Study suggests better outcomes for later treatment of deep bite

iStock_000002259334XSmall braces on teeth

The aim of this trial was to assess the outcomes of early vs late treatment of deep bite patients by means of anterior biteplane appliances followed by fixed appliance therapy.

Patients with a deep overbite (> 4.5mm) and fully erupted maxillary and mandibular incisors were allocated to either early or late treatment. Treatment for the early group (n=34) started in the mixed dentition at a prepubertal stage of skeletal development (Cervical vertebral stage [CS] 1 or 2). For the late group (n=24) treatment started in the permanent dentition at a pubertal growth stage (CS 3 or 4).  A non-extraction protocol was used for both groups with removable appliances with anterior bite planes followed by fixed appliance therapy.  A standardised protocol was followed for the fixed appliance therapy in both groups.  Cephalometric assessment was conducted at baseline, before fixed appliance phase and at least I year after completion of active fixed appliance treatment.

They found:-

  • Treatment duration was significantly shorter in the early treatment group.
  • Overbite reduction was significantly greater in the late treatment group (-3.1 mm) than in the early treatment group (-1.4 mm).
  • In the late treatment group, 92% of the patients had a corrected overbite 1 year after therapy compared with 65% in the early group.

The authors concluded that:-

Treatment of deepbite at puberty in the permanent dentition leads to significantly more favorable outcomes than treatment before puberty in the mixed dentition.


This is a small study with only 58 participants. While there were no apparent differences between the two groups at baseline the trail was not randomised and non-randomised studies tend to overestimate the effect size.  A Cochrane review published in 2012 (Millett et al) that looked at orthodontic treatment for children with deepbite and retroclined upper anterior teeth (class II division 2 malocclusion) did not identify any randomised controlled trials or controlled clinical trials.


Baccetti T, Franchi L, Giuntini V, Masucci C, Vangelisti A, Defraia E. Early vs late orthodontic treatment of deepbite: A prospective clinical trial in growing subjects. Am J Orthod Dentofacial Orthop. 2012 Jul;142(1):75-82. PubMed PMID: 22748993.

Millett DT, Cunningham S, O’Brien KD, Benson PE, Williams A, de Oliveira CM. Orthodontic treatment for deep bite and retroclined upper front teeth in children. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005972. DOI: 10.1002/14651858.CD005972.pub2.




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