The document discusses the classification of malocclusion, defining it as any deviation from normal occlusion and emphasizing the importance of classification for diagnosis and treatment planning in orthodontics. It reviews historical perspectives, notably Edward Angle's classification system introduced in 1899, and outlines different types of malocclusions, their characteristics, and subdivisions. Additionally, it presents modifications to Angle's classification, including Katz's premolar-derived classification and the classification of incisors and canines.

1. CLASSIFICATION OF
MALOCCLSION
DR.KAPIL SAROHA
BDS, MDS
ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
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2. • CONTENTS
• Introduction
• History
• Classification
• Systems of Classification
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3. • Definition
Malocclusion may be defined as ‘any variation or
deviation from the normal occlusion’.
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4. • Classification : involves the grouping together of
various malocclusion into simpler or smaller groups.
In order to have a system of classification, standard
should be set up that represent normally. The
deviation from the norms should also be grouped
into various smaller divisions or categories.
• Classification is a vital element in the diagnosis
of a malocclusion and in treatment planning for
orthodontic care. An ideal classification would
summerise the diagnostic data and imply the
treatment plan.
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5. • HISTORY
• Hippocrates included “Crooked teeth” in his 6th
book of epidemics as early as 24th centuries ago.
• What we today call normal occlusion was
described as early as 18th century by John Hunter.
• Edward Angle in 1899 introduced his classification
of malocclusion based on the relative position of the
1st molars. This classification was readily accepted by
the dental profession since it brought order out of
what previously had been confusion regarding dental
relationships
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6. • PURPOSE OF CLASSIFYING
MALOCCLUSION
• The following are the purpose for which we need
to classify.
• To identify the problem (Diagnosis)
• For better treatment planning
• Alter ourselves to possible strategies and appliances,
that may be needed in treatment.
• Recalling pass difficulties with similar cases.
• For the purpose of comparison
• Ease of reference and
• For communication
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7. • TYPES OF MALOCCLUSION
• Malocclusion can be broadly divided into
• Individual teeth mal position or intra arch malocclusion
• Mal relation of dental arches :- to one another upon bony bases
which may themselves be normally related.
• Skeletal malocclusions which involve the underlying bony bases.
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8. • DISTAL INCLINATION OR DISTAL TIPPING : this
refers to a conditions where the crown of the tooth is tilted
or inclined distally.
• MESIAL INCLINATION OR MESIAL TIPPING : This
is a condition where the crown of the tooth is tilted or
inclined mesially.
• LINGUAL INCLINATION OR LINGUAL TIPPING :
This is an abnormal lingual or palatal tilting of the tooth. This
condition is also called retroclination.
• BUCCAL INCLINATION OR BUCCAL TIPPING :
This refers to labial (in case of anterior) or buccal (in case of
posterior) tilting of the tooth. This condition is also called
proclination.
• MESIAL DISPLACEMENT : This refers to a tooth that is
bodily moved in a mesial direction towards the midline.
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9. • DISTAL DISPLACEMENT : this refers to a tooth that is
bodily moved in a distal direction away from the midline.
• LINGUAL DISPLACEMENT : this is a conditions where
the entire tooth is displacement in a lingual direction.
• BUCCAL DISPLACEMENT : This describes a condition
where the tooth is displaced bodily in a labial or buccal
direction
• INFRA VERSION OR INFRA OCCLUSION : the terms
infraversion or infraocclusion refer to a tooth that has not
erupted enough compared to the other teeth in the arch.
• SUPRAVERSION OR SUPRA OCCLUSION : This is a
tooth that has over erupted as compared to other teeth in the
arch. It is also called supra occlusion.
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10. • Rotations : this term refers to tooth movements around its long axis.
• DISTO-LINGUAL OR MESIO-BUCCAL ROTATION : this describes a tooth which
has moved around its long axis so that the distal aspect is more lingually placed.
• MESIO LINGUAL OR DISTO – BUCCAL ROTATION : this is a condition where
the tooth has rotated around its long axis so that the mesial aspect is more lingually placed.
• TRANSPOSITION : This term describes a condition where two teeth have exchanged
places.
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11. • MAXILLO-MANDIBULAR MALOCCLUSIONS
• These malocclusions are characterized by abnormal
relationship between two teeth or groups of teeth of one arch
to the other arch. These inter-arch malocclusions can occur in
the sagittal, vertical or in the transverse planes of space.
• SAGITTAL PLANE MALOCCLUSIONS
• Pre-normal occlusion
• This term refers to a condition where the lower arch is
more forwardly placed when the patient bites in centric
occlusion.
• Post-Normal occlusion
• This is a condition where the lower arch is more distally
placed when the patient bites in centric occlusion.
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12. • Vertical Plane malocclusions
• Deep bite or increased over bite
• This refers to a condition where there is an excessive
vertical overlap between the upper and lower anterior teeth.
• Open bite : This is a condition where there is no vertical
overlap between the upper and lower teeth. Thus a space may
exist between the upper and lower teeth when the patient
bites in centric occlusion. The open bites in centric occlusion.
The open bite can be in the anterior or the posterior region.
• Transverse plane malocclusions : The transverse plane
inter arch malocclusion includes various types of cross bites.
Term cross bite refers to abnormal transverse relationship
between the upper and lower arches.
•
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13. • ANGLES SYSTEM OF CLASSIFICATION
• Edward Angle the “Father of Modern Orthodontics”
introduced a system of classifying malocclusion in the year
1899. Angles classification is still in use after almost 100 years
of its introduction due to its simplicity in application.
• Basis for Angle’s Classification
• Angles classification was based on the mesiodistal relation of
the teeth, dental arches and the jaws.
• According to Angle, the maxillary 1st permanent molar is the
key to occlusion. He considered there teeth as fixed
anatomical points within the jaws.
• Based on the relation of the lower 1st permanent molar to the
upper 1st permanent molar he classified mal occlusions into
three main classes designated by the Roman numerals I, II & III.
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14. • ANGLE’S CLASS I
• Angle’s Class I malocclusion is characterized by the presence of normal
inter arch molar relation. Approximately 60-70% of all cases of
malocclusions fall in this class.
• There patient exhibit normal skeletal relations and show normal muscle
function.
• Here the mesiobuccal cusp of the maxillary 1st permanent molar occludes
in the buccal groove of mandibular 1st permanent molar.
• Along with this the patient may exhibit irregularities such as crowding,
spacing, rotations, mixing tooth etc.
• Another malocclusions that is most often categorized under class I is Class
I Bimaxillary protrusions.
• In this case the patient exhibits a normal class I molar relationship but the
dentition of both the upper and lower arches are forwardly placed in
relation to the facial profile.
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15. • ANGLE’S CLASS II
• This group is characterized by a Class II molar relation where the
Distobuccal cusps of the upper 1st permanent molar occludes in the buccal
groove of the lower 1st permanent molar.
• Angle has sub divided class II malocclusions into two divisions
Div. I
Div. II
• Class II Div.1: A malocclusion is characterized by PROCLINED : Upper
incisors with resultant increase in overjet
A deep incisor OVER BITE can occur in the ant region.
A characteristic feature of this malocclusions is the presence of abnormal
muscle activity.
The upper lip is usually hypotonic, short and fails to form a lip seal.
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16. • The lower lip cushions the palatal aspect of the upper teeth, a
feature typical of a class II Div 1 referred to as “lip trap”.
• The Tongue occupies a lower position thereby failing to
counter act the buccinator activity.
• The unrestrained Buccinator activity results in narrowing of the
upper arch at the premolar and canine regions thereby
producing a “V” shaped upper arch.
• Another muscle aberration is a hyper active mentalis activity .
the muscle imbalance is produced by a hyper active buccinator
and mentalis and an altered tongue position that accentuates
the narrowing of the upper dental arch.
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17. • Class II Div. 2 :
• As in Class II Div I malocclusion, the Div 2 also exhibits a
Class II molar relationship.
• The classic feature of this malocclusion is the presence of
lingually inclined upper central incisors and labially tipped upper
lateral incisors overlapping the central incisors.
• Variations of this form are lingually inclined central and lateral
incisors with the canines labially tipped.
• Along with this the patient exhibits DEEP ANTERIOR
OVERBITE
• Some of the other features are
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18. – Due to lingually inclined upper centrals. It gives the arch a squarish
appearance
– Mandibular labial gingival tissue is often traumatized by the
excessively tipped upper central incisors.
– The patient exhibits normal perioral muscle activity.
– An abnormal backward path of closure may also be present due to
the excessively tipped central incisors.
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19. • Class II sub division
• When a class II molar relations exists on one side and a
class I relation on the other, it is referred to as Class II
subdivision.
• Based on wheather it is a Div. 1 or Divi. 2 it can be called
Class II Div. 1 subdivision or Class II Div. II Subdivision.
• ANGLE’S CLASS III
• This malocclusions exhibits class III molar relationship. i.e.
Mesiobuccal cusp of the maxillary 1st permanent molar
occludes in the inter dental space between the mandibular 1st
and second molars.
• This can be again classified into
• True Class III and Pseudo Class III
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20. • True Class III
• Is skeletal Class III malocclusions of genetic origin that can occur due
to following causes.
• Excessively large mandible.
• Prognathic mandible
• Smaller than normal Maxilla
• Retroposition maxilla
• Combination of the above causes.
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21. • Some of the features are
– The lower incisors tend to be lingually inclined
– The patient can present with
Normal overjet.
Edge to edge incisor relations
An anterior cross bite.
• The space available for the tongue is usually more. Thus the tongue
occupies a lower position, resulting in a narrow upper arch.
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22. • Pseudo Class III :
• This type of malocclusions is produced by forward movement of the
mandible during jaw closure, thus it is also called Postural Class III
Malocclusions or Habitual Class III malocclusions
• Presence of occlusal prematureties may deflect the mandible forward.
• In case of premature loss of deciduous posteriors, the child tends to more
his mandible forward to establish contact in the anterior region.
• A child with enlarged adnoids tends to more the mandible forward in an
attempt to present the tongue from contacting the adenoids
• CLASS III SUBDIVISION
• This is characterized by a class III molar relations on one side and a
class I relation on the other side.
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23. • DRAWBACKS OF ANGLE’S
CLASSIFICATION
• Although Angle’s classification has been used for
almost a hundred years now, it still has a no of
drawbacks,
• That includes
• Angle considered malocclusion only in the anterior-
posterior plane. He did not consider malocclusions in
the transverse and vertical planes.
• Angle considered the 1st permanent molars as fixed
points in the skull, but this is not found to be so.
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24. • The classification cannot be applied if the 1st
permanent molars are extracted or missing.
• The classification cannot be applied to the deciduous
dentition.
• The classification does not differentiate between
skeletal and dental malocclusions.
• The classifications does not high light the etiology of
the malocclusion
• individual tooth malpositions have not been
considered by Angle.
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25. • INCISOR CLASSIFICATION (MILLS)
• This is also called the British Standard classifications of
incisors relationship.
• Incisors are classified into 3 class under this classification.
• They are
• Class I : the lower incisal edges occlude with or lie
immediately below the cingulum plateam of the upper incisors.
• Class II : The lower incisal edges lie part to the cingulum
platean of the upper incisors.
• Class III : the lower incisal edges lie anterior to the cingulum
platean of the upper incisors. The overjet in reduced or
reversed.
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26. • CANINE CLASSIFICATION
• CLASS I - Mesial slope of upper canine
Coincides with the distal slope of lower canine
• CLASS II - Distal slope of upper canine coincides with the mesial
slope of the lower canine.
• CLASS III - Mesial slope of upper canine coincides with that of
distal slope of lower 1st premolar
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27. • ANGLE CLASSIFICATION REVISITED
• (A MODIFIED ANGLE CLASSIFICATION BY- KATZ)
• A premolar derived classifications
• After considering the advantages and disadvantages of the
angle’s classification
• Katz introduced a premolar derived classification
• He used premolars to evaluate ideal buccal occlusion
because.
• Premolars usually present a sharply defined cusp tip, which is
centered on the central axis of the premolar crown.
• It fits precisely into the opposing embrasures.
• The cuspal inclines are steeper and deeper than molar cusps
(which makes a more positive fit.)
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28. • Class I (In modified Angle classification is defined as)
• The most anterior upper premolar
• Fits exactly into the embrasures created by the distal contact of
the most anterior lower premolar.
• This definition applies
– Whether a full complement of premolars are present
– Whether one upper premolar opposes two lower premolar
– Whether two upper premolars opposes one lower premolar (or)
– Whether only one premolar is present in each quadrantIn case
– if there are no premolars existing in the quadrant. Then the central
axis of the upper canine crown should be used as reference to the
distal contact of the lower canine.
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29. • Deciduous and mixed dentition classification.
• The deciduous and mixed dentium classification
was not considered by angle.
• But in the Katz modification.
• Class I : the center axis of the upper 1st deciduous
molar should split the embrasure between both the
lower deciduous molars.
• In case if the upper 1st deciduous molar is
prematurely last a line drawn through the center axis
of the edentulous space should bisect the embrasure
between the two lower deciduous molars.
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30. TBY –
DR. KAPIL SAROHA
BDS, MDS
DENDEN ISTIST
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