Classification of malocclusion

CLASSIFICATION OFCLASSIFICATION OF
MALOCCLUSIONMALOCCLUSION
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ContentsContents
• DefinitionDefinition
• Need to classifyNeed to classify
• Grouping of malocclusionGrouping of malocclusion
• Angle’s classification in 1899Angle’s classification in 1899
• Modified Angle’s classificationModified Angle’s classification
• Bennett’s classification in 1912Bennett’s classification in 1912
• Dewey’s modification in 1915Dewey’s modification in 1915
• Lischer’s modification in 1933Lischer’s modification in 1933
• Flush terminal planeFlush terminal plane
• Skeletal classification by Salzmann in 1950Skeletal classification by Salzmann in 1950
• Ballard’s Classification in 1964Ballard’s Classification in 1964

• Incisor classification by Ballard & Wayman inIncisor classification by Ballard & Wayman in
19641964
• Canine classificationCanine classification
• Ackermann-Proffit classification in 1960’sAckermann-Proffit classification in 1960’s
• Additions to the five- CharacteristicsAdditions to the five- Characteristics
classification systemclassification system
• W.H.O ClassificationW.H.O Classification
• Etiologic ClassificationEtiologic Classification
• Limitations of classificationLimitations of classification
• BibliographyBibliography

DEFINITION OF CLASSIFICATIONDEFINITION OF CLASSIFICATION
(STRANG) - Classification is a process to(STRANG) - Classification is a process to
analyze cases of malocclusion for the purposeanalyze cases of malocclusion for the purpose
of segregating them into a small number ofof segregating them into a small number of
groups, which are characterized by certaingroups, which are characterized by certain
specific and fundamental variations from thespecific and fundamental variations from the
normal occlusion of teeth. These variations, innormal occlusion of teeth. These variations, in
turn, become influential and deciding factor inturn, become influential and deciding factor in
determining the correct plan of treatment.determining the correct plan of treatment.

DEFINITION OF MALOCCLUSIONDEFINITION OF MALOCCLUSION
ANGLE -ANGLE - Malocclusion is defined as anyMalocclusion is defined as any
deviation from the ideal occlusion.deviation from the ideal occlusion.
STRANG – Malocclusion is any perversion ofSTRANG – Malocclusion is any perversion of
normal occlusion of teeth.normal occlusion of teeth.

Need to Classify?Need to Classify?
• Aids in the diagnosis and treatment planning ofAids in the diagnosis and treatment planning of
malocclusions by orienting the clinician to themalocclusions by orienting the clinician to the
type and the magnitude of the problems andtype and the magnitude of the problems and
possible mechanical solutions to the problemspossible mechanical solutions to the problems
• Simplifies the problems of treatment by groupingSimplifies the problems of treatment by grouping
casescases
• Grouping of various malocclusionsGrouping of various malocclusions
• CommunicatingCommunicating
• ComparisonComparison
• Visualizing & understanding the problemVisualizing & understanding the problem
associated with that malocclusionassociated with that malocclusionwww.indiandentalacademy.comwww.indiandentalacademy.com

Malocclusion GroupsMalocclusion Groups
• 4 tissue systems4 tissue systems
1. Teeth1. Teeth
2. Bones2. Bones
3. Muscles3. Muscles
4. Nerves4. Nerves
• 3 groups3 groups
1. Dental Dysplasias1. Dental Dysplasias
2. Skeletodental Dysplasias2. Skeletodental Dysplasias
3. Skeletal Dysplasias3. Skeletal Dysplasiaswww.indiandentalacademy.comwww.indiandentalacademy.com

Dental DysplasiasDental Dysplasias
• Distal inclination / distal tippingDistal inclination / distal tipping
• Mesial inclination / mesial tippingMesial inclination / mesial tipping
• Lingual inclination or lingual tipping.Lingual inclination or lingual tipping.
• Buccal inclination or buccal tipping.Buccal inclination or buccal tipping.
• Mesial displacement.Mesial displacement.
• Distal displacement.Distal displacement.
• Rotation.Rotation.
• Distolingual or mesiobuccal rotation.Distolingual or mesiobuccal rotation.
• Mesiolingual rotation .Mesiolingual rotation .
• Transposition.Transposition.

Mesial Tipping / Mesial InclinationMesial Tipping / Mesial Inclination

Distal Tipping / Distal InclinationDistal Tipping / Distal Inclination

Palatal inclination/Palatal tippingPalatal inclination/Palatal tipping

Labial inclinationLabial inclination

Infraocclusion & supraocclusionInfraocclusion & supraocclusion

Mesiopalatal rotationMesiopalatal rotation

Mesiobuccal rotationMesiobuccal rotation
TranspositionTransposition

Sagittal malocclusionsSagittal malocclusions

vertical plane malocclusionsvertical plane malocclusions

Transverse PlaneTransverse Plane
malocclusionsmalocclusions

Angle’s Classification- E.H. AngleAngle’s Classification- E.H. Angle
18991899
‘‘ All teeth are essential yet in function &All teeth are essential yet in function &
influence some are of greater importanceinfluence some are of greater importance
than others , the most important of allthan others , the most important of all
being the first permanent molars. They arebeing the first permanent molars. They are
by far the most constant in taking normalby far the most constant in taking normal
position specially upper first molar whichposition specially upper first molar which
we call the key to occlusion’we call the key to occlusion’

• 4 main classes designated by roman numerals-4 main classes designated by roman numerals-
normal occlusion, class I, class II & class III .normal occlusion, class I, class II & class III .
• Normal OcclusionNormal Occlusion: The upper first molars are: The upper first molars are
key to occlusion, and the upper and lower molarskey to occlusion, and the upper and lower molars
should be related such that the mesio-buccalshould be related such that the mesio-buccal
cusp of the upper molar occludes in the buccalcusp of the upper molar occludes in the buccal
groove of the lower molar.groove of the lower molar.
If this molar relationship existed and the teethIf this molar relationship existed and the teeth
were arranged on a smoothly curving line ofwere arranged on a smoothly curving line of
occlusion, then normal occlusion would result.occlusion, then normal occlusion would result.

LINE OF OCCLUSIONLINE OF OCCLUSION

CLASS I MALOCCLUSIONCLASS I MALOCCLUSION
• Normal relationship of the molars , but lineNormal relationship of the molars , but line
of occlusion incorrect because ofof occlusion incorrect because of
malposed teeth , rotations , or othermalposed teeth , rotations , or other
causescauses

CLASS I MALOCCLUSIONCLASS I MALOCCLUSION

• Maxilla & Mandible in normal relationshipMaxilla & Mandible in normal relationship
• Dental dysplasiaDental dysplasia
• RotationsRotations
• Individual tooth malpositionsIndividual tooth malpositions
• Missing teethMissing teeth
• Tooth size discrepancyTooth size discrepancy
• Bimaxillary protrusionBimaxillary protrusion
• Anterior open bite may be presentAnterior open bite may be present

CLASS II MALOCCLUSIONCLASS II MALOCCLUSION
• Lower molar distal to upper molar , relationshipLower molar distal to upper molar , relationship
of other teeth to line of occlusion not specifiedof other teeth to line of occlusion not specified
• As reflected by first permanent molarAs reflected by first permanent molar
relationship mesiobuccal groove of mandibularrelationship mesiobuccal groove of mandibular
first molar no longer receives mesiobuccal cuspfirst molar no longer receives mesiobuccal cusp
of maxillary first molar but usually contactsof maxillary first molar but usually contacts
distobuccal cusp of maxillary first molar or maydistobuccal cusp of maxillary first molar or may
be even farther posteriorbe even farther posterior
• distoclusiondistoclusion

CLASS II DIVISION 1CLASS II DIVISION 1
• Hypotonic upper lipHypotonic upper lip
• V shaped upper archV shaped upper arch
• Abnormal muscle functionAbnormal muscle function
• Increased overjetIncreased overjet
• Lower lip cushions to lingual aspect ofLower lip cushions to lingual aspect of
upper teethupper teeth
• Tongue occupies lower postureTongue occupies lower posture

• Abnormal mentalis activityAbnormal mentalis activity
• Aberrant buccinator activity + abnormalAberrant buccinator activity + abnormal
mentalis activity + changed tonguementalis activity + changed tongue
position = accentuation of narrowing ofposition = accentuation of narrowing of
maxilla , protrusion , spacingmaxilla , protrusion , spacing
• Supraversion of mandibular incisorsSupraversion of mandibular incisors
• Increased overjet & overbiteIncreased overjet & overbite

• Excessive lingual inclination of maxillary centralExcessive lingual inclination of maxillary central
incisors with excessive labial inclination ofincisors with excessive labial inclination of
maxillary lateral incisorsmaxillary lateral incisors
• Individual irregularities may or may not beIndividual irregularities may or may not be
present in mandibular archpresent in mandibular arch
• Deep anterior overbiteDeep anterior overbite
• Mandibular labial gingival tissue traumatizedMandibular labial gingival tissue traumatized
• Maxillary arch wider in intercanine areaMaxillary arch wider in intercanine area
• Variations may occurVariations may occur

• Normal perioral muscle functionNormal perioral muscle function
• Because of ‘closed bite’ & excessiveBecause of ‘closed bite’ & excessive
interocclusal clearance certain functionalinterocclusal clearance certain functional
problemsproblems
• Abnormal path of closureAbnormal path of closure

CLASS III MALOCCLUSIONCLASS III MALOCCLUSION
• Lower molar mesial to upper molar , relationshipLower molar mesial to upper molar , relationship
of other teeth to line of occlusion not specifiedof other teeth to line of occlusion not specified
• Mandibular incisors may be in total cross bite toMandibular incisors may be in total cross bite to
maxillary incisorsmaxillary incisors
• Mostly in spite of cross bite mandibular incisorsMostly in spite of cross bite mandibular incisors
are excessively inclined to lingual aspectare excessively inclined to lingual aspect
• Frequent individual tooth irregularitiesFrequent individual tooth irregularities
• Greater Space for tongueGreater Space for tongue

• Maxillary arch constrictionMaxillary arch constriction
• Maxillary incisors more lingually inclined -Maxillary incisors more lingually inclined -
‘pseudo class III malocclusion’‘pseudo class III malocclusion’

CLASS III MALOCCLUSIONCLASS III MALOCCLUSION

Drawbacks of Angle’s classificationDrawbacks of Angle’s classification
1. Considers malocclusion only in antero-1. Considers malocclusion only in antero-
posterior relations .posterior relations .
2. If molars are absent – cannot classify.2. If molars are absent – cannot classify.
3. Does not describe skeletal relationship.3. Does not describe skeletal relationship.
4. Maxillary and mandibular molars are not4. Maxillary and mandibular molars are not
fixed points in the skull anatomyfixed points in the skull anatomy
5. Cannot be applied to deciduous dentition.5. Cannot be applied to deciduous dentition.

6. Severity of malocclusion cannot be described.6. Severity of malocclusion cannot be described.
7.Does not consider vertical/ transverse relation.7.Does not consider vertical/ transverse relation.
8. Individual tooth malrelation is not considered.8. Individual tooth malrelation is not considered.
9.Does not differentiate skeletal/ dental mal-9.Does not differentiate skeletal/ dental mal-
relation.relation.
10. Didn’t explain about :10. Didn’t explain about :
Soft tissuesSoft tissues
TMJ associated problemsTMJ associated problems
EtiologyEtiology

ANGLE’S CLASSIFICATIONANGLE’S CLASSIFICATION
REVISITED: A MODIFIED ANGLEREVISITED: A MODIFIED ANGLE
CLASSIFICATIONCLASSIFICATION
• By Morton KatzBy Morton Katz
• A questionnaire was developedA questionnaire was developed
• A sample of 347 orthodontists (representingA sample of 347 orthodontists (representing
approximately 5% of the active Americanapproximately 5% of the active American
Association of Orthodontists (AAO) membersAssociation of Orthodontists (AAO) members
residing in the United states) was selected fromresiding in the United states) was selected from
the 1987 AAO directory of members.the 1987 AAO directory of members.
• A variety of plaster models were selected: threeA variety of plaster models were selected: three
had ideal intermeshing (to act as controls), andhad ideal intermeshing (to act as controls), and
the remainder were Class II tendency, to varyingthe remainder were Class II tendency, to varying
degrees.degrees. www.indiandentalacademy.comwww.indiandentalacademy.com

• Result - In the tabulation of the raw data (TableResult - In the tabulation of the raw data (Table
I), five categories were used: Class I, Class II,I), five categories were used: Class I, Class II,
Class III, Miscellaneous, and skipped. The firstClass III, Miscellaneous, and skipped. The first
three categories are self-explanatory, but 10% ofthree categories are self-explanatory, but 10% of
the classification responses did not fit thesethe classification responses did not fit these
Angle classes. They were personal, descriptiveAngle classes. They were personal, descriptive
classifications, because many respondentsclassifications, because many respondents
believed pure Angle classification could not bebelieved pure Angle classification could not be
applied. These efforts were grouped asapplied. These efforts were grouped as
miscellaneous. In some instances, themiscellaneous. In some instances, the
respondent inadvertently skipped classifying onerespondent inadvertently skipped classifying one
of the models, and this situation was tabulatedof the models, and this situation was tabulated
as skipped.as skipped.

• CONCLUSIONCONCLUSION
• The results of this study illustrated the concernsThe results of this study illustrated the concerns
many practitioners have that the currentmany practitioners have that the current
application of Angle's system to specificapplication of Angle's system to specific
malocclusions was inconsistent. This studymalocclusions was inconsistent. This study
indicated that further thought should be given toindicated that further thought should be given to
improving classification methodsimproving classification methods

• The classification by Angle had Class II as a fullThe classification by Angle had Class II as a full
premolar-width distoclusion and Class III as apremolar-width distoclusion and Class III as a
full premolar-width mesioclusion. Assuming anfull premolar-width mesioclusion. Assuming an
average premolar width of 7.5 mm, then Class Iaverage premolar width of 7.5 mm, then Class I
ranged from 7 mm mesioclusion to 7 mmranged from 7 mm mesioclusion to 7 mm
distoclusion, for a total range of Class I of 14distoclusion, for a total range of Class I of 14
mm. This range was far too broad, and so inmm. This range was far too broad, and so in
1907, Angle revised his definition, making Class1907, Angle revised his definition, making Class
II more than half of a cusp distoclusion andII more than half of a cusp distoclusion and
Class III more than half of a cusp mesioclusion.Class III more than half of a cusp mesioclusion.
Angle's modification reduced the range from 14Angle's modification reduced the range from 14
mm to a 7 mm range.mm to a 7 mm range.www.indiandentalacademy.comwww.indiandentalacademy.com

• Since many orthodontistsSince many orthodontists
consider class I as goal ofconsider class I as goal of
successful treatment,successful treatment,
therefore, it wastherefore, it was
necessary to redefinenecessary to redefine
class I malocclusion.class I malocclusion.
• However, the large 7mm.However, the large 7mm.
range of class I has beenrange of class I has been
discarded in this modifieddiscarded in this modified
version and all the teethversion and all the teeth
visible from buccal viewvisible from buccal view
must occlude with twomust occlude with two
antagonist teeth as Angleantagonist teeth as Angle
demanded for idealdemanded for ideal
occlusion .occlusion .

MODIFIED ANGLE’SMODIFIED ANGLE’S
CLASSIFICATIONCLASSIFICATION
A premolar-derivedA premolar-derived
classification.classification.
• Class I:Class I: The mostThe most
anterior upperanterior upper
premolar fits exactlypremolar fits exactly
into the embrasureinto the embrasure
created by the distalcreated by the distal
contact of the mostcontact of the most
anterior loweranterior lower
premolar.premolar.

• Class II relatedClass II related
molars:molars: when onewhen one
upper premolarupper premolar
correctly opposes twocorrectly opposes two
lower premolars.lower premolars.
• Class III relatedClass III related
molars:molars: when twowhen two
upper premolarsupper premolars
oppose one loweroppose one lower
premolar.premolar.

Mixed DentitionMixed Dentition
• Central axis of upperCentral axis of upper
first deciduous molarfirst deciduous molar
bisects embrasurebisects embrasure
between two lowerbetween two lower
deciduous molars indeciduous molars in
modified Class I.modified Class I.

• upper first deciduousupper first deciduous
molar is prematurelymolar is prematurely
lost, a line drawnlost, a line drawn
through the centerthrough the center
axis of the edentulousaxis of the edentulous
space should bisectspace should bisect
the embrasurethe embrasure
between the twobetween the two
lower deciduouslower deciduous
molarsmolars

Quantifying the ClassificationQuantifying the Classification
• This proposed modified classification designatesThis proposed modified classification designates
ideal cusp-embrasure occlusion (as describedideal cusp-embrasure occlusion (as described
by Angle) as zero (0). A plus sign (+) designatesby Angle) as zero (0). A plus sign (+) designates
Class II direction and a minus sign (– )Class II direction and a minus sign (– )
designates Class III tendency. In this article thedesignates Class III tendency. In this article the
right side is evaluated first, then the left side.right side is evaluated first, then the left side.
Ideal occlusion on both right and left sides is,Ideal occlusion on both right and left sides is,
therefore, (0,0).therefore, (0,0).

Bennett’sBennett’s classificationclassification,, 19121912
Classification based on etiologyClassification based on etiology
class 1;class 1; Abnormal position of one or moreAbnormal position of one or more
teeth due to local causesteeth due to local causes
class 2;class 2; Abnormal formation of a part orAbnormal formation of a part or
whole of either arch due developmentalwhole of either arch due developmental
defects of bonedefects of bone
class 3;class 3; Abnormal relationship betweenAbnormal relationship between
upper and lower arches,and between eitherupper and lower arches,and between either
arch and facial contour and correlatedarch and facial contour and correlated
abnormal formation of either archabnormal formation of either arch

Dewey’s modificationDewey’s modification
(1915)(1915)
Modified Angle’s class I and class III classifications.Modified Angle’s class I and class III classifications.
• Modification of class IModification of class I
class I molar relation with :class I molar relation with :
Type 1:Type 1: bunched or crowded maxillary anteriorbunched or crowded maxillary anterior
teethteeth
Type 2:Type 2: maxillary incisors in labioversionmaxillary incisors in labioversion
Type 3:Type 3: maxillary incisors are in linguoversion tomaxillary incisors are in linguoversion to
mandibular incisorsmandibular incisors

Type 4:Type 4: molars occasionally premolars alsomolars occasionally premolars also
premolars are in buccoversion or linguoversionpremolars are in buccoversion or linguoversion
but incisors canines innormal alignmentbut incisors canines innormal alignment
Type 5:Type 5: molars are in mesioversion due to shiftingmolars are in mesioversion due to shifting
following loss of teeth in positions anterior tofollowing loss of teeth in positions anterior to
molars the rest of teeth in normal relationmolars the rest of teeth in normal relation

• Modification of class IIIModification of class III
class III molar relation withclass III molar relation with
Type 1Type 1 –edge to edge incisor relationship.–edge to edge incisor relationship.
Type 2Type 2 –mandibular incisal crowding & in lingual–mandibular incisal crowding & in lingual
relation to maxillarelation to maxilla
Type 3Type 3 – maxillary arch constricted. Maxillary– maxillary arch constricted. Maxillary
incisors are crowded. Mandibular arch is wellincisors are crowded. Mandibular arch is well
developed & mandibular teeth are in normaldeveloped & mandibular teeth are in normal
alignmentalignment

Dewey’s class III type 3, molars inDewey’s class III type 3, molars in
Angle’s class IIIAngle’s class III

Simon’s classificationSimon’s classification
19301930
Based on occlusion of teeth to three differentBased on occlusion of teeth to three different
planes:planes:
1. Frankfort horizontal plane1. Frankfort horizontal plane
2. Orbital plane2. Orbital plane
3. Sagittal plane3. Sagittal plane
1) Frankfort horizontal plane ;1) Frankfort horizontal plane ; explains the verticalexplains the vertical
relationship of teeth to the planerelationship of teeth to the plane
• AttractionAttraction – close to the plane– close to the plane
• AbstractionAbstraction –away from the plane–away from the plane

• 2) Orbital plane -perpendicular plane dropped at2) Orbital plane -perpendicular plane dropped at
right angle to F-H plane from the lower mostright angle to F-H plane from the lower most
border of the bony orbit.border of the bony orbit.
• protractionprotraction
• RetractionRetraction
• Law of cuspids: Normally the orbital planeLaw of cuspids: Normally the orbital plane
passes through the distal third of caninepasses through the distal third of canine
• 3) Sagittal plane - Perpendicularly dropped from3) Sagittal plane - Perpendicularly dropped from
F-H plane and shows Transverse relationship.F-H plane and shows Transverse relationship.
• ContractionContraction
• DistractionDistraction

Lischer’s Modification in 1933Lischer’s Modification in 1933
Used different terminologies for the sameUsed different terminologies for the same
molar relationships, described by Angle.molar relationships, described by Angle.
Neutro - occlusion ;Neutro - occlusion ; synonymous to Angle’ssynonymous to Angle’s
class I malocclusion.class I malocclusion.
Disto - occlusion ;Disto - occlusion ;synonymous to Angle’ssynonymous to Angle’s
class II malocclusion.class II malocclusion.
Mesio - occlusion ;Mesio - occlusion ; synonymous to Angle’ssynonymous to Angle’s
class III malocclusion.class III malocclusion.

• Buccoclusion – when dental arch,Buccoclusion – when dental arch,
quadrant or group of teeth is buccal toquadrant or group of teeth is buccal to
normalnormal
• LinguoversionLinguoversion
• SupraoclusionSupraoclusion
• InfraoclusionInfraoclusion

Mixed DentitionMixed Dentition

SKELETAL CLASSIFICATION BYSKELETAL CLASSIFICATION BY
SALZMANN IN 1950SALZMANN IN 1950
• Skeletal class I – dental malocclusionsSkeletal class I – dental malocclusions
Division 1- incisors, canine & premolarsDivision 1- incisors, canine & premolars
Division 2- maxillary incisor protrusionDivision 2- maxillary incisor protrusion
Division 3- maxillary incisors in linguoversionDivision 3- maxillary incisors in linguoversion
Division 4- bimaxillary protrusionDivision 4- bimaxillary protrusion
• Skeletal class II – malocclusions with subnormal distalSkeletal class II – malocclusions with subnormal distal
mandibular development in relation to maxillamandibular development in relation to maxilla
Division 1-narrow maxillary arch, crowding in canineDivision 1-narrow maxillary arch, crowding in canine
region, decreased facial height, retrognathic profileregion, decreased facial height, retrognathic profile
Division 2- maxillary incisors are lingually inclined, lateralDivision 2- maxillary incisors are lingually inclined, lateral
incisors normal or in linguoversionincisors normal or in linguoversion
• Skeletal class III – overgrowth of mandible, prognathicSkeletal class III – overgrowth of mandible, prognathic
profileprofile

Ballard’s classificationBallard’s classification
(1964)(1964)
They are malocclusions caused due toThey are malocclusions caused due to
abnormality in maxilla and mandible .abnormality in maxilla and mandible .
The defects can be inThe defects can be in
• Size.Size.
• position .position .
• relationship between the jaw.relationship between the jaw.

Assumptions made in classificationAssumptions made in classification
• Inclinations of incisors within each archInclinations of incisors within each arch
are normal.are normal.
• If this is not so, then dental correction ofIf this is not so, then dental correction of
incisor inclinations are made such that theincisor inclinations are made such that the
lower central will make an angle of aboutlower central will make an angle of about
90 to the mandibular plane and to upper90 to the mandibular plane and to upper
centrals at an angle of 110 to Frankfortcentrals at an angle of 110 to Frankfort
Horizontal plane.Horizontal plane.

SKELETAL MALOCCLUSIONSKELETAL MALOCCLUSION
It is divided into Skeletal class I, II, IIIIt is divided into Skeletal class I, II, III
• Skeletal class I-Skeletal class I- The inclination of teeth isThe inclination of teeth is
normal and the dental base relation is alsonormal and the dental base relation is also
normal. The upward projection of axis ofnormal. The upward projection of axis of
lower incisors would pass through thelower incisors would pass through the
crowns of upper incisors.crowns of upper incisors.

• Skeletal class II- The lower apical base isSkeletal class II- The lower apical base is
relatively too far back. The lower incisor axisrelatively too far back. The lower incisor axis
would pass palatal to the upper incisor crown.would pass palatal to the upper incisor crown.
• Skeletal class III- The lower apical base isSkeletal class III- The lower apical base is
placed relatively too for forward, the projection ofplaced relatively too for forward, the projection of
lower incisor axis would pass labial to upperlower incisor axis would pass labial to upper
incisor crownincisor crown

INCISOR CLASSIFICATIONINCISOR CLASSIFICATION
• First described by Ballard & Wayman inFirst described by Ballard & Wayman in
19641964
• Now been widely adopted in UK & formsNow been widely adopted in UK & forms
the British Standard Institute’s (1983)the British Standard Institute’s (1983)
classification of malocclusionclassification of malocclusion

• CLASS I – the lower incisor edges occludeCLASS I – the lower incisor edges occlude
with or lie immediately below the cingulumwith or lie immediately below the cingulum
plateau of the upper central incisorsplateau of the upper central incisors
• CLASS II – the lower incisor edges lieCLASS II – the lower incisor edges lie
posterior to the cingulum plateau of upperposterior to the cingulum plateau of upper
central incisors.central incisors.
division 1- the overjet is increased & upperdivision 1- the overjet is increased & upper
central incisors are proclinedcentral incisors are proclined
division 2- the upper central incisors aredivision 2- the upper central incisors are
retroclined; overjet is usually minimum butretroclined; overjet is usually minimum but
maybe increasedmaybe increased

• Class 3Class 3 : lower incisal edges lie anterior to the: lower incisal edges lie anterior to the
cingulum, plateau of upper incisors andcingulum, plateau of upper incisors and
Overjet or reduced/ reversedOverjet or reduced/ reversed
ModificationModification
a.a. Paying close attention to palatal anatomy ofPaying close attention to palatal anatomy of
maxillary central incisorsmaxillary central incisors
b.b. introducing class II ‘ intermediate’ subdivisionintroducing class II ‘ intermediate’ subdivision
– upper incisors upright but overjet no more– upper incisors upright but overjet no more
than 6 mmthan 6 mm
c.c. class III category only when three or moreclass III category only when three or more
incisors were in class III relationshipincisors were in class III relationship

Canine classificationCanine classification
• Class I – mesial incline of maxillary canineClass I – mesial incline of maxillary canine
overlaps distal incline of mandibular canineoverlaps distal incline of mandibular canine
• Class II – distal incline of maxillary molarClass II – distal incline of maxillary molar
overlaps mesial incline of mandibular canineoverlaps mesial incline of mandibular canine
• Class III – mandibular canine more anteriorlyClass III – mandibular canine more anteriorly
placed. There is no overlapping of caninesplaced. There is no overlapping of canines

Class IClass I

Class IIIClass III

Ackermann – Proffit ClassificationAckermann – Proffit Classification
(1960’s)(1960’s)
• Minimum of five characteristics for completeMinimum of five characteristics for complete
diagnostic evaluationdiagnostic evaluation
1.1. Evaluation of crowding & asymmetry within theEvaluation of crowding & asymmetry within the
arch & evaluation of incisor protrusionarch & evaluation of incisor protrusion
2.2. Recognizes the relationship betweenRecognizes the relationship between
protrusion & crowdingprotrusion & crowding
3.3. Includes transverse, sagittal & vertical planesIncludes transverse, sagittal & vertical planes
of spaceof space
4.4. Skeletal jaw proportions are also incorporatedSkeletal jaw proportions are also incorporated
5.5. Readily adaptable to computer procesingReadily adaptable to computer procesingwww.indiandentalacademy.comwww.indiandentalacademy.com

ADDITIONS TO THE FIVE-ADDITIONS TO THE FIVE-
CHARACTERISTICS CLASSIFICATIONCHARACTERISTICS CLASSIFICATION
SYSTEMSYSTEM
1.1. Evaluating the ‘ Esthetic line of the dentition’Evaluating the ‘ Esthetic line of the dentition’
• Angle’s line of occlusion- hidden from viewAngle’s line of occlusion- hidden from view
when maxillary & mandibular teeth in contact.when maxillary & mandibular teeth in contact.
• Esthetic line of occlusion evaluates anteriorEsthetic line of occlusion evaluates anterior
tooth display incorporates tooth liptooth display incorporates tooth lip
relationshipsrelationships
• Follows the facial edges of maxillary anterior &Follows the facial edges of maxillary anterior &
posterior teethposterior teeth

2.2. Pitch , Roll And Yaw inPitch , Roll And Yaw in
Systematic DescriptionSystematic Description
• Particularly useful way to evaluate theParticularly useful way to evaluate the
relationship of teeth to soft tissues thatrelationship of teeth to soft tissues that
frame their displayframe their display

1.1. Dentofacial appearance – FacialDentofacial appearance – Facial
proportions, anterior tooth display,proportions, anterior tooth display,
orientation of the esthetic line oforientation of the esthetic line of
occlusion, profile.occlusion, profile.
2.2. Alignment – Crowding/ spacing, archAlignment – Crowding/ spacing, arch
form, symmetry, orientation of the line ofform, symmetry, orientation of the line of
occlusion.occlusion.
3.3. Anteroposterior – Angle’s classification,Anteroposterior – Angle’s classification,
skeletal & dental.skeletal & dental.

4. Transverse – crossbites, skeletal &4. Transverse – crossbites, skeletal &
dentaldental
5. Vertical – bite depth, skeletal & dental5. Vertical – bite depth, skeletal & dental

W.H.O ClassificationW.H.O Classification
(Geneva)(Geneva)
• K00 DISORDERS OF TOOTH DEVELOPMENTK00 DISORDERS OF TOOTH DEVELOPMENT
AND ERUPTIONAND ERUPTION
• K00.0 AnodontiaK00.0 Anodontia
K00.00 Partial anodontiaK00.00 Partial anodontia
K00.01 Total anodontiaK00.01 Total anodontia
K00.09 Anodontia, unspecifiedK00.09 Anodontia, unspecified

• K00.1 Supernumerary teethK00.1 Supernumerary teeth
Includes : supplementary teethIncludes : supplementary teeth
Excludes : impacted supernumeraryExcludes : impacted supernumerary
teeth( K01.18)teeth( K01.18)
K00.10 incisor & canine regionsK00.10 incisor & canine regions
K00.11 premolar regionK00.11 premolar region
K00.12 molar regionK00.12 molar region
K00.19 supernumerary teeth unspecifiedK00.19 supernumerary teeth unspecified

• K00.2 Abnormalities of size & form of teethK00.2 Abnormalities of size & form of teeth
K00.20 macrodontiaK00.20 macrodontia
K00.21 microdontiaK00.21 microdontia
K00.22 concrescenceK00.22 concrescence
K00.23 fusion & geminationK00.23 fusion & gemination
K00.24 dens evaginatusK00.24 dens evaginatus
K00.25 dens invaginatus & incisor anomaliesK00.25 dens invaginatus & incisor anomalies
K00.26 enamel pearlK00.26 enamel pearl
K00.27 taurodontismK00.27 taurodontism
K00.28 other & unspecified abnormalities of sizeK00.28 other & unspecified abnormalities of size
& form& form

• K00.3 mottled teethK00.3 mottled teeth
K00.30 endemic mottling of enamelK00.30 endemic mottling of enamel
K00.31 non endemic mottling of enamelK00.31 non endemic mottling of enamel
K00.39 mottled enamelK00.39 mottled enamel
• K00.4 Disturbances in tooth formationK00.4 Disturbances in tooth formation
K00.40 enamel hypoplasiaK00.40 enamel hypoplasia
K00.41 prenatal enamel hypoplasiaK00.41 prenatal enamel hypoplasia
K00.42 neonatal enamel hypoplasiaK00.42 neonatal enamel hypoplasia
K00.43 aplasia & hypoplasia of cementumK00.43 aplasia & hypoplasia of cementum
K00.44 dilacerationK00.44 dilaceration
K00.45 odontodysplasiaK00.45 odontodysplasia
K00.46 turner’s toothK00.46 turner’s tooth
K00.48 other specified disturbances in toothK00.48 other specified disturbances in tooth
formationformation
K00.49 disturbances in tooth, unspecifiedK00.49 disturbances in tooth, unspecifiedwww.indiandentalacademy.comwww.indiandentalacademy.com

• K00.5 Hereditary disturbances in tooth structure,K00.5 Hereditary disturbances in tooth structure,
not elsewhere classifiednot elsewhere classified
K00.50 amelogenesis imperfectaK00.50 amelogenesis imperfecta
K00.51 dentinogenesis imperfectaK00.51 dentinogenesis imperfecta
K00.52 odontogenesis imperfectaK00.52 odontogenesis imperfecta
K00.58 other hereditary disturbance in toothK00.58 other hereditary disturbance in tooth
structurestructure
K00.59 hereditary disturbances in toothK00.59 hereditary disturbances in tooth
structure, unspecifiedstructure, unspecified

• K00.6 disturbance in tooth eruptionK00.6 disturbance in tooth eruption
K00.60 natal toothK00.60 natal tooth
K00.61 neonatal teethK00.61 neonatal teeth
K00.62 premature eruptionK00.62 premature eruption
K00.63 retained primary teethK00.63 retained primary teeth
K00.64 late eruptionK00.64 late eruption
K00.65 premature shedding of primary teethK00.65 premature shedding of primary teeth
K00.68 other specified disturbances in toothK00.68 other specified disturbances in tooth
K00.69 disturbances in tooth, unspecifiedK00.69 disturbances in tooth, unspecified

• K00.8 other disorders of tooth developmentK00.8 other disorders of tooth development
K00.80 color changes during tooth formation dueK00.80 color changes during tooth formation due
to blood type incompatibilityto blood type incompatibility
K00.81 color changes during tooth formation dueK00.81 color changes during tooth formation due
to malformation of biliary systemto malformation of biliary system
K00.82 color changes during tooth formationK00.82 color changes during tooth formation
due to porphyriadue to porphyria
K00.83 color changes during tooth formationK00.83 color changes during tooth formation
due to tetracyclinedue to tetracycline
Koo.88 other specified disorders of toothKoo.88 other specified disorders of tooth
developmentdevelopment

• K00.9 Disorders of tooth development,K00.9 Disorders of tooth development,
unspecifiedunspecified
• K01 Embedded impacted teethK01 Embedded impacted teeth
• K01.0 embedded teethK01.0 embedded teeth
• K01.1 impacted teethK01.1 impacted teeth
K01.10 maxillary incisorK01.10 maxillary incisor
K01.11 mandibular incisorK01.11 mandibular incisor
K01.12 maxillary canineK01.12 maxillary canine
K01.13 mandibular canineK01.13 mandibular canine
K01.14 maxillary premolarK01.14 maxillary premolar
K01.15 mandibular premolarK01.15 mandibular premolar
K01.16 maxillary molarK01.16 maxillary molar
K01.17 mandibular molarK01.17 mandibular molar
K01.18 supernumerary toothK01.18 supernumerary tooth
K01.19 impacted tooth, unspecifiedK01.19 impacted tooth, unspecifiedwww.indiandentalacademy.comwww.indiandentalacademy.com

• K02 dental cariesK02 dental caries
• K03 Other diseases of hard tissues of teethK03 Other diseases of hard tissues of teeth
• K03.0 excessive attrition of teethK03.0 excessive attrition of teeth
• K03.1 abrasion of teethK03.1 abrasion of teeth
• K03.2 erosion of teethK03.2 erosion of teeth
• K03.3 pathologic resorption of teethK03.3 pathologic resorption of teeth
• K03.4 hypercementosisK03.4 hypercementosis
• K03.5 ankylosis of teethK03.5 ankylosis of teeth
• K03.6 depositsK03.6 deposits
• K03.7 posteruptive color changes of dental hardK03.7 posteruptive color changes of dental hard
tissuestissues
• K03.8 other specified diseases of hard tissues ofK03.8 other specified diseases of hard tissues of
teethteeth
• K03.9 disease hard tissues of teeth, unspecifiedK03.9 disease hard tissues of teeth, unspecifiedwww.indiandentalacademy.comwww.indiandentalacademy.com

K07 dentofacialK07 dentofacial
anomalies(including malocclusion)anomalies(including malocclusion)
• K07.00 - maxillary macrognathismK07.00 - maxillary macrognathism
• K07.01 – Mandibular macrognathismK07.01 – Mandibular macrognathism
• K07.02 – macrognathism, both jawsK07.02 – macrognathism, both jaws
• K07.03 – maxillary micrognathismK07.03 – maxillary micrognathism

• K07.05 – micrognathism, both jaws.K07.05 – micrognathism, both jaws.
• K07.08 – other specified jaw sizeK07.08 – other specified jaw size
anomalies.anomalies.
• K07.09 – anomalies of jaw size ,K07.09 – anomalies of jaw size ,
unspecified.unspecified.

• K07.1 – anomalies of jaw -cranial baseK07.1 – anomalies of jaw -cranial base
relationshipsrelationships
• K07.10 – AsymmetriesK07.10 – Asymmetries
Excludes –Excludes –
Hemifacial atrophy (Q64.40)Hemifacial atrophy (Q64.40)
Hemifacial hypertrophy (Q67.41)Hemifacial hypertrophy (Q67.41)
Unilateral condylar hyperplasia(k10.81)Unilateral condylar hyperplasia(k10.81)
Unilateral condylar hypoplasia(k10.82)Unilateral condylar hypoplasia(k10.82)
• K07.11– mandibular prognathism.K07.11– mandibular prognathism.

• K07.13—Mandibular retrognathism.K07.13—Mandibular retrognathism.
• K07.14– Maxillary retrognathismK07.14– Maxillary retrognathism
• K07.18– Other specified anomalies of jaw-K07.18– Other specified anomalies of jaw-
cranial base relationshipcranial base relationship
• K07.19– Anomaly of jaw -cranial baseK07.19– Anomaly of jaw -cranial base
relationship, unspecifiedrelationship, unspecifiedwww.indiandentalacademy.comwww.indiandentalacademy.com

• K07.2– Anomalies of dental arch relationship.K07.2– Anomalies of dental arch relationship.
• K07.20– Disto-occlusion .K07.20– Disto-occlusion .
• K07.21—Mesio-occlusion.K07.21—Mesio-occlusion.
• KO7.22– Excessive OverjetKO7.22– Excessive Overjet
(horizontal overbite).(horizontal overbite).
• K07.23—Excessive over biteK07.23—Excessive over bitewww.indiandentalacademy.comwww.indiandentalacademy.com

• K07.24—Open bite.K07.24—Open bite.
• K07.25—Cross bite.K07.25—Cross bite.
• K07.26– Midline deviation.K07.26– Midline deviation.
• K07.27—Posterior lingual occlusion ofK07.27—Posterior lingual occlusion of
mandibular teeth.mandibular teeth.
• K07.28– Other specified anomalies of dentalK07.28– Other specified anomalies of dental
arch relationship.arch relationship.
• K07.29– Anomaly of dental arch relationship,K07.29– Anomaly of dental arch relationship,

K07.3– Anomalies of tooth position.K07.3– Anomalies of tooth position.
• K07.30– Crowding.K07.30– Crowding.
• K07.31– Displacement.K07.31– Displacement.
• K07.32– Rotation.K07.32– Rotation.
• K07.33– Spacing (Diastema).K07.33– Spacing (Diastema).

• K07.34– Transposition.K07.34– Transposition.
• K07.35– Embedded or impacted teeth inK07.35– Embedded or impacted teeth in
abnormal position.abnormal position.
• Excludes– Embedded or impacted teeth inExcludes– Embedded or impacted teeth in
normal position.normal position.
• K07.38– Other specified anomalies of toothK07.38– Other specified anomalies of tooth
position.position.
• K07.39– Anomaly of tooth position,K07.39– Anomaly of tooth position,www.indiandentalacademy.comwww.indiandentalacademy.com

• K07.4 – Malocclusion, unspecified.K07.4 – Malocclusion, unspecified.
• K07.5 – Dentofacial functional abnormalities,K07.5 – Dentofacial functional abnormalities,
excluding bruxism (teeth grinding).excluding bruxism (teeth grinding).
• KO7.5O - Abnormal jaw closure.KO7.5O - Abnormal jaw closure.
• KO7.51 – Malocclusion due to abnormalKO7.51 – Malocclusion due to abnormal
swallowing.swallowing.

• KO7.54 – malocclusion due to mouthKO7.54 – malocclusion due to mouth
breathing .breathing .
• KO7.55 - malocclusion due to tongue ,lip orKO7.55 - malocclusion due to tongue ,lip or
finger habits.finger habits.
• KO7.58 - other specified dentofacialKO7.58 - other specified dentofacial
functional abnormalities.functional abnormalities.
• KO7 .59 - dentofacial functionalKO7 .59 - dentofacial functionalwww.indiandentalacademy.comwww.indiandentalacademy.com

• K07.6 temporomandibular joint disordersK07.6 temporomandibular joint disorders
• K08 other disorders of teeth & supportingK08 other disorders of teeth & supporting
structuresstructures

Etiologic ClassificationEtiologic Classification
1.Osseous1.Osseous
Includes abnormal growth, size, shape or proportions ofIncludes abnormal growth, size, shape or proportions of
any bones of craniofacial complexany bones of craniofacial complex
2. Muscular2. Muscular
All problems in malfunction of dentofacial musculatureAll problems in malfunction of dentofacial musculature
or any perversions as they cause distorted growthor any perversions as they cause distorted growth
• Functional slides due to occlusal interferencesFunctional slides due to occlusal interferences
• Detrimental sucking habitsDetrimental sucking habits
• Abnormal patterns of mandibular closureAbnormal patterns of mandibular closure
• Abnormal muscular contactAbnormal muscular contact

3. Dental3. Dental
Includes all malpositions of teethIncludes all malpositions of teeth
• Abnormal numbersAbnormal numbers
• Abnormal sizeAbnormal size
• Conformation/ texture of teethConformation/ texture of teeth
4. Comment4. Comment

Limitations of classificationsLimitations of classifications
• Most classifications do not include the entireMost classifications do not include the entire
region eg, TMJ articulationregion eg, TMJ articulation
• Most do not include entire syndromes orMost do not include entire syndromes or
malocclusion typesmalocclusion types
• Most do not include all dimensionsMost do not include all dimensions
• All are static – done at one moment in time,All are static – done at one moment in time,
future changes might occur with growthfuture changes might occur with growth
• Most are narrow in focus – new ideas cannot beMost are narrow in focus – new ideas cannot be
fit infit in
• Tradition of misuse or misapplicationTradition of misuse or misapplication

BIBLIOGRAPHYBIBLIOGRAPHY
• Morton Katz, Angle Classification Revisited ,Morton Katz, Angle Classification Revisited ,
American Journal Of Orthodontics & DentofacialAmerican Journal Of Orthodontics & Dentofacial
Orthopedics, 1992 August (277 - 284)Orthopedics, 1992 August (277 - 284)
• Edward. H. Angle(1899) Classification OfEdward. H. Angle(1899) Classification Of
Malocclusion, Dental Cosmos(248-264)Malocclusion, Dental Cosmos(248-264)
• T.M GRABER, Orthodontic principal andT.M GRABER, Orthodontic principal and
practice, 3practice, 3rdrd
Edition,(226-252).Edition,(226-252).
• WILLIAM R.PROFIT, ContemporaryWILLIAM R.PROFIT, Contemporary
orthodontics, 3orthodontics, 3rdrd
Edition(2-10, 185-191).Edition(2-10, 185-191).
• WILLIAM R.PROFIT, ContemporaryWILLIAM R.PROFIT, Contemporary
orthodontics,4th Edition(220-229)orthodontics,4th Edition(220-229)
• SAMIR E.BISHARA, Text book of orthodontics ,SAMIR E.BISHARA, Text book of orthodontics ,
33rdrd
Edition(84-93).Edition(84-93).www.indiandentalacademy.comwww.indiandentalacademy.com

• W.J.B Houston Stephens Turley, Textbook OfW.J.B Houston Stephens Turley, Textbook Of
Orthodontics (42-53)Orthodontics (42-53)
• Robert Moyers, Handbook Of Orthodontics,Robert Moyers, Handbook Of Orthodontics,
Fourth Edition.,(183-195)Fourth Edition.,(183-195)
• WORLD HEALTH ORGANIZATION (GENEVA)WORLD HEALTH ORGANIZATION (GENEVA)
1995, Application of the international1995, Application of the international
classification of diseases to dentistry andclassification of diseases to dentistry and
stomatology, 3stomatology, 3rdrd
Ed,(69-71)Ed,(69-71)
• T.C WHITE, J.H GARDINER,B.C LEIGHTONT.C WHITE, J.H GARDINER,B.C LEIGHTON
Orthodontic for dental students,3Orthodontic for dental students,3rdrd
Ed.,Ed.,
MacMillan;(58-80).(253-254)MacMillan;(58-80).(253-254)
• J.A Salzmann, Practice Of Orthodontics,vol 1,J.A Salzmann, Practice Of Orthodontics,vol 1,
(389-428)(389-428)
• Robert . H. Strang, A Textbook Of Orthodontia ,Robert . H. Strang, A Textbook Of Orthodontia ,
(83-110)(83-110) www.indiandentalacademy.comwww.indiandentalacademy.com

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