Classification of Classification of MalocclusionMalocclusion

SMEET M.SANARIASMEET M.SANARIA33rdrd YEAR YEAR

MGM DENTAL MGM DENTAL COLLAGECOLLAGE

Classification of Classification of MalocclusionMalocclusion

SMEET SMEET SANARIASANARIA33rdrd YEAR YEAR

IntroductionIntroduction

MalocclusionMalocclusion is defined as any is defined as any deviation from normal occlusion of deviation from normal occlusion of teeth .teeth .

Occlusion Occlusion : Contact relationship : Contact relationship between maxillary and mandibular between maxillary and mandibular teeth in function and parafunction.teeth in function and parafunction.

Classification of malocclusionClassification of malocclusion is the is the description of dentofacial deviations description of dentofacial deviations according to a common characteristic according to a common characteristic or norm.or norm.

Advantages of Advantages of ClassificationClassification

1.1. Helps in diagnosis and treatment Helps in diagnosis and treatment planning.planning.

2.2. Helps in visualizing and Helps in visualizing and understanding the problem understanding the problem associated with malocclusion.associated with malocclusion.

3.3. Helps in communicating the Helps in communicating the problem.problem.

4.4. Helps in comparisons of various Helps in comparisons of various malocclusions.malocclusions.

Types of Types of Malocclusion Malocclusion

1.Intra-arch malocclusion1.Intra-arch malocclusion

2.Inter-arch malocclusion 2.Inter-arch malocclusion

3.Skeletal malocclusion3.Skeletal malocclusion

Intra-arch Intra-arch malocclusionmalocclusion Includes individual tooth position, variations Includes individual tooth position, variations

and malocclusions affecting a group of teeth and malocclusions affecting a group of teeth within an arch.within an arch.

Distal inclination Distal inclination Mesial inclination Mesial inclination Lingual inclination Lingual inclination Buccal inclination Buccal inclination Mesial displacement Mesial displacement Distal displacementDistal displacement Lingual displacement Lingual displacement

Buccal displacement Buccal displacement Infra versionInfra version Supra versionSupra version RotationsRotations

Distolingual/Distolingual/MesiobuccalMesiobuccal

Mesiolingual/Mesiolingual/DistobuccalDistobuccal

TranspositionTransposition

Mesial inclination Distal inclination Palatal inclination

Lingual inclination Labial inclination

Infraocclusion Supraocclusion

Supraocclusion RotationMesiolingual or Distolabial

RotationDistolingual or Mesiolabial

Transposition

Inter-arch Inter-arch malocclusionmalocclusion

Malrelation of dental arches to one Malrelation of dental arches to one another upon skeletal bony basis another upon skeletal bony basis that may themselves be normally that may themselves be normally related.related.

Sagittal plane malocclusionsSagittal plane malocclusions Vertical plane malocclusionsVertical plane malocclusions Transverse plane malocclusionsTransverse plane malocclusions

Sagittal plane Sagittal plane malocclusionsmalocclusions

Pre-normal occlusionPre-normal occlusionMandibular arch Mandibular arch anteriorly placed in anteriorly placed in centric occlusion.centric occlusion.

Post-normal occlusionPost-normal occlusionMandibular arch Mandibular arch posteriorly placed in posteriorly placed in centric occlusion.centric occlusion.

Vertical plane Vertical plane malocclusionsmalocclusions

Deep biteDeep biteExcessive vertical Excessive vertical overlap between overlap between maxillary and maxillary and mandibular mandibular anteriors.anteriors.

Open biteOpen biteNo vertical overlap.No vertical overlap.- Anterior region- Anterior region- Posterior region- Posterior region

Anterior open bite Posterior open bite

Transverse plane Transverse plane malocclusionsmalocclusions

Includes various types of cross bites.Includes various types of cross bites.

Lateral incisor in cross bitePosterior segment in cross bite

Skeletal malocclusionSkeletal malocclusion Includes defects in underlying skeletal structure.Includes defects in underlying skeletal structure. Due to abnormalities in maxilla or mandible in size, Due to abnormalities in maxilla or mandible in size,

position or relationship between jaws.position or relationship between jaws. Sagittal abnormalitiesSagittal abnormalities

PrognathismPrognathism RetrognathismRetrognathism CombinationsCombinations

Transverse abnormalitiesTransverse abnormalities Narrowing and widening of jaws causes Narrowing and widening of jaws causes

crossbitescrossbites Vertical abnormalitiesVertical abnormalities

Variation affects lower facial height.Variation affects lower facial height.

Systems of Systems of Classification of Classification of Malocclusion Malocclusion

1.1. Angle’s classificationAngle’s classification

2.2. Dewey’s modification of Angle’s Dewey’s modification of Angle’s classification classification

3.3. Lischer’s modification of Angle’s Lischer’s modification of Angle’s classification classification

4.4. Bennet’s classification Bennet’s classification

5.5. Simon’s classification Simon’s classification

6.6. Ackermann-Profitt classification Ackermann-Profitt classification

7.7. Incisor classification Incisor classification

Angle’s Angle’s classificationclassification It was introduced by Edward Angle in 1899.It was introduced by Edward Angle in 1899.

Based on mesiodistal relationship of teeth, dental Based on mesiodistal relationship of teeth, dental arches and jaws.arches and jaws.

Maxillary 1Maxillary 1stst molar is taken as key to occlusion. molar is taken as key to occlusion.Three classesThree classes : : Class IClass I Class IIClass II

Class II division IClass II division I Class II division IIClass II division II Class II subdivisionClass II subdivision

Class II division I subdivisionClass II division I subdivision Class II division II subdivisionClass II division II subdivision

Class IIIClass III True Class IIITrue Class III Pseudo Class IIIPseudo Class III Class III subdivisionClass III subdivision

Class IClass I Normal inter-arch molar relationNormal inter-arch molar relation Mesiobuccal cusp of maxillary 1Mesiobuccal cusp of maxillary 1stst permanent molar permanent molar

occlude in the buccal groove of mandibular 1occlude in the buccal groove of mandibular 1stst permanent molar.permanent molar.

Dental irregularitiesDental irregularities CrowdingCrowding SpacingSpacing RotationsRotations Missing teethMissing teeth

Normal skeletal retaionships.Normal skeletal retaionships. Normal muscle function.Normal muscle function. Includes bimaxillary protrusion – normal Class I Includes bimaxillary protrusion – normal Class I

molar relationship but the dentitions of both arches molar relationship but the dentitions of both arches are forwardly placed in relation to the facial profile.are forwardly placed in relation to the facial profile.

Class IIClass II Distobuccal cusp of maxillary 1Distobuccal cusp of maxillary 1stst

permanent molar occludes in the buccal permanent molar occludes in the buccal groove of mandibular 1groove of mandibular 1stst permanent molar. permanent molar.

Class II division IClass II division I Characterized by proclined V-shaped Characterized by proclined V-shaped

upper incisors.upper incisors. Therefore, increased overjet, lip trap, Therefore, increased overjet, lip trap,

abnormal muscle activity – hypotonic abnormal muscle activity – hypotonic upper lip, hypertonic mentalis and upper lip, hypertonic mentalis and buccinator.buccinator.

Class II division IIClass II division II Characterized by lingually inclined upper Characterized by lingually inclined upper

incisors and labially tipped upper lateral incisors and labially tipped upper lateral incisors overlapping the centrals.incisors overlapping the centrals.

Square shaped arch, peri-oral muscle Square shaped arch, peri-oral muscle activity normal.activity normal.

Class II subdivisionClass II subdivision Class II molar relation exist on one side and Class II molar relation exist on one side and

Class I molar relation on the other side.Class I molar relation on the other side. Class II division I subdivisionClass II division I subdivision Class II division II subdivisionClass II division II subdivision

Angle’s Class I malocclusion

Angle’s Class II division 1

Angle’s Class II division 2

Class IIIClass III Mesiobuccal cusp of maxillary 1Mesiobuccal cusp of maxillary 1stst

permanent molar occlude the interdental permanent molar occlude the interdental space between mandibular 1space between mandibular 1stst and 2 and 2ndnd molar.molar.

True Class IIITrue Class III Pseudo Class IIIPseudo Class III Class III subdivisionClass III subdivision

True Class III – Skeletal Class III True Class III – Skeletal Class III malocclusion of genetic origin. malocclusion of genetic origin. Due to - Due to - Excessively large mandibleExcessively large mandible Forwardly placed mandibleForwardly placed mandible Smaller than normal maxillaSmaller than normal maxilla CombinationsCombinations

Pseudo Class IIIPseudo Class III – Produced by forward – Produced by forward movement of mandible during jaw closuremovement of mandible during jaw closure Also called Also called postural/habitual Class IIIpostural/habitual Class III Due toDue to

Occlusal prematuritiesOcclusal prematurities Premature loss of deciduous posteriors.Premature loss of deciduous posteriors. Child with enlarged adenoidsChild with enlarged adenoids

Class III subdivisionClass III subdivision – Class III molar – Class III molar relation on one side and Class I on the relation on one side and Class I on the other.other.

Angle’s Class II subdivision

Angle’s Class III malocclusion

Pseudo Class III malocclusion

Advantages of Angle’s Advantages of Angle’s Classification Classification

First comprehensive classification – First comprehensive classification – most widely accepted.most widely accepted.

SimpleSimple Easy to useEasy to use Conveys precisely what was Conveys precisely what was

conceived for ie, relationship of conceived for ie, relationship of mandibular teeth with respect to mandibular teeth with respect to maxillary 1maxillary 1stst permanent molar. permanent molar.

Drawbacks of Angle’s Drawbacks of Angle’s Classification Classification

Considers malocclusion only in the Considers malocclusion only in the anteroposterior plane and not in transverse/ anteroposterior plane and not in transverse/ vertical planes.vertical planes.

Considered 1Considered 1stst permanent molar as fixrd permanent molar as fixrd points in the skull, not found to be so.points in the skull, not found to be so.

Cannot be applied if 1Cannot be applied if 1stst permanent molar is permanent molar is missing or to deciduous dentition.missing or to deciduous dentition.

Doesn’t distinguish between skeletal/dental Doesn’t distinguish between skeletal/dental malocclusion.malocclusion.

Doesn’t highlight etiology.Doesn’t highlight etiology. Individual tooth positions aren’t considered.Individual tooth positions aren’t considered.

Dewey’s modification of Dewey’s modification of Angle’s classificationAngle’s classification

Angle’s Class IAngle’s Class I Type I – Class I with crowded anteriors.Type I – Class I with crowded anteriors. Type II – Class I with protrusive maxillary Type II – Class I with protrusive maxillary

incisors.incisors. Type III – Class I with anterior cross bite.Type III – Class I with anterior cross bite. Type IV – Class I with posterior cross bite.Type IV – Class I with posterior cross bite. Type V – Mesially drifted permanent Type V – Mesially drifted permanent

molars therefore early extraction of molars therefore early extraction of deciduous predecessors.deciduous predecessors.

Angle’s Class I with anterior crowding or Dewey’s Class I type 1

Angle’s Class I with anteriors proclined or Dewey’s Class I type 2

Dewey’s Class I type 3 malocclusion, molars in Angle’s Class I with maxillary anteriors in crossbite

Dewey’s Class I type 4. Angle’s class I with posterior crossbite

Dewey’s Class I type 5

Angle’s Class IIIAngle’s Class III Type IType I – upper and lower arches are – upper and lower arches are

normally aligned separately but show normally aligned separately but show edge-to-edge bite/ incisor edge-to-edge bite/ incisor arrangement on occlusion.arrangement on occlusion.

Type IIType II – mandibular incisors crowded – mandibular incisors crowded and in lingual relation to maxillary and in lingual relation to maxillary incisors.incisors.

Type IIIType III – maxillary incisors are – maxillary incisors are crowded and in cross bite with crowded and in cross bite with mandibular anteriors.mandibular anteriors.

Dewey’s Class III type 1

Dewey’s Class III type 2

Dewey’s class III type 3

Lischer’s modification of Lischer’s modification of Angle’s classificationAngle’s classification

Neutro-occlusion – Angle’s Class INeutro-occlusion – Angle’s Class I Disto-occlusion – Angle’s Class IIDisto-occlusion – Angle’s Class II Mesio-occlusion – Angle’s Class IIIMesio-occlusion – Angle’s Class III

Mesioversion – mesial to normal positionMesioversion – mesial to normal position Distoversion – distal to normal positionDistoversion – distal to normal position Linguoversion – lingual to normal positionLinguoversion – lingual to normal position Labioversion – labial to normal positionLabioversion – labial to normal position Infraversion – inferior or away from the line of Infraversion – inferior or away from the line of

occlusionocclusion Supraversion – superior or extended past the line of Supraversion – superior or extended past the line of

occlusionocclusion Axiversion – axial inclination is wrong, tippedAxiversion – axial inclination is wrong, tipped Torsiversion – rotated on its long axisTorsiversion – rotated on its long axis Transversion – transposed or changes in the sequence Transversion – transposed or changes in the sequence

of positionof position

Mesioversion

Distoversion of lateral incisor and canineTorsiversion of 1st premolar rotated mesiobuccally

Linguoversion Labioversion

Axiversion Torsiversion

Bennet’s classificationBennet’s classificationClass IClass I – abnormal position of one or more – abnormal position of one or more

teeth due to local causes.teeth due to local causes.

Class IIClass II – abnormal formation of a part/ whole – abnormal formation of a part/ whole of either arch due to developmental defect of of either arch due to developmental defect of bone.bone.

Class IIIClass III – abnormal relation between upper – abnormal relation between upper and lower arches and between either arch and lower arches and between either arch and facial contour and co-related abnormal and facial contour and co-related abnormal formation of either arch.formation of either arch.

Simon’s classificationSimon’s classification It is a craniometric classification relating It is a craniometric classification relating

dental arches in three planes i.e., dental arches in three planes i.e., FH plane [Frankforts Horizontal plane]FH plane [Frankforts Horizontal plane] Orbital planeOrbital plane Mid-sagittal planeMid-sagittal plane

FH planeFH planeAttraction – closer than normal Attraction – closer than normal to FH plane. to FH plane. Abstraction – away from FH Abstraction – away from FH plane than normal.plane than normal.

Orbital planeOrbital planeProtraction – Farther from orbital planeProtraction – Farther from orbital plane

Retraction – Closer/more posterior to Retraction – Closer/more posterior to orbital plane. orbital plane.

Mid-sagittal planeMid-sagittal plane

Distraction – away from mid sagittal Distraction – away from mid sagittal plane plane

Contraction – closer to mid sagittal Contraction – closer to mid sagittal planeplane

Ackermann-Profit Ackermann-Profit classificationclassification

1.1. AlignmentAlignment

2.2. ProfileProfile

3.3. Transverse Transverse relationshipsrelationships

4.4. ClassClass

5.5. OverbiteOverbite

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4

5

Based on 5 characteristicsBased on 5 characteristics

1.1. AlignmentAlignment Interarch alignment and symmetry assessed Interarch alignment and symmetry assessed

when seen in occlusal view.when seen in occlusal view. Dental arch is classified as ideal/crowded/spacedDental arch is classified as ideal/crowded/spaced

2.2. ProfileProfile can be convex/straight/concavecan be convex/straight/concave Includes assessment of facial divergence ie. Includes assessment of facial divergence ie.

Anterior or posterior divergence.Anterior or posterior divergence.

3.3. Transverse relationshipsTransverse relationships Include transverse skeletal and dental Include transverse skeletal and dental

relationships.relationships. Buccal and palatal cross bites are noted.Buccal and palatal cross bites are noted. Further classified as unilateral or bilateral.Further classified as unilateral or bilateral. Distinction made between skeletal and dental Distinction made between skeletal and dental

cross bites.cross bites.

4.4. ClassClass Sagittal relationship of teeth is assessed Sagittal relationship of teeth is assessed

using Angle’s classification as Class I / II / using Angle’s classification as Class I / II / III.III.

Distinction made between skeletal and Distinction made between skeletal and dental malocclusions.dental malocclusions.

5.5. OverbiteOverbite Assessed in the vertical planeAssessed in the vertical plane Described as anterior open bite / Described as anterior open bite /

posterior open bite / anterior deep bite / posterior open bite / anterior deep bite / posterior collapsed bite. posterior collapsed bite.

Distinction made between skeletal and Distinction made between skeletal and dental malocclusions.dental malocclusions.

Incisor classificationIncisor classification

Class IClass I Class IIClass II

Division IDivision I Division IIDivision II

Class IIIClass III

Class II div 1

Class I Class II div 2

Class III

Class IClass I

Mandibular incisor edges occlude with or Mandibular incisor edges occlude with or lie immediately below the cingulum lie immediately below the cingulum plateau of the maxillary central plateau of the maxillary central incisors.incisors.

Class IIClass II

Mandibular incisor edges lie posterior to Mandibular incisor edges lie posterior to the cingulum plateau of the maxillary the cingulum plateau of the maxillary central incisors.central incisors.

Division IDivision I Division IIDivision II

Division IDivision IMaxillary central incisors are proclined or of Maxillary central incisors are proclined or of average inclination and there is an increased average inclination and there is an increased overjet.overjet.

Division IIDivision IIMaxillary central incisors are retro-clined; the Maxillary central incisors are retro-clined; the overjet is normally minimum, but maybe overjet is normally minimum, but maybe increased.increased.

Class IIIClass III

Mandibular incisor edges lie anterior to the Mandibular incisor edges lie anterior to the cingulum plateau of the upper central cingulum plateau of the upper central incisors; the overjet is reduced or reversed.incisors; the overjet is reduced or reversed.