Malocclusion classification /certified fixed orthodontic courses by Indian dental academy


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Malocclusion classification /certified fixed orthodontic courses by Indian dental academy

  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Introduction History Defination Objectives of Classification Process Of Classifying Malocclusion Types of Malocclusions
  4. 4. Normality
  5. 5.
  6. 6. Biologic continuity It is the most frequently found relationship of the teeth and of the bones of the face in relation to each other and to the skull as a whole.
  7. 7. Malocclusion is any perversion of normal occlusion of the teeth
  8. 8. It is a condition where there is departu from the normal relation of the teeth to other teeth in the same arch and to the teeth in the opposing arch.
  9. 9. Diagnosis in orthodontics is based primarily on the classification of deviations from normal.
  10. 10. Science of Infinite Variations
  11. 11.   HISTORY
  12. 12. Normal Occlusion was described As early as the eighteenth century by John Hunter. Samuel S. Fitch, MD, whose book entitled A System of Dental Surgery, published in 1829, was the first to classify malocclusion
  13. 13. When one central incisor is turned in, and the under teeth come efore it, whilst the other central incisor keeps its proper place, anding before the under teeth. When both the central incisors are turned in, and go behind the der teeth; but the lateral incisors are placed properly and stand t before the under teeth. When the central incisors are placed properly but the lateral cisors stand very much in; and when the mouth is shut, the under eth project before them and keep them backward. When all incisors of the upper are turned in, and those of the under w shut before them.
  14. 14. Jean Nicolas Marjolin (1832-1839) of France differentiates M.O. between obliqueness of teeth and anomalies of dental arch. He further differentiates anomalies of teeth as anterior, posterior and lateral type and one from rotation ground the axis of teeth. The anomalies of dental arch classified as prominence of upper, lower or both rows of anterior teeth, and ‘retroition’ an oblique position of front teeth and ‘inversion’ todays mesial occlusion
  15. 15. George Carabelli (1842), a Viennese professor, was probably the first to describe in any systematic way abnormal relationships of the upper and lower dental arches. The terms edge-to-edge bite and overbite are actually derived from Carabelli's system of classification. He bases his classification on various positions of incisors and canines as: Mordex Normalis (Normal occlusion) Mordex Rectus (edge to edge) Mordex Apertus (open occlusion) Mordex Prorsus (protruding occlusion) Mordex Retrosus (retruding occlusion) Mordex Tortuosus (zig-zag occlusion)
  16. 16. In 1899 Dr. Edward H. Angle published a paper entitled ‘The classification of Malocclusion’ in ‘Dental Cosmos’. This Angle system was based primarily on the mesiodistal relation of the jaws and dental arches to each other and to the skull. He consider Maxillary first molar as key to occlusion and based on relation of the mandibular first molar with this tooth he divided M.O. into three classes. Class I, Class II and Class III types.
  17. 17. In 1926 Simon P.W. developed a system of Gnathostatics. He related the teeth to rest of the face and cranium in all three plane of space In 1960s Ackerman and Proffit introduced a new classification system, which formalized the system of informal additions to the Angle method by identifying five major characteristics of malocclusion that should be considered and systematically described in classification
  18. 18. In 1990s, Morton Katz introduced a premolar based classification, which is a modified Angle classification.
  19. 19. Classification is a process of analyzing cases of malocclusion for the purpose of segregating them into a small number of groups, which are characterized by certain specific and fundamental variations from normal occlusion of the teeth .
  21. 21. 1. Classification is an essential communication tool between dental school professor and student, between practitioners, and between practitioner and insurance company or government bureaucracy. It is essential that everyone "speak the same language."
  22. 22. 2.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. The result of an improper classification might be that the orthodontist would embark on patient care oriented toward solving the wrong problem. Once a patient is classified, the practitioner will tend, almost unconsciously, to apply treatment mechanics appropriate to that classification. Even though model analysis, especially buccal interdigitation, is but a small part of the complete orthodontic diagnosis, the decision to use Class II or Class III mechanics invariably is strongly influenced by the perceived Angle classification of the patient.
  23. 23. 3. If one of the goals in the treatment of a malocclusion is to achieve Class I, there must be a consensus among orthodontists as to what constitutes ideal occlusion, and Class I must be redefined to agree with the prototype standard. If every orthodontist has a different idea of what ideal buccal interdigitation means, then the dental specialty of orthodontics has no standardized method by which to evaluate successful or unsuccessful treatment. Angle developed his classification 100 years ago to eliminate the anarchy that existed in the specialty.
  24. 24. 4. It segregates the countless number of cases of tooth malposition into a comparatively low number of groups, each group containing only such cases as are characterized by a common factor or factors of fundamental significance. 5. Ease of reference – it is much easier to call a case a class III malocclusion than to go into all the detail necessary to describe the craniofacial morphology of mandibular prognathism.
  25. 25. 6. Comparison – experience with previous cases bearing the same label facilitates understanding of problems that may be encountered in treatment plan.
  27. 27. 1 A study of inclined plane relationship 2. A study of the axial inclination of teeth 3. An analysis of the relationship of the interproximal line of the central incisors in the two arches 4. Noting Rotated Teeth in the Buccal Segments 5. Examining for Teeth Prematurely Lost or Extracted, Congenital Missing Teeth or Supernumerary Teeth • Study of photographs – front view and profile • Analysis of cephalometric radiographs
  29. 29. Distal inclination or distal tipping: this refers to a condition where the crown of the tooth is tilted or inclined distally
  30. 30. Mesial inclination or mesial tipping: this is a condition where the crown of the tooth is tilted or inclined mesially.
  31. 31. Lingual inclination or lingual tipping: this is an abnormal lingual or palatal tilting of the tooth. This condition is also called retroclination
  32. 32. Buccal inclination or buccal tipping: this refers to labial or buccal tilting of the tooth. This condition is also called proclination
  33. 33. Mesial displacement: this refers to a tooth that is bodily moved in a mesial direction towards the midline.
  34. 34. Distal displacement: this refers to a tooth that is bodily moved in a distal direction away from the midline
  35. 35. Lingual displacement: is a condition where the entire tooth is displaced in a lingual direction
  36. 36. Buccal displacement: is a condition in which the tooth Is displaced bodily in a labial or buccal direction.
  37. 37. infraversion or infraocclusion: refer to a tooth that has not erupted enough compared to other teeth in the arch
  38. 38. Supraversion or supra occlusion: refers to a tooth that has overerupted compared to other teeth in the arch
  39. 39. Rotations: refers to tooth movements around its long axis.
  40. 40. Disto lingual or mesio buccal rotation: describes a tooth which has moved around it long axis so that the distal aspect is more lingually placed.
  41. 41. Transposition: this term describes a condition where two teeth have exchanged places.
  42. 42. Inter arch malocclusions These malocclusions are characterized by abnormal relationships between two teeth or groups of teeth of one arch to the other arch. These inter arch malocclusion can occur in sagi vertical or in the transverse planes of space.
  43. 43. Sagittal plane malocclusions Pre-normal occlusion Post-normal occlusion
  44. 44. Post-normal occlusion- a condition where the lower arch is more distally placed when the patient bites in centric occlusion
  45. 45. Pre-normal occlusion- refers to a condition where the lower arch is more forwardly placed when the patient bites in centric occlusion
  46. 46. Vertical plane malocclusions Open bite Deep bite or increased over bite
  47. 47. Deep bite or increased over bite: this refers to a condition where there is an excessive vertical overlap between upper and lower anterior teeth
  48. 48. Open bite: is a condition where there is no vertical overlap between upper and lower teeth . thus a space may exist between the upper and lower teeth when the patient bites in centric occlusion. Open bite can be in anterior or posterior region .
  49. 49. Transverse plane malocclusions Crossbite refers to abnormal transverse relationship between upper and lower arches.
  50. 50. Scissor bite refers to a condition in which the maxillary arch is contained within the mandibular arch
  51. 51.
  52. 52.
  53. 53.
  54. 54.
  55. 55.
  56. 56.
  57. 57. "The Upper First Molars as a Basis of Diagnosis in Orthodontics." 1.Are the largest teeth. 2.Are the firmest in their attachment. 3.Have a key location in the arches. 4.Help determine the dental and skeletal due to the lengths of their crowns.
  58. 58. 5. Occupy normal position in the arches far more often than any other teeth because they are the first permanent teeth and are less restrained in taking their position. 6. More or less control the positions of other permanent teeth anterior and posterior to them. 7. Have the most consistent timing of eruption of all the permanent teeth
  59. 59. 8. Determine the interarch relationship of all other teeth upon their eruption and "locking“ with the mandibular first molars.
  60. 60. LISCHER’S CLASSIFICATION Disto-occlusion Neutro-occlusion: Mesio-occlusion
  61. 61. Linguo version/Labio version Mesio version/Disto version Infra version/ Supra version Torsiversion or Twisted tooth Perversion or Impacted tooth Transiversion or wrong sequential order
  62. 62. DEWEY’S CLASSIFICATION Modifications of Class I are Type I - Crowded anterior teeth Type II - Maxillary incisors in labio version Type III - Anterior Cross bite Type IV- Posterior Cross bite Type V - Molars are in mesioversion due to shifting following loss of tooth anterior to first molars, all other teeth are in normal relationship
  63. 63. DEWEY’S CLASSIFICATION Modifications for Class III are Type I - Normal incisal overlapping present Type II - Edge to edge incisor relationship Type III - Incisors are in cross bite.
  64. 64. The best and the most beautiful things in this world cannot be seen or even touched, they must be felt with the heart.
  65. 65. SIMON’S CLASSIFICATION The Frankfort horizontal raphe or median sagital plane. Orbital plane
  66. 66.
  67. 67. The orbital plane passes through the distal axial aspect of the canine. This is known as “The law of the canine”.
  68. 68. 1. Deviation from the raphe or median sagital plane . Arch form and inclination of tooth axis are determined from this plane. Contraction: a part or all of the dental arch is contracted toward the raphe median 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 median plane
  69. 69. 1. Deviations from the Frankfort horizontal plan 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 this 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 the young than in older persons and in some ethnic groups. Abstraction: the distance between the occlusal plane and the Frankfort horizontal is comparatively longer than normal.
  70. 70. 1. Deviations from the Orbital plane: sagital symmetry and inclination of the axes of the teeth are determined from this 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 too far retruded. The orbital plane passes too far anteriorly to the canines.
  71. 71. Deviations of the dental arches in relation to the orbital plane, according to Simon, may occur as follows: 1. Both the jaws in normal relation to each other 2. Upper jaw normal, lower jaw distal 3. Upper jaw normal, lower jaw mesial 4. Lower jaw normal, upper jaw mesial 5. Lower jaw normal, upper jaw distal 6. Upper jaw mesial, lower jaw distal 7. Upper jaw distal, lower jaw mesial
  72. 72. Reliability of Simon Norms Hellman, Broadbent :-no true bilateral symmetry in the human head . The orbital plane of Simon was found to pass through the canine in 81% and missed the canine in 19% of cases Tarpley found that the raphe or median sagital plane to be symmetric in 43%. Slight deviations, 1 to 2 mm, were found in 37%, while 10% showed marked asymmetry.
  74. 74.
  75. 75. Classification by groups Common to all dentitions is the degree of alignment and symmetry of the teeth within the dental arches. This is represented as the universe (Group 1). Many malocclusions affect the profile. For this reason, profile is represented as a major set (Group 2) within the universe. Lateral (transverse), anteroposterior (sagittal), and vertical deviations and their interrelationships (Groups 3 to 9) are represented by three interlocking subsets within the profile set. This scheme allows any malocclusion to be sufficiently described by five or fewer characteristics.
  76. 76. Step 1 in the classification procedure is an analysis of the alignment and symmetry of the teeth in the dental arches (interproximal contact relationships). Alignment is the key word of Group 1; among the possibilities are ideal, crowding (arch-length deficiency) spacing, and mutilated.
  77. 77. In Step 2 one views the patient's profile. This can be done most accurately from a good profile or silhouette photograph. In the profile view, it should be noted whether the face is anteriorly divergent (mandible prominent) or posteriorly divergent (mandible recessive) and whether the lips are convex (prominent), straight, or concave relative to the nose and chin.
  78. 78. In Step 3 the dental arches are viewed with regard to lateral dimensions (transverse plane), and the buccolingual relationships of the posterior teeth are noted.
  79. 79. In Step 4 the patient and dental arches are viewed in the anteroposterior dimension (sagittal plane). In this dimension, the Angle classification system is utilized and is merely supplemented by stating whether a deviation is skeletal, dentoalveolar, or a combination.
  80. 80. In Step 5 the patient and the dentition are viewed with regard to the vertical dimension. Bite depth is used to describe the vertical relationships. The possibilities are anterior open-bite, anterior deep-bite, posterior open-bite, or posterior collapsed bite.
  81. 81. Thank you Leader in continuing dental education