's at the start of the treatment.
Earlier bite planes were used in class II division I and division II cases for the
correction of deep bite with moderate overjet. Bite planes can be fixed or
removable . Removable bite planes depend on patient cooperation and can
also cause mucosal trauma whereas the fixed bite blocks do not contact the
lower incisors uniformly.
•Dr. Akhter Husain
Professor and Head,Department of
Orthodontics and Dentofacial
Orthopaedics, Yenepoya Dental College,
Yenepoya University
•Dr. Vivek Amin
Professor,Department of Orthodontics and
Dentofacial Orthopaedics, Yenepoya
Dental College, Yenepoya University
Revista Latinoamericana de Ortodoncia y
Odontopediatría
Depósito Legal Nº: pp200102CS997 -
ISSN: 1317-5823 - RIF: J-31033493-5
Calle El Recreo Edif. Farallón, piso 9 Ofic.
191, Sabana Grande, Caracas, Venezuela
Teléfonos: (+58-212) 762.3892 - 76

58. The Palatal composite bite
blocks (PCB) can be used to
the following reasons.
1-They are absolutely
customized for each patient.
2-It is done by using routine
materials in Dentistry.
3-It gives an anterior bite
plane effect

59. Procedure
Step I:
The patient is clinically evaluated with an extent of deep bite and the amount of bite
to be raised. This can be done arbitrarily by bonding a bead of composite material
on the occlusal surface of the lower first molar which can be fine-tuned by grinding
of the composite till a satisfactory vertical relation is established

60. Step II:
Impressions of both the arches are made using alginate. A wax
bite registration is made clinically which is transferred to the
simple hinge articulator. Thereby recoding the desired amount
of bite opening required

61. Step III:
Small inlay or pattern wax blocks are placed on the palatal
surfaces of the upper anteriors and each one carved out as
individualized platform in such a way that all anterior contact
simultaneously.

62. Step IV:
A specialized tray is loaded with silicon putty and the
impression is made only of the palatal side

63. Take out the impression, wash and dry using a 3
way syringe. Load the depression caused by the
wax platform using restoration composite material.

64. Step V:
The palatal aspects of teeth are prepared by etching and
priming and the tray is transferred back into the mouth
positioned properly.

65. A UV light is applied on the labial sides of the
anterior till an initial set of the composite is
assured. The tray is removed again to confirm
polymerization

66. Clinically, articulating paper is used to ensure
uniform contacts of the lower anteriors on all the
platforms. Once this is done the patient is ready for
the regular orthodontic strap up.

67. Advantages:
Simple to use.
Customized individual anterior bite
blocks.
Does not require patient compliance.
Uniform contact of the lower anterior on
the platform.
Does not interfere with the
mechanotherapy.

68. Several appliances both fixed and removable have been utilized for this
purpose, including anterior or posterior bite splints, bonded lingual bite
planes and bonded occlusal composite resin build-ups. These appliances
have some limitations. Bite splints require impressions, laboratory
procedures, and extra appointments for insertion and monitoring.
Removable plates require patient compliance

72. 8-step fixed bite block procedure without cementation offers multiple advantages
November 16, 2016
By Amit Sidana, BDS, MDS; Pooja Tiwari, BDS; and
Ragni Tandon, BDS, MDS
Bite planes can be used in Class I and Class II, Division 1 and Division 2 cases for the
correction of a deep bite with moderate overjet. A deep bite must be opened before brackets
can be bonded in the mandibular arch. The most common devices used to open the bite are
removable anterior or posterior bite planes and glass ionomer cement (GIC).

73. Fixed bite block procedure
1. Place the band on teeth Nos. 19 and 30, and take an alginate impression. Keep in mind
that in the impression, the band is placed in the proper position.
2. Pour the impression in plaster of paris, and then remove the cast after the plaster of paris
sets.
3. Bend the lingual arch (0.9 mm) wire and adapt it lingually in the mandible (figure 1)

74. 4. For the occlusal component, adapt the wire (0.7 mm) to the occlusal surface. Start from
the middle of the second molar and move up mesially to the interdental space between the
first and second premolar. Then, give a vertical bend downward to adapt between the
embrasure area and the end resting on the lingual arch (figure 1)
5. Solder the lingual arch onto the band and the occlusal component onto the lingual arch
(figures 2a and 2b).

75. 6. Apply separating media on the occlusal surface of the posterior teeth, and
form an acrylic bite block on the occlusal component (figures 3a and 3b)

76. 7. Remove it from the cast and cement the band onto the respective teeth (figures 4a and 4b
8. After the desired correction is achieved, cut the occlusal component near the solder point with
the help of a cutter, and remove the block.
Advantages
This fixed bite plan technique offers several advantages:
•It does not need patient cooperation.
•It can be used full time.
•It does not require any bonding material, so there is no damage to enamel.
•It is hygienic.
•It can be easily removed.

77. A removable posterior bite plane is temporary, can be lost or broken, and
sometimes may even be swallowed by patients. GIC bite blocks can cause
discomfort during chewing due to the single points of contact on each side.
Many of these problems can be overcome, however, by using a fixed bite
plane without cementation, which is then easy to remove after correction.

78. The Bite Plane is a removable or fixed device to prop open the bite. It is
usually used when the front teeth overlap too much (deep overbite)
which can cause impingement on the gum tissue or the teeth to wear
down. It also props open the upper teeth to keep lower braces from being
bitten off and the wires to work more freely

79. The removable Bite Plane fits in the roof of the mouth and has a flat plane
just behind the upper front teeth. The lower front teeth contact this plane
which keeps the front teeth apart. This also keeps the back teeth apart
which makes chewing a little difficult until the back teeth grow down into
contact (6 months to one year). It is worn all the time even for eating
unless the doctor gives different instructions.

80. Bonded lingual bite planes can’t be adjusted and are difficult to remove.
Composite resin bite-blocks require additional clinical time and may cause
occlusal enamel wear of opposite teeth if filled composite resins are used.

82. Güray (1999) introduced a new type of bite-opening appliance, the temporary
bite raiser. Its main disadvantage is that it does not allow headgear or auxiliary
wires to be placed simultaneously.
Picture 1: Insert the proximal wings of the Bite
Raiser into the headgear tube and tie the proximal
wings to the headgear tube with a stainless steel
ligature followed with an elastomeric separator.
Picture 2: Overlay the Bite Raiser onto
the molar occlusal surface and tie the
“T” spur to the palatal button or lingual
cleat with an elastomeric separator
Application of
the Güray Bite
Raiser™

83. Also in cases of bruxism, composite may wear down making it
ineffective, requiring extra clinical time to restore it to the
appropriate height. As proposed by Fine, bonding lingual brackets
to the maxillary central incisors causes opening of bite but its use
should be limited to Class I or Class II division 2 cases with minimal
overjet.

84. Further, these lingual brackets can be fragile similar to the
mandibular labial brackets they are supposed to protect.

85. Correction of palatally blocked out canines in adults can pose a problem in aspects of
patient tolerance to various appliances like bite plates and /or bite blocks, given to
provide occlusal clearance for the tooth to be moved buccally.
INNOVATIVE TEMPORARY BITE RAISING APPLIANCES USED IN ORTHODONTICS
EUROPEAN JOURNAL OF PHARMACEUTICAL
AND MEDICAL RESEARCH
ejpmr, 2016,3(9), 156-157

86. In this case, the patient compliance for bite plate and bite block was minimal
as the patient was a stage artist and didn’t want any palatal coverage which
would hamper speech. Thus, bilateral temporary acrylic bridges were used to
provide anterior bite clearance, so that the palatally blocked out canine could
be moved buccally into proper alignment

87. PROCEDURE Upper and lower alginate impressions were made. The casts
were then sent to the laboratory for fabrication of bilateral lower temporary
acrylic bridges extending from the 1st premolar to the second molars on
either side without altering the natural contours of the teeth. Bite was taken
for uniform occlusal contact.

88. Space was created for blocked out canine after initial alignment and
levelling before cementation of the bridges. The bridges were
cemented using zinc oxide eugenol cement and could be easily
removed after the desired tooth movement. The bridges provided
enough occlusal clearance for the upper left canine to be moved
buccally into alignment .

91. Correction of a maxillary canine-first premolar
transposition using mini-implant anchorage

93. Bite raising was achieved
by bonding composite on
the occlusal surfaces of
both mandibular first
molars.

96. After biteplanes are bonded,
speech can be slightly affected for a day and mastication for a week, however p
atients adjust to speaking
more quickly than with removable biteplanes. Accidental debonding of a bond
ed biteplane is rare because
occlusal forces are moderated by the propioceptive reflex, and most pressure is
directed against the tooth surfaces

97. The bite ramp in a kind of bite plane developed by GAC and its ad
vantages are: it is not necessary to be built,
it is easy to bond and it is hygienic. The only disadvantage is that
this orthodontic device is more expensive
than the other ways of opening the bite
Anterior BTs provided an incisal stop that allowed the posterior
segments to extrude and level to correct the lower curve of
Spee. In addition, the mandible was free to move anteriorly for
a more comfortable occlusion with the maxilla

99. Case Report This case report concern an 12year-
old male, presenting with a Class II division 2 malocclusion, with an
accentuated curve of Spee and deep overbite. The patient still presented two
deciduos teeth, the maxillary
right canine and the second molar (figure 1). The periapical and panoramic ra
diographs showed sound
periodontal conditions and the presence of all permanent teeth (figures 2 an
d 5).

101. The cephalometric analyses shows that, according to ANB, patient presented a regular basal bone relationship
because the mandible retrusion. The maxillary and mandibular incisors were tipped lingualy, according to 1.N
A and 1.NB and his growth was predominantly vertical. Patient presented a good profile with competent lips
(figure 2 and table).

102. To decrease treatment time during leveling curve of Spee and overbite correction, it was used the bite ramp,
which is an orthodontic device that is bonded on lingual face of the maxillary central incisors. This procedure
allows the bonding of mandibular incisors and facilitates the overcorrection of overbite because the brackets
can be bonded on a more incisal position. After three months, the deep bite was corrected
and the posterior teeth occluded, what shows the effectiveness of the bite ramp, mainly because the fulltime
use. Radiografically no significant alterations were noted on maxillary and mandibular incisors roots during the
use of the bite ramp
A, overjet after bite ramp bonding; B, bonding of mandibular teeth; C, bite ramp bonding

103. Overjet after 1 month of use of bite ramp
Periapical radiographs: A and B, before bite ramp bonding; C and D, after bite ramp removal

104. The malocclusion was treated with 0.022inch slot preadjusted appliances. Patient used IHG for 12 hours a
day during leveling and alignment, which sequentially progressed from 0.016inch NiTi wires, through 0.016,
0.018, 0.020 and finally 0.018 X 0.025inch rectangular stainless steel archwires. In the end of treatment,
patient used Class II elastics bilateral to improve the anteroposterior relationship. Treatment time lasted 2
years and 3 months. At the end of treatment a Hawley plate and a bonded caninetocanine retainer were
installed in the maxillary and mandibular arches respectively

105. The facial photographs show a good posttreatment facial profile with competent lips. The patient was satisfied
with his teeth and profile. The final occlusion showed a Class I molar relationship on both sides and the inicial
deep overbite was overcorrected . The superimpositions show that patient had a predominanant
vertical growth and the mandible experienced a downward and posterior displacement. The maxill
ary incisors were retruded and the mandibular incisors were labially tipped and retruded .

106. There are basically four ways to treat a deep bite: (1) leveling of the arch through eruption of premolars,
associated with a clockwise rotation of the mandible, which serves to increase lower facial height; (2) intrusion
of lower and/or upper incisors; (3) labial inclination of the incisors; and (4) molar extrusion8. In this case,
overbite was corrected by extrusion of mandibular molars and restriction of vertical development of
mandibular incisors (figure 8).

107. The bite ramp was very useful in this case because made possible the overbite correction in the beginning of
treatment and in a little time (3 months), consequently decreasing treatment time. According to some authors912
, the higher inicial overbite, the higher relapse and the necessity of overcorrection during treatment. The bite
ramp allows the brackets bonding of mandibular incisor in a more incisal position, what helps in attain an
overcorrection of deep bite in the end of treatment. In this case report it is not observed any alteration of
maxillary and mandibular incisors root during the use of the bite ramp.
Bite ramp is a very effective device in orthodontic treatment to correct rapidly deep overbite in the beginning
of treatment. Its advantages are: it doesn’t need patient cooperation, it is used fulltime, it is not necessary to
be built, it is easy to bond and it is hygienic

108. Tongue Trainers
Tongue Trainers may be used in severe tonguethrusts to aid in
closing an open bite