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DR. EVELYN CO ORTHO-PEDO SS2

ORTHODONTICS 1. Angle considered malocclusion on the antero-

posterior plane. He did not consider malocclusions
- Branch of dentistry concerned with the study of the
in the transverse and vertical planes.
growth of the craniofacial complex, the development of
2. Angle considered the first permanent molars as
occlusion and the treatment of dentofacial
fixed points in the skull but is not found to be so.
abnormalities.
3. The classification cannot be applied if the first
DR. EDWARD ANGLE molars are extracted or missing.
4. The classification cannot be applied to the
- Credited for the development of the concept
deciduous dentition.
of occlusion in the natural dentition and classified
5. The classification does not differentiate between
malocclusion based on molar relations into 3 major
skeletal and dental malocclusions.
class.
6. The classification does not highlight the etiology of
- He is instrumental and evolutionary in the field
the malocclusion.
of orthodontics.
7. Individual tooth malpositions have not been
- One of his best contribution in orthodontics considered by Angle.
that outland him: Classification of occlusion based on
the 1st molar relationship
LISCHER’S CLASSIFICATION OF ANGLE’S
ANGLE’S CLASSIFICATION CLASSIFICATION

 CLASS I – maxillary 1st molar’s MBC occludes  ANGLE CLASS I (NEUTROCLUSION)

with the buccal groove (mesial) of mandibular - MBC of upper 6’s occludes with MBG of
1st molar. lower 6’s
 CLASS II – maxillary 1st molar DBC occludes - Cusp of the upper and embrasure of the
with the buccal groove (mesial) of mandibular lower
1st molar - Upper canine is more distal than the
 CLASS III – maxillary 1st molar MBC occludes lower canine
with the distal groove that demarcates the
midbuccal cusp of mandibular 1st molar with
the ditobuccal cusp.

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DR. EVELYN CO ORTHO-PEDO SS2

 ANGLE CLASS II DIVISION I

- Positive overbite (Vertical relation)
(DISTOCLUSION)
- If negative overbite = it happens
- Distoclusion with labioversion of the
when there is a failure in U&L set of
upper incisors
teeth to overlap ; no overlapping
- Very protruded maxilla
- If negative = open bite because of
- Labially inclined/flared anterior incisors
tooth sucking
- Large overjet

LISCHER’S CLASSIFICATION
 ANGLE CLASS II DIVISION II
(DISTOCLUSION)
- Distoclusion with linguoversion of the
upper incisors
- Not labially flared but it is lingually
inclined / retroclined upper anterior
incisors
- Minimal overjet

VERTICAL VARIATIONS OF GROUPS OF

TEETH
 ANGLE CLASS III (MESIOCLUSION)
- MBC of upper 6’s occludes with DBG of - Excessive vertical overlap of the incisors
lower 6’s
- Upper 1st molar and canine is more distal
- Labial surface of the upper are behind
- There’s a large overjet (Horizontal
relation)
- Normal overjet is 1-2mm
- If negative overjet = abnormal
Deep bite

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DR. EVELYN CO ORTHO-PEDO SS2

- Localized absence of occlusion while the remaining

teeth are in occlusion

- Generalized upper anterior crossbite more

lingual than the lower anterior incisors (Lingual
crossbite of the upper incisors)
- This case can be generalized / localized
- Due to:
- Open Anterior Bite  Excessive mandibular growth
 Normal/abnormal maxilla
- Due to:
(deficiency in maxilla)
 Prolonged thumb sucking
 Prolonged thumb thrusting  Posterior crossbite can be buccal or lingual
 Bottle feeding crossbite.

- How long would cause this problem?

Any habits indulge 6 hours a day for the
next 3 years will cause damages on the
occlusion or complication depending on
the: - Scissors bite is when the lingual cusp of the
upper is related to the buccal cusp of lower
 Duration
 Intensity SIMON SYSTEM
 Frequency
Principal contribution:
 If it is in a short period of time it cannot cause
complication but with other factors it can  Emphasis on the orientation of the dental
aggravate the problem. arches to the facial skeleton
 Separates carefully, by means of its
TRANSVERSE VARIATIONS OF GROUPS OF
TEETH terminology, problems in malpositions of the
teeth from the teeth from the osseous dysplasia
- Abnormal buccolingual/labiolingual relationship of the
teeth ANTEROPOSTERIOR RELATIONSHIP

 Buccal crossbite  Orbital Plane

- Lingual cusps of upper posterior teeth  PROTRACTION – when the dental arch or part
occlude bucally of the buccal cusps of of it is more ANTERIORLY placed than normal
the lower teeth with respect to the orbital plane
 Lingual crossbite  RETRACTION - when the dental arch or part of it
- 1 or more maxillary teeth are in is more POSTERIORLY placed than normal with
crossbite toward the midline respect to the orbital plane
 Complete lingual crossbite

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DR. EVELYN CO ORTHO-PEDO SS2

 Class – Angle’s classification, dental and/or

MEDIOLATERAL RELATIONSHIP
skeletal
 Midsagittal Plane  Bite depth – open bite, deep overbite
 CONTRACTION – when the dental arch or part
of it is NEARER to the midsagittal plane than the
GROUP 1: INTRA-ARCH ALIGNMENT
normal
SYMMETRY
- very narrow arch, V-shaped arch
 IDEAL
-
- Difficult to achieve because of the
 DISTRACTION - when the dental arch or part of wear and tear
it is FARTHER AWAY to the midsagittal plane
than the normal
- also known as expanded arch

 CROWDING
- Upper pic: Experiencing lack of space
VERTICAL RELATIONSHIP in the canine. It is palatally lock out
- Lower pic: Second premolar should
 Frankfurt Plane
undergo ortho treatment before dental
 ATTRACTION – when the dental arch or part of
caries lesion occurs that can lead to
it is NEARER to the Frankfurt plane than the
extraction of teeth. It can affect 2 or 3
normal
teeth because of difficulty cleaning it.
 ABSTRACTION - when the dental arch or part of - If 1 or 2 teeth can’t fully erupt because
it is FARTHER AWAY to the Frankfurt plane than lack of scape = think of ways to get
the normal enough space for it to fully erupt. Is it to
- Tend to have long face expanding the arch or exo?
- It is better to expand if the
space is not that big. Expansion is the
safest treatment because
excess/deficient space can be a failure.

ACKERMANN AND PROFFIT

- Uses Venn Diagram

5 characteristics and their interrelationships are

assessed has been developed
 Alignment – ideal, crowded, spacings
 Profile – straight, convex or concave
 Type – crossbite, bilateral, skeletal or dental

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DR. EVELYN CO ORTHO-PEDO SS2

 SPACING
o CONVEX
o Retainers / Hawley’s Retainer / Wrap
- Retrognathic/Class II/Anterior
around Retainer
Hyperdivergence
- is an appliance that can be - less than 165 °
used to maintain the teeth after
closing the spaces.

o Circumferential Supracrestal Fiberotomy

- destroying the memories of PDL fibers
and loss the memory to bring it back to
the original position.
 When putting retainers make sure to check the
occlusion because any iatrogenic factor is not
forgiveable.
o CONCAVE
- Prognathic/Class III/Anterior
Hypodivergence
- Greater than 175 °
- Usually has strong mandible

GROUP 2: PROFILE
- Soft tissue glabella, subnasale and pogonion

o STRAIGHT
- Orthognathic/Class I
- Soft tissue glabella, subnasale and
pogonion GROUP 3: TRANSVERSE DEVIATION
- 165 ° - 175 °
Type:

 BUCCAL
 PALATAL

 2nd pic: Unilateral Crossbite

- Check biting on the different side
- Due to cheek biting, there is a whitish
line and it is painful when it becomes a
habit.

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DR. EVELYN CO ORTHO-PEDO SS2
o DEEP BITE
- One of the first sign for the patient
with TMJ Dysfunction is when 1 or more
teeth are crossbite. There is an
asymmetric movement.

GROUP 4: SAGITTAL DEVIATION

Class:

 CLASS I o COLLAPSED BITE

GROUP 6: TRANS-SAGITTAL
GROUP 7: SAGITTO-VERTICAL
 CLASS II
GROUP 8: VERTICO-TRANSVERSE
GROUP 9: TRANS-SAGITTO-VERTICAL

 CLASS III

GROUP 5: VERTICAL DEVIATION LIMITATIONS OF CLASSIFICATION

SYTEM
Bite Depth:
 None are truly inclusive
o OPEN BITE
 Omit entire regions, dimensions, syndromes

 All are static in concept

 Allowance not made for future changes

 Most are narrow in focus and perspective

 There is tradition of misuse and misapplication

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DR. EVELYN CO ORTHO-PEDO SS2

ORIENTATION OF PLANES PROBLEMS RELATED TO THE

DIFFERENT PLANES
 SAGITTAL PLANE (MEDIAN PLANE)
- An imaginary plane that passes
longitudinally through the middle of the
head and divides it into right and left
halves

- Used to describe anterior-posterior

relationships.

 TRANSVERSE PLANE (HORIZONTAL

PLANE)
- An imaginary plane that passes
through the head at right angles to the
sagittal and frontal planes dividing the
head into upper and lower halves.

- Used to describe right to left

relationships

- Cross bite relationship

 FRONTAL PLANE (CORONAL OR

VERTICAL PLANE)
- An imaginary plane that passes  For soft tissue: Glabella, Subnasale, Pogonion
longitudinally through the head  How to check for buccal corridor: By smiling you can
perpendicular to the sagittal plane see if it is normal or abnormal. As much as possible
dividing the head into front and back we want na sakto lang yung laki ng buccal corridor.

- Used to describe superior-inferior o Buccal corridor is a dark space

relationships  To check for the face symmetry: Check from right
side – midpoint/midline – left side of the face

o If one is larger or smaller from another it is

abnormal or asymmetry

 For vertical plane, if any disproportion in the face is

unesthetic.

 If there’s a presence of anterior crossbite, there’s a

problem in inclination

 Dental Midline is formed by mesial surface of upper

and lower central incisors

 Canting - It describes the vertical position of the

teeth when the left and right sides are different

o It can compare to the interpupillary line. It

will not be parallel to one another. One is
either inferior or superior.

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DR. EVELYN CO ORTHO-PEDO SS2

BOLTON ANALYSIS ADVANTAGES

 Wayne A. Bolton pointed out that the extraction of  They are three dimensional records of the patient
one tooth or several teeth should be done according dentition
to the ratio of tooth material between the maxillary
o Casts are useful when the patient is absent
and mandibular arch
and also it is the record of original baseline
 To get an ideal interdigitation, overjet, overbite and relationship
alignment of teeth
 Occlusion can be visualized from lingual aspect
o If the patient has an overjet or overbite we
 They provide a permanent record of the
can know which arch is the problem and
intermaxillary relationship
also the teeth in the arch that is causing the
problem  Helps to motivate the patients as they can visualize
the treatment progress
 To attain an optimum interarch relationship
 They are needed for comparison purposes at the end
 Bolton analysis helps to determine the disproportion
of the treatment and act as reference for post
between the size of maxillary and mandibular teeth.
treatment changes
o We can know the culprit and deal with the DISADVANTAGES
teeth.
 Most of the studies were done on a specific
MODEL ANALYSIS population and the ratio obtained need not be
 Study of dental casts, which helps to study the applicable to other population groups
occlusion and dentition from all three dimensions o Mostly it is done in US so dealing with
o Need to have a caliper to analyze the different population and places may be
occlusion and dentition from all three difficult
dimensions o The result may not be applicable to Asians
o Analyze also how severe the problem and  It does not take into account the sexual dimorphism
correct it as possible in the teeth
 Analyze the degree and severity of malocclusion o For male and female
 To derive the diagnosis and plan for treatment  Male has bigger and greater
mesiodistal width of the central
 It is the study of maxillary and mandibular dental
incsiors
arches in all three planes of space:
 Does not take skeletal malrelation into consideration
o Sagittal Plane
o Because it deals with the teeth not the
o Vertical Plane
skeletal
o Transverse Plane
 It does not take into account the relationship of the
teeth to surrounding bone or the difficulties in
increasing the mandibular dimensions

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DR. EVELYN CO ORTHO-PEDO SS2

PROCEDURE BOLTON ANALYSIS

 The sum of mesiodistal diameter of the 12 maxillary  If the ratio is more than the mean value, then the
teeth and the sum of the mesiodistal diameter of the mandibular tooth material is excess
12 mandibular teeth are determined.
 If the ratio is less than the mean value, then the
o When measuring, the tip of the caliper maxillary tooth material is excess
should be at the greatest width of the teeth
towards the contact area .  Bolton preferred to do interproximal stripping on the
upper arch if the upper anterior tooth material is in
excess and extraction of lower incisor, if necessary to
reduce tooth material in lower arch.

o Upper anterior teeth: Interproximal

stripping or reduction

 How much enamel are we supposed to

remove in proximal with tooth that has
the problem?

 As much as possible we must

confine it
 In the same manner the sum of the 6 maxillary  .1 or .3 can be reduce
anterior teeth and the sum of the 6 mandibular
teeth is determined  Remove on the mesial then distal
to avoid overstripping and
sensitivity

 After stripping we need fluoride

to prevent sensitivity just case the
patient feel it.

 Fluoride is the most widely

available and cheapest that can
help prevent sensitivity

o Lower anterior teeth: Extraction

 If there’s a need for a large amount

OVERALL RATIO of space extraction must be done
Sum of mesiodistal width of mandibular 12 teeth x 100
 Intentionally extract it even though
Sum of mesiodistal width of maxillary 12 teeth it is a sound tooth to reduce the
problem of interdigitation
MEAN: 91.3 %
 For smaller space, central incisor
can be extracted.
ANTERIOR RATIO  When extracting consider the:
Sum of mesiodistal width of mandibular 6 teeth x 100  Normal size
Sum of mesiodistal width of maxillary 6 teeth  Proximity of problem
MEAN: 77.2 %  But when one tooth has a problem
like death of pulp this tooth must
be extracted.

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DR. EVELYN CO ORTHO-PEDO SS2

QUIZ 8. Class II molar relation on one side and a Class I

relation on the opposite side –
1. Distobuccal cusp of tooth 26 occludes with
mesiobucccal cusp of tooth 36 with linguoversion of  Class II subdivision
maxillary incisors and minimal overjet
9. Primary canine relationship
 Class II Division 2

2. Dewey's modification of neutroclusion with

posterior crossbite

 Class I type 4

 Class I

10. Patient's profile

3. Ackerman & Proffit characterized Class under

_______ deviation  Anterior hypodivergence

 Sagittal

4. Simon's System used this as reference plane to

determine if the dental arch or part of it is in
contraction or distraction

 Midsagittal plane

5. Prolonged thumb sucking habit can cause a/an

____________ maxillary arch

 Underdeveloped

6. This molar terminal plane relationship of the primary

dentition will lead to ___________ in the permanent
dentition

 Class II

7. Identify the problem in this picture

 Anterior crossbite

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DR. EVELYN CO ORTHO-PEDO SS2

MANAGEMENT OF THE DEVELOPING  Check for airway

DENTITION AND OCCLUSION IN
o Chronic mouth breathing can cause
PEDIATRIC DENTISTRY
improper position of tongue and
(Additional information from ma’am) surrounding structures like cheeks
and lips.
STAGES OF DEVELOPMENT OF OCCLUSION
 Check the proportion of upper and lower
 To know the best time for treatment set of teeth and also check the maxillary
and mandibular bone
 To know the expected growth of teeth, dentition
and craniofacial structures. EARLY MIXED DENTITION (6-9 years old)
 To prevent iatrogenic factors  Open bite is more common than deep bite
CROWDING OF DENTITION  Easiest to correct the problem because it is not so
- it is seen mostly in the anterior segment of teeth complicated

CONDITION:  Where the permanent 1st molars erupt

1. Lack of growth and development of o When primary second molar is extracted

arches early it will cause a problem in the 6’s.

 Maybe the teeth are bigger or  Ectopic eruption and chain

wider mesiodistally reaction of the problem will occur.

2. Too much growth and development of HOW TO STOP TOO MUCH GROWTH OF MAXILLA
IN A GROWING CHILD?
arches
 Use the normal headgear
 The teeth are smaller
mesiodistally o Parietal/High Pull Headgear
 There could be an absence of o Cervical/Low Pull Headgear
teeth
o Combination pull
 Most common abnormal
teeth: Maxillary lateral incisors  Reverse Pull Headgear is only indicated to protract
maxillary arch which is lack of growth
o Peg shaped lateral
TRUE SKELETAL CLASS III
o Congenitally missing
(mostly in lower  A condition where there is an overgrowth in mandible
lateral incisors) and underdevelop maxilla (sometimes normal size
maxilla)
REMEMBER!
 Concave profile
 Count the teeth to know if it is present or
absent  We use expansion appliances like palatal expansion in
the maxillary arch to make the maxilla bigger than the
 Know the morphology mandible to arrive at the ideal occlusion
 Know the relationship of upper and lower LATE MIXED DENTITION (10-12 years old)
arches
 Stage where we see if there’s problem in the late
 Do radiograph to support the clinical stage teeth because the spaces could have been
assessment occupied with the teeth that has first erupted.

 Connective phase

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DR. EVELYN CO ORTHO-PEDO SS2

ADOLESCENT

 Make sure to check functional balance and esthetics.

 Leeway Space

o Should be maintained for the proper

eruption of canine and premolars

o If there is generalized spacing (Flush

Terminal Plane) in can lead to Class 1 molar
relationship in adult dentition

o Checking the teeth C, D, E and 3, 4, 5

o If there’s enough leeway space, most

assured that there is a proper eruption of
3,4,5 and will result to Class 1 molar
relationship

OSAS: OBSTRUCTIVE SLEEP APNEA SYNDROME

 Blockage in nasopharynx

 Narrow nasopharyngeal airway

 Difficulty in breathing

 Tongue position is in the floor of the mouth

REMEMBER!

 The dentist should make sure to recognize the oral

habits while doing history taking to the patient.

 To get the information of the child inquire from the

parent or baby sitter.

BRUXISM

 Can occur while sleeping or awake

In orthodontics, supervision and guidance during

eruptive period is important to prevent problems in the
oral cavity like crowding.

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