CLASSIFICATION OF

MALOCCLUSION

Presented by- Dr. Sonali Bhatt

MDS 1st Year
Department of Orthodontics and Dentofacial Orthopedics
CONTENTS: 


INTRODUCTION
OCCLUSION
 MALOCCLUSION
 NEED FOR CLASSIFICATION
 TYPES OF MALOCCLUSION
 VARIOUS SYSTEMS OF CLASSIFICATION
-Classification in primary dentition (Baum 1959)
-Angle’s classification
-Dewey’s modification
-Lischer’s modification
-Incisor classification (Ballard and Wayman 1964)
-Simons classification
-Ackerman Proffit classification
- Katz Premolar classification
-Canine classification
-skeletal classification
- Moyers classification
 CONCLUSION
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 OCCLUSION

Occlusion is defined as the manner in which the upper and lower teeth
intercuspate between each other in all mandibular positions and movements.
It is a result of neuromuscular control of the components of the mastication
systems, namely, teeth , periodontal structures, maxilla and mandible,
temporomandibular joints and their associated muscles and ligaments.
(Ash and Ramfjord, 1982).

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 MALOCCLUSION
Any deviation from normal occlusion is malocclusion.

Why classification of malocclusion?

For ease of communication among professionals and understanding the
nature of deviations, terminologies have been coined to categorise
malocclusion.
A classification is specific to an aim, which includes documentation, and
to some extent, an approach to a treatment plan.

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Malocclusions are broadly classified into:

Dental malocclusion
Intra-arch
Inter-arch
Skeletal malocclusion
Both

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 DENTAL MALOCCLUSION
Intra-arch malocclusion
INCLINATION

Labial Lingual Distal Mesial

inclination or inclination or inclination or inclination or
buccal tipping lingual tipping distal tipping mesial tipping

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 DISPLACEMENT

Mesial Distal Lingual Buccal

displacement displacement displacement displacement

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 MALERUPTIONS

Supra-eruption/Supra-occlusion: Infra-eruption/Infra-occlusion:
Tooth overerupted as compared to Tooth not erupted enough compared
other teeth in arch. to the other teeth in arch.

(A) Supraocclusion of the left maxillary first molar. (B) Infraocclusion of left maxillary premolars.

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 ROTATIONS or TORSIVERSION

Distolingual or Mesiobuccal Mesiolingual or Distobucal

rotation rotation

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 TRANSPOSITIONS

This term describes a condition where two teeth have

exchanged places.

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 Inter-arch malocclusions
Sagittal plane malocclusions

Sagittal plane malocclusions include increased overjet and anterior cross-bite.

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 Vertical plane malocclusions

Deep bite or increased overbite: Deep bite refers to a condition where there
is an excessive vertical overlap of the upper to the lower anterior teeth.

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Open bite: Open bite is a condition where there is no vertical overlap between the
upper and lower teeth. Thus, a gap may exist between the upper and lower teeth
when the patient bites in centric occlusion.
Open bite can be in the anterior or posterior region.

(A) Edge-to-edge bite with a tendency for open bite. (B) Open bite.
(C) Moderate open bite. (D) Severe open bite.
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 Transverse plane malocclusions

Cross-bite: Cross-bite refers to an abnormal transverse relationship between the

upper and lower arches. Cross bite may affect a single tooth, a group of teeth or
an entire arch. It may affect anterior or posterior teeth on their own or both in
combination.
Posterior cross-bite can be unilateral or bilateral

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Scissors bite: Scissors bite refers to a condition in which a tooth or group of
teeth in the mandibular buccal arch are lingual to the lingual cusps of the
maxillary teeth.

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SYSTEMS OF CLASSIFICATION
Classification in primary dentition (Baum 1959)
Flush terminal plane relationship

The mandibular deciduous second molar is usually wider mesiodistally than

the maxillary second deciduous molar giving rise to a flush terminal plane
relationship.
When a line is drawn on the distal surface of the upper second deciduous
molar, it falls along the distal surface of the lower deciduous second molar.
As the first permanent molars erupt, they will be in an end-on molar relationship in the
presence of complete deciduous dentition having a flush terminal plane.

This relation develops into a class I molar relationship following exfoliation of the lower
deciduous second molar as a result of mesial migration of the lower permanent first molars.
Distal step. In cases where the upper deciduous second molar is
ahead of the lower deciduous second molar, it gives rise to a distal
step. This can lead to a class II molar relationship in permanent
dentition.
Mesial step. In cases where the lower deciduous second molar is
ahead of the upper deciduous second molar, it gives rise to a mesial
step. This can either lead to a class I molar relationship or a class III
molar relationship in permanent dentition.
Angle’s classes of malocclusion(1899)

Though many
One of the major classifications emerged in
contributions of Edward Edward Angle introduced course of time, Angle’s
Hartley Angle to the field a system of classifying system of classification is
of Orthodontics is system malocclusion in the year undoubtedly the most
of classification given a 1899. widely accepted and used
century ago. because of its simplicity in
application.
 Angle’s
Thus, he fixed
assumption when
Angle’s first permanent
formulating this Angle then
classification classification was
molar as a key
described three
was based on point and based
that the maxillary classes of
on lower first
the mesiodistal first permanent malocclusion as I
molar deviation
relation of molar is always , II and III, based
in relation to the
teeth, dental in the correct on the occlusal
upper first
position and the relationships of
arches and the permanent molar,
variability comes the first molars.
jaws. he classified the
from the
malocclusion.
mandible.
 Angle’s classes of malocclusion(1899)

Angle’s class I

Normal anteroposterior relationship between the maxilla and the

mandible fall in this class.
The triangular- ridge of the mesiobuccal cusp of the maxillary first
permanent molar articulates in the buccal groove of the mandibular
first petmanent molar.
The bony base supporting the mandibular dentition is direct1y beneath
that of the maxillary, and neither is too far anterior or posterior in
relation to the cranium .
The malocclusion therefore is confined to malpositions of the teeth
themselves which may be misaligned, malplaced on their bony bases,
(dentoalveolar protrusion), etc.
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 Angle’s class II

e malocclusions in which there is a It emphasizes the "distal" positioning of

“ relationship of mandible to maxilla mandible to the maxilla, but of course many
make up Class II cases are seen in which the maxilla is
Class II. prognathic.

mesial groove of the mandibular first

ent molar articulates posteriorly to the
iobuccal cusp of the maxillary first
permanent Molar.
Angle’s class II
Class II div. 1
Class II div. 2

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CLASS ii DIV. 2

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 Angle’s class III

Those malocclusions in which there is a "mesial, i.e., a ventral,“

relationship of mandible to maxilla make up Class III.

The mesial groove of the mandibular first permanent molar articulates

anteriorly to the mesiobuccal cusp of the maxillary first permanent
molar

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 True Class III: Pseudo Class III:

- Concave profile - Straight or concave profile

- Usually genetic in origin - Acquired or habitual
- Forward path of closure - Deviated path of closure
- Increased Gonial angle - Normal gonial angle
- Retroclined or normal - Proclined lower incisors
lower incisors

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 Dewey’s modification
Dewey (1915) divided Angle’s class I into five types and Angle’s class III into three
types. There were no modifications for class II. He considered the same molar
relationship as in Angle’s classification.

Modifications of class I malocclusion

Type I. Crowded maxillary anterior teeth
Type II. Proclined maxillary incisors
Type III. Anterior cross-bite
Type IV. Posterior cross-bite
Type V. Molars are in mesioversion due to shifting following loss of a
tooth anterior to the first molars; all other teeth are in a normal
relationship.

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 Modifications for class III malocclusion

Type I. The dental arches are well aligned, but have an edge-to-edge incisor
relationship.
Type II. The mandibular incisors are crowded.
Type III. The maxillary incisors are in cross-bite. The maxillary arch is usually
underdeveloped, while the mandibular arch is either normal, or overdeveloped
with teeth in normal alignment. Consequently, there is crowding in the anterior
region.

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 Lischer’s modification

Lischer (1912) substituted the terms class I, class II and class III given by
Angle with the terms Neutro-occlusion, Disto-occlusion, and Mesio-
occlusion. He devised a suffix version to describe
malpositioned teeth as follows:
1. Linguoversion
2. Labioversion
3. Mesioversion
4. Distoversion
5. Infraversion
6. Supraversion
7. Torsiversion or twisted tooth
8. Axiversion
9. Transversion
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 Incisor classification (1964)
Ballard and Wayman (1964) devised the incisor classification in the
United Kingdom.

1. Class I: the edges of the lower incisors occlude with or lie directly
below the cingulum plateau of the upper central incisors.

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2. Class II: the edges of the lower incisors lie posterior to the cingulum
plateau of the upper central incisors. There are two divisions of class II:
i. Division 1: the upper central incisors are of average inclination or are
proclined; overjet is thus increased.
ii. Division 2: the upper central incisors are retroclined; overjet is usually
within normal limits but overbite is often increased.

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3. Class III: the edges of the lower incisors lie anterior to the
cingulum plateau of the upper central incisors.

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 SIMON CLASSIFICATION
Simon described malocclusion in relation to three
reference planes:
The Median saggital plane
The Frankfort plane
The Orbital or Simon plane
1. The angle between the Frankfort horizontal and the occlusal plane, the
form of the occlusal curve, and the inclination of the teeth axes are
determined from the Frankfort plane:
Attraction: the distance between the occlusal plane and the Frankfort
horizontal is comparatively shorter than normal. This distance is as a rule
normally shorter in younger than older persons and in some ethnic groups.
Abstraction: the distance between the occlusal plane and the Frankfort
horizontal is comparatively longer than normal.
2. Sagittal symmetry and inclination of the axes of the teeth are determined
from the Simon plane:
Protraction: the teeth, one or both dental arches and/or jaws are too far
forward. Normally, the orbital plane passes through the distal incline of the
canine.
Retraction: the teeth, one or both dental arches and/or jaws are retruded too far.
The orbital plane passes anteriorly to the canines too far.
3. The arch form and inclination of the tooth axis are
determined from the median sagittal plane.

Contraction: a part or the entire dental arch is

contracted towards the raphe or median sagittal plane.
The abnormality may be mandibular, alveolar, dental,
anterior, posterior, unilateral or bilateral.
Distraction: a part or all of the dental arch is wider than
usual from the raphe or median sagittal plane.
ACKERMAN AND PROFFIT CLASSIFICATION(1969)

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Step 1
Group 1: This is also called the universal group and consists of
malalignment and asymmetry within the dental arches
Step 2
Group 2 (Profile): The soft tissue profile is considered here.
Step 3
Group 3 (Type): Deviations in the transverse plane.
Step 4
Group 4: Deviations in the anteroposterior or sagittal plane.
Step 5
Group 5 (Bite): Deviations in the vertical plane
Group 6: Deviations in the transverse and sagittal planes
Group 7: Deviations in the sagittal and vertical planes
Group 8: Deviations in the vertical and transverse planes
Group 9: Deviations in the transverse, sagittal and vertical planes

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 CANINE CLASSIFICATION

Class I canine relationship:

When the mesial slope of upper canine coincide with the distal slope of
lower canine.

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Class II canine relationship:
When the mesial slope of upper canine is ahead of the distal slope
of lower canine.

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Class III canine relationship:
When the mesial slope of upper canine lies behind the distal
slope of lower canine.

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 Katz premolar classification (1992)
Premolar class I: It is identified when the most anterior upper premolar fits
exactly into the embrasure created by the distal contact of the most anterior
lower premolar.

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Premolar class II: Here the most anterior
upper premolar is occluding mesial of the
embrasure created by the distal contact of
the most anterior lower premolar. The
measurement has a (+) sign.

Premolar class III: Here the most anterior

upper premolar is occluding distal of the
embrasure created by the distal contact of
the most anterior lower premolar. The
measurement has a (-) sign.

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 Skeletal classification

Skeletal class I: An orthognathic face with the following

important features:
1. Straight profile
2. Normal ANB angle: 2° ± 2
3. Normal facial angle (downs): 82–95° (mean 87.3°)
4. Angle of convexity (downs): +10 to −8.5° (mean 0°).

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Skeletal class II: A retrognathic face that may be due to a
prognathic maxilla or retrognathic mandible . Important
features are:
1. Convex profile
2. Increased ANB angle
3. Reduced facial angle
4. Increased angle of convexity
5. Severe backwards rotation of the mandible may also be
present.

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Skeletal class III: A prognathic face at chin that may be due to a
prognathic mandible or retrognathic maxilla Possible significant
features are:
1. Concave profile
2. Prominent chin
3. Decreased ANB angle
4. Increased facial angle
5. Reduced angle of convexity.

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 MOYER’S CLASSIFICATION

Diagrammatic representation of the horizontal facial types in Class II. The large rectangles symbolize the maxilla
and the mandible, and the small squares represent the first molars. Incisors are represented as vertical lines when
normal, angled when in labioversion. The ideal profile seen in orthognathism is depicted by a dotted
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 VERTICAL CLASSIFICATION:

Type 1.
• The characteristic features of vertical Type 1 are
a mandibular plane steeper than normal, an even
steeper functional occlusal plane, and a palate
which is tipped somewhat downward.
• The anterior cranial base tends to be upward.
• The result is an anterior face height that is
significantly greater than the posterior face
height.

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Type 2.
• Vertical Type 2 is essentially a square face.
The mandibular plane, functional occlusal
plane, and palatal plane are all flatter than
normal and are nearly parallel.
• The gonial angle is normal, and the anterior
cranial base is more horizontal than normal.
• Under these conditions, the incisors tend to
be vertical and in deep-bite

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Type 3.
• The characteristic feature of vertical Type 3 is a
palatal plane which is tipped upward anteriorly.
• During growth the upper face height does not
keep pace with the total face height, resulting in a
strong tendency to open-bite.

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Type 4.
• In vertical Type 4 the mandibular plane, the functional
occlusal plane, and the palatal plane are all tipped
markedly downward.
• The gonial angle is obtuse.
• In vertical Type 4 the lower incisors are tipped
lingually.
• Vertical Type 4 is among the most rare and severe of
the vertical types.

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Type 5.
• Vertical Type 5 is most closely related to vertical
Type 2, “the square face syndrome”.
• In Type 5 the mandibular and functional occlusal
planes are normal. However, the palatal plane is
tipped downward.
• The gonial angle is the most squarish of all the
types, resulting in a skeletal deep-bite .
• The lower incisors are found in extreme
labioversion, whereas the upper incisors are nearly
vertical.

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REFERENCES:
 Differential diagnosis of Class II malocclusions ; Robert E.
Moyers et al ; Am. J. Orthod. November 1980.
 Handbook of Orthodontics; Moyers.
 OP Kharbanda

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THANK YOU

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