Correction of distal bite in adults without surgery

Causes
Signs of pathology
Classification of pathology
What complications can there be?
Treatment and correction of distal bite

Distal bite is a pathology in which the occlusion (closing) of the upper and lower jaws is disrupted. In this case, the teeth of the upper jaw protrude much forward relative to the lower jaw. Another name for the anomaly is prognathia. It has a negative effect on appearance, causes consequences in the form of disruption of the digestive system, and psychological problems.

If a distal bite is diagnosed, correction is faster and easier in childhood. Correction in adults is also possible, but it requires a lot of effort and time.

Manifestations of distal bite in the mouth

Closing of lateral teeth during distal occlusion.

Distal occlusion is manifested in the mouth by the closure of the upper and lower teeth according to the “second class” (violation of the relationship between the projections of the antagonist teeth of the upper and lower jaw).

In the frontal segment (at the level of the front teeth) there are two closure options (the so-called first or second subclasses).

In the first case, a “sagittal gap” is observed, which reflects the discrepancy between the dentition in the sagittal plane (anterior-posterior direction). And the upper incisors are in protrusion (inclined forward). In the second option, the upper front teeth are tilted back (into retrusion). With the formation of a deep bite (when the lower teeth are not visible from under the upper ones).

Sagittal chain with distal occlusion. 2 class 1 subclass.
Distal occlusion. 2nd class 2nd subclass.

Mouth guards

Mouthguards, or aligners, are removable plastic or silicone transparent covers on the teeth. Made individually for a specific patient. They are worn constantly and are removed only for eating and hygiene procedures.

They are practically invisible, so they do not cause moral discomfort. The therapeutic effect is determined by a soft force effect on the dental elements, causing them to move in a given direction. The main disadvantage is the inability to eliminate particularly complex defects.

Important: the effectiveness of mouth guards for correcting malocclusion depends not only on the severity of the clinical case, but also on strict self-discipline. Failure to comply with the orthodontist's instructions will negate all efforts made.

Causes of distal bite (distal occlusion)

They are almost always (in the vast majority of cases) skeletal...

Posterior position of the lower jaw. This is the most common cause of distal occlusion
Small (short) lower jaw.

Many people write that the cause of a distal bite may be an overdeveloped (excessively large) upper jaw. They say that this is why there is a “gap” between the front upper and lower teeth (sagittal gap)... Many years of observations and our experience have shown that this is not so. With any anomaly of occlusion, there can be no talk of any OVERdevelopment. Everything, on the contrary, is UNDERdeveloped.

The lower jaw ends up in a posterior position (the first reason) only because the lower teeth bump into the upper teeth while the upper jaw is shortened and narrowed (generally underdeveloped). Or, when the upper incisors are “wrapped” back, into retrusion (second subclass). In addition, with distal occlusion, the upper jaw is always narrower than the lower jaw. Which, by the way, is another reason for blocking the lower jaw in the posterior position. And this same “blocking” does not allow the lower jaw, which is caught in the trap, to develop normally. Here is the second reason for distal occlusion - underdevelopment of the lower jaw.

There is also a “dental” reason for distal occlusion. Or more precisely, the dental cause of closure is “second class”. This is when mesial (front) displacement of the upper lateral teeth occurs. And then, even with a normal relationship of the jaws in the sagittal plane, the closure of the lateral teeth (molars) will also be in the second class. True, this is not a true distal occlusion...

A “dental” cause of the second class may complement or may camouflage true distal occlusion. Therefore, it will not be possible to figure out what is the reason for the closure in class 2 visually (by eye). Diagnostics required.

What complications can there be?

If an adult or child has developed a distal bite, treatment will help avoid the consequences of pathology. In the absence of correction, the following complications are possible, which are dangerous to health:

problems with diction, speech defects arise, correctly constructed speech becomes impossible;
dysfunction of chewing and swallowing food;
disruption of the proper functioning of the respiratory system;
the appearance of dental diseases - caries and stomatitis develop;
rapid wear of teeth, which leads to their premature loss;
the formation of complexes due to unsightly appearance.

Malocclusion affects a person’s entire life, causing psychological problems and the development of an inferiority complex. People with this problem are often unhappy and lack self-confidence. Only correction will help improve your condition and appearance.

Diagnostics

The main goal of any diagnosis is to identify the cause of the problem. And make a diagnosis. Likewise, the diagnosis of distal occlusion is designed to identify the cause of closure in the second class. In order to separate the flies from the cutlets during treatment, so to speak. That is, dental causes of closure are in the second class from non-dental (maxillary, skeletal).

The main diagnostic methods are:

Analysis of TRG (teleradiogram) of the skull in a lateral projection. It allows you to clearly determine all the skeletal (jaw) nuances of the problem. Both with the position of the jaws and with their sizes.
Analysis of plaster models of jaws (for this, casts are taken). It allows you to clarify the “dental” nuances: the size of the teeth, the length and width of the dentition, the features of the relationship (including closure) of the upper and lower teeth

Analysis of TRG (teleradiogram) of the skull in a lateral projection.
Analysis of plaster models of jaws.

It is not recommended to fall below this diagnostic “bar”. Below - just by eye. But this, as we understand, is not the best option.

Diagnostics is the first and key step in the treatment of distal occlusion. Do you want to know why it’s impossible to do without diagnostics?

Records

Vestibular plates are removable orthodontic devices. This means that they can be removed for a while, for example, to eat or brush your teeth. The plate for correcting pathologies is made individually for each patient using personal casts of the jaws.

The base of the plate is a plastic base that is adjacent to the palate. Arcs, clasps and screws are integrated into it. The base color can be neutral or colored.

These devices are mainly used in childhood and adolescence, when the dental system is not yet fully formed and therefore the dental elements are able to move relatively easily under the influence of directed force. The plates are also used to correct pathologies in adult patients, but only in mild cases.

Errors in the treatment of distal occlusion

The first, main mistake is that many try to treat distal bite with one device. For example, only with braces (this is the most popular option). But braces, although a cool device, are not for skeletal problems. The level of hardware competence of the braces system does not extend further than “to place the teeth on the jaw.” And distal occlusion, as we have already said, is a purely skeletal problem. Jaws and posture are to blame. And braces are not capable of solving problems with posture or jaw problems. After all, braces cannot change the position or size of the jaw. No matter what the would-be doctors promise...

And therefore, such videos are just an advertising gimmick.

Or rather, a convenient “hook” that catches gullible patients. Convenient because it coincides with the desire to do everything quickly and efficiently... But it doesn’t coincide with reality.

And braces cannot be the main device in the treatment of distal occlusion.

Braces are the wrong choice when treating distal malocclusions. In any case, you definitely shouldn’t start with them. Braces, as mentioned and shown above, can be effectively used only at the final stage of treatment of distal occlusion. All major “feats” must be accomplished before working on the teeth. Before using braces. And they are accomplished at the level of the jaws and skeleton (posture). Otherwise, there will simply be nothing to “clog” (close) these teeth (read with braces). See “Fundamentals of the therapeutic concept of “Ortho-Arteli”.

The second common mistake in correcting distal occlusion is treatment with the removal of upper premolars (4 or 5 teeth).

And this mistake is much more serious. Because it can have the most dire consequences. See "Orthodontic treatment with tooth extraction."

After all, as we said above, the main causes of distal occlusion are skeletal. And most often the lower jaw is to blame. And if so, then a reasonable question arises: if the lower jaw is to blame, what does the upper teeth have to do with it (their removal). Where is the logic?

In general, all errors in the treatment of distal occlusion in an adult are usually associated with insufficient diagnosis. Which entails a misunderstanding of the reasons for the occurrence of distal occlusion in each specific case.

For example, the “dental” cause of distal occlusion is very often confused with the “skeletal” (jaw) cause. We remind you that in the first case you need to move the lateral teeth back. And in the second - to push the lower jaw forward and develop the upper one. And if you get confused, if you don’t figure it out... Start distalizing the upper teeth, or worse, remove them when it is necessary to advance the lower jaw... Or vice versa. It is clear that nothing good will come of it.

The third mistake is when, without understanding what’s what, what exactly is the cause of distal occlusion, but realizing, however, that the problem cannot be corrected with braces, they try to solve the problem surgically. Using orthognathic surgery. Through osteotomy of the lower and upper jaws.

This is where I would like to dwell in more detail. And explain something. Why do orthodontists send to a surgeon to “treat” a distal bite? They have already said: they understand that braces will not cope. But they don’t understand how to treat it without braces. They don’t understand because in dentistry in general, and orthodontics in particular, there are a lot of prejudices regarding the possibilities of moving the lower jaw forward and developing the upper jaw. And these, as we saw above, are the main (“key”) points in the treatment of distal occlusion.

Most orthodontists simply do not believe in this (that it is possible in principle). Because someone (even a “great one”) said two hundred years ago that this cannot be done. Time has passed. Everyone has already forgotten why it is “impossible”. But no one even bothered to check why, in fact, it was impossible...

And therefore, those doctors who blindly believe in these moss-covered “dogmas” simply do not see an alternative. And for them there are only two extreme poles in the treatment of distal occlusion: braces and surgery. That's all.

During a direct examination by a specialist, you will be able to find out your exact diagnosis, as well as receive a referral for diagnosis or a treatment plan.

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And in our clinic we treat distal occlusion between these two poles. Using methods of maxillofacial orthopedics and craniodontics. Here are the ones: changing the position of the lower jaw and changing the size of the upper. And we get good results, without regard to the fact that someone once said something... We must always double-check what was said. We checked. And everything turned out to be somewhat different. Or rather, not at all the way they “frightened” us. You can also push it out. It can be developed. You just need to know how, because there are some “secrets” here. And we, at the Orto-Artel clinic, knowing these “secrets”, take advantage of these opportunities, successfully eliminating distal occlusion of any complexity.

By the way, if we are talking about surgical treatment of distal occlusion, then we need to determine when and in what cases surgery is generally appropriate. But the indication is basically the same - a small lower jaw, the so-called lower micrognathia, and the micrognathia is very pronounced.

We indicated this reason above as one of the skeletal reasons. I will add: the lower jaw should be VERY short. Literally ugly. Only then can this be resolved surgically. In all other cases, you can do without surgery. Proven and tested many times.

By the way... In our clinic, a good half of the patients have formal indications for surgical treatment of distal occlusion. But only a few got to the surgeon. Because formalities are formalities, but compromise solutions were found that satisfied everyone: both the patients and us. This is because we approach treatment not formally, but in essence. And we are guided by logic and common sense.

Well, as a special case of a short lower jaw, which cannot be corrected except by surgery, this is a small chin. If it is small and spoils the face, then even by pushing the lower jaw forward we will not get the aesthetics we want. Simply because orthodontists do not have the means and instruments (devices) to selectively influence the chin. It is impossible to stimulate the chin to grow. Only surgery.

Inferior micrognathia.

This is where the indications (and there is essentially one) for surgical intervention for distal occlusion end.

Going with a knife into the upper jaw - God forbid! Even if the upper jaw is indirectly to blame for the distal occlusion. More precisely, the upper jaw also, as a rule, suffers (dimensionally) with distal occlusion. The upper jaw is directly connected to the base of the skull. And such interventions can then backfire. Literally. And the most important thing is that there is no need to go there surgically. The upper jaw can be developed!!!

Types of occlusion defects and methods of their correction

Scientists have calculated that only 40% of the planet's inhabitants are the happy owners of an ideal bite. All others have deviations from the norm to one degree or another. Defects can be critical when they have a negative impact on human health, and practically unnoticeable, not leading to moral or physical discomfort.

The picture below shows occlusion anomalies:

Modern orthodontics includes several methods for correcting malocclusion:

using braces;
through surgery;
using myotherapy (physical exercises) and non-braces corrective devices.

How to effectively correct an overbite. Treatment methods for abnormalities

Treatment of dental malocclusion begins with assessing the condition of the oral cavity and carefully studying the problem. Next, the dentist can recommend one of the popular ways to restore the correctness of the dentition:

Braces. They can solve almost any bite problem. They are divided into metal, plastic and ceramic, sapphire, self-ligating, lingual. Each type has its own advantages, for example, metal ones are the cheapest, but also the most noticeable, but lingual ones are very expensive, but are placed on the inside of the teeth, so they are not visible.
Kapu. A mouthguard is a removable polymer structure that is harmless to enamel and can be easily removed while eating or brushing your teeth.
Surgical intervention. Allows you to correct almost any bite problem. It is required only in very complex cases, usually with congenital pathologies.
Laser treatment. This is not an independent way to correct a bite. Auxiliary procedures using lasers accelerate regeneration and help reduce the risk of complications.

Modern methods are almost always safe and cause only minor discomfort. But after the course of treatment you will not recognize yourself: you will become more confident, braver, healthier. And sometimes the correct bite changes the appearance in the photo and in reality, forming healthier and more pleasant facial features.

Fig. 3. Braces and mouth guard for malocclusion treatment

Prevention

Preventive measures in most cases can prevent the development of this pathology or slow down its progress. To do this, you should follow these recommendations:

Children and adults should see a doctor at least once every six months to detect the initial stage of the disease. During this period, the correction will take much less time and will be carried out using gentle methods.
Watch your posture.
Prevent rickets or treat it promptly.
Introduce natural breastfeeding and fight bad childhood habits.
Ensure the constant presence of solid food in the diet.
Avoid chronic ENT diseases or allergic conditions that cause nasal breathing problems.

You know why you endure temporary inconvenience!

The devices we talked about today complicate the life of a person wearing braces, but if you follow the doctor’s recommendations, you don’t need to wear additional devices for very long.

In conclusion of the article, we would like to draw the attention of young parents to the importance of preventing defects of the dental system in children and the timely initiation of orthodontic treatment.

By following the recommendations of orthodontists, you can avoid the use of corrective equipment in adulthood. You will find out what these recommendations are by reading the article A beautiful smile of a child is the care of loving parents.

Orthodontists at NORD DENTAL clinics are ready to work hard and make your smile beautiful!

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pediatric dentistry, orthodontics, topic articles: Herbst apparatus, distal bite, bite correction, face bow, face mask, mesial bite, microimplants, palatal clasp, palatal expander