DEEP BITE CORRECTION USING TRUE OR RELATIVE INTRUSION. WHICH IS BETTER? A SYSTEMATIC REVIEW AND META-ANALYSIS
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Keywords
Abstract
Introduction: Deep bite is one of the challenges which orthodontists face. Treating this with true
intrusion or relative intrusion is the question we would like to explore to find an answer in this review.
The aim is to find out which intrusion method Is better in terms of incisors intrusion, molars extrusion
overbite reduction, treatment duration, root resorption and stability.
Methods: 4 electronic databases were searched; Medline, Scopus, PubMed and Web of Science up
to march/2019 (updated 11/2019) combined with a manual search among the reference lists of the
included and relevant studies. Unpublished grey literature was searched using ClinicalTrials.gov.
Randomized trials and prospective cohort studies were included. There were no restrictions on the
search, and authors were to be contacted if necessary. Data were extracted using pre-standardized
data extraction forms. Quality assessment was performed using the Cochrane’s risk of bias tool for
randomized and non-randomized studies respectively.
Results: 15 studies (2 randomized and 13 prospective cohort) met the inclusion criteria. Most were
prospective studies with considerable potential for bias. 7 studies were included in the quantitative
synthesis and 3 meta-analyses were undertaken for 3 different outcomes. Meta- analysis comparing
intrusion of incisors found significant difference between the 2 groups (MD=0.63mm, 95%CI 0.37
to 0.88, P<0.0001). For molars extrusion significant difference was found between the 2 groups (MD=
-0.27, 95%CI -0.45 to -0.08, P=0.005). No significant difference was found for both groups
(MD=0.09mm, 95%CI -0.25 to 0.43).
Conclusion: There is evidence to support true intrusion of incisors with mini screws, but it is weak.
Overbite reduction with either processes is equally effective, and the evidence is weak as well.
Therefore, there is need for more high-quality studies in the future.
verbite is measured by how much the maxillary incisors overlap the mandibular incisors vertically 1.
Deep bite is an increase in this vertical overlap. Deep bite is mostly associated with class II division 2 type malocclusions. A large crosssectional study in the United States reported that 15% - 20% of the population had overbite >5mm 2.
Extremely deep may be associated with impingement of the palatal tissues, resulting in damage to the periodontium on the lingual surface of the maxillary incisors. Different methods are used to treat deep-bite malocclusions. They range from removable appliances to fixed appliances. All these methods use the concept of either proclination of incisors, intrusion of incisors and extrusion of molars. Although all these treatments reduce deep bites, it is not clear which treatment is better than the other in terms of tooth movement (intrusion/extrusion), amount of overbite correction, time to treat, root resorption and stability.
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Dr. Ahmed Kamal Dogar
Specialist Orthodontist, Orthodontics Section, Bright Look Medical and Dental Centre, Dubai
Dr. Farhan Riaz
Associate Professor, Community and Preventive Dentistry, Niazi Medical & Dental College, Sargodha
Dr. Ehsan Rathore
Associate Professor, Oral Medicine and Diagnosis, Faryal Dental College, Shaikhupura
Dr. Muhammad Zeeshan
Assistant Professor, Science of Dental Materials, Niazi Medical & Dental College, Sargodha
Dr. Muhammad Behzad Salahuddin
Associate Professor Oral Pathology, Rahbar College of Dentistry, Lahore
Dr. Faisal Shafiq Malik
Assistant Professor, Community and Preventive Dentistry, Riphah International University, Islamabad