A retrospective cephalometric study for the quantitative assessment of relapse factors in cover-bite treatment

Cover-bite ("Deckbiss") is regarded as a highly relapse-prone malocclusion. In this context the great significance of a high lip line (LipL) as an etiologic factor for the retroclination of the upper central incisors was recently proven within the framework of lip pressure measurements. It therefore seemed likely that a persisting high LipL after correction of cover-bite might have an equally negative impact on the stability of the treatment outcome.

This issue was investigated in the present retrospective study by cephalometric analysis of the findings prior to therapy (T1), immediately after active mechanotherapy (T2), and after a mean follow-up period of 2 years (T3). The study group consisted of 40 former cover-bite patients with initial linguoversion of the upper central incisors (axial angle to anterior cranial base < 98 degrees ) and anterior deep bite (> or = 4 mm) from the records of the Department of Orthodontics, University of Freiburg i. Br., Germany.

The average relapse was ca. 20% of the total correction of the anterior linguoversion and deep bite, with the relapse tendency, however, displaying substantial interindividual variations. Multiple regression analysis revealed an increased relapse tendency in specific cases: patients with maxillary extractions, cases with a pronounced therapeutically induced change of upper central incisor inclination, and patients with a high post-therapeutic LipL or with poor compliance in the retention phase. In view of the relatively good opportunity to influence the level of the LipL therapeutically, one of the most important therapeutic objectives for cover-bite patients should be to reduce the amount by which the lower lip overlaps the upper incisors ( to a maximum value of 3 mm). This can be achieved by active mechanical intrusion of the upper incisors. If the orthodontist fails to take account of this aspect when planning or performing the treatment, he has to accept an increased risk of relapse.