Malocclusion classification /certified fixed orthodontic courses by Indian dental academy

CLASSIFICATION
OF
MALOCCLUSION

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INDIAN DENTAL ACADEMY
Leader in continuing dental education



Introduction
History
Defination
Objectives of Classification
Process Of Classifying Malocclusion
Types of Malocclusions

Normality

Biologic continuity
It is the most frequently found relationship of the teeth
and of the bones of the face in relation to each other
and to the skull as a whole.

Malocclusion is any perversion of
normal occlusion of the teeth


It is a condition where there is departu
from the normal relation of the teeth to
other teeth in the same arch and to the
teeth in the opposing arch.

Diagnosis in orthodontics is based
primarily on the classification of
deviations from normal.


Science
of
Infinite Variations

HISTORY


Normal Occlusion was described

As early as the eighteenth century by John Hunter.

Samuel S. Fitch, MD, whose book entitled
A System of Dental Surgery, published in 1829,
was the first to classify malocclusion


When one central incisor is turned in, and the under teeth come
efore it, whilst the other central incisor keeps its proper place,
anding before the under teeth.

When both the central incisors are turned in, and go behind the
der teeth; but the lateral incisors are placed properly and stand
t before the under teeth.

When the central incisors are placed properly but the lateral
cisors stand very much in; and when the mouth is shut, the under
eth project before them and keep them backward.

When all incisors of the upper are turned in, and those of the under
w shut before them.

Jean Nicolas Marjolin (1832-1839) of France
differentiates M.O. between obliqueness of teeth
and anomalies of dental arch.
He further differentiates anomalies of teeth as
anterior, posterior and lateral type and one
from rotation ground the axis of teeth.
The anomalies of dental arch classified as
prominence of upper, lower or both rows of
anterior teeth, and ‘retroition’ an oblique
position of front teeth and ‘inversion’ todays
mesial occlusion

George Carabelli (1842), a Viennese professor,
was probably the first to describe in any systematic
way abnormal relationships of the upper and
lower dental arches. The terms edge-to-edge bite
and overbite are actually derived from Carabelli's
system of classification. He bases his classification
on various positions of incisors and canines as:
Mordex Normalis (Normal occlusion)
Mordex Rectus (edge to edge)
Mordex Apertus (open occlusion)
Mordex Prorsus (protruding occlusion)
Mordex Retrosus (retruding occlusion)
Mordex Tortuosus (zig-zag occlusion)

In 1899 Dr. Edward H. Angle published a paper
entitled ‘The classification of Malocclusion’ in
‘Dental Cosmos’. This Angle system was based
primarily on the mesiodistal relation of the jaws
and dental arches to each other and to the skull.
He consider Maxillary first molar as key to
occlusion and based on relation of the mandibular
first molar with this tooth he divided M.O. into
three classes.
Class I, Class II and Class III types.

In 1926 Simon P.W. developed a system of
Gnathostatics. He related the teeth to rest of
the face and cranium in all three plane of space
In 1960s Ackerman and Proffit introduced
a new classification system, which formalized
the system of informal additions to the Angle
method by identifying five major characteristics
of malocclusion that should be considered and
systematically described in classification

In 1990s, Morton Katz introduced a
premolar based classification, which is
a modified Angle classification.

Classification is a process of analyzing
cases of malocclusion for the purpose
of segregating them into a small
number of groups, which are
characterized by certain specific and
fundamental variations from normal
occlusion of the teeth .

OBJECTIVES
OF
CLASSIFICATION

1.
Classification is an essential communication
tool between dental school professor and student,
between practitioners, and between practitioner
and insurance company or government
bureaucracy.
It is essential that everyone "speak the same
language."

2.Classification aids in the diagnosis and treatment
planning of malocclusions by orienting the clinician
to the type and the magnitude of the problems and
possible mechanical solutions to the problems.
The result of an improper classification might be
that the orthodontist would embark on patient care
oriented toward solving the wrong problem. Once a
patient is classified, the practitioner will tend, almost
unconsciously, to apply treatment mechanics appropriate
to that classification. Even though model analysis,
especially buccal interdigitation, is but a small part of the
complete orthodontic diagnosis, the decision to use Class II
or Class III mechanics invariably is strongly influenced by
the perceived Angle classification of the patient.

3. If one of the goals in the treatment of a malocclusion
is to achieve Class I, there must be a consensus among
orthodontists as to what constitutes ideal occlusion, and
Class I must be redefined to agree with the prototype
standard. If every orthodontist has a different idea of
what ideal buccal interdigitation means, then the dental
specialty of orthodontics has no standardized method by
which to evaluate successful or unsuccessful treatment.
Angle developed his classification 100 years ago to
eliminate the anarchy that existed in the specialty.


4. It segregates the countless number of cases of
tooth malposition into a comparatively low number
of groups, each group containing only such cases as
are characterized by a common factor or factors of
fundamental significance.

5. Ease of reference – it is much easier to call a
case a class III malocclusion than to go into all the
detail necessary to describe the craniofacial
morphology of mandibular prognathism.

6.
Comparison – experience with previous cases
bearing the same label facilitates understanding of
problems that may be encountered in treatment
plan.


THE PROCESSES OF
CLASSIFYING
A CASE OF
MALOCCLUSION

1

A study of inclined plane relationship

2. A study of the axial inclination of teeth
3. An analysis of the relationship of the interproximal line of the
central incisors in the two arches
4. Noting Rotated Teeth in the Buccal Segments
5. Examining for Teeth Prematurely Lost or Extracted,
Congenital Missing Teeth or Supernumerary Teeth
•

Study of photographs – front view and profile

•

Analysis of cephalometric radiographs

TYPES OF MALOCCLUSIONS


Distal inclination or distal tipping: this refers to a
condition where the crown of the tooth is tilted or
inclined distally


Mesial inclination or mesial tipping: this is a
condition where the crown of the tooth is tilted or
inclined mesially.


Lingual inclination or lingual tipping: this is an
abnormal lingual or palatal tilting of the tooth.
This condition is also called retroclination


Buccal inclination or buccal tipping: this refers to
labial or buccal tilting of the tooth. This condition
is also called proclination


Mesial displacement: this refers to a tooth
that is bodily moved in a mesial direction towards
the midline.


Distal displacement: this refers to a tooth that is
bodily moved in a distal direction away from the
midline


Lingual displacement: is a condition where the entire
tooth is displaced in a lingual direction


Buccal displacement: is a condition in which the tooth
Is displaced bodily in a labial or buccal direction.


infraversion or infraocclusion: refer to a tooth
that has not erupted enough compared to other
teeth in the arch


Supraversion or supra occlusion: refers to a tooth
that has overerupted compared to other teeth in
the arch


Rotations: refers to tooth movements around
its long axis.


Disto lingual or mesio buccal rotation: describes a
tooth which has moved around it long axis so that the
distal aspect is more lingually placed.


Transposition: this term describes a condition where two
teeth have exchanged places.


Inter arch malocclusions

These malocclusions are characterized by abnormal
relationships between two teeth or groups of teeth of
one arch to the other arch.

These inter arch malocclusion can occur in sagi
vertical or in the transverse planes of space.


Sagittal plane
malocclusions

Pre-normal occlusion

Post-normal occlusion


Post-normal occlusion- a condition where the lower arch is
more distally placed when the patient bites in centric
occlusion


Pre-normal occlusion- refers to a condition where the
lower arch is more forwardly placed when the patient
bites in centric occlusion


Vertical plane malocclusions

Open bite

Deep bite or increased
over bite

Deep bite or increased over bite: this refers to a condition
where there is an excessive vertical overlap between upper
and lower anterior teeth


Open bite: is a condition where there is no vertical overlap
between upper and lower teeth . thus a space may exist
between the upper and lower teeth when the patient bites
in centric occlusion. Open bite can be in anterior or
posterior region .


Transverse plane malocclusions

Crossbite refers to abnormal transverse
relationship between upper and lower arches.


Scissor bite refers to a condition in which the
maxillary arch is contained within the mandibular arch


"The Upper First Molars as a Basis of Diagnosis in
Orthodontics."

1.Are the largest teeth.

2.Are the firmest in their attachment.
3.Have a key location in the arches.
4.Help determine the dental and skeletal
due to the lengths of their crowns.

5. Occupy normal position in the arches far
more often than any other teeth because they
are the first permanent teeth and are less
restrained in taking their position.

6. More or less control the positions of other
permanent teeth anterior and posterior to them.

7. Have the most consistent timing of eruption
of all the permanent teeth

8. Determine the interarch relationship of all
other teeth upon their eruption and "locking“
with the mandibular first molars.


LISCHER’S CLASSIFICATION

Disto-occlusion

Neutro-occlusion:


Mesio-occlusion

Linguo version/Labio version
Mesio version/Disto version
Infra version/ Supra version
Torsiversion or Twisted tooth
Perversion or Impacted tooth
Transiversion or wrong sequential order

DEWEY’S CLASSIFICATION
Modifications of Class I are
Type I - Crowded anterior teeth
Type II - Maxillary incisors in labio version
Type III - Anterior Cross bite
Type IV- Posterior Cross bite
Type V - Molars are in mesioversion due to
shifting following loss of tooth anterior to
first molars, all other teeth are in normal
relationship

DEWEY’S CLASSIFICATION
Modifications for Class III are
Type I - Normal incisal overlapping present
Type II - Edge to edge incisor relationship
Type III - Incisors are in cross bite.


The best and the most
beautiful things in this world
cannot be seen or even
touched, they must be felt with
the heart.

SIMON’S CLASSIFICATION

The Frankfort horizontal

raphe or median sagital plane.

Orbital plane

The orbital plane passes through the distal axial
aspect of the canine.
This is known as “The law of the canine”.


1.
Deviation from the raphe or median sagital plane .
Arch form and inclination of tooth axis are determined from this plane.
Contraction: a part or all of the dental arch is contracted toward
the raphe median plane.
The abnormality may be mandibular, alveolar, dental, anterior,
posterior, unilateral or bilateral.
Distraction: a part or all of the dental arch is wider than usual
from the raphe median plane


1.
Deviations from the Frankfort horizontal plan
the angle between the Frankfort horizontal and the
occlusal plane, the form of the occlusal curve, and
the inclination of the teeth axes are determined from
this plane.
Attraction: the distance between the occlusal plane
and the Frankfort horizontal is comparatively shorter
than normal. This distance is as a rule normally shorter
in the young than in older persons and in some ethnic
groups.
Abstraction: the distance between the occlusal plane
and the Frankfort horizontal is comparatively longer
than normal.

1.

Deviations from the Orbital plane: sagital
symmetry and inclination of the axes of the teeth are
determined from this plane.

Protraction: the teeth, one or both dental arches,
and or jaws are too far forward. Normally the orbital
plane passes through the distal incline of the canine.
Retraction: the teeth, one or both dental arches
and or jaws are too far retruded. The orbital plane
passes too far anteriorly to the canines.

Deviations of the dental arches in relation to
the orbital plane, according to Simon, may
occur as follows:
1. Both the jaws in normal relation to each other
2. Upper jaw normal, lower jaw distal
3. Upper jaw normal, lower jaw mesial
4. Lower jaw normal, upper jaw mesial
5. Lower jaw normal, upper jaw distal
6. Upper jaw mesial, lower jaw distal
7. Upper jaw distal, lower jaw mesial

Reliability of Simon Norms
Hellman, Broadbent :-no true bilateral symmetry
in the human head .
The orbital plane of Simon was found to pass
through the canine in 81% and missed the canine
in 19% of cases
Tarpley found that the raphe or median
sagital plane to be symmetric in 43%.
Slight deviations, 1 to 2 mm, were found
in 37%, while 10% showed marked asymmetry.

ACKERMANN -PROFFIT
CLASSIFICATION


Classification by groups
Common to all dentitions is the degree of alignment
and symmetry of the teeth within the dental arches.
This is represented as the universe (Group 1). Many
malocclusions affect the profile. For this reason,
profile is represented as a major set (Group 2) within
the universe. Lateral (transverse), anteroposterior
(sagittal), and vertical deviations and their
interrelationships (Groups 3 to 9) are represented by
three interlocking subsets within the profile set. This
scheme allows any malocclusion to be sufficiently
described by five or fewer characteristics.

Step 1 in the classification procedure is an analysis
of the alignment and symmetry of the teeth in the
dental arches (interproximal contact relationships).
Alignment is the key word of Group 1; among the
possibilities are ideal, crowding (arch-length deficiency)
spacing, and mutilated.


In Step 2 one views the patient's profile.
This can be done most accurately from a
good profile or silhouette photograph. In
the profile view, it should be noted whether
the face is anteriorly divergent (mandible prominent)
or posteriorly divergent (mandible recessive)
and whether the lips are convex (prominent),
straight, or concave relative to the nose and chin.

In Step 3 the dental arches are viewed with
regard to lateral dimensions (transverse plane),
and the buccolingual relationships of the posterior
teeth are noted.


In Step 4 the patient and dental arches are
viewed in the anteroposterior dimension
(sagittal plane). In this dimension, the Angle
classification system is utilized and is merely
supplemented by stating whether a deviation is
skeletal, dentoalveolar, or a combination.


In Step 5 the patient and the dentition are
viewed with regard to the vertical dimension.
Bite depth is used to describe the vertical
relationships. The possibilities are anterior
open-bite, anterior deep-bite, posterior open-bite,
or posterior collapsed bite.


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Malocclusion classification /certified fixed orthodontic courses by Indian dental academy

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