case study
J. Stomat. Occ. Med. (2011) 4:67–71
DOI 10.1007/s12548-011-0010-y
Functional cephalometry analysis and computerized
axiography before and after therapy with “Function
Generating Bite” in a deep bite patient
Matteo Reverdito, Maria Grazia Piancino, Gianluigi Frongia,
Andrea Adriano Bracco, Maurizio Gribaudo Fresi,
Cesare Lorenzo Debernardi, Pietro Bracco
Received: 7 March 2011 / Accepted: 24 May 2011 / Published online: 12 July 2011
© Springer-Verlag 2011
Abstract
Background The interest of this case report is the evalu-
ation of the correlation between the condylar pathways
and incisor guidance recorded by computerized axio-
graphy and functional cephalometry analysis before and
after therapy with the “Function Generating Bite” (FGB-
D) appliance for deep bite correction.
Methods A 12-year-old Italian male patient affected
by deep bite was treated with the functional appliance
FGB-D to correct the malocclusion. Computerized axi-
ography and functional cephalometry analysis were per-
formed before and after therapy to evaluate the tempo-
romandibular joint function (TMJ).
Results The results showed an improvement of mor-
phology and symmetry of the axiographic tracings and
in particular a very good coordination between condylar
movement and incisal guide.
Conclusions The FGB-D appliance is a useful appli-
ance to correct deep bite dental malocclusions improv-
ing occlusion and TMJ function.
Keywords: Deep bite, Computerized axiography, Tem-
poromandibular joint, Temporomandibular disorders,
Functional movement, Function generating bites
Introduction
Deep bite is a malocclusion characterized by an increa-
sed overbite of the upper on the lower incisors (> 5 mm).
M. Reverdito · M. G. Piancino · G. Frongia · A. A. Bracco ·
M. G. Fresi · C. L. Debernardi · P. Bracco ()
Department of Orthodontics and Gnathology-Masticatory
Function, University of Turin – Dental School,
Via Nizza 230, 10126 Turin, Italy
e-mail: pietro.bracco@unito.it
Functional cephalometry analysis and computerized axiography before and after therapy with “Function Generating Bite”    67
It directly involves the position in the space of the incisal
region [1, 2] influencing anterior guidance and conse-
quently mandibular dynamics and static posture [3–5]. It
is known that the anterior guidance is related to the joint
functional movements of the temporomandibular joint
(TMJ) which can be evaluated in axiography by recor-
ding mandibular border movements. The importance of
the correlation between the condylar protrusion pathway
inclination in the sagittal plane and incisor guidance
has been described in the literature [6, 7]. Some stu-
dies reported extended axiographic paths in the sagittal
plane [3, 5, 8] in patients with deep bite, while Hausser [9]
reported a transverse limitation of border movements in
the frontal plane associated with dental deep bite.
Slavicek [10] not only emphasized the importance of
the correlation of incisor guidance and TMJ movements
but also described functional cephalometry analysis
which is a very useful tool to diagnose incisor guidance
characteristics before and after therapy to check the
results of the orthodontic treatment from a functional
point of view.
The interest of this case report is the evaluation of the
correlation between the condylar pathways and the inci-
sor guidance recorded by computerized axiography and
functional cephalometry analysis before and after the-
rapy with the “Function Generating Bite” (FGB-D) appli-
ance for deep bite correction.
Case report
Materials and methods
A 12-year-old Italian male patient was referred to the
Department of Orthodontics and Gnathology in the Uni-
versity of Turin Dental School, Italy.
Informed consent was obtained from the parents
before beginning the treatment.
 case study
The patient underwent computerized axiography and
functional cephalometry analysis before and after cor-
rection with the FGB-D for deep bite.
Clinical analysis
• Molar class II;
• overjet 3 mm;
• overbite 9 mm;
• mixed dentition.
Laterolateral cephalometric analysis
• Skeletal class II according to Steiner as AN^B = 5°
(n.v. = 2° ± 2; ANB angle formed by the intersection of
lines NA and NB, which measures the anterior-poste-
rior relation of the maxilla and the mandible);
• hypodivergent according to Steiner as SN^GoGn = 18°
(n.v. = 32° ± 4; SN-GoGn angle measuring the inclina-
tion of the mandibular plane in relation to the anterior
base of the cranium);
• interincisal angle 11^41 = 163° (n.v. = 135 ± 5°);
• counterclockwise growth according to Jarabak, as
PostHt/AntHt = 80%, counterclockwise growth accor-
ding to Bjork as SU^M = 373°.
Fig. 1 (a) Deep bite patient before therapy, (b) deep bite pa-
tient during therapy with the Function Generating Bite appli-
ance and (c) deep bite patient after therapy. (d) The sagittal
condylar guide (SKN) and the incisal guide (FF) are defined
by the orbital-axis plane. Differences between relative incisal
68   Functional cephalometry analysis and computerized axiography before and after therapy with “Function Generating Bite”
PostHt/AntHt is the rate between the posterior
facial height (Sella-Gonion length) and anterior facial
height (Nasion-Menton length). The normal value is
60°–64°. SUM is the sum between three angles: Nasi-
on-Sella-Articular, Sella-Articular-Gonion, Articular-
Gonion-Menton. The normal value is 396° ± 5°.
Appliance
The FGB-D appliance for deep bite correction was used to
correct the deep bite malocclusion (Fig. 1a–c). This appli-
ance was developed at the University of Turin expressly
to correct deep bite and to improve TMJ function [11, 12],
peripheral neuromuscular balance [13] and body post-
ure. The FGB-D appliance is characterized by posterior
metallic bite planes, a double anterior bite plane and a
resin palatal plate. It is activated by the patient’s muscle
contractions during swallowing. The double anterior bite
corrects the overbite by the simultaneous action of the
lower and upper incisors. Metallic posterior and anterior
bite planes allow the mandible to move without tooth
interference and the resin palatal plate induces recondi-
tioning of the tongue.
The appliance influences the neuromuscular system
improving muscular balance, masticatory function [14]
guide (RFF) and relative condylar inclination (RKN) relative
to the occlusal plane before therapy (90° − 22° = 68°. Normal
value 0–9°. (e) Difference between the relative incisal guide
(RFF) and relative condylar inclination (RKN) related to the oc-
clusal plane after therapy has been decreased from 68–35°

Fig. 2 (a) Axiographic tracing during protrusion before therapy, (b) patient with Cadiax axiograph® positioned during recording
and (c) axiographic tracing during protrusion after therapy
and TMJ function and gives more regularity to condylar
sagittal tracings [4].
The patient wore the appliance night and day except
during meals and sports activity. The duration of the-
rapy was 5 months (Fig. 2) and the patient underwent a
second axiographic evaluation after therapy.
Instrumental evaluation
Border condylar movements were measured with the
Cadiax® diagnostic axiograph and Gamma dental soft-
ware. The Cadiax® diagnostic axiograph is connected
with a condylograph face bow and interfaces with a com-
puter for data storage and subsequent analysis.
The axiograph simultaneously tracks and records hin-
ge-axis movements in horizontal, vertical and transverse
dimensions; furthermore, horizontal condylar inclina-
tion and the Bennet angle can be determined using com-
puterized axiography [15, 16]. In 1993 Piehslinger et al.
demonstrated the high reproducibility of the condylar
reference position [17].
The axiographic parameters considered and evaluated
were as follows:
1. Length, morphology and symmetry of the tracings,
during protrusion, mediotrusion and opening move-
ments, on the sagittal plane, for both condyles;
2. sagittal condylar guide (SKN) during protrusion and
mediotrusion movements, on the sagittal plane, for
both condyles [10];
3. Bennet angle during mediotrusion movements, on
the horizontal plane.
Reference values used (length of the tracings) were those
suggested by Slavicek [10], Piehslinger et al. [18] and
Piehslinger and Ertl [19].
After the axiographic registration the maxillary and
lower casts were mounted in the articulator (SAM2“C”,
SAM Präzisionstechnik, Munich, Germany; Snow White
Plaster No. 2, Kerr, Turin, Italy). A dental impression of
the upper incisor was made and the inclination of the
palatal concavity (in the sagittal plane) of the upper inci-
sor was related to the axio-orbital plane to obtain the
value of the incisal guide (FF; [10]).
Functional cephalometry analysis and computerized axiography before and after therapy with “Function Generating Bite”    69
case study
Functional cephalometry analysis
Functional cephalometry analysis is a technique develo-
ped by Slavicek, described in his book [10] and is useful
for correlating the SKN, the FF and the occlusal plane.
The protocol included:
1. x-ray in lateral view;
2. axiography analysis;
3. cephalometry tracing;
4. mean value (between the right and the left values) of
the SKN, recorded in axiography and the FF recorded
in articulator are transferred on the axio-orbital plane
in cephalometry;
5. extension on the occlusal plane of the SKN and the FF
values determine two new angles, RKN and the RFF;
6. relationship between RFF and RKN, i.e. the value of
the FF and the SKN relative to the occlusal plane.
In adult subjects the system is considered to be in equili-
brium when the difference between the RKN and the RFF
related to the occlusal plane has a value between 0° and
9°.
Results
The results are reported in Table 1 and showed:
1. Improvement in the symmetry of the SKN during
protrusion, left and right mediotrusion in the sagittal
plane for both condyles;
2. reduction of the displacement for the right condyle
(worker condyle) during left mediotrusion;
3. improvement in the symmetry of the Bennet angle
between right and left mediotrusion in the horizontal
plane;
4. improvement in the morphology and the symme-
try of the tracings, during protrusion, mediotrusion
and opening movement in the sagittal plane for both
condyles;
5. improvement in the relationship between the RFF
and RKN relative to the occlusal plane (before therapy
90° − 22° = 68°; after therapy 65° − 30° = 35°; Adult nor-
mal value 0–9°; Fig. 1d, e).
 case study

Table 1 Comparison between axiographic measurements before and after therapy with the FGB-D functional appliance
Axiographic Measuring
Before After Before After
Protrusion Right mediotrusion
Length (mm) Length (mm)
R   7.04   6.89 R   6.73   8.57
L   6.79   7.18 L   3.28   3.67
S.K.N. (°) S.K.N. (°)
R 28.5 40.2 R
L 37.9 46.2 L 28.9 43.7
Bennet (°)
R
L   8.7   6.8
Opening Left mediotrusion
Length (mm) Length (mm)
R 10.41 10.07 R   6.36   3.10
L 11.43 10.86 L   7.35   7.65
S.K.N. (°)
R 53.7 47.2
L
Bennet (°)
R 24.5   7.4
L
R right; L left; S.K.N. Sagittal Condylar Guide

Discussion valuable orthodontic therapy and to check the results

A patient with a severe deep bite malocclusion was
evaluated before and after functional therapy with the
FGB-D appliance.
The improvement in the TMJ tracings in axiogra-
phy and the incisor guidance after therapy have been
demonstrated by computerized axiography and functio-
nal cephalometry analysis. The value of the functional
cephalometry analysis decreased from 68–35° meaning
that the orthodontic therapy successfully improved the
functional aspects, even if it is still necessary to continue
the treatment.
Deep bite malocclusion is a dental malocclusion
involving both the structural morphology and the neu-
romuscular system. The normal TMJ movements are
characterized by the disk freely sliding down the slope of
the eminence. Aberrations in the lubrication system are
considered important causes for TMJ dysfunction [20, 21]
and deep bite malocclusion was, in some studies, asso-
ciated with signs and symptoms of temporomandibular
disorders (TMD; [22, 23]).
There is a correlation between form and function but
it is still not clearly known whether a genetically deter-
mined facial morphology dictates the strength of the
mandibular muscles or whether a strong musculature
influences the form of the face. The orthodontist has to
consider this influence both during treatment and reten-
tion to obtain the stability of the treatment and prevent
future dysfunction. For this reason the correlation bet-
ween incisor guidance and the sagittal condylar guide is
a very important factor to diagnose the functional alte-
rations of the malocclusion, to program a functionally
from a functional point of view.
Deep bite malocclusion is a “functional” malocclu-
sion characterized by a dental displacement responsible
for an important functional alteration and an instrument
is needed to simultaneously improve the position of the
mandible and the teeth.
The action of FGB appliances on the TMJ is due to
the metallic bite planes which disengage the mandible
enabling the condyle to regain its physiological posi-
tion decompressing the joint by applying traction on the
ligaments, thus decreasing the load, re-establishing the
function of the lubrication system and normalizing the
trophism of the meniscus. It has been demonstrated that
the FGB-D appliance for deep bite correction not only
corrects the dental malocclusion but also influences the
joint function [4] and the neuromuscular structures of
the patient [12].
The presentation of this case report is proposed to
emphasize the potential value of research to determine
functional concordance between the posterior deter-
minant (condylar pathway) and the anterior determin-
ant (anterior guidance inclination). The coordination
between the incisor guidance and the sagittal condylar
guide could be an important reference to program ortho-
dontic therapy valuable from a functional point of view.
It can be readily determined by computerized axiogra-
phy and functional cephalometry analysis.
Acknowledgements
This research was partially supported by a grant of the
Italian Ministry of Research.

70   Functional cephalometry analysis and computerized axiography before and after therapy with “Function Generating Bite”

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