Orthodontics

1. SEMINAR PRESENTATION

2. Classification Of Malocclusion
Presented By
DR. SHEETAL SHARMA (Jr 1)
Department Of Orthodontics And
Dentofacial Orthopedics.

3. CONTENTS
• Introduction
• Definition
• Need for classification
• Intra arch malocclusion
• Inter arch malocclusion
• Angle's classification
• Modification of Angle's classification.
• Deweys modification
• Lischers modification
• Simon's classification.
• Bennett's classification.
• Ackerman-Proffit classification.
• Incisor classification.
• Canine classification
• Skeletal classification
• Classification of primary dentition.
• Conclusion.
• References

4. INTRODUCTION
 The earliest scientific description of malocclusion
was given by Samuel S. Fitch in his book A System
of Dental Surgery (1829). He was the first to
classify malocclusion into four states of
irregularity.
 Friedrich Christopher described malpositions of
all the teeth as general obliqueness and partial
obliqueness
 Nicolas marjolin differentiated the obliqueness of
teeth and anomalies of the dental arch
 Georg carabelli described abnormal relationship
of the upper and lower dental arches in coined the
term ‘Edge-to-Edge Bite’ and Overbite.
William Proffit, Henry ,Contemporary Orthodontics

5. DEFINITION 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.
William Proffit, Henry ,Contemporary Orthodontics

6. NEED FOR CLASSIFICATION
• Grouping of Orthodontic problems.
• Location of problems to be treated.
• Diagnosis & treatment plan.
• Comparison of different types of malocclusion for communication.
• Documentation of problems.
• Used for epidemiological studies.
• Helps in visualizing and understanding the problem associated with
that malocclusion.
• Comparison of the various malocclusions is made easy by
classification.

7. TYPES OF MALOCCLUSION:
Intra-arch malocclusion: It include variations in
individual tooth position or a group of teeth
within an arch.
Inter-arch malocclusions: It compromise of
malrelationship between two teeth or group of
teeth of one arch to another arch.
Skeletal malocclusions: It involves the apical
bases, upper and lower relative positions of
maxilla and mandible.

8. 1)Mesial inclination: This is a condition where the crown
of tooth is tilted or inclined mesially.
2) Distal inclination: Refers to a condition where the
crown is tilted or inclined distally.
INTRA-ARCH MALOCCLUSION

9. 3)Lingual inclination(Retroclination): This is an abnormal
lingual or palatal tilting of tooth.
4) Buccal inclination(Proclination): This refers to labial or
buccal inclination of tooth

10. 1) 1)Mesial displacement: This refers to a tooth that is
bodily moved in a mesial direction towards the
midline.
2) 2) Distal displacement: This refers to a tooth that is
bodily moved in a distal direction away
from the midline.

11. 3) Lingual displacement: This is a condition where
the entire tooth is displaced in lingual direction.
4) Buccal displacement: This is a condition where
the tooth is displaced bodily in labial or
buccal direction.

12. 5) Extrusion (supra-
version): this is a
condition in which a
tooth that has over
erupted as compared
to other teeth in the
arch.
6) Intrusion(infra-
version): Refers to a
tooth that has not
erupted enough as
compared to other
teeth in the arch.
7)Disto-lingual or
mesio-buccal
This describes a tooth
that has rotated
around its long axis so
that the distal aspect
is more lingually
placed.
8)Mesio-lingual or
disto-buccal
This is a condition in
mesial aspect is more
lingually placed.

13. 9)Transposition: This term describes a condition
where two teeth have exchanged places.

14. INTER ARCH MALOCCLUSION
These can be in sagittal, vertical or transverse planes
Vertical plane malocclusion
Deep bite or increased overbite. This refers to a condition
where
there is an excessive vertical overlap between upper and lower
anterior teeth.
Open bite. It is a condition where there is no vertical overlap
between upper and lower teeth .

15. Transverse plane malocclusions
Crossbite. The term crossbite refers to abnormal transverse relationship
between upper and lower arches.
May affect a - single tooth
- Multiple tooth
- Anterior
- Posterior a) unilateral.
b) bilateral.
- Combination
Scissors bite. It refers to a condition in which the mandibular arch is
contained within the maxillary arch. It is condition in which a tooth or
group of teeth in a mandibular buccal arch are lingual to the lingual cusp
of maxillary teeth.

16. SAGITTAL PLANE OF MALOCCLUSION
Where the upper and lower arches are
abnormally related to each other in sagittal
plane.
Pre normal occlusion- where the lower arch is
more forwardly placed when patient bites in
centric relation.
Post normal occlusion- where the lower arch is
more distally placed when the patient bites in
centric relation.

17. ANGLE'S CLASSIFICATION:-
It was introduced by Edward H Angle in 1899.
-Based on mesio-distal relation of the teeth, dental arches
and the jaws.
-According to him, the maxillary 1st permanent molar is the
key to occlusion and considered these as fixed anatomical
points within jaws.
-Classified into 4 classes-
Class I Class II Class III Class IV

18. ANGLE'S CLASSIFICATION: MOLAR RELATIONSHIP
NORMAL OCCLUSION:
Angle's Classification: Molar Relationship Normal Occlusion:
The mesiobuccal cusp of the maxillary first molar occludes
with the buccal groove of the mandibular first molar.
the line of occlusion of the-
As described by Edward Angle (1899), the line of occlusion is a
smooth, parabolic curve passing through the central fossa of
each upper molar and across the buccal cusps and incisal
edges of the lower teeth, and along sulcus between buccal
and lingual cusp of upper molar and bicuspid thus specifying
the occlusal as well as the inter-arch relationship once the
molar position is established.
Angles molars classification revisited (Sage journals)

19. 1. Are the largest in size.
2. Are the firmest in their attachment.
3. Key ridge - Have a key location in the dental arches.
4. Help to determine the dental and skeletal vertical proportions due to the height of their
crowns.
5. The maxillary first molars occupy a 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. The maxillary first molars also more or less control the positions of other permanent teeth.
7. Have the most consistent timing of eruption.
8. Determine the inter-arch relationship of all teeth upon their eruption and locking with the
mandibular first molars.

20. Classification of malocclusion article in
journal of AJOD
ANDREWS 6 KEYS TO NORMAL OCCLUSION

21. Ideal occlusion
A coincident mid-line
No (crowding/spacing/rotations)
Overjet = 2-3mm
Correct crown angulation and
inclination
Class I molar & canine relationship
A flat or slightly upwards curve of Spee
Normal occlusion
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

22. ANGLES CLASSIFICATION
Class I represented by Relative positions of jaws and dental arches
mesio-distally normal, with first molars usually in normal occlusion,
although one or more may be in lingual or buccal occlusion, ranging
from the simple overlapping of a single incisor to the most complex
derangement involving the positions of all the teeth of both arches.
Class II Relative mesiodistal relations of jaws and dental arches
abnormal, all the lower teeth occluding distally to normal such that
Class II has more than half cusp premolar width of disto occlusion.

23. Class III -The relation of the jaws and dental arches is abnormal,
the lower being more or less mesial to the upper , such that it is
half cusp premolar width mesio occlusion.
Class IV – The relation of jaw in which there is mesio occlusion on one side
and disto occlusion on other.
Treatment of malocclusion Angle system by Edward H Angle.

24. ANGLE'S CLASS 1:-
• Angles Class 1characterized by presence of
normal inter arch Molar relation.
• Angle defined Class 1 malocclusion as-
Relative position of dental arches,
mesiodistally , normal ,with malocclusion
usually confined to anterior teeth.
• The mesio-buccal cusp of maxillary 1st
molar occludes in buccal groove of
mandibular 1st molar.
• malocclusion could be crowding, spacing,
rotations, missing tooth etc.
• May also include displaced or impacted
tooth or anomalies in Size , number, or
form of teeth, which may lead to localised
Malocclusion.

25. Bimaxillary protrusion
Where the patient exhibits a normal Class 1 molar relationship
But the dentition of both the upper and lower arches are
forwardly
placed in relation to the facial profile.

26. ANGLE'S CLASS 11:-
Angle defined class 11 malocclusion as Retrusion of lower jaw ,
with distal occlusion of lower teeth.
The distobuccal cusp of the maxillary I permanent molar lies
within the buccal groove of the lower 1 permanent mandibular
molar.
Divided into
Division 1
Division 2

27. Division 1: - proclined upper
incisors with a resultant
increase in overjet.
- A deep incisor overbite can
occur in anterior region.
- Presence of abnormal
muscle activity.
-The upper lip is usually
hypotonic, short fails to form a
lip seal.
-The lower lip cushions the
palatal surface of upper teeth
called as "lip trap“.
-the muscle imbalance is
produced by a hyperactive
buccinator and mentalis and
an altered tongue that
accentuates the narrowing
of upper dental arch(V
shape).
Division 1:

28. DIVISION 2:-
Presence of lingually
inclined upper
central incisors and
labially tipped lateral
incisors overlapping
the central incisors.
-Patient exhibits a
deep anterior
overbite.
- lingually inclined
upper centrals gives
arch squarish
appearance.
- Abnormal
backward path of
closure may be
present.

29. VAN DER LINDEN CLASSIFICATION OF
CLASS II DIV 2
Depending on the spatial conditions in the maxillary dental arch.
Type A- The upper central and lateral incisors are retroclined. It is
of less severe in nature
Type B- The central incisors are retroclined and overlapped by
the lateral incisors.
Type C- The central and lateral incisors are retroclined and
overlapped by the canines.
Van der Linden- Development of the dentition.

30. CLASS 11 SUBDIVISION:-
When a class II molar relationship exists on
one side and a class I relationship on other
side it is referred as class II subdivision.
It can be –
Class II division 1 Subdivision
Class II division 2 Subdivision

31. ANGLE'S CLASS 111:
Angle defined Class 111 malocclusion as Protrusion
of lower jaw with mesially occlusion of lower teeth ,
lower incisors and cuspid inclined lingually.
-In this the mesiobuccal cusp of maxillary 1st molar
occludes the interdental space between mandibular
1st and 2nd molars.
-Classified into:
1) True class III (skeletal)
Pseudo class III (false or postural).

32. True class III: It is of
genetic origin and is due
to:
• Excessively large mandible
• Forwardly placed mandible
Smaller than normal maxilla
• Retro positioned maxilla
• Combination of above causes
• The lower incisor tend to be
lingually inclined.

33. Pseudo class III: - It
is produced by
forward movement
of mandible during
jaw closure; thus it is
also called postural
or habitual class III
malocclusion.
- It is due to:
• Presence of occlusal
prematurities may
deflect the mandible
forward.
• In case of premature loss
of deciduous posteriors.
• A child with
enlarged adenoids , tend
to move mandible
forward to prevent
tongue from contacting
adenoids.

34. True Class III
• Class III molar relation seen
• Skeletal Class III features
• Usually no functional interference occurs as
mandible moves from rest position to
occlusion
• Class III molar relation when mandible closes
in centric occlusion
• Patient cannot move mandible backwards to
edge to edge relation
• Path of closure is upwards and forwards
• Well developed maxillary arch
• No change in profile as mandible moves
from centric to rest
Pseudo Class III
• Class I molar relation normally seen Class I
skeletal base usually seen Functional interference
may occur as mandible moves from rest position
to occlusion.
• A noticeable shift seen from Class I molar
relation to class III as mandible closes in centric
occlusion.
• Patient can move mandible backwards to edge to
to edge.
• Path of closure is upwards and forwards until the
point of premature contact. Then it is only
forwards.
• Maxillary arch may be constricted.
• The profile improves as mandible moves
from centric to rest
Comparison between true Class III and pseudo Class III malocclusion.

35. CLASS 111 SUBDIVISION
This is a condition characterized by a class III
molar relationship on one side ad class I on
other side.

36. DRAWBACKS OF ANGLE'S CLASSIFICATION:
1)Angle considered
malocclusion only in
antero- posterior plane
not in transverse and
vertical plane.
2) He considered the
1st permanent molars
as fixed points in skull
which was not found
so.
3) The classification
cannot be applied if
1st permanent
molars are extracted
or missing.
4) The classification
cannot be applied to
deciduous dentition.
5) The classification
does not differentiate
between skeletal and
dental malocclusions.
6) The classifications
does not highlight
the etiology of
malocclusion.
7) Individual tooth
malposition have not
been considered by
Angle.

37. MOYERS CLASSIFICATION CLASS 11
Diffrential diagnosis Class II Malocclusion(seminar in
orthodontics

39. DEWEY'S MODIFICATION OF ANGLE'S
Divided class I into 5 subtypes and class III into 3 subtypes.
Class 1 modification:
Type 1: Class I malocclusion with bunched or crowded
anterior teeth.
Type 2:- Class I with protrusive maxillary incisors.
Type 3: -Class I malocclusion with anterior crossbite
.
Type 4: Class I molar relation with posterior crossbite.
Type 5: - The permanent molar has drifted mesially due
to early extraction of second deciduous molar or second
premolar.

40. Class 111 modification:
Type 1:- The upper and lower dental arches when
viewed separately are in normal alignment.
But when the arches are made to occlude the
patient shows an edge to edge incisor alignment
,suggestive of forward movement of mandible.
Type 2:- The mandibular incisors are crowded and
are in lingual relation to the maxillary incisors.
Type 3:- The maxillary incisors are crowded and are
in cross bite in relation to mandibular anteriors.

41. LISCHER'S MODIFICATION OF ANGLE'SCLASSIFICATION:
Neutrocclusion:
Angle's class I
malocclusion.
Distocclusion:
Angle's class II
malocclusion.
Mesiocclusion:
Angle's class III
malocclusion.
Buccocclusion:
placement of a tooth
or group of teeth.
Linguocclusion:
lingual placement
of tooth or group of
teeth.
Supraocclusion:
When a tooth or
group of teeth have
erupted beyond the
normal level.

42. Infraocclusion: when
a tooth or group of
teeth erupted below
the normal level.
Mesioversion: mesial
to normal position.
Distoversion: Distal
to normal position.
Transversion:
transposition of two
teeth.
Axiversion:
Abnormal axial
inclination of a
tooth.
Torsiversion:
Rotation of a tooth
around its long axis.

43. BENNET'S CLASSIFICATION:
-Based on etiology.
-Class 1:- Abnormal position of one or more teeth due to local causes.
-Class 11:- Abnormal formation of a part of or whole of either arch due
to developmental defects of bone.
-Class 111:- Abnormal relationship between upper and lower arches,
and between either arch and facial contour correlated abnormal and
formation of either arch.

44. SIMMON'S CLASSIFICATION:
-It is a craniometric classification.
-made use of anthropometric planes i.e. the
Frankfort horizontal plane,
The orbital plane,
The midsagittal plane.
Classification was based on abnormal deviations of dental
arches form their normal position in relation to these three planes.

45. FRANKFORT HORIZONTAL PLANE:-
-It connects the margin of the external auditory meatus
to the infra-orbital margin.
-This plane is used to classify malocclusions in vertical
plane.
- When the dental arch or part of it is closer than
normal to Frankfort plane, it is called attraction.
When the dental arch or part of it is farther away from
the Frankfort plane, it is called abstraction.
Sridhar Premkumar, Textbook of Craniofacial Growth

46. Orbital plane:-
This plane is perpendicular t Frankfort plane, dropped down from
the orbital margins directly under the pupil of the eye.
-According to Simon, this plane should pass through the distal third
of upper canine called as Simon's law of canine.
-This plane is used to describe malocclusion in sagittal or
antero-posterior direction.
-When the dental arch or part of it is away from orbital plane,
it is called as protraction.
-When the dental arch is closer or placed more posteriorly to this
plane, it is called as Retraction.
Sridhar Premkumar, Textbook of Craniofacial Growth

47. Mid sagittal plane:-
-it is used to describe malocclusion in transverse
direction.
-When a part or whole of arch is away from the
this plane, it is called as distraction.
- When the dental arch is near to this plane, it is
called as contraction.
Sridhar Premkumar, Textbook of Craniofacial Growth

48. ACKERMAN-PROFITT SYSTEM OF
CLASSIFICATION
Ackerman and Profitt in 1960 proposed a diagrammatic
classification of malocclusion to overcome the limitations
of the Angle's classification. Salient features of the classification
include:
a. Transverse as well as vertical discrepancies can be considered in
addition to antero-posterior malrelations.
b. Crowding and arch asymmetry can be evaluated.
c. Incisor protrusion is taken into account.
Based on 5 characteristics:
• Alignment
• Profile
• Transverse relationship
• Class
• Bite depth
Op Kharbanda , Diagnosis and management of malocclusion and dentofacial deformity.

49. Step 1 (Alignment)The first step involves assessment of the alignment and symmetry of the dental arch.
It is classified as ideal / crowded / spaced.
-Step 2 (Profile)It involves the consideration of the profile.
The profile is described as convex/straight/concave.
The facial divergence is also considered i.e., anterior or posterior divergence.
Step 3 (Type)The transverse skeletal and dental relationship is evaluated.
Buccal and palatal crossbites if any are noted.
The crossbite is further sub-classified as unilateral or bilateral.
Step 4 (Class)This involves the assessment of the sagittal relationship. It is classified as Angle's Class I/Class II/ Class III malocclusion.
Step 5 (Bite depth)Malocclusions in the vertical plane are noted.
They are described as anterior or posterior open bite, anterior deep bite or posterior collapsed bite.

50. ADVANTAGES
1.Only cases with arch length problems are
recognized
2. Influence of the dentition on the profile is
considered
3. Malocclusion can be recorded in all the
three planes of space
4. Skeletal and dental problems can be
segregated at appropriate levels
5. Diagnosis is inherent in this methodology
6. Quantification and assessment of severity
of malocclusion can be done in this system
7. Can serve as an aid in treatment planning
8. The classification can be modified to be
used on computers for large surveys and data
analysis.
9 Computer compatibility makes it amenable
to data storage , retrieval and processing
DISADVANTAGES
1. 1.Very detailed and therefore
time consuming and tedious.
2. 2.Does not include aetiology.
3. 3. Only the static view of
occlusion is considered.
4. 4. Communication is not easy
without thorough
knowledge of the system.

51. BRITISH STANDARD CLASSIFICATION OF INCISOR
RELATIONSHIP (1983)
CLASS I: The lower incisor edges occlude with or lie
immediately below the cingulum plateau of upper
central incisors.

52. • CLASS II : The lower incisor edges lie posterior to the
cingulum plateau of the upper incisors .
There are two sub-divisions:-
DIVISION 1:Class II div. 1The upper central incisors are
proclined or of average inclination & there is an increase in
overjet.
DIVISION 2:The upper central incisors are retroclined. The
overjet is usually minimal or may be increased.

53. • CLASS III : The lower incisor edges lies anterior to the cingulum
plateau of the upper incisors. The overjet is reduced or reversed.

54. INCISOR CLASSIFICATION
Introduced by BALLARD AND WAYMAN (1964)
:-Incisor classification.-A classification of malocclusion based on
incisor.
-Three classes:
1. Class I: the edges of the lower incisors occlude with or lie
directly below the cingulum plateau of the upper central
incisors.

55. 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. a. Division 1: the upper central incisors are of average inclination or are proclined; overjet is thus
increased.
ii. b. Division 2: the upper central incisors are retroclined; overjet is usually within normal limits but
overbite is often increased.
3. Class III: the edges of the lower incisors lie anterior to the cingulum plateau of the upper
central incisors.

56. KATZ PREMOLAR RELATIONSHIP:
Premolar class 1- most anterior upper premolar fits exactly into the
embrasure created by distal contact of most anterior lower premolar.
Premolar class 11:- the most anterior premolar is occluding mesial
embrasure created by distal contact of most anterior lower premolar.
Premolar class 11I:-the most anterior premolar is occluding distal of the
embrasure created by the most anterior lower premolar.
Katz M.I- Angle classification revisited 2: A modified angle classification. AJO 1992;102;277-84.Siegel, M.A. : A matter of Class: Interpreting subdivision in a
malocclusion. AJO 2002;122;582-6

57. Advantages
The benefits of the premolar classification system are:
1. This system provides a quantitative treatment objective that is needed to
attain excellent buccal occlusion.
2. 2. It provides some flexibility concerning finishing a case in functional class II
II or class III buccal occlusion while keeping buccal interdigitation as the
prime goal.
3. 3. In deciduous and mixed dentition cases, the emphasis is shifted from the
permanent first molars to the region of current importance (i.e. the
deciduous molar region).
Disadvantages
1. The The disadvantages of this system are:
2. 1. Premolars are commonly missing, malformed or supernumerary. Hence
measurement is not always possible.
3. 2. Severely rotated and ectopically erupted premolars present problems.
4. 3. Katz's premolar classification does not consider deviations of facial
balance and aesthetics.

58. SKELETAL CLASSIFICATION
Skeletal class I:
Straight profile
Normal ANB angle: 2° +-2
Normal facial angle (downs): 82 - 95 deg (mean 87.3°)
Angle of convexity (downs): +10 to - 8.5 deg (mean 0°).
Skeletal class II:
Important features are:
1. 1. Convex profile
2. 2. Increased ANB angle
3. 3. Reduced facial angle
4. 4. Increased angle of convexity
5. 5. Severe backwards rotation of the mandible may also be present.

59. 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. 2. Prominent chin
3. 3. Decreased ANB angle
4. 4. Increased facial angle
5. 5. Reduced angle of convexity.
6. . William Proffit, Henry ,Contemporary Orthodontics 3rd edittion

60. CLASSIFICATION IN PRIMARY
DENTITION
Introduced by Baume 1959
Flush terminal plane relationship –
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.
William Proffit, Henry ,Contemporary Orthodontics 3rd edittion

61. 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.
Op Kharbanda , Diagnosis and management of malocclusion and dentofacial deformity.

62. CONCLUSION
A comprehensive classification of malocclusion is beneficial in
orthodontics as it aids in:
Treatment Planning
Communication
interdisciplinary collaboration
Research
Education
In conclusion, the classification of malocclusion in orthodontics serves as a
crucial roadmap for orthodontic professionals, guiding them through the
complexities of diagnosis and treatment planning. This systematic approach
enhances patient care, ensuring tailored interventions that address specific
malocclusion types.

63. REFERENCES
• William Proffit, Henry ,Contemporary Orthodontics 3rd edittion
• Sridhar Premkumar, Textbook of Craniofacial Growth
• Op Kharbanda , Diagnosis and management of malocclusion and dentofacial deformity.
• Katz M.I- Angle classification revisited 1: Is current use reliable? AJO 1992;102;173-9.
• Katz M.I- Angle classification revisited 2: A modified angle classification. AJO 1992;102;277-
84.Siegel, M.A. : A matter of Class: Interpreting subdivision in a malocclusion. AJO 2002;122;582-
6.
• Brin I, Weinberger T, Benchorin E- Classification of occlusion reconsidered. EJO 21(1991)169-
174.James c. Ackerman, Williams R.
• Proffit- The characteristics of malocclusion: A modern approach to classification and diagnosis.
Am J Orthod. 1969; vol-56, no-5.
• Angles classification of malocclusion article.(orthodontics north York)
• Van der Linden- Development of the dentition.
• Daskalogiannakis J- Glossary of orthodontic terms.

64. THANK YOU.