Orthodontic Reduction of an Increased Overbite in Adolescents - the Mechanism and Rate of Occlusal Adaptation
Condition: Increased Overbite
MeSH terms: Overbite; Malocclusion, Angle Class II
Study type: Interventional

Summary: 
      The correction of a deep overbite is assumed to involve incisor intrusion and the extrusion
      or eruption of premolars and molars. The latter is also assumed to be the major contributor
      for growing patients where the vertical facial growth increase accommodates for the
      additional eruption of posterior teeth with anterior bite plane appliances.

      In this study the nature and rate of adaptation of the occlusal changes following insertion
      of a fixed anterior bite plane for the reduction of a deep overbite in growing patients will
      be investigated.
    

Detailed description: 
      All subjects who meet the inclusion criteria will be informed of the study and written
      consent sought for their participation. Subjects will be recruited from the new patient
      clinics and routine treatment waiting list. A standard initial lateral cephalogram will be
      taken of all subjects, unless this is already available within the specified age range.
      Active growth will be determined using the Bacetti CVM method. For the Intervention group -
      an intra-oral scanner will be used to accurately record the occlusal relationships prior to
      insertion of the fixed anterior bite plane (T0) and repeated immediately after placement
      (T1). Each subject will then be re-scanned on a six weekly basis for a period of six months
      (T2-T5). Conventional clinical photographs and three-dimensional stereophotogrammetry will be
      used to assess the vertical facial relationships at T0-T5. A further lateral cephalogram will
      be taken at T5 to assess for skeletal change and assess for evidence of intrusion and
      eruption as well as determine if there has been an alteration in incisor inclination.

      A control group of subjects from the treatment waiting list who meet the inclusion criteria
      will be used. An intra-oral scanner will record the baseline occlusal relationship (T0) and
      will be repeated after six months (T5). The control group will also have a standard
      pre-treatment lateral cephalogram taken, as well as conventional and three-dimensional
      stereophotogrammetry at baseline (T0) and after six months (T5). This will allow changes
      resulting from growth to be assessed whilst no active orthodontic treatment has taken place.

      The primary outcomes to be assessed will be the nature of the change in occlusal-vertical
      dimension and the rate of occlusal adaptation in relation to facial growth changes. The
      intra-oral scans and photographs will be analysed using three-dimensional technology to
      determine the immediate change and any resultant occlusal adaptation and change in lower face
      height on a six weekly basis for six months.

      All subjects and guardians in the intervention group will be asked to complete a short
      questionnaire immediately after visits T1 and T5. This will assess their experience of the
      3-D scanning and bite planes (if applicable). We will also assess their knowledge of overbite
      definition, process of overbite reduction and effects of an increased overbite on oral
      health. The control group will be asked to complete the same questionnaire at T0.

      The economic impact of managing the increased overbite as an initial phase of treatment
      versus single phase comprehensive treatment will be investigated. A cost analysis will be
      performed to investigate any economic difference in using bite turbos versus a removable
      appliance to reduce the overbite.
    

Intervention name(s): Bite turbo
Intervention type(s): Device
Intervention description(s): In this study the nature and speed of adaptation of the occlusal changes following insertion of an anterior bite plane (bite turbos) for the reduction of a deep overbite in growing patients will be investigated.
Other intervention name(s): Ormco Europe 350-0000
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: orthodontics