4

Classification of malocclusion

Reem Qawasmi

Emad Maayta

Classification of malocclusion
Today we will talk about classification of malocclusion, and how to classify the malocclusion according to the case. Malocclusion means any features of dental alignment or occlusion at variance from the ideal. Either there is a problem in teeth alignment or a problem in the occlusion between upper and lower teeth. There are many classification systems for malocclusion, usually we divide teeth and occlusion into two segments; anterior segment and posterior segment and each segment needs to be assist in 3 dimensions: o 1- Anterioposterior. o 2- Vertical. o 3- Transverse.

(A)anterior-posterior dimension:
incisors ,the system we use in the

lets start with the

anterioposterior relationship there is a classification system done by the British Standards Institute (BSI) in 1983: This classify incisor into three classes: class I, class II and class III. Then they subdivided class II into 2 subdivisions: class II division 1, class II division 2. **Class I incisors relationship: when the lower incisal edges occlude on the cingulum plateau of upper centrals (or just immediately below the cingulum plateau) <which is the normal class>.
[Type text] Page 2

**Class II incisor relationship: when the lower incisal edges bite posterior to the cingulum plateau of upper centrals.

**Class III incisor edge relationship: when the lower incisal edges bite anterior to the cingulum plateau of upper centrals.

( picture in the slide) A clinical example of class I inscial relationship , in this case we call it class I malocclusion, although the normal findings class I incisor relationship which is normal, however if there are features of malocclusion if you see the canine buccally erupted ,mild crowding in the upper and lower arch we call it class I malocclusion . ***** Now class I as we mentioned before, incisal edges bite on the cingulum plateau of the upper central incisors ,there is another type of class I malocclusion which is bimaxillary proclination ,when the upper incisor procline and lower incisors are also procline but the relationship between upper and lower is class I , since the definition is the lower incisal edge relative to the cingulum plateau of the upper, both are proclined and both
[Type text] Page 3

are class I, so its class I malocclusion but its called bimaxillary proclination or bimaxillary protrusion .

***** Class II incisor relationship as mentioned before where the lower incisal edges bite posteriorly to the cingulm plateau, now mentioned before there are 2 divisions of class II, division 1 and division 2, for both divisions lower incisal edges should bite behind the upper centrals cingulum plateau. Division 1 when the upper central incisors are proclined or normally inclined but with increased overjet. Division 2 when the upper central incisors are retroclined. o so to be class II the lower incisal edges should bites behind the cingulum plateau of the upper . o to be division 1 upper incisal should be proclined or normally inclined with increased over-jet.

o to be division 2 upper incisor should be retroclined and the over-jet is usually minimal but it can be increased .

[Type text]

Page 4

 ***** now class III when the lower incisal edges bites anteriorly to the cingulum plateau of upper centrals, anterior to the cingulum plateau means if the over-jet is positive not negative but anterior to the cingulum plateau this class III. SO we can find ((class III just anterior to the cingulum plateau which is positive over-jet )) or ((class III edge to edge )) or ((class III negative over-jet))

* the over-jet either (reduced / positive) or ( negative / reverse ).

(reversed over jet )

In the molar area anterio-posteriorly again, molar relationship between upper permanent first molar and lower permanent first molar, this can be classified according to Angles classification ( class 1molar relationship , class 2 molar relationship ,class 3 molar relationship) o the point for molar classification is the mesio-buccal cusp of the upper permanent first molar where just the cusp bite .
[Type text] Page 5

 class 1: if the cusp bites in the buccal groove of the lower first molar< this is normal>. class 2: if the mesio-buccal cusp bites anterior to the buccal groove of the lower first molar . class 3: if the mesio-buccal cusp bites posterior to the buccal groove of the lower first molar. Now the severity of class 2 or class 3 is determined by how much its anterior or posterior to the buccal groove, so it can be anterior to the buccal groove by quarter unit and it can be half unit and it can be by or 1 unit ( the unit called the width of the cusp itself )
# please refer to the slide to see clinical examples about it #

Upper and lower permanent canine also can be classified anterio-posteriorly : class I , class II , class III . Class I : when the long axis of the canine is biting in the embrasure between the lower canine and first premolar. Class II :when the upper canine is biting anterior to the embrasure. Class III : when the upper canine is biting posterior to the embrasure. << It can be quarter or half or full unit >>

[Type text]

Page 6

Class I

class II

(B) vertical dimension:

Now we will talk about the second dimension which is the (vertical) dimension , and here we are talking about over bite which means the amount of vertical overlap between upper central incisor and lower central incisor ,overbite can be : 1- normal<average> 2- increased 3- decreased reduced 4- open
(NORMAL) Average overbite:The upper incisor should overlap (COVER) the incisal third of the lower incisor . - Some book says the upper incisor should cover the incisal third middle of the lower incisor. Reduced overbite :when the overlap between the upper and the lower is less than the incisal third . Increased over bite: where the vertical overlap between maxillary and mandibular incisors exceeds the incisal third of the mandibular incisors.

It has many types : complete or incomplete or traumatic . 1. Increased complete :: when there is a touch between the lower incisal edge and the tooth surface of the upper or the soft tissue of the palate without causing trauma. 2. Incomplete :when there is no touch between the lower incisal edge and the tooth or the soft tissue .
[Type text] Page 7

3. Traumatic : when the lower touches the gingiva of the upper and this touch is causing trauma . Open Bite : when there is no vertical overlap at all.

<<See the pictures in the slides >>

If the upper overlaps more than the incisal third of the lower it is increased overbite. If the upper overlaps more than the incisal third of the lower it is increased If less than the incisor third it's decreased overbite, and if there is no vertical over overbite. If less than the incisor third it's decreased overbite, and if there is no lab it is open. vertical over lab it is open.

Now posteriorly again there is vertical relation , it can be normal when there is overlap between upper posterior teeth and lower posterior teeth, or it can be deep or open like lateral open bite when there is no vertical overlap at all .

(C ) Transverse Relationship: Posteriorly , in the premolars

and molars region ,normally the upper is overlaping the lower ( the palatal cups of the upper molars and premolars occlude in the central fossa of the lower premolars and molars ) and so (the buccal cusp will be bucally to the the lower teeth and this is the normal) - now if the buccal cusp of the lower posterior teeth occlude buccaly to the buccal cusps of the upper posterior teeth its called buccal croos-bite : 1) and it can be unilateral (one side -right or left is normal and the other isn't) or bilateral (both sides).
[Type text] Page 8

2) It also can be localized on just one or two teeth. - and if the buccal cusps of the lower posterior teeth occlude lingually to the palatal cusps of the upper posteriors this is called scissor bite or lingual cross-bite , it also can be unilateral , bilateral or localized.

SO ! the relation can be normal , buccal or lingual cross bite .

- Buccal crossbite: always the reference is the lower teeth ,so buccal crossbite means the lower posterior teeth are buccal to the upper. - Lingual crossbite: the lower posterior teeth are lingual to the upper much more than the normal.

the Reference is the lower teeth.

Now we will talk about skeletal classification , which is the relationship between the maxilla and the mandible , class I , class II , class III .

Class I : when the maxilla is slightly ahead of the mandible , where the the upper teeth overlap the lower teeth (ANB= 2-4) . Class II : when the maxilla is protruded advanced prominent relative to the mandible or the mandible retrouded behind the maxilla (ANB > 4)
[Type text] Page 9

 Class III : when the maxilla is back , retrouded behind the mandible , or the mandible is protruded (ANB < 2). Clinically we can assess this relationship by palpating the maxilla and the mandible, or from the profile, or from radiographs where we can use ANB angle (A represents maxilla, B represents mandible, N represents nasion -the reference point).

If this angle is (2 degree-4degree) then this is class I. If it is more than 4 degree then this is class II. And if it less than 2 degree then it's class III. Class I can be normal or bimaxillary protrusion or bimaxillary retrusion. Class II can be maxillary protrusion or mandibular retrusion or combination of both. Class III can be maxillary retrusion or Mandibular protrusion or combination of both. Now the vertical

skeletal relationship :

[Type text]

Page 10

There is an angle between maxillary plane and mandibular plane called MaxillaryMandibular-Planes-Angle ( MMPA) , which is the relation between maxillary plane and mandibular plane .

- Normally this angle should be around (275 degree), from 22 up to 32 this is normal, and it can be high, we call it high angle, which may cause skeletal open bite, or the opposite where the angle is low and we call it skeletal deep bite.

High angle

(more than 32 ) :

means the jaws are divergent this can causeanterior open bite ,which is called skeletal anterior open bite because the relation between maxilla and mandible is wrong , so the maxilla will carry teeth away with it as the mandible will do the same ,and it's called skeletal because the etiology of this anterior open bite is due to skeletal problem.

Low angle (less than 22

) : will produce skeletal deep bite.

the other thing that I should look to it in the vertical skeletal relationship , the

lower facial hight ( from the sub-nasale to the

menton ) , it can be average or increased or decreased .

[Type text]

Page 11

- The normal average is 55 % of the total . - If it is > 55% then it's increased. - And if it's less than 55 % then it's reduced. to see the maxillary mandibular plane angle you need lateral cephalogram , you can see mandibular plane clinically but you cant see maxillary plane clinically . clinicllay you can use frankfort plane instead of maxillary plane , frankfort plane is from the tragus to the lower border of the orbital eye and we use it because its almost parallel to the maxillary plane, and we call this angle ( Frankfort-mandibular plane angle). <<lower facial hight should be almost equal to the upper facial hight or just slightly above it >> the last thing is the transverse skeletal relationship : Skeletal maxilla can be normal , or wide maxilla , or narrow maxilla . If the Maxilla is wide this will cause lingual cross bite. if the maxilla is narrow this will cause buccal cross bite. Mandible can be normal , wide , narrow . If the mandible is wide this will cause buccal crossbite. if the mandible narrow this will cause lingual crossbite. And it could be both narrow mandible and maxilla and so the relation is normal , or it could be both wide and also the skeletal relation is normal .

[Type text]

Page 12

Done by: Reem qawasmi

[Type text]

Page 13