classification of malocclusion including new system of classification

1. CLASSIFICATION OF MALOCCLUSION
Presented by,
Dr. Bibin Ninan Mathew

2. 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

3. INTRODUCTION
In the specialty of orthodontics, the classification
of malocclusion plays several very important
roles. 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…

4. OCCLUSION
oc
UP
clusion
CLOSING
CLOSING UP

5. MALOCCLUSION
OCCLUSION
MAL
BAD
BAD BITE
BITE

6. OCCULSION
IDEAL OCCLUSION
NORMAL OCCLUSION
MALOCCLUSION

7. OCCLUSION
DEFINITION
The relation of the
Maxillary and Mandibular
teeth when the jaws are
- Closed in centric
relation
- Without strain of
musculature or
displacement of
condyles in their
fossae

8. IDEAL & NORMAL OCCLUSION
“IDEAL” is a hypothetical concept or
a standardized goal
The Perfect Occlusion
“Normal” implies to the variations
around an average mean value

9. 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.

10. Ideal occlusion
•
•
•
•
•
•
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
Normal occlusion
- Is one which shows:
some deviation from that of the ideal
but is aesthetically acceptable and
functionally stable for the individual
- the upper and lower teeth fit nicely
and evenly together with the least
amount of destructive interferences

11. Andrews 6 KEYS of Normal Occlusion (1972)
Class I molar relationship
Correct crown angulation
Correct crown inclination
No rotation
No spaces
Flat to slight curve of spee

12. MALOCCLUSION
Definition:
Malocclusion may be defined as
―A condition where there is
departure from the normal relation
of the teeth to
- other teeth in the same dental arch
and/or to
- teeth in the opposing arch
The term was coined by Edward H Angle, the "father of modern
orthodontics“.

13. 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)

14. Occlusion and malocclusion

15. HISTORICAL REVIEW

16. ( 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.

17.  (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 occulsion
Mordex rectus : Edge to edge
Mordex apertus : Open occlusion
Mordex prorsus : protruding occlusion
Mordex retrous : Retruding occlusion
Mordex 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

18. (1905-1921)- Calvin case -anatomical groups- grouped into 5
classes- treatment standpoint of view
(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

19. 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”

20. What is a classification system ??

21. 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

22. Why we need a Classification for
malocclusion ???

23. 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

24. TYPES OF MALOCCULSION
INTER ARCH
INTRA ARCH
SKELETAL

25. 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

26. Distal inclination
Buccal inclination
ABNORMAL INCLINATION
Mesial inclination
Lingual inclination

27. ABNORMAL DISPLACEMENTS
Labioversion
Lingoversion

28. Palatoversion
Buccoversion

29. Supraversion
Infraversion

30. Torsiversion

31. INTERARCH PROBLEMS
Abnormal relationship between two teeth or group of teeth of
one arch to the other
Types
Sagittal plane malocclusions
Vertical plane malocclusions
Transverse plane malocclusions

32. SAGITTAL DIRECTION
Either :
- Abnormal overjet
- Anterior cross-bite
Anteriorly
OR
Class II malocclusion
Class III malocclusion
Posteriorly

33. Vertical plane malocclusions
Normal overbite
Deep overbite
Open bite

34. Transverse plane malocclusions
Either :
DEVIATIONS OF THE MIDLINE
Anteriorly
OR
POSTERIOR CROSS BITE:
Posteriorly

35. 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.

36. 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

37. 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

39. THREE CLASSES
Class I
Class II
Class II div 1
Class II div 2
Class II Subdivision
Class II division 1 Subdivision
Class II division 2 Subdivision
Class III
True Class III
Pseudo Class III
Class III Subdivision

40. NORMAL LINE OF OCCLUSION

41. 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/…)

42. Angle Class ІІ malocclusion
Distoclusion
Molar relationship:
Canine relationship:
- the distal incline of upper canine anterior to
the mesial incline of lower first premolar
There are two divisions of class ІІ designated, division 1 and division 2

43. Angle Class ІІ malocclusion division 1

44. Angle Class ІІ malocclusion division 2

45. Angle Class ІІ malocclusion division I
Class ІІ Division 1 :
-Mandible is retruded and
- all maxillary incisors are protruded

46. Angle Class ІІ malocclusion division II
Class ІІ Division 2 :
Mandible is retruded and one or more
maxillary incisors are retruded

47. Class ІІ malocclusion
class I molar
subdivision
class ІІ molar

48. Angle Class ІІI malocclusion
Class ІІІ malocclusion: 2 types
- True class ІІІ malocclusion (Skeletal)
- Pseudo class ІІІ (FALSE or postural)
True class III




Genetic in origin
Excessively large mandible
Smaller than normal maxilla
Retropositioned maxilla
Pseudo class ІІІ
 Forward movement of mandible during jaw closure
Occlusal prematurities
Premature loss of deciduous posteriors
Enlarged adenoids

49. Advantages of ANGLE classification
 First comprehensive classification- most widely accepted
 Simple
 Easy to use
 Most POPULAR
 Easy to Communicate

50. 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

51. DEWEY’S MODIFICATION OF ANGLES
MALOCCLUSION (1915)

52. Divided angles class I into five types and angles class III into three types
 Class I modification of Dewey
 Class III modification of Dewey

53. 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

54. 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

55. 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

56. Lischer’s modification (1933)

57. 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 teeth
Linguocclusion : 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 level
when a tooth or group of teeth have not erupted to
normal level
Infraocclsion
:
Mesioversion
Distoversion
: mesial to the normal position
: distal to the normal position
Transversion
Axiversion
Torsiversion
:
:
:
transposition of two teeth
Abnormal axial inclination of a tooth
Rotation of a tooth around its long axis

58. BENNET’S CLASSIFICATION

59. 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

60. SIMONS CLASSIFICATION (1926)

61.  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 ’

62. FH PLANE
ATTRACTION
ABSTRACTION
This plane help to detect devotions in the
VERTICAL DIRECTION

63. ORBITAL PLANE
 Perpendicular to the FHP
 Simon’s law of canine- “this
plane should pass through
the distal third of the canine”
Protraction
Retraction
This plane used to describe malocclusion in ANTERIO-POSTERIOR direction

64. MID SAGITTAL PLANE
THIS plane passes at right angle to FHP
CONTRACTION
DISTRACTION
It classifies malocclusion according to TRANSVERSE DEVIATION from MSP

65. ACKERMAN-PROFIT SYSTEM ( 1960 )

66. Based on five characteristics
o
o
o
o
o
ALIGNMENT
PROFILE
TRANSVERSE RELATIONSHIP
CLASS
BITE DEPTH

67. Features…
Transverse & vertical discrepancies –considered
Crowding and arch asymmetry -evaluated
Incisor protrusion
Influence of dentition on the profile

68. BALLARDS
CLASSIFICATION

69. Incisor classification (1965)
 A classification of malocclusion
based on incisor
 As treatment is often primarily
aimed at correcting this
relationship
Three CLASSES
Class I incisor
Class II incisor
Class III incisor

70. Class I incisor
Class II incisor
Div 1

71. Class III incisor

72. KATZ PREMOLAR
CLASSIFICATION (1992)

73. 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

74. 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
5
4
3
4
3

75. 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

76. 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

77. 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

78. NEWLY PROPOSED SYSTEM
FOR MALOCCLUSION CLASSIFICATION (MIGUEL-NETO & MUCHA)
(2010)
CLASS I
CLASS II
CLASS III
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.

79. CLASS I

80. CLASS II

81. 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..

82. 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.

83. BIBINS
PHOTOGRAPHY