Gaining vertical dimension for the deep bite restorative patient.

Some of the most perplexing problems that the restorative dentist is called upon to treat involve those of the Class II deep bite patient. Class II deep bites are usually hereditary or are problems associated with growth or habit. Others have developed during adult life as a result of posterior teeth being lost or worn own, with subsequent tooth drift. These patients usually display a significant loss of vertical dimension, and this should be corrected in order to treat the patient successfully. Some of the more common clinical features observed in the Class II deep bite patients which require dental intervention are: (1) temporomandibular joint syndromes with possible joint pain, tinnitus, clicking, vertigo, and sometimes loss of hearing; (2) tension and tiredness in facial and masticatory muscles; (3) periodontal disease; (4) labial migration of the upper incisors; (5) poor profile and poor esthetics with an adverse psychological and aging effect on the patient; (6) disruption in phonetics: (7) impingement of lower incisors on palatal tissue or upper incisors on labial tissue, and finally, (8) the lack of proper anteriortooth position for good incising function and for protection of the posterior teeth from excessive lateral and protrusive stress. Although it is not difficult to diagnose the poor esthetics, phonetics, and pathologic conditions of the gnathic system observed in these deep bite patients, it is often difficult to reduce the situation to a state in which the destruction will cease and at the same time achieve a good functional and esthetic result. Many dentists have restored deep bite conditions at the collapsed vertical dimension which the patient presented. Often the temporomandibular joint and periodontal degeneration still progressed, the maxillary anterior teeth continued to migrate labially and separate, and the over bite continued to deepen. The discouraging results in many instances