Classification of Occlusion and Malocclusion Dr. Nabil Al-Zubair

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Classification of Occlusion and Malocclusion Dr. Nabil Al-Zubair

  1. 1. Classification of Occlusion and Malocclusion Dr. Nabil Al-Zubair
  2. 2. UP OCCLUSION OC CLUSION CLOSING CLOSING UP Bite ‫إطباق‬ ‫عضة؛‬
  3. 3. BAD MAlOCCLUSION MAL OCCLUSION BITE BAD BITE ‫اإلطباق‬ ‫سوء‬
  4. 4. 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 OCCLUSION Definition
  5. 5. Ideal & Normal occlusion “Normal” implies to the variations around an average mean value ‫اإلطباق‬"‫المثالي‬"‫افتراضي‬ ‫مفهوم‬ “IDEAL” is a hypothetical concept or a standardized goal The best arrangement and relationship of teeth in both the maxilla and mandible The Perfect Occlusion
  6. 6. Ideal occlusion Normal occlusion - A coincident mid-line - 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 Any deviation from ideal (normal) that may be considered aesthetically or functionally unsatisfactory is called Malocclusion - No (crowding/spacing/rotations) Over-jet = 2-4mm - Correct crown angulation and inclination - Class I molar & canine relationship A flat or slightly upwards curve of Spee maximum contact Maxillary teeth slightly overlap Mandibular teeth
  7. 7. Class I molar relationship Correct crown angulation Correct crown inclination No rotation No spaces Flat to slight curve of spee Andrews 6 keys of Normal Occlusion(1972)
  8. 8. •The maxillary teeth OVERLAP the mandibular ones CENTRIC OCCLUSION •The mesial surfaces of the upper & lower central incisors are in one line at the median plane
  9. 9. 1) Each tooth in the dental arch occludes with 2 antagonist teeth in the opposing arch except 2 teeth ?? GENERAL CHARACTERISTIC SIGNS OBSERVED IN THE INTERCUSPAL RELATION BETWEEN THE 2 ARHES IN NORMAL CENTRIC OCCLUSION Importance of such design: a- Stabilizing teeth in position & prevention of tooth elongation in case of loss of opposite one b- better distribution of forces
  10. 10. 2) Each maxillary tooth is in a more distal position to its antagonist in the mandibular arch (this is reflected in the molar relationship)
  11. 11. Overbite is a vertical measurement Overjet is a horizontal measurement 3) Overlap relationship a- Overbite (vertival overlap) b- Overjet (horizontal overlap)
  12. 12. -The Incisal Ridges of the mandibular anterior teeth CONTACT the lingual surfaces of the maxillary ones 4) Intercuspal relationship:
  13. 13. Maxillary teeth The buccal cusps OVERLAP the buccal cusps of mandibular Lingual Cusps OCCLUDE with the fossae & central grooves on the occlusal surfaces of their lower Mandibular teeth The buccal cusps occlude with the opposing central grooves & fossae on the occlusal surfaces of their upper antagonists lingual cusps situated in a lingual position to the upper lingual cusps
  14. 14. Importance of normal occlusion •Mastication •Speech •Appearance •Stability
  15. 15. tooth‐ to‐ tooth contact which prevents or hampers smooth mandibular movement • Wear of the functional surfaces of the teeth which is out of proportion to the patients age. Interferences: ‫الذي‬ ‫اإلطباق‬‫السفلي‬ ‫الفك‬ ‫حركة‬ ‫سالسة‬ ‫يعوق‬ ‫أو‬ ‫يمنع‬ The occlusal abnormality may result into: • Drifting of anterior teeth, loose teeth(mobility). biomechanical induced dental disease: • Sensitivity, fracture of tooth or root, chipping, cracks • Gingival recession‐ exposed root surfaces, abfraction ( stress induced lesions at the cervicoenamel junction)
  16. 16. or incorrect relation between the teeth of the two dental arches. The term was coined by Edward Angle, the "father of modern orthodontics", as a derivative of occlusion, which refers to the manner in which opposing teeth meet. Malocclusion is a misalignment of teeth
  17. 17. 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‖ Malocclusion ‫المألوف‬ ‫عن‬ ‫الخروج‬ ‫اإلطباق‬ ‫سوء‬
  18. 18. ii. The buccal cusps and incisal edges of the mandibular teeth the line of occlusion passes through i. The central fossae and along the cingulae of the maxillary teeth In Normal Occlusion,
  19. 19. 1. (intra-arch problems) Malpositions of individual or group of teeth in the same arch 2. (inter-arch problems) 3. Malrelation b/w upper & lower dental arches Malocclusion can be classified depending upon the problems present: Classification based on intra-arch and intra-arch problems
  20. 20. 1. Malpositions of individual or group of teeth in the same arch i. Sagittal problems - Labioversion - Linguoversion - Mesioversion - Distoversion ii. Transverse problems - Crowding - Spacing - Linguoversion - Buccoversion iii. Vertical problems - Supraversion - Infraversion iv. Rotated teeth v. Transposition of teeth 2. Malrelation b/w upper & lower dental arches Sagittal • Class II malocclusion • Class III malocclusion ii. Transverse • Crossbites, scissor bite • Midline shift iii. Vertical • Deep bite • Open bite Classification based on intra-arch and inter-arch problems
  21. 21. is identified by adding the suffix ―version to the direction of deviation, as follows: Malposition of individual teeth: ‫الحقة‬ The direction of the deviation of a tooth from the line of normal occlusion Mesioversion Mesial to the normal position Distoversion Distal to the normal position Labioversion Towards the lip—Maxillary and Mandibular anterior teeth. Buccoversion Towards the cheeks – Maxillary and Mandibular posterior teeth Palatoversion Towards the Palate – Maxillary teeth Linguoversion Towards the tongue—Mandibular teeth Supraversion Erupted past the line of occlusion— Overerupted Infraversion: Short of the line of occlusion—Submerged Torsiversion Rotated on its long axis
  22. 22. intra-arch problems
  23. 23. Labioversion • A tooth that has assumed a position labial to normal • Position lingual to normal Lingoversion
  24. 24. Palatoversion • Position palatal to normal Buccoversion • Position buccal to normal
  25. 25. Supraversion • Over-erupted beyond the level of occlusion • Depressed below the line of occlusion, for example, primary tooth that is submerged or ankylosed Infraversion
  26. 26. What else do you see in this photograph? • Turned or rotated Torsiversion
  27. 27. inter-arch problems
  28. 28. Malrelation of the upper and lower dental arch is analyzed in the three planes of space: Transverse Vertical Antero-posterior/sagittal
  29. 29. - Abnormal overjet - Anterior cross-bite Anteriorly Posteriorly Class II malocclusion Class III malocclusion In the Sagittal direction OR Either :
  30. 30. Overjet It is the h o r i z o n t a l d i s t a n c e between the labial aspect of the lower incisors and the incisal edge of the upper incisors when the teeth are in centric occlusion. It is normally 1 to 3 mm.
  31. 31. i. Increased overjet: Overjet is more than 3 mm. ii. Edge to Edge bite: No overjet. iii. Reversed overjet/ anterior cross bite: Overjet is negative Abnormal overjet may be:
  32. 32. Anterior Crossbite It’s the situation when upper teeth are behind lower teeth. Normally, upper teeth should be in front of lower teeth. the primary or permanent maxillary incisors locked lingual to mandibular incisors Malocclusion in which the mandibular teeth are in buccal version to the maxillary teeth
  33. 33. Pre-normal Occlusion Class II malocclusion Class III malocclusion Postnormal Occlusion Class I malocclusion Normal Occlusion Class III molar and Class III canine relationships Class I molar and Class I canine relationships Class II molar and Class II canine relationships Posterior Sagittal inter-arch problems:
  34. 34. Deviations of the midline: Posterior Cross bite: In the Transverse direction inter-arch problems Either : Anteriorly Posteriorly OR
  35. 35. This may be due to: deviation of the upper midline, lower midline or both - The midline may be deviated to the right or to the left Deviations of the midline: The upper and lower midlines may be: - Coincident: normal - Incoincident: ‫متطابق‬ ‫متطابق‬ ‫غير‬
  36. 36. one or more Posterior Teeth occlude in an abnormal buccolingual relation with their antagonist Posterior Cross bite:
  37. 37. In a posterior cross bite the buccal cusps of the maxillary posterior teeth usually occlude in the central fossae of the mandibular teeth. Posterior Cross bite: It is either unilateral or bilateral: ii. Bilateral Crossbite: The etiology is usually skeletal—A narrow maxilla and a wide mandible. i. Unilateral Crossbite: The etiology is usually abnormal soft tissue behavior, and sometimes a slight skeletal discrepancy.
  38. 38. Vertical Deep Overbite Open Bite Normal Overbite inter-arch problems
  39. 39. Definition: overbite defined as “the overlapping of the upper anterior teeth over the lowers in the vertical plane”. “the amount and percentage of overlap of the lower incisors by the upper incisors” . 5-25% normal (yellow), 25-40% increased (orange) >40% excessive (red) Ranges of overbite. Overbite ideal overbite ranges from 5-25% overlap.
  40. 40. Deep overbite Normal overbite Open bite
  41. 41. Incomplete overbite Complete overbite Normal overbite
  42. 42. i. Deep overbite: if the overbite is excessive This abnormality may be due to: Supraposition of the anterior teeth Infraposition of the buccal segments
  43. 43. ii. Open bite: if the overbite is negative, it is called open bite This term is applied when there is no vertical overlap of the upper and lower incisors
  44. 44. This abnormality may be due to: Infrapositon of anterior teeth Supraposition of posterior teeth Open bite is associated by: - abnormal soft tissue behavior patterns preventing the dentoalveolar structures from closing the intermaxillary space, e.g. thumb, lip and/or tongue.
  45. 45. Malrelation is analyzed in three planes, similar to malrelation of the dental arches: I. Anteroposterior II. Vertical III. Transverse 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. Malrelation of the apical bases:
  46. 46. Assessment of the malrelation of the apical bases in the transverse plane is done through the analyses of Postero-anterior Cephalometirc X-ray films Assessment of the malrelation of the apical bases in the anteroposterior and vertical planes is done through the analysis of Lateral Cephalometric X-rays films
  47. 47. Let’s take a look at how orthodontists classify malocclusions: To understand what’s involved in orthodontic treatment
  48. 48. Why we need a Classification for malocclusion? In order to: - acquire a better understanding of the many deviations from normal occlusion and to - assist in diagnosis and treatment planning, it becomes necessary to group the varieties of malocclusion into order
  49. 49. Classification of Malocclusion Orthodontics made its first appearance more than a hundred years ago ANGLE SYSTEM AND ITS MODIFICATIONS SIMONS SYSTEM AETIOLOGICAL CLASSIFICATION BAUME CLASSIFICATION OF PRIMARY TEETH ACKERMANN AND PROFITT CLASSIFICATION BALLARDS CLASSIFICATION WHO CLASSIFICATION VARIOUS SYSTEMS OF CLASSIFICATION
  50. 50. PIONEERED a system of categorizing dental irregularities. Provided the first clear definition of the normal occlusion Dr. Edward Angle He related it to the arrangement of the occlusal contact of the first permanent molars ANGLE SYSTEM AND ITS MODIFICATIONS
  51. 51. - the mesiobuccal cusp of the maxillary first molar and - the buccal groove of the mandibular first molar!!!!!! Angle Classification • If this molar relationship exists then the teeth can align into normal occlusion • In 1890 Edward H. Angle published the first classification of malocclusion based on the relationship of: • The classifications are
  52. 52. Angle’s Classification of malocclusion Class I Class II Class III Division 1 and Subdivision Division 2 and Subdivision Class III Pseudo Class III Sub- division Skeletal Class III Angle describes three classes of malocclusion
  53. 53. The mesio-buccal cusp of the upper first permanent molar occludes in the buccal groove of the lower first permanent molar -‫ــــــــــــــــــ‬ Class I The mesio-buccal cusp of the upper first permanent molar occludes anterior to the buccal groove of the lower first permanent molar ‫ــــــــــــــــــ‬ Class II The mesio-buccal cusp of the upper first permanent molar occludes posterior to the buccal groove of the lower first permanent molar ‫ــــــــــــــــــ‬ Class III
  54. 54. Angle Class І malocclusion: Line of occlusion: ALTERED in the max. & mand. Arches: • individual tooth irregularities (crowding/spacing/….etc) • Inter-arch problems (deep bite/open bite/ increased overjet/…..etc) Neutroclusion Molar relationship : The mesio-buccal cusp of the upper first permanent molar occludes in the buccal groove of the lower first permanent molar Canine relationship: - the mesial incline of upper canine occludes with the distal incline of lower canine - the distal incline of upper canine occludes with the mesial incline of lower first premolar
  55. 55. Problems associated with Class I malocclusion • Crowding • Spacing • Deep Bite • Open Bite • Cross Bite • Localized Teeth Problems (impaction)
  56. 56. Molar relationship: The mesio-buccal cusp of the upper first permanent molar occludes anterior to the buccal groove of the lower first permanent molar ‫ــــــــــــــــــ‬ Class II Angle Class ІІ malocclusion: Distoclusion There are two divisions of class ІІ designated, division 1 and division 2: Class II canine relationship: - the distal incline of upper canine anterior to the mesial incline of lower first premolar
  57. 57. Angle Class ІІ malocclusion: Class ІІ Division 1: - Mandible is retruded and - all maxillary incisors are protruded 1. V- shaped or constricted maxilla 2. Proclined maxillary incisors 3. Lip trap 4. Exaggerated curve of Spee 5. Deep bite Line of occlusion: altered in the max. & mand. Arches: Class II canine & molar relationship
  58. 58. Normal occlusal relation on one side of the arch and class ІІ occlusion on the other side. Class ІІ malocclusion: class ІІ molar class I molar Subdivision:
  59. 59. This is usually characterized by: (1) Lingual inclination of the maxillary central incisors and may be overlapped by the maxillary lateral incisors. (2) Broad maxillary arch (3) Deep overbite with the maxillary and mandibular incisors in apparent supraocclusion (4) Normal length upper lip contacting the lower lip but deep mental groove may be present. (5) The mandible is frequently of good size. Angle Class ІІ malocclusion: Class ІІ Division 2: Mandible is retruded and one or more maxillary incisors are retruded Class II canine & molar relationship
  60. 60. Class II division 1 Class II division 2 1) The upper incisors teeth are proclined 1) The upper incisors teeth showed lingual inclination and may be overlaped by the upper lateral incisors teeth 2) Excessive overjet & deep overbite 2) Deep overbite 3) V-shaped upper arch, narrow in the canine region and broad between the molars 3) The upper arch usually broad 4) Short upper lip with failure in the anterior lip seal 4) Normal upper lip and lip seal, with deep mental groove 5) The mandible may be deficient and chin under developed 5) The mandible is of good size
  61. 61. The mesio-buccal cusp of the upper first permanent molar occludes posterior to the buccal groove of the lower first permanent molar ‫ــــــــــــــــــ‬ Class III MesioclusionAngle Class ІІІ malocclusion: Molar relationship:
  62. 62. Angle Class ІІІ malocclusion: This prenormal occlusion may result from : -excessively large mandible, -lack of forward growth of the maxilla, or - a combination of both. Class ІІІ malocclusion: 2 types - True class ІІІ malocclusion (Skeletal) - Pseudo class ІІІ (FALSE or postural)
  63. 63. This is not a true class ІІІ malocclusion but its presentation is similar Here the mandible shifts anteriorly during final stages of closure (acquiring a bite of accommodation) due to premature contact of the incisors or the canines. Angle Class ІІІ subdivision: Where normal occlusal relation exists on one side and class ІІІ relation on the other side. Pseudo class ІІІ (false or postural):
  64. 64. Merits/Advantages 1. Angle’s system of Classification is the most traditional and oldest system still in use 2. Most practical and easy to comprehend method of Classification 3. Most POPULAR 4. Easy to Communicate 5. Widely used for teaching purpose Merits/Demerits of Angle’s Classification ‫مزايا‬ ‫فهم‬
  65. 65. 1. Disregarded the relationship of the teeth to the face 2. Malocclusion is a three-dimensional problem, but Angle considered only sagittal dimension 3. NOT APPLICABLE when first molars are missing 4. Differentiation between dento-alveolar and skeletal malocclusion is not possible Demerits/Disadvantages ‫تجاهل‬ ‫عيوب‬
  66. 66. Classification of Malocclusion
  67. 67. ANGLE SYSTEM AND ITS MODIFICATIONS SIMON’S SYSTEM AETIOLOGICAL CLASSIFICATION BAUME CLASSIFICATION OF PRIMARY TEETH ACKERMANN AND PROFITT CLASSIFICATION BALLARDS CLASSIFICATION WHO CLASSIFICATION VARIOUS SYSTEMS OF CLASSIFICATION
  68. 68. SIMON’S CLASSIFICATION in 1926 the teeth are related to the Frankfort, mid-sagittal, and orbital planes
  69. 69. FRANKFORT HORIZONTAL PLANE This plane help to detect devotions in the VERTICAL DIRECTION Formed by: drawing a straight line through the bony margins of the orbit to external Auditory meatus Attraction: when the dental arch or part of it is closed to the FHP Abstraction: when the dental arch or part of it is away from FHP
  70. 70. ORBITAL PLANES This plane used to describe malocclusion in anterio-posterior direction • Perpendicular to the FHP • Simon’s law of canine- “this plane should pass through the distal third of the canine” Protraction: when the dental arch or part of it is away from this plane Retraction: when the arch or part of it is closed or more posteriorly placed Teeth too anterior to the orbital plane Teeth too posterior to the orbital plane
  71. 71. MID SAGITTAL PLANE It classifies malocclusion according to Transverse deviation from MSP Contraction: A part or all of the dental arch is contracted towards MSP Distraction: A part or all of the dental arch is wider or placed at a distance which is normal THIS plane passes at right angle to FHP
  72. 72. Advantages 1. 3 dimensional – more precise 2. Lays emphasis on the orientation of dental arch to the facial skeleton Disadvantages It is time consuming and cumbersome ‫مرهق‬ / ‫ثقيل‬ ‫التركيز‬ ‫يضع‬
  73. 73. Flush terminal Mesial step Distal step Baume’s classification of primary teeth
  74. 74. Flush terminal Distal step Mesial step
  75. 75. BALLARDS CLASSIFICATION Incisor classification A classification of malocclusion based on incisors is ADVANTAGEOUS As treatment is often primarily aimed at correcting this relationship
  76. 76. Incisor classification ‘the lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper incisor’ British Standard incisor classification Class I incisor Class II incisor Class III incisor Definition
  77. 77. Incisor classification British Standard incisor classification Class II incisor Definition The lower incisor edges occlude posterior To the cingulum plateau of the upper incisor
  78. 78. Incisor classification British Standard incisor classification Class III incisor Definition The lower incisor edges occlude anterior To the cingulum plateau of the upper incisor
  79. 79. • Addresses the limitations of the Angle’s Classification • Step–by–step systematic approach to ensure nothing is overlooked • COMPREHENSIVE Ackerman-Proffit system of classification A distinction is made b/w skeletal & dental malocclusions
  80. 80. AlignmentProfile Transverse relationship Alignment: a dental arch is classified as ideal/crowded/spaced Profile: convex/ straight /concave Transverse relationship: Bucco-lingual relationship of posterior teeth Class Class: Class I/ Class II/ Class III Overbite Overbite: deep bite/open bite (posterior/anterior)

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