Classifications of Malocclusion

Malocclusion: Deviation from the accepted or normal relation of teeth in occlusion

o May include issues with speech, mastication, swallowing, perio conditions, or esthetics
Terminology
o Relationship of incisors
Overjet: horizontal distance
Overbite: vertical distance
o Malpositions of the teeth
Supraversion: abnormal elongation of the tooth from its socket
Infraversions: abnormal intrusion of a tooth in its socket
Supraclusion: projection of the tooth beyond the occlusal plane
Infraclusion: tooth does not extend to the occlusal plane
Rotations usually have 2 descriptions
Distobuccal and mesiolingual are the same rotation
Etiology of malocclusion
o Pathological
o Developmental, accidental, hereditary, or acquired
Cleft lip/palate
Congenitally missing or supernumerary teeth
Ectopic eruption or impaction
Early loss of primary teeth (caries)
Trauma
habits
Angles Classifications published in 1890, they are based on the relationship of the MB cusp of
the Mx first molar and Bu groove of the Mn first molar
o Class 1: triangular ridge of the MB cusp of the Mx 1st molar articulates with the Bu
groove of the Mn 1st molar
Body of the mandible supporting the teeth is directly beneath that of the
maxilla in a good anterior-posterior relationship with the cranium
o Class II: Bu groove of Mn 1st molar articulates posterior to the MB cusp of the Mx 1st
molar
Relative distal relationship of the mandible to the maxilla exists. Most often the
Mn is retrognathic/distal, but it could also be that the Mx is prognathic
o Class III: Bu groove of the Mn 1st molar articulates anteriorly to the MB cusp of the Mx
1st premolar
Relative mesial relationship of the mandible to the maxilla exists. Most often
the Mx is deficient (80%), but it could also be that the Mn is prognathic
o Limitations to Angles
Describing alignment, soft tissues, and 3D relationship
Andrews 6 keys to normal occlusion
o Molar relationship (essentially Angles)
Distal surface of DB cusp of Mx 1st molar occludes with M surface of Mn 2nd
molar (same location as Angles)
 o Mesial crown angulation (especially posteriors)
Allows for proper interdigitation and esthetics
o Crown inclination
Incisors tipped labially
Canines and posteriors tipped lingually
o No rotations present
o No spaces present
o Occlusal plane flat or slightly curved
Orthodontists tend to flatten out occlusal planes to try and prevent deep bites
Other components of a normal occlusion
o Normal apical/base relationship
o Good interdigitation
o Minimum overjet and overbite
2 mm overjet
3 mm overbite
o Smooth, coordinated arch shapes
o Symmetrical dental arches and matching midlines
o Normal axial inclination of the roots
o Absence of cross bites
o Absence of crowding or spacing
o No supernumerary or missing teeth
o No oversized or undersized teeth (Bolton discrepencies)
o MIP and CR close together (CO)
o Normal curves of Wilson and Spee
Ackerman and Proffit Classifications
o Transverse dysplasias
Crossbite of teeth or tooth groups (lingual and buccal relationships of Mx to Mn)
Lingual crossbite is most common, usually one or two teeth
Apical base discrepancies
Lateral shifts
o Antero-posterior dysplasias
Class II or Class III relationships
Sagittal shifts
Sunday Bite/pseudo-class III: they stick their jaw forward to compensate
for the malocclusion, but when they relax their jaw is actually much
further back
Described a class I, II, or III
Class II or Class III are listed in percentages sometimes
o 50% class II (end-to-end) vs. 100% class II (shifted to next
interdigitation/step)
Class II has different incisor classifications
o Division I: Incisors are proclined/extruded forward
o Division II: incisors are retroclined/retruded.
Usually the centrals retrocline, but laterals extrude
 Class II or III could only be on one-side: classified as subdivision left or
subdivision right based on which side it is.
Vertical Dysplasias
Open bite or Deep bite (can be skeletal or dental)
o Deep bites often have periodontal issues
Excessive gingival display
o Incisial retroclination: with retroclined incisors the lip can show
more gum. Simply putting the incisors at a good inclincation can
change the lip shape and fix this many times
o Maxillary vertical excess
o Gingival hyperplasia (check with probings. Fixed with laser
ablation)
o Short upper lip
Intra-arch discrepancies
Crowding (most common)
Spacing (most common)
Anomaly in tooth numbers
Rotations
Esthetic line of Occlusion
Follows the facial edges of the maxillary anterior and posterior teeth
The relationship of this line to the soft tissue of the face during
animation is whats important
Described in terms of pitch, roll, and yaw (3D directions for aviation)