CLASSIFICATION OF MALOCCLUSION
Presented by,
Dr. Bibin Ninan Mathew
SYNOPSIS INTRODUCTION
DEFINITIONS: OCCLUSION
IDEAL OCCULSION NORMAL OCCLUSION MALOCCLUSION
HISTORICAL REVIEW
NEED OF CLASSIFICATION
TYPES OF MALOCCLUSION
VARIOUS SYSTEMS OF MALOCCLUSION
NEWLY PROPOSED CLASSIFICATION
CONCULSION
INTRODUCTION
In the specialty of orthodontics, the classificationof malocclusion plays several very importantroles. 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…
OCCLUSION
oc clusion
CLOSINGUP
CLOSING UP
MALOCCLUSION
MAL OCCLUSION
BITEBAD
BAD BITE
OCCULSIONIDEAL OCCLUSION
NORMAL OCCLUSIONMALOCCLUSION
The relation of theMaxillary and Mandibularteeth when the jaws are
- Closed in centricrelation
- Without strain ofmusculature ordisplacement ofcondyles in theirfossae
OCCLUSIONDEFINITION
IDEAL & NORMAL OCCLUSION
“IDEAL” is a hypothetical concept ora standardized goal
“Normal” implies to the variationsaround an average mean value
The Perfect Occlusion
It is a theoretical concept based on the ideal teeth position and arches relationships. It is rarely, , if ever, found in nature. However, it provides a standard
by which all other occlusions may be judged.
• A coincident mid-line• No (crowding/spacing/rotations)• Over-jet = 2-3mm• Correct crown angulation and inclination• Class I molar & canine relationship• A flat or slightly upwards curve of Spee
Ideal occlusion Normal occlusion
- Is one which shows:some deviation from that of the idealbut is aesthetically acceptable andfunctionally stable for the individual
- the upper and lower teeth fit nicelyand evenly together with the leastamount of destructive interferences
Andrews 6 KEYS of Normal Occlusion(1972)
Correct crown inclination
No spaces Flat to slight curve of spee
No rotation
Correct crown angulationClass I molar relationship
Definition:
Malocclusion may be defined as―A condition where there isdeparture from the normal relationof the teeth to
- other teeth in the same dental archand/or to
- teeth in the opposing arch
The term was coined by Edward H Angle, the "father of modern orthodontics“.
MALOCCLUSION
It is a condition that reflects an expression of
normal biologic variability in the way the maxilla
and mandible teeth occlude (BISHARA)
An occlusion In which there is a malrelationship
between the arches in any of the planes of the spaces
or in which there are anomalies in tooth position
beyond the limit of normal. (Walther & Huston)
Occlusion and malocclusion
HISTORICAL REVIEW
( 1829) Samuel S Fitch - described in his book‘ A System of Dental Surgery’ first classified into 4 states of irregularity.
(1836) Christopher kneisel - ‘The oblique position of teeth’- classified –general obliqueness & paritial obliqueness.
(1839) Jean Nicolas Marjolin - differentiated obliqueness of teeth and anomalies of dental arch.
(1842) George Carabelli - coined the term edge-to-edge bite and overbite.
Classification was based on the positions of incisors and canines which has termed as:
Mordex Normalis : Normal occulsionMordex rectus : Edge to edgeMordex apertus : Open occlusionMordex prorsus : protruding occlusionMordex retrous : Retruding occlusionMordex tortuosus : Zig –zag occlusion
(1880) Norman Kingsely – classified into 2 broad categories based on etiology
Developmental malocclusion Accidental malocclusion Edward H Angle ( 1899, 1900, 1906.1907) – detailed
description of malocclusion into 3classes
(1912) Lischer– terms distocclusion and
mesiocclusion
(1915) Martin Dewey–modified Angles classes
(1920) Paul Simon-based on the gnathostatics and
canine law
(1964) Ballard and Wayman- British classification
based on incisor overjet
(1969) Ackerman and proffit - based on venn diagram
(1992) Katz- based on premolar as a reference
landmark
(1905-1921)- Calvin case -anatomical groups- grouped
into 5 classes- treatment standpoint of view
The World Health Organization (1987), had included
malocclusion under the heading of Handicapping Dento
Facial Anomaly, defined as an anomaly which causes
disfigurement or which impedes function, and requiring
treatment “if the disfigurement or functional defect was
likely to be an obstacle to the patient’s physical or
emotional well-being”
What is a classification system ??
A classification system is a grouping of clinical cases of similar appearance for ease in handling and discussion; it is not a system of diagnosis , method for determining prognosis ,or a way of defining treatment
Robert E.Moyers
Why we need a Classification for malocclusion ???
Acquire a better understanding of the many
deviations from normal occlusion
1) divide the wide range into small groups.
2) describe the salient features.
3) provide a verbal and mental picture.
4) simplify the documentations
5) unify the communications.
7) give clue about the etiology.
8) help to select treatment modality.
Thinking of possible treatment modalities that may
be needed in a particular case
TYPES OF MALOCCULSION
INTER ARCH
SKELETAL
INTRA ARCH
INTRA ARCH
Includes variation in individual tooth position & a group of teeth within in a arch
Abnormal inclination
Abnormal Displacements
Spacing and crowding within the same
arch
Distal inclination Mesial inclination
Buccal inclination
Lingual inclination
ABNORMAL INCLINATION
Labioversion
Lingoversion
ABNORMAL DISPLACEMENTS
Palatoversion
Buccoversion
Supraversion
Infraversion
Torsiversion
Types
INTERARCH PROBLEMS
Abnormal relationship between two teeth or group of teeth of one arch to the other
Sagittal plane malocclusions
Vertical plane malocclusions
Transverse plane malocclusions
SAGITTAL DIRECTION
Either :
- Abnormal overjet- Anterior cross-bite
Anteriorly
Class II malocclusionClass III malocclusion
Posteriorly
OR
Vertical plane malocclusions
Normal overbite
Deep overbite Open bite
Transverse plane malocclusions
Either :
DEVIATIONS OF THE MIDLINEAnteriorly
POSTERIOR CROSS BITE: Posteriorly
OR
Skeletal malocclusions
Malrelation of the apical bases:
Malrelation of the upper and lower apical bases is due to:
a. Abnormal size;
b. Abnormal shape;
c. Abnormal relation to the
skull;
d. Abnormal relation to
each other.
VARIOUS SYSTEMS OF CLASSIFICATION
ANGLE CLASSIFICATION
DEWEY’S MODIFICATION OF ANGLES
CLASSIFICATION
LISCHER’S MODIFICATION OF ANGLES
CLASSIFICATION
SIMONS SYSTEM
BENNET’ S CLASSIFICATION
ACKERMANN AND PROFITT CLASSIFICATION
BALLARDS CLASSIFICATION
PREMOLAR CLASSFICATION
NEWLY PROPOSED SYSTEM
ANGLE CLASSIFICATION
It was introduced by Edward H. Angle (1889)
• Based on the mesiodistal relationship of teeth, dental arches and jaws
• Maxillary first molar is taken as the key of occlusion
• Three classes
Class I
Class IIClass II div 1Class II div 2Class II SubdivisionClass II division 1
SubdivisionClass II division 2 Subdivision
Class IIITrue Class IIIPseudo Class III
THREE CLASSES
Class III Subdivision
NORMAL LINE OF OCCLUSION
Angle Class І malocclusion Neutroclusion
Molar relationship
Canine relationship
-
Line of occlusion: ALTERED in the max. & mand. Arches:
• individual tooth irregularities (crowding/spacing/….)
• Inter-arch problems (deep bite/open bite/ increased overjet/…)
Angle Class ІІ malocclusion
Canine relationship:- the distal incline of upper canine anterior to the mesial incline of lower first premolar
DistoclusionMolar relationship:
There are two divisions of class ІІ designated, division 1 and division 2
Angle Class ІІ malocclusion division 1
Angle Class ІІ malocclusion division 2
Angle Class ІІ malocclusion division I
Class ІІ Division 1 : -Mandible is retruded and- all maxillary incisors are protruded
Angle Class ІІ malocclusion division II
Mandible is retruded and one or more maxillary incisors are
retruded
Class ІІ Division 2 :
class I molar
class ІІ molar
Class ІІ malocclusion
subdivision
Angle Class ІІI malocclusion
True class III
Genetic in origin Excessively large mandible Smaller than normal maxilla Retropositioned maxilla
Class ІІІ malocclusion: 2 types
- True class ІІІ malocclusion (Skeletal)- Pseudo class ІІІ (FALSE or postural)
Pseudo class ІІІ
Forward movement of mandible during jaw closure Occlusal prematurities Premature loss of deciduous posteriors Enlarged adenoids
Advantages of ANGLE classification
First comprehensive classification- most widely
accepted
Simple
Easy to use
Most POPULAR
Easy to Communicate
DEMERTIS OF ANGLE CLASSIFICATION
Considers malocculsion only in antroposterior plane
not in transeverse/vertical
Considered 1st molar as fixed point – skull
Deciduous dentition
1st molar extracted
Doesn't distinguish between skeletal and dental malocclusion
Doesn’t highlight etiology
Individual tooth positions
DEWEY’S MODIFICATION OF ANGLES MALOCCLUSION (1915)
Divided angles class I into five types and angles class III into three types
Class I modification of Dewey
Class III modification of Dewey
Type 1 : Class I malocclusuion with bunched or crowded anterior teeth
Type 2: class I with protrusive maxillary incisors
Type 3: Class I malocclusion with anterior crossbite
Type 4: Class I malocclusion with posterior crossbite
Type 5: the permanent molar has drifted mesially due early extraction of second deciduous molar or second premolar
Class III modification of Dewey
Type 1:Upper and lower arches are normally aligned separetely but show edge incisor bite
Type 2: the mandibular incisors are crowded and lingual to the maxillary incisors
Type 3: maxillary incsiors are crowded and in crossbite with mandibular anteriors
Lischer’s modification (1933)
Neutrocclusion : Angles class I malocclusion
Distocclusion : Angles class II malocclsion
Mesioclusion : Angles class III malocclsion
Buccocclusion : Buccal placement of a tooth or a group of teethLinguocclusion : lingual placement of a tooth or a group of a tooth or a group of teeth
Supraocclusion : when a tooth or group of teeth have erupted beyound normal levelInfraocclsion : when a tooth or group of teeth have not erupted to normal level
Mesioversion : mesial to the normal positionDistoversion : distal to the normal position
Transversion : transposition of two teethAxiversion : Abnormal axial inclination of a toothTorsiversion : Rotation of a tooth around its long axis
BENNET’S CLASSIFICATION
Based on ETIOLOGY
CLASS I- Abnormal position of one or more teeth due to
local causes
CLASS II- Abnormal formation of a part or a whole of
either arch due to developmental defects of bone
CLASS III- Abnormal relationship between upper and
lower arches, and between either arch and facial contour
and correlated abnormal formation of either arch
SIMONS CLASSIFICATION (1926)
It is craniometric classification
Based on abnormal deviations of dental arches from their normal position in relation to these 3 planes
VERTICAL PLANE
ANTERO-POSRTERIOR
TRANSVERSE PLANE
‘ GNATHODYNAMOMETER ’
ATTRACTION ABSTRACTION
FH PLANE
This plane help to detect devotions in the VERTICAL DIRECTION
ORBITAL PLANE
Perpendicular to the FHP
Simon’s law of canine- “thisplane should pass throughthe distal third of the canine”
This plane used to describe malocclusion in ANTERIO-POSTERIOR direction
Protraction
Retraction
THIS plane passes at right angle to FHP
MID SAGITTAL PLANE
It classifies malocclusion according to TRANSVERSE DEVIATION from MSP
CONTRACTION
DISTRACTION
ACKERMAN-PROFIT SYSTEM ( 1960 )
Based on five characteristics
o ALIGNMENTo PROFILEo TRANSVERSE RELATIONSHIPo CLASSo BITE DEPTH
Transverse & vertical discrepancies –considered
Crowding and arch asymmetry -evaluated
Incisor protrusion
Influence of dentition on the profile
Features…
BALLARDS CLASSIFICATION
Incisor classification (1965)
A classification of malocclusion based on incisor
As treatment is often primarily aimed at correcting this relationship
Three CLASSES
Class I incisorClass II incisorClass III incisor
Class I incisor
Class II incisor
Div 1
Class III incisor
KATZ PREMOLAR CLASSIFICATION (1992)
PREMOLAR CLASS I - most anterior upper premolar fits exactly into the embrasure created by the distal contact of the most anterior lower premolar represent prefect interdigitations , the value – 0 mm
Premolar class II- the most anterior upper premolar is occluding mesial of the embrasure created by the distal contact of the most anterior lower premolar ( )
5 4 3
5 4 3
PREMOLAR CLASS III- the most anterior upper premolar is occluding distal of the embrasure created by the distal contact of the most anterior lower premolar. The meaurement has a(-) sign
Advantages
This system provides a quantitive treatment objective that is needed to attain excellent buccal occlusion
It provides some flexibility in terms of finishing a case in functional class II or class III buccal occlusion ,while keeping buccal interdigitation as the prime goal
In deciduous and mixed dentition cases, emphasis is shifted from the permanent first molars to the region of current importance i.e. deciduous molar region
Disadvantages
Premolars, are commonly missing, malformed or supernumerary , hence measurement is not always possible
Severely rotated and ectopically erupted premolars problems
No consideration for the facial balance and aesthetics
NEWLY PROPOSED SYSTEMFOR MALOCCLUSION CLASSIFICATION (MIGUEL-NETO & MUCHA) (2010)
MIGUEL-NETO, A. B.; NISHIO, C. & MUCHA, J. N. Agreement evaluation of a newly proposed system for malocclusion classification. Int. J. Odontostomat., 4(1):33-41, 2010.
CLASS I
CLASS II
CLASS III
CLASS I
CLASS II
CONCLUSION
AS ORTHODONTISTS A GOOD KNOWLEDGE OF DIFFERENT SYSTEMS OF CLASSIFICATIONS OF MALOCCLUSION,IT’S MERITS AND DEMERITS IS VERY IMPORTANT IN MAKING PROPER DIAGNOSIS AND EFFECTIVE TREATMENT PLANNING..
References Contemporary Orthodontics,-William R. Profitt, 3rd edition
Grabers Textbook of Orthodontics Basic principles and practice- 4th edition
Handbook of Orthodontics 4th edition- Robert E. Moyres
Textbook of Orthodontics , Samir E.Bishara
Orthodontics, Current principles and Techniques, 4th edition, Graber Vanarsdal
Classification of Malocclusion, Edward H.Angle,The Dental Cosmos
The six keys to normal occlusion, Lawrence F. Andrews, D.D.S. Am. J. Orthod. September 1972, vol 62 number-3
Angle classification revisited 1: Is current use reliable? Morton I. Katz, DDS"Washington,D.C.
A matter of Class: Interpreting subdivision in a malocclusion . Molly A. Siegel, DDS,Am J Orthod Dentofacial Orthop 2002;122:582-6)
Agreement Evaluation of a Newly Proposed System for Malocclusion Classification
Miguel-neto, A. B.; Nishio, C. & Mucha, J. N. Int. J. Odontostomat., 4(1):33-41, 2010.
Thank you
BIBINS PHOTOGRAPHY
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