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Correction of distal bite

We tell you what a distal bite is and show examples of treatment
We use the most effective devices and advanced bite correction techniques
Treatment time — from 8 months

According to various studies, distal or prognathic bite — is the most common pathology and occurs in about 30% of children and 15-20% of adults with a malocclusion bite.

Distal occlusion (distal occlusion) — is a dental pathology in which the upper jaw is strongly forward in relation to the lower jaw when the teeth are clenched together. The disproportionate occlusion is caused by both overdevelopment of the upper jaw and underdevelopment of the lower jaw.

Signs of distal bite

Any malocclusion is primarily determined by the position of the tooth rows when they clasp together. But some occlusal anomalies affect the whole appearance: they shape facial features, facial expressions, symmetry, affect the position of the body.

Intraoral signs

In the oral cavity, a distal bite is identified by the upper frontal teeth protruding forward. In a normal, orthognathic bite, the upper incisors overlap the lower incisors by about 1/3. In distal pathology, a distance — «saggital gap is formed between the upper and lower incisors».

Saggital cleft and bite are normal

External signs

Because of the disproportionately extended upper jaw, the distal bite can be identified by a convex or «bird-like» profile. The nose and upper lip protrude forward, the lower lip is receding. The chin is oblique, disproportionately small, sometimes with a fold — «second chin». In severe distal occlusion (with a large saggital gap), the lips are not closed in a relaxed state and the mouth is always slightly ajar.

Distal occlusion is visually reflected in the posture — the whole body leans slightly forward. A patient with a distal occlusion is characterized by a pronounced slouch, an elongated neck bent forward, and a protruding abdomen.

Profile before and after distal bite treatment
Posture in distal dentition

Functional signs

In addition to the external signs, a distal bite is accompanied by discomfort in swallowing, chewing food, nasal breathing and speech functions.

But occlusal anomalies usually develop gradually from childhood, so an adult is more likely to adapt and not experience discomfort.

We have described a number of possible signs that can be used to identify a distal bite. However, only an orthodontist determines the exact diagnosis and treatment methods.

Causes of distal bite formation

There are many factors that influence the formation of the jaws, some of which determine the bite before a child is born or during intrauterine development. Some causes of malocclusion can be controlled and anomalies can be prevented at an early age. Most often, distal occlusion — is the result of a combination of many factors, which we will discuss below.

Genetic causes

Distal bite is inherited in about 66% of cases. If there is a hereditary predisposition — incorrect bite in parents, distal bite is formed at an earlier age. Without timely prophylaxis, further exposure of the bite to external factors will only aggravate the anomaly.

Peculiarities of intrauterine development

Fetal growth, and including the formation of jaws, is disturbed by unfavorable environment and the state of health of the mother. The main harmful factors include: maternal illness, vitamin deficiencies, high levels of radiation, alcohol consumption.

Peculiarities of feeding and early development

Normally, in newborns, the lower jaw is slightly underdeveloped and set back in relation to the upper jaw.  The growth of the lower jaw occurs due to its intensive movement and natural tension during breastfeeding. After about six months, the child develops a correct orthognathic bite. Feeding from the wrong bottle (with a too wide milk opening) during the first months of the infant's development does not provide the necessary load on the lower jaw. Consequently, it does not grow and remains in distal relationship to the upper jaw.

However, the lower jaw does not grow and remains in distal relationship to the upper jaw.

Sucking a pacifier, finger or other objects for too long can aggravate the distal bite and increase the saggital gap. It is recommended to wean the child from the pacifier before the age of 2 years.  

With the further development of the baby, it is necessary to remember to introduce moderately solid foods into the diet in time. Without exercise and training in chewing, the jaws become weaker and do not grow.

Childhood diseases

Diseases affecting malocclusion can be divided into 2 groups:

  1. Respiratory diseases.Rhinitis, sinusitis, adenoiditis, curved septum, other pathologies and diseases that disrupt natural nasal breathing. If a child is forced to breathe through his mouth frequently or constantly, then his mouth is slightly open and his lower jaw is lowered. This position of the jaws is fixed and turns into a distal bite.

  2. Diseases that negatively affect the development of the body as a whole. Rakhitis, endocrine disorders, lack of fluoride, calcium and other nutrients affect, among other things, and the normal growth and formation of the jaws, eruption of teeth.

Decay or early loss of baby teeth

The loss or poor condition of teeth also negatively affects jaw growth and the formation of a normal bite.  

Classification of distal bite

Orthodontists use several classifications of distal bite.

Clinical forms of distal bite according to Khoroshilkina:

  1. Dental-alveolar form. This form of malocclusion is caused by individual teeth that are not growing properly or by an abnormal development of the alveolar process — the part of the mouth from which the teeth grow.

  2. Gnathic or skeletal form. A bite resulting from the disproportionate size and position of the jaws in relation to the skull and each other.

  3. Mixed form — a bite that combines abnormal jaw development and abnormal growth of individual teeth.

Engle subclasses:

  1. I subclass — The upper incisors are forward, sometimes slightly upward. This type of distal occlusion is characterized by a saggital gap.

  2. II subclass — The anterior teeth grow backward, clasping the lower incisors, no saggital gap.

1 subclass
2 subclass

Consequences of distal bite

A misaligned bite always means an uneven distribution of the load on the different teeth — while some teeth are not involved in the chewing process, others have to process a larger volume of food with greater intensity. This predictably leads teeth to wear down more quickly. The entire jaw and teeth system is at risk of premature damage:

  • periodontal tissue.  Gingival recessions, gingival pockets, and inflammation are formed.

  • tooth enamel. Under pressure in the gingival area, chipping —wedge-shaped defects occur on the enamel. If the teeth do not clench properly, they are worn away.

  • The roots of the teeth become mobile and gradually weaken, increasing the risk of pulpitis and periodontitis.

  • temporomandibular joint.

A distal bite can cause GI disorders and abnormalities due to inefficient food processing.

Diagnosis of distal bite

To evaluate the condition of the bite and determine its type, the orthodontist first performs a visual examination of the teeth and mouth and gathers information from the patient. During the initial examination, the doctor also pays attention to the condition of the joint, posture, and signs of nasal breathing disorders.  Further calculations and treatment plans require more precise data, which can be obtained with the help of modern diagnostic methods.

Convex profile in distal dentition
Distal jaw position on teleradiography
  1. Computed tomography or 3D projection of the skull. It can be used to evaluate important indicators for orthodontic treatment: the clinical shape of the bite, the size and position of the jaws. The position and ratio of teeth in bone tissue and its volumes. The condition and position of the head of the temporomandibular joint. A three-dimensional model of the skull gives a more accurate idea of the position of the teeth and jaws than a classic 2D image of the skull in a lateral projection.

  2. Dental impressions. They determine the nuances of closure, position and future movement of teeth.

  3. Photo protocol. To assess the condition of the bite and oral cavity, teeth are recorded in the photo from different angles, in a closed, unclosed state, as well as a face in profile, full-face, with a smile, with an open and closed mouth. The images help to track the dynamics of treatment, adjust and evaluate the final result of treatment.

Treatment of distal bite

Treatment of distal bite in children

Distal bite can begin to develop at different stages: from birth, at the appearance of milk teeth or when changing to a permanent bite. The earlier the pathology is diagnosed and treatment begins, the less time and less complex techniques will have to be used.

Parents can prevent the development and complications of a distal bite by following feeding recommendations, monitoring breathing patterns, avoiding chronic ENT diseases, and preventing bad habits from taking hold.

If malocclusion is still suspected, orthodontists can be seen for the first time when the first teeth appear, from about age three.

At an early age, a distal bite can be corrected with removable appliances such as muscle trainers, appliances to stimulate growth of the lower jaw and slow growth of the upper jaw, and tongue guards.

In addition to orthodontic appliances, depending on the nature and cause of the bite, the orthodontist may prescribe myogymnastics, referral for extraction of overcomplete teeth or to the ENT, and grinding of canines that interfere with normal alignment.  

Treatment of distal bite in adults

From adolescence, with a permanent bite alignment of teeth and correction of abnormalities is possible only with fixed appliances — braces or removable aligners. All types of braces are suitable for the treatment of distal occlusion: external braces metal and ceramic, internal (lingual)

Often distal overbite is accompanied by displacement of the head of the temporomandibular joint. Such patients additionally use an articular splint to correct jaw movement and position.

If it is impossible to correct the position of the jaws with apparatuses because of their abnormal size, it is necessary to resort to maxillofacial surgery: expansion of the lower jaw or narrowing of the upper jaw.

Treatment of distal bite in the clinic «Konfidencia»

The clinic «Konfidencia» offers its patients competent treatment using modern European and American methods of bite correction.

The orthodontic department at Konfidencia consists of experienced orthodontists who not only practice orthodontics, but also give lectures and orthodontic training workshops for specialists. Their portfolio includes a wide range of complex distal bite cases.

The orthodontic team also includes specialists in the treatment of TMJ dysfunction.

We pay great attention to the diagnostic phase. We ensure its accuracy through state-of-the-art equipment, detailed analysis and discussion with orthodontic colleagues and dentists from other specialties.

 Our doctors work with a variety of braces and eliners, so the patient can choose the most comfortable method of treatment. 

Diagnostic consultation with a leading orthodontist
  • A detailed treatment plan in 1.5 hours
  • Planning according to the concept of accelerated treatment
  • Personal curator's help
4 900 rub
10 000 rub

Cost of distal bite treatment


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02.09.2022
Updated 17.01.2024