MALOCCLUSION

&
CLASSIFICATION

DEPARTMENT OF ORTHODONTICS
CONTENTS

• Introduction
• Historical background
• Classification system
OCCLUSION

• When 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)
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)

WHY IS THE CLASSIFICATION OF MALOCCLUSION
IMPORTANT?

• Communication tool, as per saying "speak the same language."

E.g.: No one has difficulty classifying the extremes of a full Class II and a full Cla
ssIII.

• Treatment planning / assessment of treatment effects of orthodontic

appliances.

• Documentation

• Epidemiological studies
CLASSIFICATION SYSTEM
• Angle’s system of Classification

• Simon’s system of Classification

• Bennet’s system of Classification

• Ackerman-Profitt system of Classification

 Angle EH. Classification of malocclusion. Dent Cosmos
ANGLE’S CLASSIFICATION
Angle’s postulates:

• Upper 1st molars were key to occlusion

• Upper and lower molars should be related so that mesiobuccal cusp of upper

1899;41(3):248-264
molar occludes in the buccal groove of the lower molar.

• If the teeth were arranged on a smoothly curving line of occlusion and this
molar relationship existed, then normal occlusion would result.
• Angle considered the upper first molar as the most reliable point of reference from which to compare other
teeth because of its constancy in taking a correct position relative to the bony skeleton's jugal buttress (also
known as the key ridge).

• The key ridge is a ridge of bone descending downward and forward from the zygoma, which is the anterior
edge of the jugal or molar buttress of the maxillary bone and which marks the union of the anterior and the
posterior buccal walls of the antrum of Highmore.

• Contemporary orthodontists, however, do not consider the anatomic interrelationship of the upper molar to
the cranium as significant.
• Angle acknowledged that the first molar might erupt in an altered position when influenced by the
malpositions of other teeth or the loss or non-development of deciduous and permanent teeth
anterior to the first molar.

• Therefore Angle recommended visualizing the upper first molar into its proper position relative to
the jugal buttress before classifying the malocclusion.
CLASSIFICATION
• Class I: Normal relationship of the molars, but line of occlusion incorrect because of malposed
teeth, rotations or other causes.

• Class II: Lower molar distally positioned relative to upper molar, line of occlusion not
specified.

• Class III: Lower molar mesially positioned relative to upper molar, line of occlusion not
specified.
Note: Angle’s classification has four classes: Normal occlusion, Class I malocclusion, Class II malocclusion and Class III
malocclusion
CLASSIFICATION

• Class I
The 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
The mesiobuccal cusp of the lower first permanent molar occludes distal to the class I
position.
Class II division I
• Condition when class II molar relationship is present with proclined upper central
incisors.

• There is an increase in overjet.

Class II division II

• 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 subdivision

Condition when the class II molar relationship exists on only one side with normal
molar relationship on the other side.
Class III
• The mesiobuccal cusp of the lower fist molar occludes mesial to the class I position.
Pseudo Class III:

• 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 subdivision:
• Condition in which class III molar relationship is present only on one side with
normal relation on the other side.
DRAWBACKS

• Maxillary 1st permanent molar as a fixed point but it was not found so.

• Considered only anteroposterior plane.

• Cannot be applied if 1st permanent molars are missing or extracted.

• Cannot be applied in deciduous dentition.

MAIN PROBLEMS IN THIS CONCEPT:

• 1st, visualizing the "correct" position of the upper first molar to the jugal buttress
and lining up the remaining dental units relative to it is a very subjective pursuit.

• It is quite probable that no two orthodontists would exactly visualize the same
"correct" position.
 Main problems in this concept:

• 2nd, modern orthodontists are more concerned with the proper position of the incisors
relative to the profile for esthetic and stability concerns and are willing to adjust first molar
position and even sacrifice teeth to better align the incisors (concepts Angle would never
have accepted).

• Modern orthodontists advance molars in extraction treatments or distalize molars in non-

extraction treatments with little concern for the immutable relationship of the upper first
molar to the bony landmarks, such as the key ridge, as promulgated by Angle.
Friel S. Occlusion. Observations on its development from infancy to old age. lNT J
ORTHOD 1927;13:322-34.

Arya BS, Sarava BS, Thomas DR. Prediction of the first molar occlusion. AM J ORTHOD
1973;63:610-21.

Friel and later Arya et al. demonstrated the dynamic nature of the position of the first molar in the
mixed dentition, changing as the occlusion matures into the permanent dentition because of jaw
growth and second deciduous molar leeway space considerations. This natural "adjustment" makes
a molar defined classification awkward in young patients.
MODIFICATIONS

• Dewey’s modification
• Lischer’s modification
LISCHER’S MODIFICATION(1912)

He introduced following names to the Angle’s classification:

– Neutrocclusion- Class I

– Distocclusion- Class II

– Mesiocclusion- Class III

He devised a suffix version to describe malpositioned teeth as follows:
• Linguoversion • Supraversion

• Labioversion • Torsiversion or twisted tooth

• Perversion or impacted tooth
• Mesioversion
• Transversion or wrong sequential order
• Distoversion

• Infraversion
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: Normal incisor overlapping. Crowded mandibular incisors, placed lingually

thereby presenting normal sagittal relationship in the anterior region.

• Type 3: Anterior cross bite present. Underdeveloped maxilla. Crowded maxillary

incisors. Mandibular arch is well-developed , normal or overdeveloped with teeth in
normal alignment.
ANDREW (1970) 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)

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

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.