‫بسم الله الرحمن‬

‫الرحيم‬
Ortho lec. 4
date of lec: 23/10/08

CLASSIFICATION OF MALOCLUSION

In our teeth we can have a normal occlusion and we

discussed that previously, or an abnormal occlusion
which we call it “malocclusion”. If you have a case and
you realized that this person has a malocclusion, it’s not
enough to say that this is a malocclusion, you must
classify this type of malocclusion and be more specific.
Before we start to talk about the classification of
malocclusion, we must know the types of abnormalities in
the relationship between the upper and lower arches, and
they are :
1- Teeth malposition :
Which means that the problem is in the
alignment of the teeth on the line of the arch only, not
on the bone itself, in this case, the relationship between
the upper and the lower arches is within normal limit .
2- Arch relationship abnormalities :
In this case, the alignment of the teeth is
normal (not necessarily in normal occlusion) and the
problem is in the bone itself. Maybe the upper arch is
situated more anteriorly (class II), or the lower is more
anteriorly (class III). Because we have two different
bones in the mouth (alveolar bone which is attached
to a basal bone) we will have two type of arch
relationship abnormalities, and they are :
a- Dentoalveolar relationship: which mean we
have abnormal relationship between the upper and
lower teeth with normal alignment but still we have
malocclusion, in this case, the tilting of the teeth is
abnormal.
Tilting: is the lingo/palatelabial inclination of the
teeth.

b- Skeletal relationship: which mean that the

problem isn’t in the alveolar bone, it’s in the basal
 bone of the maxilla or the mandible and their
relationship relative to each other.
Note : the results of treating a case where the
malocclusion is due to dentoalveolar abnormalities are
better than if we have skeletal abnormalities because only
the teeth

inclination is abnormal, but in

skeletal the basal bone isn’t in its place like the case
below.

In order to describe teeth

malposition or the
irregularities within the arches
we usually use the word “VERSION”, and according to the
abnormal position we can have: buccoversion,
Lingoversion, supraversion, infraversion, distoversion, and
mesioversion. All these terms used only if the tooth is in
 its place, but we have some terms
used if the tooth has been moved
away from his place like:
1- Transposition or transversion :
where the tooth has changed
places with another tooth.

2- Ectopic eruption : where the tooth has been erupted

in unusual place.

3- Torse version (not sure) : used when the tooth is

rotated .
 Note : we said that sometimes we have
malocclusion due to teeth malposition but with normal
relationship between arches, or abnormal arch
relationship with normal teeth position, but sometime
we can have both together in the same person,
abnormal arch relationship with teeth malposition.
In order to reach a diagnosis about the status of the
occlusion, the teeth and the arches must be examine in
3 planes:

1- Antro-posterior plane:
It’s the first plane to look at and we have to look
to a specific teeth to determine the relation between
the upper and lower jaws, so we have divisions of this
plane and they are:

a- Molar relationship – angle’s

classification : which has been published in
1907, and angle believed that when the upper and
lower 1st molars erupts and reach occlusion they
don’t move, but this fact isn’t believed now
because in a case of premature loss of the E’s,
these molars can move forward.
Back to our discussion, angle classify the molar
relationship into 3 classes:
** Class I molar relationship: which is the
normal one, and it’s when the mesiobuccal cusp of
the upper 1st molar occludes in the buccal groove of
the lower 1st molar.

** Class II molar relationship: the case when the

mesiobuccal cusp of the upper 1st molar occludes
anterior to the buccal groove of the lower 1st molar,
and we have two situations :
1- Half-unit : it means that the mesiobuccal cusp
has passes only half the mesiobuccal cusp of
the lower molar, and this is called “cusp to cusp
relationship”
2- Full-unit : when the mesiobuccal cusp of the
upper molar passes all the way and the full
width of the mesiobuccal cusp of the lower
molar and
becomes in
the embrasure
between
the 5 and the 6 .

Just for knowledge, unit means the width of

the cusp of the upper or lower molar.
Note: saying class II molar relationship isn’t
enough, we have to specify if it half unit or full
unit.

** Class III molar relationship : the case when

the mesiobuccal cusp of the upper 1st molar
occludes posterior to the buccal groove of the
lower 1st molar, and also here we have two
situations:
1- Half-unit: when the mesiobuccal cusp of the
upper 1st molar passes only half the distobuccal
cusp of the lower 1st molar.
2- Full-unit: when the mesiobuccal cusp of the
upper 1st molar passes the whole width of the
distobuccal cusp of the lower 1st molar.

Note: According to Andrew’s suggestion, if we

have abnormal relationship of the molars so we
must have an abnormal relationship of the arches
because the teeth when erupt they don’t move
according to him, but this suggestion isn’t true
because in a case of premature loss of the E’s,
there is mesial drift of the molars, and to correct
this case we only need to move back the molars
distally but it’s not easy.
Due to the fact that the molars aren’t stable
and they sometimes move, they choose a tooth
that will not move anywhere after eruption and
they come with:
b- Incisor relationship (British system): the
incisors won’t move if we had premature loss of
primary incisors. We have 3 incisor relationship :
** Class I incisor relationship: where the incisal
edge of the lower incisors bites in the cingulum of
the upper incisors, and
this is the normal
occlusion .

** Class II incisor relationship : when the incisal

edge of the lower incisors is biting behind the
cingulum of the upper incisors. As with class II
molar relationship, we have two division of this
class:
1- Class II division I : when the incisal edges of
the lower incisor bite behind the cingulum of
the upper incisors
and the upper
incisors are
proclined.
 2- Class II division II : when the incisal edges of
the lower incisors bite behind the cingulum of
the upper incisors and

the upper incisors are retroclined.

Note : in class II division II we can have only the

centrals retroclined, or all the incisors (centrals and
laterals) are retroclined. Both we called “classII division II”
.
Q1 : in which case we will see increase overjet ??
Ofcaurse in class II division I, because the upper
centrals are proclined.

Q2: In which case we will see increase overbite ??

Ofcaurse in class II division II, because the upper
centrals are retroclined and more labial surface of the
lower incisor is hiding behind.

** Class III incisor relationship : when the

incisal edges of the lower incisors bite infront of the
cingulum of the upper incisors, and we have two cases :
1- The edges are infront of the cingulum but still behind
the upper incisors.
2- The edges are infront of the cingulum and also the
upper incisors, so we have “reverse overjet” and that
known as “anterior crossbite” .
So what we are going to use? The angle’s molar
classification or the British classification (incisors
relationship) ??
 We use the British classification either class I, class II
division I, class II division II, or class III, but it doesn’t
means to forget about the angle’s molar classification, we
must be aware about it and to know how to examine the
molar relationship .

2-Vertical plane :
In this plane we should look to the amount of
overlaping between the lower and upper incisors. Normaly
the upper incisors overlap nearly the incisal 1/3 of the
labial surface of the lower incisors during intercuspation,
and this is called “normal bite” .

Now what are the abnormalities we could find at this

plane ?
1- Openbite: it means that there is no overlap at all
between the upper and lower incisors during
 maximum intercuspation of the molars, so we will
have a space anteriorly .

2- Reduced overbite : in this case we will find

overlaping between incisors but it’s less than 1/3 of
the labial surface and without spacing, so to make it
easy, it’s somewhere
between normal bite
and openbite .

3- Deep bite : when the overlaping is more that 1/3 and

almost all the surface of the
lower incisors is hiding
behind the upper incisors
 but the incisal edge of the lower isn’t touching the
palate (v. imp.) .

4- Deep impinging bite : if we have a case with deep

bite but the incisal edge of the lower incisor is
touching the palate we
will call it “deep
impinging bite” .

3-Transverse plane :
In this plane we should look
at the buccal surface of the
upper lateral teeth (premolars and
molars) in relation the buccal surface of the lower lateral
teeth. Normaly we must find that the buccal surface of the
upper teeth is more outside (buccaly) than the lower teeth
.

In other words, the buccal cusps of the lower teeth

should occlude in the fossa of the upper teeth and the
palatal cusps of the upper should occlude in the fossa of
the lower teeth .
What malocclusion we can find in this plane ??
We have something called “crossbite”, which means that
the upper teeth aren’t more outside than the lower teeth,
the lower are more buccaly and the cusps will change
places, we will see that the buccal cusps of the upper
teeth are in the fossa of
the lower teeth and
the lingual cusps of the
lower teeth are in the
fossa of the upper
teeth.
 Note : this crossbite can be either in one side and then
called unilateral, or in both sides and then it’s called
bilateral .
As we said before about the dentoalveolar and
skeletal problems, the same thing apply here in crossbite,
it could be either due to tilting of the upper teeth more
palataly and that is known as “dental lateral crossbite”, or
it could be due to the fact that the maxilla is narrow or
constricted and then it’s called “skeletal crossbite” .

Sometimes you will face a cases opposite to

crossbite, where the upper teeth moved more buccaly
than their normal position, then we will see that the
lingual cusps of the upper are on the buccal surface of the
lower and the teeth will act like a scissor (‫)مقص‬, this case
is called “scissor bite” .
 We mentioned previously that the results of treating
a case where class II malocclusion is due to dentoalveolar
abnormalities will be better and more esthetics than if it’s
due to skeletal abnormalities, because in the last one, the
basal bone isn’t in its place and after treatment it won’t
come back to its normal place, and in case of class II
malocclusion we will have retruted chin after treatment as
we saw in the pictures in the 2nd page.
Note : the same thing apply to class III malocclusion .
At the end, when we want to reach a diagnosis, we
must start with the antro-posterior plane to know the
classification of this malocclusion, and as we said it
depends on the incisors relationship rather than molars
relationship, and we must include every abnormality in
the teeth (remember the version, transposition, and
ectopic eruption).

As an examples :
It’s a class II division I complicated by : 1- deep impinging
bite .
2- spaced upper
incisors .

It’s a class II division II complicated by : deep bite .

It’s a class III complicated by : 1- buccoversion of lower

canine .
2- distoversion of upper
incisors .
3- impacted upper canine .
4- unilateral
crossbite (left of the pt) .
It class III complicated by : 1- anterior open bite .
2- bilateral cross bite .
3- crowdening of upper and
lower

incisors .

In this case, if the lower incisors bite behind the cingulum

so :
It’s class II division I complicated by : 1- buccoversion of
upper canine .
 2- infraversion of
nd
the lower 2 premolar .
But if the incisors bite on the cingulum then our diagnosis
will be :
It’s class I complicated by : 1- buccoversion of the
upper canine .
2- infraversion of the
lower 2nd premolar .

Now if we can judge the skeletal relationship clinically

by looking at the pt facial profile we can add it to our
diagnosis for ex. We say: class II division I malocclusion in
skeletal base one or two complicated by etc… but if we
couldn’t, we must take a lateral cephalogram x-ray to
determine the relationship then add it to the diagnosis .
This is all about the classification of malocclusion and
it’s half of the orthodontics, the other half is how to treat
these malocclusions after we diagnose them and that will
take about a year to explain .

Forgive me if there is any mistake …. My

greeting to everyone .
 Done by :
Abdalla awadi …..