classification of malocclusion

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classification of malocclusion including new system of classification

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classification of malocclusion

  1. 1. CLASSIFICATION OF MALOCCLUSION Presented by, Dr. Bibin Ninan Mathew
  2. 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. 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. 4. OCCLUSION oc UP clusion CLOSING CLOSING UP
  5. 5. MALOCCLUSION OCCLUSION MAL BAD BAD BITE BITE
  6. 6. OCCULSION IDEAL OCCLUSION NORMAL OCCLUSION MALOCCLUSION
  7. 7. OCCLUSION DEFINITION 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
  8. 8. IDEAL & NORMAL OCCLUSION “IDEAL” is a hypothetical concept or a standardized goal The Perfect Occlusion “Normal” implies to the variations around an average mean value
  9. 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. 10. Ideal occlusion • • • • • • 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 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. 11. Andrews 6 KEYS of Normal Occlusion (1972) Class I molar relationship Correct crown angulation Correct crown inclination No rotation No spaces Flat to slight curve of spee
  12. 12. MALOCCLUSION 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“.
  13. 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. 14. Occlusion and malocclusion
  15. 15. HISTORICAL REVIEW
  16. 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. 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. 18. (1905-1921)- Calvin case -anatomical groups- grouped into 5 classes- treatment standpoint of view (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
  19. 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. 20. What is a classification system ??
  21. 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. 22. Why we need a Classification for malocclusion ???
  23. 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. 24. TYPES OF MALOCCULSION INTER ARCH INTRA ARCH SKELETAL
  25. 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. 26. Distal inclination Buccal inclination ABNORMAL INCLINATION Mesial inclination Lingual inclination
  27. 27. ABNORMAL DISPLACEMENTS Labioversion Lingoversion
  28. 28. Palatoversion Buccoversion
  29. 29. Supraversion Infraversion
  30. 30. Torsiversion
  31. 31. INTERARCH PROBLEMS Abnormal relationship between two teeth or group of teeth of one arch to the other Types Sagittal plane malocclusions Vertical plane malocclusions Transverse plane malocclusions
  32. 32. SAGITTAL DIRECTION Either : - Abnormal overjet - Anterior cross-bite Anteriorly OR Class II malocclusion Class III malocclusion Posteriorly
  33. 33. Vertical plane malocclusions Normal overbite Deep overbite Open bite
  34. 34. Transverse plane malocclusions Either : DEVIATIONS OF THE MIDLINE Anteriorly OR POSTERIOR CROSS BITE: Posteriorly
  35. 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. 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. 37. ANGLE CLASSIFICATION It was introduced by Edward H. Angle (1889) • Based on the mesiodistal relationship of teeth, dental arches and jaws • Maxillary first molar is taken as the key of occlusion • Three classes
  38. 38. THREE CLASSES 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 Class III Subdivision
  39. 39. NORMAL LINE OF OCCLUSION
  40. 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. 41. Angle Class ІІ malocclusion Distoclusion Molar relationship: Canine relationship: - the distal incline of upper canine anterior to the mesial incline of lower first premolar There are two divisions of class ІІ designated, division 1 and division 2
  42. 42. Angle Class ІІ malocclusion division 1
  43. 43. Angle Class ІІ malocclusion division 2
  44. 44. Angle Class ІІ malocclusion division I Class ІІ Division 1 : -Mandible is retruded and - all maxillary incisors are protruded
  45. 45. Angle Class ІІ malocclusion division II Class ІІ Division 2 : Mandible is retruded and one or more maxillary incisors are retruded
  46. 46. Class ІІ malocclusion class I molar subdivision class ІІ molar
  47. 47. Angle Class ІІI malocclusion Class ІІІ malocclusion: 2 types - True class ІІІ malocclusion (Skeletal) - Pseudo class ІІІ (FALSE or postural) True class III     Genetic in origin Excessively large mandible Smaller than normal maxilla Retropositioned maxilla Pseudo class ІІІ  Forward movement of mandible during jaw closure Occlusal prematurities Premature loss of deciduous posteriors Enlarged adenoids
  48. 48. Advantages of ANGLE classification  First comprehensive classification- most widely accepted  Simple  Easy to use  Most POPULAR  Easy to Communicate
  49. 49. DEMERTIS OF ANGLE CLASSIFICATION  Considers malocculsion only in antroposterior plane not in transeverse/vertical  Considered 1st molar as fixed point – skull  Deciduous dentition  1st molar extracted  Doesn't distinguish between skeletal and dental malocclusion  Doesn’t highlight etiology  Individual tooth positions
  50. 50. DEWEY’S MODIFICATION OF ANGLES MALOCCLUSION (1915)
  51. 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. 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. 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. 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. 55. Lischer’s modification (1933)
  56. 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 when a tooth or group of teeth have not erupted to normal level Infraocclsion : Mesioversion Distoversion : mesial to the normal position : distal to the normal position Transversion Axiversion Torsiversion : : : transposition of two teeth Abnormal axial inclination of a tooth Rotation of a tooth around its long axis
  57. 57. BENNET’S CLASSIFICATION
  58. 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. 59. SIMONS CLASSIFICATION (1926)
  60. 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. 61. FH PLANE ATTRACTION ABSTRACTION This plane help to detect devotions in the VERTICAL DIRECTION
  62. 62. ORBITAL PLANE  Perpendicular to the FHP  Simon’s law of canine- “this plane should pass through the distal third of the canine” Protraction Retraction This plane used to describe malocclusion in ANTERIO-POSTERIOR direction
  63. 63. MID SAGITTAL PLANE THIS plane passes at right angle to FHP CONTRACTION DISTRACTION It classifies malocclusion according to TRANSVERSE DEVIATION from MSP
  64. 64. ACKERMAN-PROFIT SYSTEM ( 1960 )
  65. 65. Based on five characteristics o o o o o ALIGNMENT PROFILE TRANSVERSE RELATIONSHIP CLASS BITE DEPTH
  66. 66. Features… Transverse & vertical discrepancies –considered Crowding and arch asymmetry -evaluated Incisor protrusion Influence of dentition on the profile
  67. 67. BALLARDS CLASSIFICATION
  68. 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. 69. Class I incisor Class II incisor Div 1
  70. 70. Class III incisor
  71. 71. KATZ PREMOLAR CLASSIFICATION (1992)
  72. 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. 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 5 4 3 4 3
  74. 74. PREMOLAR CLASS III- 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. 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. 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. 77. NEWLY PROPOSED SYSTEM FOR MALOCCLUSION CLASSIFICATION (MIGUEL-NETO & MUCHA) (2010) CLASS I CLASS II CLASS III 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.
  78. 78. CLASS I
  79. 79. CLASS II
  80. 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. 81. References  Contemporary Orthodontics,-William R. Profitt, 3rd edition  Grabers Textbook of Orthodontics Basic principles and practice- 4th edition  Handbook of Orthodontics 4th edition- Robert E. Moyres  Textbook of Orthodontics , Samir E.Bishara  Orthodontics, Current principles and Techniques, 4th 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. 82. BIBINS PHOTOGRAPHY

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