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Shape of Head
Cephalic index =
Maximum skull width / Maximum skull length


Facial complex attaches to basicranium .thus
the cranial floor acts as a template and
establishes many of the dimensional ,angular
and topographic features of face.
 Dolichocephalic
- narrow ,long protrusive face
- leptoproscopic face
- Eyes are closely set



Dolicocephalic
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-

-

-

Nose is thin ,vertically long and protrusive.there may be
(aqualine)convex nasal contour(Roman nose/Dick Tracy
nose). Tip may point point down.
In some cases,there may be a S-shaped configuration
where the middle part is protrusive relative to the upper
part.
Forehead is more sloping.
Glabella and upper orbital rims are prominent
Face is more angular with deep set eyes.
Long midface and obtuse cranial base downward and
backward rotation of mandibleretrusive mandible and
lower lip, retrognathic (convex ) facial profile
Slumped head posture

Brachycephalic
-

-

-

Broad , less protrusive face
Euryprosopic type
Eyes are wide apart thus the nose is wide ,pug
like,short with rounded tip
Straight forehead with thin frontal sinus
Face is less angular and more flat
Cheekbones are prominent
Eyes are exopthalmic
Lower jaw is protrusive
Profile may be straight or concave
Erect head posture

Dinaric
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Named after dinaric mountains in Yugoslavia
Anterio-posterior short head like in brachycephalics.
Wide and / flat occipital/ lamboidal regions
Bossing of parietal region
Skull appears triangular from above
Anterior part is narrow like in dolicocephalic
Face is leptoproscopic,long protrusive
Ear is characteristically closer to head due to occipital
flattening .
Large and aquiline nose.


Shape of Head
Classification and index values according to Martin and
Saller,
Dolicocephalic (x – 75.9)
- Long and narrow head
- anterior cranial fossa is narrow and long thus
maxilla is narrow and palate is deep.
- They have narrow dental arches


Shape of Head
Mesocephalic (76.0 – 80.9)
- Average shape of head
- They have normal dental arches


Shape of Head
Brachycephalic (81.0 – 85.4)
- Broad and short head
-Anterior cranial fossa is broad and short thus
maxilla is wide and palate is shallow
- They have broad dental arches
Hyper Brachycephalic (85.5 – x)


Facial Form
Morphologic facial height  distance between
nasion & gnathion
Bizygomatic width  distance between the
zygoma points.
Morphologic facial index =
Morphologic facial height /
Bizygomatic width


Facial Form
Classification and index values according to Martin
and Saller,
Hyper Euryprosopic (x – 78.9).
-Wide base of jaw
-In case of dental crowding,it is usually
coronal crowding.
-Transverse expansion is indicated.
Euryprosopic – Broad and short face (79.0 – 83.9)


Facial Form
- Mesoprosopic – Average or normal face
(84.0 – 87.9)


Facial Form
Leptoprosopic – Long & narrow face (88– 92.9)
- Apical base is narrow
- In cases of maxillary crowding, there is
not only coronal crowding but also apical.
- Extraction is indicated.
- Mandibular plane and gonial angles are
usually quite obtuse, with appearance of
a longer lower face height
Hyper Leptoprosopic (93.0 - x)

Facial Form


Face can be divided into 3 equal parts. By
horizontal lines adjacent to hairline, Nasal
base and Menton.


Facial Form


Increased facial height is due to vertical maxillary
excess or excessive lower facial height.



Decreased face height is due to vertical maxillary
deficiency, mandibular deficiency with diminished
mandibular body or ramus height or short chin
height.


Facial Form - Rule of Fifths


The face is divided sagittally into 5 equal parts
from helix to helix of outer ears, all measuring the
width of one eye.

Alar width should coincide
with inter canthal distance
and commissural width
should coincide with
medial limbus of eyes.


Facial Profile


It is determined by a line joining the nasion with
Point A & Point B. It helps in diagnosing gross
deviations in maxillo mandibular relationship. It
also evaluates the lip posture ,incisor
prominence, vertical facial proportions and
mandibular plain angle.


Facial Profile


Facial Profile
Orthognathic – All the 3 points are in the same
plane
Convex – Point A is ahead. Seen in Class II jaw
relationship
Concave – Point B is ahead. Seen in Class III
jaw relationship


Facial Divergence


It is the anterior or posterior inclination of
the lower face relative to the forehead.
Straight
Anterior divergence
Posterior divergence


Facial Symmetry


Asymmetries that are gross and easily detectable
should be recorded.


Facial Symmetry


a)

b)
c)

Etiology of asymmetry includes:
Genetic or congenital malformations e.g.
Hemifacial microsomia and unilateral clefts of
the lip and palate;
Environmental factors, e.g. habits and trauma
Functional deviations, e.g. mandibular shifts
as a result of tooth interferences.


Lips


Normally upper and lower lip touch each other
when the jaws are at rest to form a lip seal. The
upper lip is 2-3 mm above the incisal edge of the
upper central incisor. The lower lip extends up to
the incisal third of labial surface of upper
anteriors.


Lip line
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It is the relationship of the lower lip to upper
central incisor.
In class II div 1- lip line will be lower
In class II div 2 – lip line will be higher


Lip seal


Based on the lip seal the lips can be classified as
Competent – Lips are in slight contact when the
musculature is relaxed


Lip seal

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Incompetent – They are morphologically short lips which do
not form a lip seal in relaxed state. Lip seal is achieved only
by active contraction of orbicularis oris and circumoral
muscles.
(a) Short Upper Lip
(b) Short Lower Lip


Lip seal
Potentially Incompetent – Normal lips that fail to
form a lip seal due to protruding upper incisors.


Lip seal



Everted / Curled – They are hypertrophic lips
with redundant tissue but weak muscular
tonicity.


Lip Projection


According to ideal E-Line relationship
(Ricketts – E esthetic line) lower lip should
coincide with a line from the nasal tip to
anterior chin and upper lip should be 1 mm
behind it.


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According to Reed Holdaways ,H
line(harmony line)is a tangent lip from the tip
of the upper lip.the depth of upper lip sulcus
is measured from this point.normal value- 2.5
mm
It varies with thickness of lips(+/- 1.5 mm)
Lip strain decreased depth
Lip redundancy or jaw overclosure
increased depth

Lip Projection




Lip projection is affected by both dental and skeletal
protrusion or retrusion. Lip projection is an important
factor in facial esthetics and it decreases with ageing.
Lip prominence can also be evaluated by relating the
upper lip to a true vertical line passing through the
concavity at the base of upper lip and relating the
lower lip to a similar true vertical line passing through
a point in the concavity between the lower lip and
chin.


Lip Projection
If the lip is forward to the line, it is prominent.
If it falls behind the line, it is retrusive.
 If both the lips are prominent and are separated by
more than 3-4 mm, it indicates dento alveolar
protrusion.



Lips
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When the upper lip tubercle lies superior to the
adjacent vermilion or is entirely absent, it is called as
gull wing deformity.
Vertical maxillary excessexcessive tooth exposure
from embrasure to embrasure
Gull wing deformity excessive exposure of central
incisors with progressively less tooth exposure
laterally.

Dentofacial deformity volume I Epker and Stella


Lip step
It gives us the relation of lower lip to upper lip.
 According to korkhaus
 Positive lip step-Protrusion of lower lip in relation to
upper lip
 Negative lip step- Protrusion of upper lip in relation to
lower lip
 Normal- slightly negative
Orthodontic diagnosis – Thomas Rakosi


Smile Evaluation
1.

Amount of incisor display - It may be the entire or
only a percentage of upper incisor.


Smile Evaluation
2.

3.

Crown height and width – Height is normally
9 – 12 mm. With age, it increases due to
apical migration. Width-height ratio for
central incisors is 8:10

Gingival Display – A gummy smile is
considered more esthetic than a smile with
diminished tooth display.


Smile Evaluation
4.

Smile arc – It is the relationship of the
curvature of the incisor edges of maxillary
incisors and canines to the curvature of
lower lip in posed social smile.


Smile Evaluation
It can be,
 Consonant – It is the ideal smile arc with
maxillary incisal edge curvature parallel to
curvature of lower lip on smile
 Non Consonant – It is flat smile arc
characterized by maxillary incisal edge
curvature being flatter than the curvature of
lower lip.
 Reversed

Smile Evaluation
5.

Buccal Corridor Width – It is measured from
mesial line angle of maxillary first premolars
to interior portion of commissure of lips.
Buccal corridor width= inter commissure
width / distance from 1st premolar to 1st
premolar.
Excessive width is referred to as negative
space.

Smile Evaluation
6.

Amount of incisor Proclination
It has dramatic effects on incisor display.
Flared maxillary incisor reduces incisor
display and upright maxillary incisors
increases incisor display.


Mentolabial Sulcus




It is the concavity below the lower lip. It is
deep in Class II Division I malocclusions and
shallow in bimaxillary protrusions.
It is a feature of hyperactivity of mentalis
muscle.


Nasolabial Angle
It is the angle formed between lower border of nose
and the line connecting the intersection of nose and
upper lip with the tip of lip.
Normal value is 110 .
Increased value is seen in
retroclined maxillary anteriors.
Decreased value is seen in
proclined maxillary anteriors
or prognathic maxilla.



Chin


Projection of chin depends on bony projection
of anterio-inferior border of mandible and
amount of soft tissue over lying that bony
projection.



Prominent chin is seen in Class III
malocclusions.
Recessive chin is seen in Class II
malocclusions

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Clinical FMA


Clinical examination of mandibular plane to the true
horizontal plane should be noted.

Steep Mandibular Plane Angle: Long anterior facial vertical dimensions
 Open bite


Flat Mandibular Plane Angle: Short anterior facial height
 Deep bite
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Clinical FMA


It is visualized by placing a finger or a mirror
handle along the lower border of mandible.


Visualized Treatment
Objective




This examination helps us decide whether
any functional appliance that postures the
mandible forward will improve the facial
profile and appearance.
Patient is instructed to swallow,lick the lips
and then relax.His profile with teeth in
habitual occlusion is observed.He is then
asked to bring the mandible forward into a
correct sagittal relationship reducing the over
jet.

Profile does not improve when
-Excessive anterior facial height
-Procumbency of lower incisors
-Deficient symphyseal development
-Steep mandibular plane


Improved profile is seen in
-Anteriorly rotating growth patterns
-Functional retrusion
-Deep overbites
-Excessive interocclusal clearances with
normally positioned maxilla



Visualized Treatment
Objective
It helps in predicting treatment changes that
would occur in the future for the patient.


The accuracy of prediction is a combination of
the effect of treatment procedures and accuracy
of predicting future growth.


They are not very accurate but may act as
rough estimate of actual outcome.



Functional examination
Respiration
Mirror test – A double-sided mirror is held
between the nose and the mouth. Fogging on
nasal side of mirror indicates nasal breathing and
fogging on oral side indicates oral breathing.


Cotton Test – A butterfly shaped piece of cotton is
placed over the upper lip below the nostrils. If the
cotton flutters down, it indicates nasal breathing



Respiration


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Water Test – Patient fills the mouth with water
and retains it for some time. Oral breathers
fail to perform this test.
Observation of external nares – The external
nares dilate during inspiration for nasal
breathers. No change is observed in oral
breathers


Path of closure


During closure of mandible, it can undergo
both rotational + sliding movements.



Types of movements during closure,

 Pure rotational
 Rotational movement with an anterior sliding
component
 Rotational movement with posterior sliding
component.

Path of closure


Class II Malocclusion


Path of closure


Class III Malocclusion


Postural Rest Position
It is 2-3 mm below & behind the centric occlusion
(recorded at canine). This position depends on
head posture, thus patient should be completely
relaxed, sitting upright and looking straight ahead.
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Phonetic Method
-Pronounce consonant like M or words like Ram,
Mississippi
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Command Method
-Command patient to swallow saliva
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-

-

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Non Command Method
Distract the patient + note the mandibular
position when patient relaxes.

Combined
Palpate the sub mental region to ascertain
that the muscles are relaxed.


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Influences

Short Term

Long Term

1. Inconsistency in
muscle tonicity
2. Respiration
3. Body Posture
4. Stress
5. TMS dysfunction

1. Attrition
2. Premature loss of
teeth
3. Diseases of neuro
muscular system


Interocclusal clearance


It is the distance between the upper and
lower canines when they mandible is at the
postural rest position.



It is usually 2-3mm.

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It is increased in cases with decreased
vertical development of buccal segments.


Temporo Mandibular Joint


Auscultation: -

 Initial Clicking- Retruded condyle in relation to
articular disc
 Intermediate Clicking- Uneven condylar surface
+ articular disc surface
 Terminal Clicking- Most Common – Condyle is
moved too far anteriorly in relation to disc on
max. jaw opening
 Reciprocal Clicking-Displaced condyle + disc
occurs during opening & closing

Temporo Mandibular Joint
 Pain on Palpation – Lateral pterygoid muscle
palpatory pain is common in children.
 Masseter muscle pain is also seen in
children


- Check for coordinated condylar
movements


Range of motion


Maximum mouth opening - It is measured as the
distance between the upper and lower incisal
edges.it is usually 4-4.5 cm. It is measured using
a bole gauge.in case of overbite,the amount of
overbite is added to inter incisal distance.



In case of open bite,its value is subtracted from
inter incisal distance.

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Protrusion-The patient is asked to protrude the
mandible forward to the maximum.

Range of motion


Lateral excursions - The patient is asked to
move the mandible laterally and the distance
between the midline of upper and lower
dentition is measured.



It should be same on both the right and the
left sides


Intra Oral Examination


Soft Tissues


ORAL HYGIENE STATUS & BRUSHING
HABITS



Rapid Orthodontic treatment requires the
patient to maintain a good Oral Hygiene. Poor
Oral Hygiene causes debonding of the
bracket, delayed tooth movement, increased
pre-disposition to caries and gingival
diseases.

Gingiva


Localised gingival lesions may suggest,

Traumatic occlusion
Poor oral hygiene
Delayed eruption of permanent teeth
Hyper activity of mentalis muscle
Mouth breathing


Gingiva
The texture and colour of gingival tissue is an index of
periodontal health.
Gingival diseases and periodontal diseases have a
direct and highly localized effect on the teeth. They may
cause loss of teeth, changes in closure pattern of
mandible, teeth ankylosis



Frenal Attachment
A thick, fibrous, low maxillary frenum may lead to malocclusion
by leading to a midline diastema. The mandibular labial frenum
can exert a strong pull on gingival leading to recession.
Blanch test can confirm the diagnosis of high frenal
attachment. The upper lip is pulled in an upward and
Outward direction. Presence of
blanching in the papilla
indicates abnormal frenal


attachment.




Tongue
Size: The tongue can be small, long or broad. A long
tongue can usually reach the tip of the nose.
Macroglossia implies a large tongue.


Position:
It may be affected by enlarged tonsils/adenoids
In class III cases, the tongue is broad and low lying
and extends over the dental arches. In such cases, the
size of the dental arch should not be decreased by
further Orthodontic treatment (Eg:- Extractions)



Tongue
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Movements:
They may be restricted due to ankyloglossia.
Proffit has stated that the resting pressure of
the tongue is one of the primary factors in the
maintenance of dental equilibrium


Palatal Contour
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The palate may be,
- Shallow
- Normal
- Deep

Shallow palate may be seen in broad arch forms
Deep palate is common in class II cases and in
children with oral habits.


Circumoral muscle tone


Abnormal circumoral muscle tone tends to
accentuate the developing malocclusions.So,
during treatment such conditions should be
eliminated first to achieve stable results.


Hard Tissues
Teeth present
Number of teeth present,number of deciduous
teeth,number of permanent teeth,teeth which are
missing,teeth which are erupting should be
determined.


This helps us in calculating the dental age of the
patient. A difference of +/- 2.5 years between
dental and skeletal age is considered normal.


Helps us to find over retained
teeth,supernumerary teeth, congenitally absent
teeth which may contribute to malocclusion.



Caries


It is one of the local causes of malocclusion.


Caries


It results in premature loss of tooth leading to
drifting of adjacent tooth, abnormal axial
inclination, over eruption & bone loss. They
should be restored to prevent further infection
or loss of teeth.



Series of proximal carious lesions, if
unrepaired leads to loss of arch length which
may be more than actual tooth loss.

Teeth size shape form
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Variations in size of teeth are seen due to
- sex, males have larger teeth than females
- size and shape of face and head
- racial variations
The incisors may appear large sized in a child
, but it must be remembered that there will be
further facial growth.


Teeth size shape form
Shape
Variations in shape occurs most commonly iin
maxillary lateral incisors.


According to Garn,Lewis and Kerewsky,
The more distal a tooth in each morphologic class is ,
the more likely it is to be subject to greater numerical
variations than the tooth nearer to midline.


All these variations affect the alignment and occlusion
of teeth



Key Ridge


The key ridge is the prominence below
the molar process which divides the
canine from the infra temporal fossa on
the lateral surface of maxillary bone.



Eur J Orthod. 2001 Jun;23(3):263-73.
Location of the centre of resistance of the upper
dentition and the nasomaxillary complex. An
experimental study.
Billiet T, de Pauw G, Dermaut

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


Gnathic examination - Arch
Shape: It can be average,V shaped,U shaped or
square.


Symmetry: Etiology of asymmetry includes: a) Genetic
or congenital malformations e.g. hemifacial microsomia
and unilateral clefts of the lip and palate; b)
Environmental factors, e.g. habits and trauma; c)
Functional deviations, e.g. mandibular shifts as a result
of tooth interferences






Alignment- crowding,spacing,rotation

Crowding


It can be classified according to amount of
space deficiency (Mixed Dentition)

 First Degree
- Slight malalignment of anterior teeth
- No abnormality of supporting zone
 Second Degree
- Pronounced malalignment of anterior teeth
- No abnormality of supporting zone


Crowding
 Third Degree
- Severe malalignment of anterior teeth
- Adjacent permanent teeth undermines the
deciduous teeth due to unusual root resorption.
-

Crowding in conjunction with reduced supporting
zones is difficult to treat.

-

Supporting zones in mixed dentition should be
maintained to provide space for eruption of
permanent teeth.


Crowding
Classification according to etiology.
 Primary - Hereditary
- Disproportion between size of jaws
- Persistence of tooth germ position in
anteriors
- Lingually blocked out lateral incisors
 Secondary - Acquired anomaly
- Prematured loss of deciduous molars
- Mesial drift of posteriors



Crowding
Tertiary
- Primarily lower anterior crowding
- Occurs in 18-20 year olds
- Causes:- Eruption of third molars, Differential
growth termination of upper and lower arches


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
-

-

According to inclination,
Coronal crowding
There is this harmony between width of apical
base and dental arch due to broad apical
base. Thus the posteriors are tipped
Lingually. There is inter dental spacing in the
posteriors and crowding anteriorly.
Treatment - Expansion

Crowding


-

-

Apical crowding
There is disharmony in width of apical base &
maxillary dental arch. Upper posteriors are
tilted buccaly in relation to their apical base.
Upper arch is constricted anteriorly.
Treatment - Extraction


Spacing






Spacing in deciduous dentition is normal.
However in permanent dentition, it is
unesthetic.
It is a result of arch length and tooth width
discrepancy.


Rotations


It may be centric or eccentric.localization of
axis of rotation is important


Curve of Spee
Curve of spee in normal occlusion is not deeper than
1.5 mm. There is good intercuspation around premolars
and molars. The occlusal plane is flat.



Curve of Spee


Reverse curve of spee creates excessive
space in the upper jaw and insufficient space
in the lower jaw. There is open bite anteriorly.


Curve of Spee
Excessive curve of spee restricts the space available
for upper teeth, thus they move towards the mesial
and distal. There is inadequate space in lower arch.
The intercuspation is not normal. There is an
increased over bite.



Angles classification


Dr. Edward Angle described three (3) classes
of malocclusion based on the occlusal
relationship of the first molars


Class I Malocclusion
Mesio buccal cusp of maxillary first permanent molar
occludes in buccal grew of mandibular first permanent
molar. There may be intra arch dental irregularities like,
Crowding
Spacing


Rotations
Anterior-Posterior cross bite
Deep bite
Proclination
Retroclination
Bimaxillary protrusion

Disto- buccal cusp of maxillary first permanent molar
occludes in the buccal grew of mandible.


Division 1: -



Proclined upper incisors
Increased overjet
Convex profile
Short hypotonic upper lip with lip trap
& incompetent lips
Increased over bite
Excessive curve of Spee
Proclinated lower anteriors
Abnormal buccinator and mentalis

Division 2: Retroclined upper central incisors
Overlapping of lateral incisors on central
Deep overbite
Backward path of closure of mandible
Deep mentolabial sulcus

Straight profile with no abnormal muscle activity
Sub Division: Class I relation on one side and Class II relation
on the other side.

Class III Malocclusion



Mesio buccal cusp of maxillary first permanent
molar occludes in the inter dental space between
the mandibular first and second molars.


TRUE Class III
True Class III: It is a skeletal malocclusion showing,
v Edge to edge relationship or anterior cross bite
v Narrow upper arch and broad lower arch
v Crowding in upper teeth and spacing in the lowers
v Concave profile with prominent chin
v May show anterior open bite


Pseudo Class III









(Postural or Habitual Class III): It involves the forward movement of the
mandible during jaw closure.
Causes: Occlusal prematurities
Premature loss of deciduous posteriors
Enlarged adenoids in children


Canine relationship
Class I canine relation-this is a normal relation
where the upper canine overlaps the distal
incline of lower canine
Class II canine relationship- the upper canine
is placed forward. The distal incline of upper
canine inclines with mesial incline of lower
canine.
Class III canine relationship-the lower canine is
placed forward to the upper canine and there is
no overlapping



Incisor relationship
It is based on relationship of lower incisal edge to the
cingulum of upper central incisors.
 Class I
Mandibular incisal edges
occludes
with upper incisor
at a point just below the
cingulum


Incisor relationship
Class II
Mandibular incisal edges lie posterior to the
cingulum of maxillary central incisors
Division 1-- Maxillary central incisors are normal
or proclined with increased overjet
Division 2 -- Maxillary central are retroclined.
Overjet is usually normal but may be increased in
certain cases.
Class III
Mandibular incisal edges lie anterior to cingulum.
There is a reverse overjet



Over Jet


Over jet is the horizontal over lap of the incisors.
Normally the incisors are in contact with the upper
incisors ahead of the lower incisors by the
thickness of the upper edges of maxillary incisors.
I-e 2-3 mm.When it is increased, it is called as
open bite.,


Over Jet




Open bite can classified on the basis of
localization of malocclusion
Anterior open bite
-Caused by tongue dysfunction, digit sucking
habits
-The tongue thrusts forward anteriorly.


Over Jet
Lateral open bite
-Tongue thrusts between the teeth laterally
-There is also a disturbance in physiologic growth
processes around molar region



Over Jet





Complex open bite
-Severe vertical malocclusion
- Teeth occlude only on second molars


Over Bite




It is the vertical over lap of the incisors.
Normally the lower incisal edges contact the
lingual surface of the upper incisors at or
above the cingulum. I-e 1-2 mm.
If it is more than the normal value, it is called
as deep bite.


Deep Bite
Deep bite can be,
Dentally supported
Gingivally supported


In deciduous dentition, incisal overlap of more
than half is considered as deep bite. But, in
genuine deep bite lower anteriors are completely
covered due to increase in height of upper anterior
alveolar process www.indiandentalacademy.com


Over Bite
Closed Bite:It it caused by increased forward and upward rotation
of mandible occurring due to lack of posterior dental
support.
It may be a result of premature extraction of teeth in
mixed dentition.


TROUTEN, JAMES C., ENLOW, DONALD H., RABINE, MILTON, PHELPS,
ARTHUR E., SWEDLOW, DAVID. 1983: Morphologic Factors in Open Bite
and Deep Bite. The Angle Orthodontist: Vol. 53, No. 3, pp. 192–211



Over Bite
Classification according to Hotz and Muhlemann,
True deep over bite
-Large free ray space
-Infra occlusion of molars
-Treatment:- functional appliance
Pseudo deep over bite
-Small free ray space
-Fully erupted molars
-Over eruption of incisors



Vertical Malposition



-

-

-

It is the malocclusion in relation to occlusion
plane. It usually occurs along with irregular
vertical development of alveolar process.
Supra Version / Supra Occlusion: Teeth exceeds the level of occlusal plain
Increased over bite
Infra Version / Infra Occlusion: Teeth are below the level of occlusal plain
Anterior open bite

Cross Bite






-

-

When the lower incisors are in front of the
upper incisors, the condition is called as
reverse over jet or anterior cross bite.
Causes:Narrow upper jaw and/or
Broad lower jaw
Bilaterally symmetric
Bilaterally Asymmetric
Unilateral

Cross Bite
Posterior cross bite exists when maxillary posterior
teeth are lingually positioned relative to mandibular
teeth. It usually reflects a narrow maxillary dental arch.


Buccal malocclusion: - Upper posterior teeth occlude completely buccally of
lower teeth



Midline Deviation
It can be,
 Dento
alveolar
 Skeletal
 Combined
OR
 Maxillary
 Mandibular
 Combined

References
Orthodontics Current Principles and Techniques
Thomas Graber , Robert Vanarsdall, Katherine Vig

Orthodontic diagnosis – Thomas Rakosi
Handbook of Orthodontics – Robert E. Moyers
Contemporary Treatment of Dentofacial Deformity
William R. Proffit

Contemporary Orthodontics - William R. Proffit
Orthodontics Principles and Practice - T.M.Graber
Enlow DH: Handbook of facial growth 2nd Edition Philadelphia,
PA: WB Saunder 1982

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