Looking at bimaxillary protrusion from a different perspective

Bimaxillary protrusion has a significant influence on facial esthetics and orthodontics plays an important role in its correction, since incisor retrusion allows major lip changes. In contemporary orthodontics this can be achieved, in varying degrees, by three basic mechanisms: interproximal reduction, full arch distalization using skeletal anchorage, or premolar extractions. In premolar extraction cases it is not yet clear if there is a difference in anchorage loss and therefore in the amount of incisor retraction with two-step or en-masse retraction mechanics. Three dimensional aspects of cases treated with such mechanics will be presented regarding occlusal and facial effects. Although bimaxillary protrusion has been traditionally looked at in a profile view by our profession, it will be shown that this malocclusion is of greater impact in the frontal view, being associated with perioral muscular contraction, which can suggest unrested facial expressions. This presentation will demonstrate that 3D analysis and frontal perception of bimaxillary protrusion can shed light to a whole new perspective on this malocclusion.

Learning Objectives:

a) Understand the tridimensional differences of space closure in two- step and en masse retraction . 

b) Recognize the tridimensional effect of incisor retraction on the lips . 

c) Realize the impact of the bimaxillary protrusion in the frontal view on facial esthetics .

Game Changers in Open Bite Treatment

Open bite treatments are challenging due to its high rate of relapse. The literature presents many researches on this subject, but with controversial information. There are disagreements on the definition of open bite, its etiology and types of treatment. Possibly, the lack of consensus on the etiology of the anterior open bite may have led to different types of treatment and can be the explanation for the high level of relapse of this malocclusion. Function has a primary role in open bite stability, but other factors are of utmost importance to achieve an adequate and esthetic occlusion. With this in mind, the purpose of this lecture is to discuss how dental, skeletal and functional aspects should be considered in treatment planning, as well as the impact of different types of orthodontic appliances on clinical results.

Learning Objectives:

a) Understand the importance of oral function in open bite stability. 

b) Outline the criteria to define on incisor extrusion or molar intrusion to correct anterior open bites. 

c) Critically analyze the effects of different appliances on open bite treatments.

Pearls of Knowledge on Deep Bite Treatment: Esthetic and Functional Considerations

Deep bite is an excessive overlap of incisors and should be treated in cases with gingival impingement or with long incisor guidance, that can

lead to incisor wear. It is multifactorial in nature and can be associated to a decreased mandibular angle, incisor extrusion and/or posterior underdevelopment. Posterior tooth wear or erosion can also lead to deep bite due to loss of occlusal vertical dimension, mandibular

counterclockwise rotation, and bite deepening. Many treatment approaches are available, which may include incisor intrusion, molar and

premolar extrusion or posterior prosthodontic build ups. Esthetic and functional aspects will determine which treatment approach to use and

should be considered in treatment planning, most specifically upper incisor display at rest and occlusal vertical dimension. To illustrate and discuss different treatment approaches a series of cases are presented, pointing out important diagnostic criteria to define where and how deepbite should be treated. 

Learning Objectives: 

a) Understand the importance of dynamic occlusion in overbite correction. 

b) Outline the criteria to define on incisor intrusion or molar extrusion to correct deep overbites. 

c) Present the effects of vertical dimension changes in deep bite correction.