Malocclusion/certified fixed orthodontic courses by Indian dental academy

CLASSIFICATIONCLASSIFICATION
OFOF
MALOCCLUSIONMALOCCLUSION
www.indiandentalacademy.com
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing dental educationLeader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com

IntroductionIntroduction
Normality is the basis of classification inNormality is the basis of classification in
orthodontics. It rests on what is known as biologicorthodontics. It rests on what is known as biologic
continuity, i.e., the most frequently found relationshipcontinuity, i.e., the most frequently found relationship
of the teeth and of the bones of the face in relation toof the teeth and of the bones of the face in relation to
each other and to the skull as a whole.each other and to the skull as a whole.
Malocclusion is any perversion of normalMalocclusion is any perversion of normal
occlusion of the teeth. It is a condition where there isocclusion of the teeth. It is a condition where there is
departure from the normal relation of the teeth todeparture from the normal relation of the teeth to
other teeth in the same arch and to the teeth in theother teeth in the same arch and to the teeth in the
opposing arch.opposing arch.

INTRODUCTIOINTRODUCTIO
NN
In order to acquire a better understanding of theIn order to acquire a better understanding of the
many deviations from normal occlusion and to assistmany deviations from normal occlusion and to assist
in diagnosis and treatment planning, it becomesin diagnosis and treatment planning, it becomes
necessary to group the varieties of malocclusion intonecessary to group the varieties of malocclusion into
order. This is difficult as occlusal anomalies are manyorder. This is difficult as occlusal anomalies are many
and varied. Orthodontics has been described,and varied. Orthodontics has been described,
admirably, as a ‘Science of Infinite Variations’.admirably, as a ‘Science of Infinite Variations’.

DEFINITIONDEFINITION
Classification is a process of analyzing cases ofClassification is a process of analyzing cases of
malocclusion for the purpose of segregating them intomalocclusion for the purpose of segregating them into
a small number of groups, which groups area small number of groups, which groups are
characterized by certain specific and fundamentalcharacterized by certain specific and fundamental
variations from normal occlusion of the teeth.variations from normal occlusion of the teeth.

OBJECTIVESOBJECTIVES
 Classification is an essential communication toolClassification is an essential communication tool
between dental school professor and student, betweenbetween dental school professor and student, between
practitioners, and between practitioner and insurancepractitioners, and between practitioner and insurance
company or government bureaucracy. It is essentialcompany or government bureaucracy. It is essential
that everyone "speak the same language."that everyone "speak the same language."
 Classification aids in the diagnosis and treatmentClassification aids in the diagnosis and treatment
planning of malocclusions by orienting the clinicianplanning of malocclusions by orienting the clinician
to the type and the magnitude of the problems andto the type and the magnitude of the problems and
possible mechanical solutions to the problems.possible mechanical solutions to the problems.

OBJECTIVESOBJECTIVES
 Segregation of the countless number of cases ofSegregation of the countless number of cases of
tooth malposition into a comparatively low number oftooth malposition into a comparatively low number of
groups, each group containing only such cases as aregroups, each group containing only such cases as are
characterized by a common factor or factors ofcharacterized by a common factor or factors of
fundamental significance.fundamental significance.
 Ease of reference i.e. giving name to a group ofEase of reference i.e. giving name to a group of
symptoms making together a single problemsymptoms making together a single problem
 Comparison of cases with other cases having sameComparison of cases with other cases having same
problemproblem

GENERALGENERAL
CLASSIFICATIOCLASSIFICATIO
NN
 Malocclusion can be broadly divided into-Malocclusion can be broadly divided into-
 Individual tooth malposition or Intra arch malocclusionIndividual tooth malposition or Intra arch malocclusion
 Maxillo-mandibular malocclusions or Inter archMaxillo-mandibular malocclusions or Inter arch
malocclusionmalocclusion

GENERALGENERAL
NN
Individual tooth malposition or Intra archIndividual tooth malposition or Intra arch
 A tooth can be abnormally related to its neighboringA tooth can be abnormally related to its neighboring
teeth, such abnormal variations are called individualteeth, such abnormal variations are called individual
tooth malpositions or intra arch malpositions. Some oftooth malpositions or intra arch malpositions. Some of
the commonly seen individual tooth malpositions arethe commonly seen individual tooth malpositions are
 Distal inclination or distal tippingDistal inclination or distal tipping
 Mesial inclination or mesial tippingMesial inclination or mesial tipping
 Lingual inclination or lingual tippingLingual inclination or lingual tipping
 Buccal inclination or buccal tippingBuccal inclination or buccal tipping

GENERALGENERAL
NN
Individual tooth malposition or Intra archIndividual tooth malposition or Intra arch
 Mesial displacementMesial displacement
 Distal displacementDistal displacement
 Lingual displacementLingual displacement
 Buccal displacementBuccal displacement
 Infraversion or infraocclusionInfraversion or infraocclusion
 Supraversion or supra occlusionSupraversion or supra occlusion
 Disto lingual or mesio buccal rotationDisto lingual or mesio buccal rotation
 Mesio lingual or disto buccal rotationMesio lingual or disto buccal rotation
 TranspositionTransposition

GENERALGENERAL
NN
MESIALMESIAL
INCLINATIONINCLINATION
DISTALDISTAL
LINGUAL AND LABIALLINGUAL AND LABIAL
MESIALMESIAL
DISPLACEMENTDISPLACEMENT
DISTALDISTAL

GENERALGENERAL
NN
INFRAVERSIONINFRAVERSION SUPRAVERSIONSUPRAVERSION LINGUAL AND LABIALLINGUAL AND LABIAL
TORSIVERSIONTORSIVERSION TRANSPOSITIONTRANSPOSITION

GENERALGENERAL
NN
Inter arch malocclusionsInter arch malocclusions
These malocclusions are characterized by abnormalThese malocclusions are characterized by abnormal
relationships between two teeth or groups of teeth of onerelationships between two teeth or groups of teeth of one
arch to the other arch. These inter arch malocclusion canarch to the other arch. These inter arch malocclusion can
occur inoccur in
 Sagital planeSagital plane
 Vertical planeVertical plane
 Transverse planeTransverse plane

GENERALGENERAL
NN
Sagital plane malocclusionsSagital plane malocclusions
Pre-normal occlusion-Pre-normal occlusion- refers to a condition where therefers to a condition where the
lower arch is more forwardly placed when the patientlower arch is more forwardly placed when the patient
bites in centric occlusion.bites in centric occlusion.
Post-normal occlusion-Post-normal occlusion- a condition where the lowera condition where the lower
arch is more distally placed when the patient bites inarch is more distally placed when the patient bites in
centric occlusion.centric occlusion.

GENERALGENERAL
NN
Vertical plane malocclusionsVertical plane malocclusions
Deep bite or increased over biteDeep bite or increased over bite: this refers to a: this refers to a
condition where there is an excessive vertical overlapcondition where there is an excessive vertical overlap
between upper and lower anterior teeth.between upper and lower anterior teeth.
Open biteOpen bite: is a condition where there is no vertical: is a condition where there is no vertical
overlap between upper and lower teeth . Thus a spaceoverlap between upper and lower teeth . Thus a space
exist between the upper and lower teeth when the patientexist between the upper and lower teeth when the patient
bites in centric occlusion. Open bite can be inbites in centric occlusion. Open bite can be in anterioranterior
oror posteriorposterior regionregion..

GENERALGENERAL
NN
Transverse plane malocclusionsTransverse plane malocclusions
Cross biteCross bite – refers to a condition in which mandibular– refers to a condition in which mandibular
teeth overlap their maxillary antagonists. Cross bite canteeth overlap their maxillary antagonists. Cross bite can
bebe anterioranterior oror posteriorposterior
Buccal Non occlusion –Buccal Non occlusion – refers to a condition in whichrefers to a condition in which
maxillary posteriors are completely buccally placed inmaxillary posteriors are completely buccally placed in
relation to mandibular antagonists without occludingrelation to mandibular antagonists without occluding
Palatal Non occlusionPalatal Non occlusion – refers to a condition in which– refers to a condition in which
maxillary posteriors are completely palatally placed inmaxillary posteriors are completely palatally placed in
relation to mandibular antagonists without occludingrelation to mandibular antagonists without occluding

ANGLE’SANGLE’S
NN
Angle believed that since biologic entities asAngle believed that since biologic entities as
well as inanimate elements can be arranged intowell as inanimate elements can be arranged into
well-defined classes, the same held also of thewell-defined classes, the same held also of the
occlusion of the teeth and the shape of the face.occlusion of the teeth and the shape of the face.
Angle based his classification of malocclusion onAngle based his classification of malocclusion on
the normal mesiodistal relations of the mesiobuccalthe normal mesiodistal relations of the mesiobuccal
cusps of the upper first molars in relation to thecusps of the upper first molars in relation to the
mandibular first molars.mandibular first molars.

ANGLE’SANGLE’S
NN
Basis for Angle’s classificationBasis for Angle’s classification
Most indicative irregularity of teeth found in antero-posteriorMost indicative irregularity of teeth found in antero-posterior
relationship of the teeth and the jaws.relationship of the teeth and the jaws.
There is a normal mesio distal or antero-posterior positionThere is a normal mesio distal or antero-posterior position
for the body of the mandible with its superimposed mandibularfor the body of the mandible with its superimposed mandibular
dental arch to occupy in the anatomy of the skull.dental arch to occupy in the anatomy of the skull.
The maxillary dental arch being built upon a base that is aThe maxillary dental arch being built upon a base that is a
fixed section of the skull anatomy, is more or less stable in itsfixed section of the skull anatomy, is more or less stable in its
relationship to various landmarks on the head and consequentlyrelationship to various landmarks on the head and consequently
the first molar teeth in this arch may be quite safely selected asthe first molar teeth in this arch may be quite safely selected as
a key tooth from which to judge the relationship of mandibulara key tooth from which to judge the relationship of mandibular
dental arch and intern to the body of mandible upon which it isdental arch and intern to the body of mandible upon which it is
locatedlocated

ANGLE’SANGLE’S
NN
Basis for Angle’s classificationBasis for Angle’s classification
If there is shifting of maxillary molars in theirIf there is shifting of maxillary molars in their
relationship to the skull anatomy, this variation can berelationship to the skull anatomy, this variation can be
detected by changes in the axial inclination of teeth indetected by changes in the axial inclination of teeth in
the maxillary arch. The axial change is especiallythe maxillary arch. The axial change is especially
manifested by canine teeth.manifested by canine teeth.
Curvature and line of occlusion is unique to eachCurvature and line of occlusion is unique to each
individualindividual..

ANGLE’SANGLE’S
NN
Angle used the Roman numerals I, II and III toAngle used the Roman numerals I, II and III to
designate the three main classes of mesiodistal archdesignate the three main classes of mesiodistal arch
relationship viz., Class I or normal, Class II or distal andrelationship viz., Class I or normal, Class II or distal and
Class III or mesial relationship of the cusps of theClass III or mesial relationship of the cusps of the
mandibular first molars to the maxillary first molars.mandibular first molars to the maxillary first molars.
He employed the Arabic numerals 1 and 2 toHe employed the Arabic numerals 1 and 2 to
denote divisions of the classifications. Unilateraldenote divisions of the classifications. Unilateral
deviations he termed subdivisions.deviations he termed subdivisions.

ANGLE’SANGLE’S
NN
Angle classified malocclusion as followsAngle classified malocclusion as follows
Class IClass I
Class IIClass II
Division 1Division 1
Division IIDivision II
SubdivisionSubdivision
Class IIIClass III

ANGLE’SANGLE’S
NN
Class I MalocclusionClass I Malocclusion
The mandibular dental arch and the body of theThe mandibular dental arch and the body of the
mandible are in normal relation to the maxillary archmandible are in normal relation to the maxillary arch
indicated by the fact that mesiobuccal cusp of theindicated by the fact that mesiobuccal cusp of the
maxillary first permanent molar occludes in the buccalmaxillary first permanent molar occludes in the buccal
groove of the mandibular permanent first molar andgroove of the mandibular permanent first molar and
the mesiolingual cusp of the maxillary first molarthe mesiolingual cusp of the maxillary first molar
occludes with the occlusal fossa of the mandibular firstoccludes with the occlusal fossa of the mandibular first
permanent molar when the jaws are in centricpermanent molar when the jaws are in centric
occlusionocclusion

ANGLE’SANGLE’S
NN

ANGLE’SANGLE’S
NN
Class II MalocclusionClass II Malocclusion
mandible are in distal relation to the maxillary arch bymandible are in distal relation to the maxillary arch by
half the width of the maxillary first permanent molarhalf the width of the maxillary first permanent molar
or mesioodistal width of a premolar indicated by theor mesioodistal width of a premolar indicated by the
fact that mesiobuccal cusp of the maxillary firstfact that mesiobuccal cusp of the maxillary first
permanent molar occludes in the space between thepermanent molar occludes in the space between the
mesiobuccal cusp of the mandibular permanent firstmesiobuccal cusp of the mandibular permanent first
molar and the buccal cusp of the second premolar.molar and the buccal cusp of the second premolar.

ANGLE’SANGLE’S
NN
The mesiolingual cusp of the maxillary first molarThe mesiolingual cusp of the maxillary first molar
occludes mesial to the mesiolingual cusp of theoccludes mesial to the mesiolingual cusp of the
mandibular first permanent molar when the jaws are inmandibular first permanent molar when the jaws are in
centric occlusioncentric occlusion..

ANGLE’SANGLE’S
NN
Division IDivision I
A class II malocclusion in which maxilary incisorsA class II malocclusion in which maxilary incisors
are in labioversionare in labioversion
A class II division I malocclusion occuring onA class II division I malocclusion occuring on
only one sideonly one side

ANGLE’SANGLE’S
NN
Division IIDivision II
A class II malocclusion in which maxilary incisorsA class II malocclusion in which maxilary incisors
are not in labioversion rather they are retroclinedare not in labioversion rather they are retroclined
with laterals overlapping centrals or canineswith laterals overlapping centrals or canines
overlapping lateralsoverlapping laterals
A class II division I malocclusion occuring onA class II division I malocclusion occuring on
only one sideonly one side

ANGLE’SANGLE’S
NN
Class III MalocclusionClass III Malocclusion
mandible are in mesial relationship to the maxillarymandible are in mesial relationship to the maxillary
arch indicated by the fact that mesiobuccal cusp of thearch indicated by the fact that mesiobuccal cusp of the
maxillary first permanent molar occludes in themaxillary first permanent molar occludes in the
interdental space between the distal aspect of the distalinterdental space between the distal aspect of the distal
cusp of the mandibular first permanent molar and thecusp of the mandibular first permanent molar and the
mesial aspect of the mesial cusp of the secondmesial aspect of the mesial cusp of the second
permanent molarpermanent molar

ANGLE’SANGLE’S
NN
Class III MalocclusionClass III Malocclusion
A class III malocclusion in which malocclusion isA class III malocclusion in which malocclusion is
only unilaterallyonly unilaterally

ANGLE’SANGLE’S
NN
Pseudo-Class III MalocclusionPseudo-Class III Malocclusion
In this condition the mandible is protruded a little duringIn this condition the mandible is protruded a little during
the final stages of closure in order to avoid a prematurethe final stages of closure in order to avoid a premature
contact of incisors or caninescontact of incisors or canines
This is most likely to arise in cases where theThis is most likely to arise in cases where the
relationship of the incisors is edge-to-edge, and may berelationship of the incisors is edge-to-edge, and may be
caused by a mildly prenormal relationship of the dentalcaused by a mildly prenormal relationship of the dental
basesbases
Such pseudo – or postural Class III cases may tend, ifSuch pseudo – or postural Class III cases may tend, if
left untreated, to become established by a furtherleft untreated, to become established by a further
development of the whole occlusion in Class III relation.development of the whole occlusion in Class III relation.

Features True Class III Pseudo Class III
1 Profile Concave Straight to concave
2 Etiology Hereditary Habitual/developmental
3 Premature
contacts
Absent Present
4 Path of closure Forward Deviated
5 Gonial angle Increased/decreased Normal
6 Retrusion of
mandible
further
Not possible Possible
7 Treatment Orthopedic or
surgical
Elimination of prematurities,
replacement of lost posterior
teeth
8 Left untreated No further changes Becomes established into true
class III
Differences between true and pseudo class III malocclusionDifferences between true and pseudo class III malocclusion

ANGLE’SANGLE’S
NN
Drawbacks of Angle’s ClassificationDrawbacks of Angle’s Classification
The Angle classification was readily acceptedThe Angle classification was readily accepted
by the dental profession, since it brought order out ofby the dental profession, since it brought order out of
what previously had been confusion regarding dentalwhat previously had been confusion regarding dental
relationships. It was recognized almost immediately,relationships. It was recognized almost immediately,
however, that there were deficiencies in the Anglehowever, that there were deficiencies in the Angle
system.system.

ANGLE’SANGLE’S
NN
Angle considered malocclusion only in antero-posteriorAngle considered malocclusion only in antero-posterior
planeplane
Angle considered maxillary first permanent molar as aAngle considered maxillary first permanent molar as a
fixed point but it was not found sofixed point but it was not found so
The classification cannot be applied if first permanentThe classification cannot be applied if first permanent
molars are missing or extractedmolars are missing or extracted
The classification cannot be applied in the deciduousThe classification cannot be applied in the deciduous
dentitiondentition

ANGLE’SANGLE’S
NN
The classification does not differentiates betweenThe classification does not differentiates between
skeletal and dental malocclusionsskeletal and dental malocclusions
The classification does not highlight the etiology of theThe classification does not highlight the etiology of the
Individual tooth malpositions have not been consideredIndividual tooth malpositions have not been considered
in the classificationin the classification

LISCHER’SLISCHER’S
NN
Lischer introduced the following terms which areLischer introduced the following terms which are
widely used to describe the varieties of malocclusion. Hewidely used to describe the varieties of malocclusion. He
substituted the term Class I, Class II, Class III given bysubstituted the term Class I, Class II, Class III given by
angle with the terms Neurtro-occlusion, Disto-occlusion andangle with the terms Neurtro-occlusion, Disto-occlusion and
Mesio-occlusionMesio-occlusion..

NN
Neutro-occlusion: Normal relation of dentalNeutro-occlusion: Normal relation of dental
arches. It is synonymous with Angle’s Class Iarches. It is synonymous with Angle’s Class I
malocclusion.malocclusion.
Disto-occlusion: Synonymous with Angle’s ClassDisto-occlusion: Synonymous with Angle’s Class
II, used to describe all cases of post-normalII, used to describe all cases of post-normal
occlusion.occlusion.
Mesio-occlusion: Synonymous with Angle’sMesio-occlusion: Synonymous with Angle’s
Class III and describes all cases of prenormalClass III and describes all cases of prenormal
occlusion.occlusion.

NN
He gave the suffix “version” to describe theHe gave the suffix “version” to describe the
wrong position of individual teeth as follows:wrong position of individual teeth as follows:
Linguo version—Lingual placementLinguo version—Lingual placement
Labio version—Labial placementLabio version—Labial placement
Mesio version—Mesial placementMesio version—Mesial placement
Disto version—Distal placementDisto version—Distal placement
Infra version—Intrusion of teethInfra version—Intrusion of teeth
Supra version—Extrusion of teethSupra version—Extrusion of teeth
Torsiversion—RotationTorsiversion—Rotation
Perversion—Impacted toothPerversion—Impacted tooth

Dewey’s Modification ofDewey’s Modification of
Angle’s ClassificationAngle’s Classification
Dewey proposed a modification of theDewey proposed a modification of the
Angle’s classification of malocclusion. HeAngle’s classification of malocclusion. He
divided the Angle’s class I into five types anddivided the Angle’s class I into five types and
Angle’s Class III into three types. There were noAngle’s Class III into three types. There were no
modifications for Class II. He considered themodifications for Class II. He considered the
same molar relationship as in Angle’ssame molar relationship as in Angle’s
classificationclassification

Modification of Angle’s Class IModification of Angle’s Class I
 Type 1Type 1. Bunched or crowded maxillary anterior teeth.. Bunched or crowded maxillary anterior teeth.
The canines may be in labioversion or infraversion. AllThe canines may be in labioversion or infraversion. All
other versions of individual teeth may be presentother versions of individual teeth may be present
 Type 2.Type 2. Maxillary incisors in labioversionMaxillary incisors in labioversion
 Type 3Type 3. The maxillary incisor teeth are in linguoversion. The maxillary incisor teeth are in linguoversion
to the mandibular incisorsto the mandibular incisors
 Type 4Type 4. The molars, occasionally also premolars are in. The molars, occasionally also premolars are in
linuoversion or labiobversion but canines and incisorslinuoversion or labiobversion but canines and incisors
are in normal relationare in normal relation
 Type 5Type 5. The molars are in mesioversion due to shifting. The molars are in mesioversion due to shifting
following loss of teeth anterior to molarsfollowing loss of teeth anterior to molars

Modification of Angle’s Class IIIModification of Angle’s Class III
 Type 1Type 1. The dental arches are well formed and the teeth. The dental arches are well formed and the teeth
are in normal alignment when viewed individually butare in normal alignment when viewed individually but
there is edge-to-edge bite in anterior regionthere is edge-to-edge bite in anterior region
 Type 2.Type 2. The mandibular incisors are crowded and inThe mandibular incisors are crowded and in
lingual relation to the maxillary incisorslingual relation to the maxillary incisors
 Type 3Type 3. The maxillary arch is underdeveloped. The. The maxillary arch is underdeveloped. The
maxillary incisor are crowded. The mandibular arch ismaxillary incisor are crowded. The mandibular arch is
well developed and the mandibular teeth are in normalwell developed and the mandibular teeth are in normal
aligmentaligment

BENNET’SBENNET’S
NN
Sir Norman Bennett introduced a classification ofSir Norman Bennett introduced a classification of
abnormalities of occlusion which was based on their etiology.abnormalities of occlusion which was based on their etiology.
Briefly the classification is as follows:Briefly the classification is as follows:
 Class I - Abnormal position of one or more teeth due to localClass I - Abnormal position of one or more teeth due to local
causes.causes.
 Class II - Abnormal formation of a part or whole of either archClass II - Abnormal formation of a part or whole of either arch
due to developmental defects of bone.due to developmental defects of bone.
 Class III- Abnormal relationship between upper and lowerClass III- Abnormal relationship between upper and lower
arches, and between either arch and facial contour andarches, and between either arch and facial contour and
correlated abnormal formation of either arch.correlated abnormal formation of either arch.

SIMON’SSIMON’S
NN
Since growth of the face and jaws occurs in the threeSince growth of the face and jaws occurs in the three
planes of space-height, width and depth, abnormalities alsoplanes of space-height, width and depth, abnormalities also
occur in any one or more of the foregoing planes.occur in any one or more of the foregoing planes.
Simon’s craniometric classification relates the denture toSimon’s craniometric classification relates the denture to
the face and cranium in the three planes of space,the face and cranium in the three planes of space,
(1) The Frankfort horizontal(1) The Frankfort horizontal
(2) The Orbital plane and(2) The Orbital plane and
(3) The raphe or median sagittal plane.(3) The raphe or median sagittal plane.

SIMON’SSIMON’S
NN
The Frankfort horizontal planeThe Frankfort horizontal plane
The Frankfort horizontal plane or the eye-ear planeThe Frankfort horizontal plane or the eye-ear plane
is determined by drawing a straight line through the margin ofis determined by drawing a straight line through the margin of
the bony orbit directly under the pupil of the eye, to the upperthe bony orbit directly under the pupil of the eye, to the upper
margin of the auditory meatus (the notch above the tragus ofmargin of the auditory meatus (the notch above the tragus of
the ear). This plane is used to determine deviations in the heightthe ear). This plane is used to determine deviations in the height
of the dental arches and teeth in relation to the face andof the dental arches and teeth in relation to the face and
cranium.cranium.

SIMON’SSIMON’S
NN
The Frankfort horizontal planeThe Frankfort horizontal plane

SIMON’SSIMON’S
NN
The Orbital planeThe Orbital plane
The orbital plane is a perpendicular at right anglesThe orbital plane is a perpendicular at right angles
to the eye-ear plane at the margin of the bony orbit directlyto the eye-ear plane at the margin of the bony orbit directly
under the pupil of the eye. This plane is used to determineunder the pupil of the eye. This plane is used to determine
sagittal deviations of the dental arches and the axial inclinationsagittal deviations of the dental arches and the axial inclination
of the teeth to the face and the cranium.of the teeth to the face and the cranium.

SIMON’SSIMON’S
NN
The Orbital planeThe Orbital plane

SIMON’SSIMON’S
NN
The Raphe or Median Sagittal planeThe Raphe or Median Sagittal plane
The Raphe or Median Sagittal plane is determinedThe Raphe or Median Sagittal plane is determined
by points approximately 1.5 cm apart on the median raphe ofby points approximately 1.5 cm apart on the median raphe of
the palate. The raphe median plane passes through these twothe palate. The raphe median plane passes through these two
points at right angles to the Frankfort horizontal plane. Thispoints at right angles to the Frankfort horizontal plane. This
plane is used to determine the deviations in the general formplane is used to determine the deviations in the general form
and width of the dental arches and the axial inclination of theand width of the dental arches and the axial inclination of the
teeth in relation to the midline of the palate and the headteeth in relation to the midline of the palate and the head

SIMON’SSIMON’S
NN
The Raphe or Median Sagittal planeThe Raphe or Median Sagittal plane

SIMON’SSIMON’S
NN
The Law of the CanineThe Law of the Canine
In normal arch relationship, according to Simon,In normal arch relationship, according to Simon,
the orbital plane passes through the distal axial aspect of thethe orbital plane passes through the distal axial aspect of the
canine. This is known as “The law of the canine”.canine. This is known as “The law of the canine”.

SIMON’SSIMON’S
NN
Deviation from the raphe or median sagittal planeDeviation from the raphe or median sagittal plane ..
Arch form and inclination of tooth axisArch form and inclination of tooth axis are determinedare determined
from this plane.from this plane.
ContractionContraction: A part or all of the dental arch is contracted: A part or all of the dental arch is contracted
toward the raphe median plane. The abnormality may betoward the raphe median plane. The abnormality may be
mandibular, alveolar, dental, anterior, posterior, unilateralmandibular, alveolar, dental, anterior, posterior, unilateral
or bilateral.or bilateral.
DistractionDistraction: A part or all of the dental arch is wider than: A part or all of the dental arch is wider than
usual from the raphe median planeusual from the raphe median plane

SIMON’SSIMON’S
NN
Deviations from the Frankfort horizontal planeDeviations from the Frankfort horizontal plane::
The angle between the Frankfort horizontal and theThe angle between the Frankfort horizontal and the
occlusal plane, the form of the occlusal curve, and theocclusal plane, the form of the occlusal curve, and the
inclination of the teeth axesinclination of the teeth axes are determined from this plane.are determined from this plane.
AttractionAttraction: The distance between the occlusal plane and: The distance between the occlusal plane and
the FH Plane is comparatively shorter than normal. Thisthe FH Plane is comparatively shorter than normal. This
distance is as a rule normally shorter in the young than indistance is as a rule normally shorter in the young than in
older persons and in some ethnic groups.older persons and in some ethnic groups.
AbstractionAbstraction: The distance between the occlusal plane and: The distance between the occlusal plane and
the FH plane is comparatively longer than normal.the FH plane is comparatively longer than normal.

SIMON’SSIMON’S
NN
Deviations from the Orbital planeDeviations from the Orbital plane::
Sagittal symmetry and inclination of the axes of the teethSagittal symmetry and inclination of the axes of the teeth
are determined from this plane.are determined from this plane.
ProtractionProtraction: The teeth, one or both dental arches, and or: The teeth, one or both dental arches, and or
jaws are too far forward. Normally the orbital plane passesjaws are too far forward. Normally the orbital plane passes
through the distal incline of the canine.through the distal incline of the canine.
RetractionRetraction: The teeth, one or both dental arches and or: The teeth, one or both dental arches and or
jaws are too far retruded. The orbital plane passes too farjaws are too far retruded. The orbital plane passes too far
anteriorly to the canines.anteriorly to the canines.

SIMON’SSIMON’S
NN
Deviations of the dental arches in relation to the orbital plane,Deviations of the dental arches in relation to the orbital plane,
according to Simon, may occur as follows:according to Simon, may occur as follows:
Both the jaws in normal relation to each otherBoth the jaws in normal relation to each other
Upper jaw normal, lower jaw distalUpper jaw normal, lower jaw distal
Upper jaw normal, lower jaw mesialUpper jaw normal, lower jaw mesial
Lower jaw normal, upper jaw mesialLower jaw normal, upper jaw mesial
Lower jaw normal, upper jaw distalLower jaw normal, upper jaw distal
Upper jaw mesial, lower jaw distalUpper jaw mesial, lower jaw distal
Upper jaw distal, lower jaw mesialUpper jaw distal, lower jaw mesial

SKELETALSKELETAL
NN
Malocclusion may or may not be associated with facialMalocclusion may or may not be associated with facial
dysplasia. Dental malocclusion may be present in an otherwisedysplasia. Dental malocclusion may be present in an otherwise
orthognathic face. However, normal occlusion may also beorthognathic face. However, normal occlusion may also be
present in a face which is not orthognathic. Facial skeletalpresent in a face which is not orthognathic. Facial skeletal
patterns are divided intopatterns are divided into
Class 1, in which the profile is orthognathic,Class 1, in which the profile is orthognathic,
Class 2, where the mandible is retrognathic, andClass 2, where the mandible is retrognathic, and
Class 3, in which the mandible is prognathic.Class 3, in which the mandible is prognathic.

SKELETALSKELETAL
NN
Classification of the facial skeletal pattern takes intoClassification of the facial skeletal pattern takes into
consideration also the relationship of the teeth as follows:consideration also the relationship of the teeth as follows:
Skeletal Class 1Skeletal Class 1: The bones of the face and the jaws are in: The bones of the face and the jaws are in
harmony with one another and with the rest of the head. Theharmony with one another and with the rest of the head. The
maxilla is slightly ahead of the mandible. The profile ismaxilla is slightly ahead of the mandible. The profile is
orthognathic.orthognathic.
Division 1. Local malrelations of incisor, canine orDivision 1. Local malrelations of incisor, canine or
premolar teeth.premolar teeth.
Division 2. Maxillary incisor protrusion.Division 2. Maxillary incisor protrusion.
Division 3. Maxillary incisors in linguoversion.Division 3. Maxillary incisors in linguoversion.
Division 4. Bimaxillary protrusion.Division 4. Bimaxillary protrusion.

SKELETALSKELETAL
NN
Skeletal Class 2Skeletal Class 2: Subnormal distal mandibular: Subnormal distal mandibular
development in relation to the maxilla.development in relation to the maxilla.
Division 1. Maxillary dental arch is narrower thanDivision 1. Maxillary dental arch is narrower than
mandibular and there is crowding in the caninemandibular and there is crowding in the canine
region, crossbite and reduced vertical height.region, crossbite and reduced vertical height.
Protrusion of the maxillary anterior teeth. TheProtrusion of the maxillary anterior teeth. The
profile is retrognathic.profile is retrognathic.
Division 2. Lingual inclination of the maxillary incisors.Division 2. Lingual inclination of the maxillary incisors.
The lateral incisors may be normal or inThe lateral incisors may be normal or in
labioversion.labioversion.

SKELETALSKELETAL
NN
Skeletal Class 3Skeletal Class 3: Overgrowth of the mandible and obtuse: Overgrowth of the mandible and obtuse
mandibular angle. The profile is prognathic at the mandible.mandibular angle. The profile is prognathic at the mandible.

ACKERMAN –ACKERMAN –
PROFFITPROFFIT
Ackerman and Proffit proposed a classification scheme forAckerman and Proffit proposed a classification scheme for
malocclusions in which five characteristics and theirmalocclusions in which five characteristics and their
interrelationships are assessed.interrelationships are assessed.
This system is a synthesis of two schemes, the AngleThis system is a synthesis of two schemes, the Angle
classification and the Venn diagram, both of which wereclassification and the Venn diagram, both of which were
proposed late in the nineteenth century by Angle and Venn.proposed late in the nineteenth century by Angle and Venn.
Venn proposed this representation in 1880, and it hasVenn proposed this representation in 1880, and it has
become prominent in symbolic logic for computer use.become prominent in symbolic logic for computer use.

INTRA ARCHINTRA ARCH
ALIGNMENTALIGNMENT
IDEALIDEAL
CROWDINGCROWDING
SPACINGSPACING
PROFILEPROFILE
GROUP 1GROUP 1
GROUP 2GROUP 2
GROUP 3GROUP 3 GROUP 4GROUP 4
GROUP 5GROUP 5
Gp6Gp6
Gp7Gp7
Gp8Gp8
Gp9Gp9
VERTICAL DEVIATIONVERTICAL DEVIATION
Open Bite anteriorOpen Bite anterior
Open bite posteriorOpen bite posterior
Deep bite anteriorDeep bite anterior
Collapsed bite posteriorCollapsed bite posterior
SkeletalSkeletal
DentalDental
AnteriorAnterior
divergentdivergent
PosteriorPosterior
divergentdivergent
ConvexConvex
ConcaveConcave
StraightStraight
TRANSVERSETRANSVERSE
DEVIATIONDEVIATION
Cross bitesCross bites
BuccalBuccal
PalatalPalatal
UnilateralUnilateral
BilateralBilateral
SkeletalSkeletal
DentalDental
SAGITTALSAGITTAL
DEVIATIONDEVIATION
Class IClass I
Class II Div1Class II Div1
Class II Div 2Class II Div 2
Class IIIClass III
SkeletalSkeletal
DentalDental
TRANS-TRANS-
SAGITTALSAGITTAL
SAGITO-SAGITO-
VERTICALVERTICAL
VERTICO-VERTICO-
TRANSVERSETRANSVERSE
TRANS-TRANS-
SAGITO-SAGITO-
VERTICALVERTICAL

PROFFITPROFFIT
Classification by groupsClassification by groups
Common to all dentitions is the degree of alignment andCommon to all dentitions is the degree of alignment and
symmetry of the teeth within the dental arches. This issymmetry of the teeth within the dental arches. This is
represented as the universerepresented as the universe (Group 1).(Group 1).
Many malocclusions affect the profile. For this reason,Many malocclusions affect the profile. For this reason,
profile is represented as a major setprofile is represented as a major set (Group 2)(Group 2) within thewithin the
universe.universe.
Lateral (transverse), anteroposterior (sagittal), and verticalLateral (transverse), anteroposterior (sagittal), and vertical
deviations and their interrelationshipsdeviations and their interrelationships (Groups 3 to 9)(Groups 3 to 9) areare
represented by three interlocking subsets within the profile set.represented by three interlocking subsets within the profile set.

PROFFITPROFFIT
Step 1Step 1 in the classification procedure is an analysis of thein the classification procedure is an analysis of the
alignment and symmetry of the teeth in the dental archesalignment and symmetry of the teeth in the dental arches
(interproximal contact relationships).(interproximal contact relationships).
Alignment is the key word of Group 1; among theAlignment is the key word of Group 1; among the
possibilities arepossibilities are idealideal,, crowding (arch-length deficiencycrowding (arch-length deficiency),),
spacingspacing, and, and mutilatedmutilated. Irregularities of individual teeth. Irregularities of individual teeth
are described, if desired, by the method of Lischer, namely,are described, if desired, by the method of Lischer, namely,
the use of the suffix -version to describe the direction ofthe use of the suffix -version to describe the direction of
individual tooth malalignments.individual tooth malalignments.
Ideal occlusion, plus many (but by no means all) AngleIdeal occlusion, plus many (but by no means all) Angle
Class I malocclusions, would fall into Group 1.Class I malocclusions, would fall into Group 1.

PROFFITPROFFIT
InIn Step 2Step 2 one views the patient's profile.one views the patient's profile.
In the profile view, it should be noted whether the face isIn the profile view, it should be noted whether the face is
anteriorly divergentanteriorly divergent (mandible prominent) or(mandible prominent) or posteriorlyposteriorly
divergentdivergent (mandible recessive) and whether the lips are(mandible recessive) and whether the lips are
convexconvex (prominent),(prominent), straightstraight, or, or concaveconcave relative to therelative to the
nose and chin. The "divergence" is most often related to thenose and chin. The "divergence" is most often related to the
facial skeleton; lip position is strongly influenced by thefacial skeleton; lip position is strongly influenced by the
teeth. Lip and mouth posture should also be considered inteeth. Lip and mouth posture should also be considered in
the evaluation.the evaluation.

PROFFITPROFFIT
InIn Step 3Step 3 the dental arches are viewed with regard to lateralthe dental arches are viewed with regard to lateral
dimensions (transverse plane), and the buccolingualdimensions (transverse plane), and the buccolingual
relationships of the posterior teeth are noted.relationships of the posterior teeth are noted.
The term type is used to describe the various kinds of cross-The term type is used to describe the various kinds of cross-
bite. A judgment is also made as to whether the problem isbite. A judgment is also made as to whether the problem is
basically dentoalveolar or skeletal or due to a combinationbasically dentoalveolar or skeletal or due to a combination
of the two.of the two.
Buccal and palatal cross bites ( unilateral or bilateral)Buccal and palatal cross bites ( unilateral or bilateral)
comes under this categorycomes under this category

PROFFITPROFFIT
InIn Step 4Step 4 the patient and dental arches are viewed in thethe patient and dental arches are viewed in the
anteroposterior dimension (sagittal plane).anteroposterior dimension (sagittal plane).
In this dimension, the Angle classification system is utilizedIn this dimension, the Angle classification system is utilized
and is merely supplemented by stating whether a deviationand is merely supplemented by stating whether a deviation
is skeletal, dentoalveolar, or a combination. Thisis skeletal, dentoalveolar, or a combination. This
information can be derived from observing the patient orinformation can be derived from observing the patient or
more accurately from a cephalometric head film.more accurately from a cephalometric head film.

PROFFITPROFFIT
InIn Step 5Step 5 the patient and the dentition are viewed with regard tothe patient and the dentition are viewed with regard to
the vertical dimension.the vertical dimension.
Bite depth is used to describe the vertical relationships. TheBite depth is used to describe the vertical relationships. The
possibilities arepossibilities are anterior open-bite, anterior deep-bite,anterior open-bite, anterior deep-bite,
posterior open-bite, or posterior collapsed biteposterior open-bite, or posterior collapsed bite. To. To
determine whether this is on adetermine whether this is on a skeletal,skeletal, dentoalveolardentoalveolar, or, or
combinedcombined basis, a cephalometric analysis may bebasis, a cephalometric analysis may be
particularly helpful.particularly helpful.

PROFFITPROFFIT
This approach defines nine groups of malocclusions. TheThis approach defines nine groups of malocclusions. The
complexity of the orthodontic problem increases with the groupcomplexity of the orthodontic problem increases with the group
number. Thus, a Group 9 malocclusion is the most complex innumber. Thus, a Group 9 malocclusion is the most complex in
that there is an alignment problem, a problem in profile, andthat there is an alignment problem, a problem in profile, and
problems in the lateral, vertical, and anteroposterior dimensionsproblems in the lateral, vertical, and anteroposterior dimensions
as well.as well.

PROFFITPROFFIT
Advantages of this classificationAdvantages of this classification
 This method of classification based on five descriptive characteristicsThis method of classification based on five descriptive characteristics
and defining nine groups of malocclusions overcomes the majorand defining nine groups of malocclusions overcomes the major
weaknesses of the Angle systemweaknesses of the Angle system
 Specifically, arch-length problems, with or without an influence on theSpecifically, arch-length problems, with or without an influence on the
profile, are recognized; the influence of the dentition on the profile isprofile, are recognized; the influence of the dentition on the profile is
taken into accounttaken into account
 All three planes of space, not just the sagittal plane, are taken intoAll three planes of space, not just the sagittal plane, are taken into
considerationconsideration
 The differentiation between dental and skeletal problems is made at theThe differentiation between dental and skeletal problems is made at the
appropriate levelappropriate level
 Diagnosis is inherent in the classificationDiagnosis is inherent in the classification

ETIOLOGICETIOLOGIC
NN
According to Moyers, Classification ofAccording to Moyers, Classification of
malocclusion can be based on the origin of themalocclusion can be based on the origin of the
problem. There are four classes depending on originproblem. There are four classes depending on origin
Skeletal or OsseousSkeletal or Osseous
DentalDental
MuscularMuscular
Combination of aboveCombination of above

CONCLUSIONCONCLUSION
The goal of modern orthodontics can be summed up as theThe goal of modern orthodontics can be summed up as the
creation of the best possible occlusal relationships within thecreation of the best possible occlusal relationships within the
framework of acceptable facial aesthetics and stability of theframework of acceptable facial aesthetics and stability of the
occlusal result. The classification systems aid in diagnosis andocclusal result. The classification systems aid in diagnosis and
treatment planning of malocclusions. There is a basic need for atreatment planning of malocclusions. There is a basic need for a
system of classification of malocclusion that would be adequate forsystem of classification of malocclusion that would be adequate for
clinical, semantic and public health purpose and could beclinical, semantic and public health purpose and could be
universally employed by those practicing the specialty throughoutuniversally employed by those practicing the specialty throughout
the worldthe world

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