Classification of Malocclusion

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. OC CLUSION oc clusion CLOSING UP CLOSING UP

5. MAL OCCLUSION MAL OCCLUSION BITE BAD BAD BITE

6. OCCULSION IDEAL OCCLUSION NORMAL OCCLUSION MALOCCLUSION

7. 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 OCCLUSION DEFINITION

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

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. 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 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 ) Correct crown inclination No spaces Flat to slight curve of spee No rotation Correct crown angulation Class I molar relationship

12. 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“. MALOCCLUSION

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. ( 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

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 SKELETAL INTRA ARCH

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 Mesial inclination Buccal inclination Lingual inclination ABNORMAL INCLINATION

27. Labioversion Lingoversion ABNORMAL DISPLACEMENTS

28. Palatoversion Buccoversion

29. Supraversion Infraversion

30. Torsiversion

31. 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

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

33. Vertical plane malocclusions Normal overbite Deep overbite Open bite

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

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) • B ased on the mesiodistal relationship of teeth, dental arches and jaws M axillary first molar is taken as the key of occlusion Three classes

38. 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 THREE CLASSES Class III Subdivision

39. NORMAL LINE OF OCCLUSION

40. 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 /…)

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

42. Angle Class ІІ malocclusion division 1

43. Angle Class ІІ malocclusion division 2

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

45. Angle Class ІІ malocclusion division I I Mandible is retruded and one or more maxillary incisors are retruded Class ІІ Division 2 : Class II molar relation Lingually tiped upper central incisors Labially tipped lateral incisors Anterior Normal muscle activity

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

47. Angle Class ІІ I 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

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

49. DEMERTIS OF ANGLE CLASSIFICATION Considers malocculsion only in antroposterior plane not in transeverse /vertical Considered 1 st molar as fixed point – skull Deciduous dentition 1 st molar extracted Doesn't distinguish between skeletal and dental malocclusion Doesn’t highlight etiology Individual tooth positions

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

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

52. 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

53. 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

54. 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

55. Lischer’s modification ( 1933 )

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

57. BENNET’S CLASSIFICATION

58. 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

59. SIMONS CLASSIFICATION ( 1926 )

60. 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 ’

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

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

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

64. ACKERMAN-PROFIT SYSTEM ( 1960 )

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

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

67. BALLARDS CLASSIFICATION

68. 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

69. Class I incisor Class II incisor Div 1

70. Class III incisor

71. KATZ PREMOLAR CLASSIFICATION ( 1992 )

72. 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

73. 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

74. PREMOLAR CLASS II I- 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

75. 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

76. 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

77. NEWLY PROPOSED SYSTEM FOR 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

78. CLASS I

79. CLASS II

80. 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..

81. References Contemporary Orthodontics,-William R. Profitt , 3 rd edition Grabers Textbook of Orthodontics Basic principles and practice- 4 th edition Handbook of Orthodontics 4 th edition- Robert E. Moyres Textbook of Orthodontics , Samir E.Bishara Orthodontics , Current principles and Techniques, 4 th 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 .

82. Thank you BIBINS PHOTOGRAPHY