classification of malocclusion

PRESENTER: SAPEEDEH AFZAL.ROLL # 10GROUP : A

CLASSIFICATION OF MALOCCLUSION

ROAD MAP• WHAT IS MALOCCLUSION?• NEED OR USES FOR CLASSIFICATION.• SYSTEMS OF CLASSIFICATION & TERMINOLOGIES.

– ANGLE’S CLASSIFICATION.

• MODIFICATIONS OF ANGLE’S CLASSIFICATION.– ANDREW’S SIX KEYS.– SKELETAL CLASSIFICATION.

– BRITISH STANDARD CLASSIFICATION OF INCISOR RELATIONSHIP.

– CANINE CLASSIFICATION.– SIMON’S CLASSIFICATION.– ACKERMAN & PROFFIT CLASSIFICATION.

OCCLUSIONWHEN THE TEETH IN THE MANDIBULAR ARCH

COME INTO CONTACT WITH THOSE IN THE MAXILLARY ARCH IN ANY FUNCTIONAL

RELATION, ARE SAID TO BE IN OCCLUSION. (WHEELER’S)

WHAT IS MALOCCLUSION..??A CONDITION IN WHICH THERE IS A DEFLECTION FROM THE NORMAL RELATION OF THE TEETH TO

OTHER TEETH IN THE SAME ARCH AND/OR TO TEETH IN THE OPPOSING ARCH. (GARDINER, WHITE

& LEIGHTON)

NEED FOR CLASSIFICATION• Grouping of orthodontic problems.• Location of problems to be treated.• Diagnosis & treatment plan.• Comparison of different types of malocclusion.• For self-communication.• Documentation of problems.• Used for epidemiological studies.• Assessment of treatment effects of orthodontic

appliances.

QUESTIONNAIRE, INTERVIEW

CLINICAL EXAMINATION

ANALYSIS OF DIAGNOSTIC

RECORDS

DATA BASE

PROBLEM LIST = DIAGNOSIS

CLASSIFICATION

METHODS OF CLASSIFICATION OF MALOCCLUSION

CAN BE BROADLY DIVIDED INTO TWO TYPES

QUANTITATIVE & QUALITATIVE

TYPES OF MALOCCLUSION

INTRA-ARCH & INTER- ARCH PROBLEMS

MALOCCLUSION: INTRA-ARCH & INTER-ARCH PROBLEMS

INTRA-ARCH PROBLEMS (INDIVIDUAL OR GROUPS OF TEETH)

MALOCCLUSION: INTRA-ARCH & INTER-ARCH PROBLEMS

INTER-ARCH PROBLEMS

ANGLE’S CLASSIFICATION OF MALOCCLUSION

• In 1899 Edward H. Angle published the first classification of malocclusion.

• The classifications are based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.

ANGLE’S CLASSIFICATION OF MALOCCLUSION

CLASS I MALOCCLUSION

CLASS II MALOCCLUSION

CLASS III MALOCCLUSION

DIVISION 1 DIVISION 2

CLASS III PSEUDO CLASS III

SUB-DIVISION

SUB-DIVISION

CLASS I MALOCCLUSIONTHE MESIOBUCCAL CUSP OF THE UPPER FIRST PERMANENT

MOLAR OCCLUDES WITH THE MESIOBUCCAL GROOVE OF THE LOWER FIRST MOLAR, BUT LINE OF OCCLUSION IS INCORRECT

BECAUSE OF MALPOSED TEETH, ROTATIONS OR OTHER DISCREPANCIES.

CLASS II MALOCLUSIONTHE MESIOBUCCAL CUSP OF THE LOWER FIRST PERMANENT

MOLAR OCCLUDES DISTAL TO THE CLASS I POSITION.

Condition when class II molar relationship is present with proclined upper central incisors.• There is an increase in overjet.

CLASS II DIVISION 1

Condition when class II molar relationship is present with retroclined upper central incisors, upper lateral

incisors may be proclined or normally inclined.• Overjet is usually minimal or may be increased.

CLASS II DIVISION 2

CLASS II SUB-DIVISIONCondition when the class II molar relationship

exists on only one side with normal molar relationship on the other side.

CLASS III MALOCCLUSIONTHE MESIOBUCCAL CUSP OF THE LOWER FIST MOLAR

OCCLUDES MESIAL TO THE CLASS I POSITION.

PSEUDO CLASS III MALOCCLUSION

Due to occlusal prematurity, when the mandible moves from rest position to occlusion, it slides

forward into a pseudo class III position. It’s also known as postural class III.

CLASS III SUB-DIVISIONCondition in which class III molar relationship is present only on one side with normal relation on

the other side.

MODIFICATIONS OF ANGLE’S CLASSIFICATION

There are two modifications of Angle’s classification

1.Lischer’s modification.2.Dewey’s modification.

LISCHER’S MODIFICATION• He introduced following names to the

Angle’s classification:

– Neutrocclusion- Class I.– Distocclusion- Class II.– Mesiocclusion- Class III

DEWEY’S MODIFICATION (1915)• Martin Dewey divided Angle’s class I & III into

further types:– CLASS I:

• Type 1: Crowded maxillary anterior teeth. Canines may be abnormally positioned.

• Type 2: Proclined or labioversion of maxillary incisors.• Type 3: Anterior cross bite present.• Type 4: Posterior cross bite present.• Type 5: Mesioversion of molars.

– CLASS III:• Type 1: Well aligned teeth & dental arches. Edge-edge

relationship.• Type 2: Crowded mandibular incisors.• Type 3: Crowded maxillary incisors, underdeveloped

maxilla. Anterior cross bite present.

DEWEY’S MODIFICATION

ANDREW’S SIX KEYS (1970)Andrew extended Angle’s classification:

1. Correct molar relationship.2. Correct crown angulations.3. Correct crown inclination i.e. Class I incisor relationship.4. No rotation present.5. Teeth in tight contact with no spacing.6. Occlusal plane/ curve of spee should be flat i.e. it should

not be deeper than 1.5mm.7. No tooth size discrepancies. (Bannet & McLanghlan’s)

SKELETAL CLASSIFICATIONIt considered relationship

between maxilla & mandible, in antero-posterior direction.

• CLASS I:Maxilla & mandible

are in harmony with each other.

• CLASS II: Maxilla lies ahead

of mandible with refrence to anteroir cranial base. In other words maxilla is prgnated.

SKELETAL CLASSIFICATION

• CLASS III:Maxilla lies

posterior to mandible with reference to anterior cranial base. In other words maxilla is retrognathed.

SKELETAL CLASSIFICATION

BRITISH STANDARD CLASSIFICATION OF INCISOR RELATIONSHIP (1983)

Based upon incisor relationship, proposed in 1983. Do not consider molar relationship in some cases.

• CLASS I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of upper central incisors.

• CLASS II:The lower incisor edges lie posterior to the

cingulum plateau of the upper incisors.There are two sub-divisions:– DIVISION 1:

The upper central incisors are proclined or of average inclination & there is an increase in overjet.

– DIVISION 2:The upper central incisors are retroclined. The

overjet is usually minimal or may be increased.

BRITISH STANDARD CLASSIFICATION OF INCISOR RELATIONSHIP

• CLASS III:The lower incisor edges lies anterior

to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

BRITISH STANDARD CLASSIFICATION OF INCISOR RELATIONSHIP

CANINE CLASSIFICATION• CLASS I :

When the mesial slope of upper canine coincides with the distal slope of lower canine.

• CLASS II : When the mesial slope of upper canine is ahead of

the distal slope of lower canine.

CANINE CLASSIFICATION

• Class III : When the mesial slope of the upper canine lies

behind the distal slope of the lower canine.

CANINE CLASSIFICATION

SIMON’S CLASSIFICATION (1926)

• In Simon’s classification system, the dental arches are related to three anthropologic planes.

• PLANES USED:– Frankfort horizontal plane or eye-ear-plane.– Orbital plane.– Raphe median plane or mid-saggital plane.

SIMON’S CLASSIFICATION• FRANKFORT HORIZONTAL

PLANE:

-Helps detect deviations in the vertical plane.

-Dental arch closer to the plane is called attraction and farther away is called abstraction.

• ORBITAL PLANE: -Helps to detect deviations in

the transverse plane. -Dental arch more anteriorly

placed is called protraction and posteriorly placed dental arch is called retraction.

SIMON’S CLASSIFICATION

• MID-SAGGITAL PLANE: - Helps to detect deviations

in the saggital plane. - Dental arch closer to mid-

saggital plane is called contraction and farther away is called distraction.

SIMON’S CLASSIFICATION

ACKERMAN & PROFFIT CLASSIFICATION (1960)

• It was proposed to overcome the drawbacks of Angle’s classification.

• This system includes Angle’s classification & five characteristics of malocclusion within a Venn diagram.

FIVE MAJOR CHARACTERISTICS

ADDITION TO THE FIVE-CHARACTERISTICS CLASSIFICATION SYSTEM

• Two things particularly help this more thorough analysis:

1. Esthetic line of occlusion.2. Rotational axes.

1. ESTHETIC LINE OF OCCLUSION• In modern analysis, another

curved line characterizing the appearance of the dentition is important.– Esthetic line of occlusion, follows

the facial edges of the maxillary anterior and posterior teeth.

2. ROTATIONAL AXES • In addition to relationship in the transverse, antero-

posterior and vertical planes of space used in traditional 3-D analysis, rotations around axes perpendicular to three planes also must be evaluated.

• It’s a useful way to evaluate the relationship of the teeth to the soft tissues that frame their display.– Pitch.– Roll.– Yaw.

ROTATIONAL AXESPITCH:

•The vertical relationship of the teeth to the lips & cheeks can be

conventionally described as up-down deviations around the antero-

posterior axes.•Evaluated clinically & from cephalometric radiographs.

ROLL:•Roll describes the vertical position of the teeth when this is different on the

right & left sides.•Viewed as up-down deviations

around the transverse axes.•It’s seen with lips relaxed and more clearly on smile, in both frontal and

oblique views.

•YAW:•Rotation of the jaw or dentition to

one side or the other, around a vertical axes, produces a skeletal or

dental midline discrepancy.•Viewed as left-right deviations

around the vertical axes.

REFRENCES• CONTEMPORARY ORTHODONTICS, WILLIAM R.

PROFFIT (5TH. EDITION)• INTRODUCTION TO ORTHODONTICS, LAURA

MITCHELL (3RD. EDITION)• ORTHODONTICS, PREM KUMAR (2ND. EDITION)