2Q2B. Vertical

Correction of vertical problem

Vertical problems

There are numerous vertical problems. The problem can be skeletal in origin; skeletally, it could be maxillary bone is positioned too low or too high and mandible bone that are more open or more closed. Dentally, vertical problem can be caused by excessive extrusion of upper front or back teeth or extrusion of lower front or back teeth. Instead of excesses, vertical problem can be also be caused by under-eruption of any of the tooth. To make the problem ore complex, certain skeletal vertical problem such as the degree of mandibular opening are influenced by other skeletal problem (maxillary bone with excessive vertical growth) and dental problem (excessive eruptions of upper and lower posterior teeth).

 

Certain problems may look worse or look not as bad depend on favorable or unfavorable soft tissue covering. For example, patient with excessive maxillary bone or excessive eruption of upper anterior teeth will look worse for patient with short upper lip and will not look as bad if patient has longer than normal upper lip.

 

In fact, the soft tissue shape and size are so important in that a patient with ideal maxillary skeletal position with ideal incisial position can still look awkward if the patient have excessively short upper lip. Similarly, patient with ideally positioned lower jaw can still look retrognathic, if the patient have excessive tissue under the chin (platysmal fold).

The most common dental vertical problem include the following, deep bite caused by excessive eruption of upper front teeth, deep bite caused by excessive eruption of lower front teeth, deep bite caused by inadequate eruption of posterior upper or lower teeth leading to over closed mandible. The latter problem is actually a combined skeletal vertical problem (“over closed” mandible ) and dental vertical problem (inadequate eruption of posterior teeth).

Other common dental vertical problem include open bite by inadequate eruption of upper and lower front teeth, open bite caused by super eruption of posterior teeth. This latter problem is also a combined skeletal vertical problem (“excessively open” mandible) and dental vertical problem (super erupted posterior teeth).

The most common skeletal vertical problem would include the following. Open bite caused by excessively large or downward positioned maxilla. Closed bite from small maxilla or maxilla that positioned too high.

Common terms often used to describe vertical problem is dental open bite, dental closed bite, skeletal open bite, and skeletal closed bite. As one would expect, dental open and closed bite describes a vertical problem that is primary dental in origin and, therefore, are primary concerned with the excessive eruption or inadequate eruption of the anterior teeth. Skeletal open bite and skeletal closed bite on the other hand can be purely skeletal in origin (as in mal- position of maxilla) or combined skeletal-dental problem (as in overly open mandible combined with super erupted posterior teeth). For skeletal open or deep bite, one may not necessary see an actual open bite or deep bite. Patient’s anterior teeth may have compensated by super eruption for skeletal open bite, and inadequate eruption for skeletal deep bite.

 

As one can image, vertical problems must be clearly diagnosed or identified before any treatment plan initiated. If a clinician haphazardly initiate treatment without properly identifying the source of the problem, clinician can potentially make patient’s vertical problem worse.

 

Treatments of dental vertical problems are relatively straight forward and can either be solved independently or simultaneously with sagittal problems. However, some dental vertical problems such as excessive eruption of anterior teeth may be more efficiently resolved when addressed by itself.

Skeletal vertical problem or combined skeletal-dental vertical problem are often more difficult to solve and may be less stable after completion of treatment.

 

Regardless of the choice, vertical problem would take about 6 to 9 months to resolve.

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