Classification of Malocclusion Jai - Pptsaurabh / Orthodontic Courses by Indian Dental Academy

Seminar on
Classification of malocclusion

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Index
Introduction
What is a classification system
Definition of classification
Purpose of classification
When to classify
Characteristic of normal occlusion
Keys of normal occlusion
Definition of malocclusion
Types of malocclusion
Various classification of malocclusion
Summery
Bibliography

Introduction
It has been said that the introduction of Angle
classification of malocclusion was the
principal step in turning disorganized clinical
concept into the disciplined science of
orthodontics.
Many new and simplified system for
classifying malocclusion have been introduces,
and each soon has many modification.
Whenever we examine a patient we
subconsciously classify him or her in many
different ways.
Like a 8 year boy not having permanent
central incisors. But in this one sentence we
have classified him in 3 standard : age sex and
time of eruption.
But this doesnt tell us about treatment plan
or prognosis.

So a classification system is a grouping of
clinical cases of similar apperance for ease in
handling and discussion, it is not a system of
diagnosis, method for determining prognosis,
or way of defining treatment
DEFINITION OF CLASSIFICATION
STRANG
Classification is a process to analyze
cases of malocclusion for the purpose of segregating
them into a small number of groups, which are
characterized by certain specific and fundamental
variations from the normal occlusion of teeth. These
variations, in turn, become influential and deciding
factor in determining the correct plan of treatment.
Than one must ask why to classify?
Several reason for doing this are:
1) historically: certain type are always been
grouped together, thus the literature may
confined, ex: treatment of Angle class 2 div 1. so
if we go through an article we should have a clear
concept how does Angle class 2 div 1 appear,
however all cases of Angle class 2 div 1 are not
alike, there etiology nor there prognosis nor the
treatment plan are same .
2)Ease of reference: so the listener have
rough idea of problem simply by one label like
Angle class 2 div 1. Later fine necessary detail
can be given, so with his previous experience
he can tell problem encountered in treatment,
although have no knowledge of etiology,
prognosis, or best treatment plan. Thus aid in
comparison.
3) self communicating reason: like if we are
saying severe Angle class 2 div 1, we are
a) identifying problem of which we must
be worry.
b) recalling past difficulties with similar
cases
c) alerting ourselves to possible strategies
and appliance that may be necessary in
treatment.
So we can say that classification is done for
1) traditional reasons
2) ease of reference
3) for purpose of comparison
4) for ease of self communication
PURPOSE OF CLASSIFICATION
(AJODO 1992 SEPT.; STRANG)
1. Grouping various malocclusions.
2. Diagnosis .
3. Treatment planning.
4. Comparision.
5. Visualizing and understanding the problem
associated with that malocclusion.
6. Communication.
When to classify
One of the most common mistake is that of
trying to label each case immediately.
The classification is not diagnosis.
It is better first to describe that what is wrong
in complete and precise manner. And if at the
end of examination, it fall into a certain group,
it should be then named.
The famous anatomist John Hunter described
what orthodontists call a ideal occlusion today
as early as in 18
th
century.
Carabelli in mid 19
th
was the first to describe
abnormal relationship of upper and lower
dental arches in a systematic way.
The term edge to edge and overbite are
derived from carabelli system
Historically dental arches described in simple
geometric terms such as ellipse, parabola, or
modified spheres, etc.
Ideal arrangement of teeth in geometrically
described by Angle as an line of occlusion.
It is best described by as a catenary curve-
curved fromed when a chain or rope is hang
from both ends.
LINE OF OCCLUSION
Line of occlusion
Is a smooth (catenary) curve passing through
the central fossa of each upper molar and
across the cingulum of upper canine and
incisor teeth. The same line runs along the
buccal cusps and incisal edges of the lower
teeth, thus specifying the occlusion as well as
interarch relationship.
Line of occlusion
Spatial position of each teeth within the
arches can be described in relation to the line
of occlusion.
Angle termed the movement necessary to
bring a tooth into the line of occlusion as first,
second, third order, according to type of
movement required.

Line of occlusion
1) first order band: in- out movement.

2) second order band: tip or angulations
movement.

3) third order band: torque or inclination
movement.
Old Glory
Angle also describe the normal occlusion in term of
old glory.
It represent all the teeth in normal occlusion, it will
be seen that each dental arch describe a graceful
curve, and that all the teeth in these arches are so
arranged as to be in harmony with their fallow in
same arch, as well as those in opposing arch, each
tooth help to maintain every other tooth in these
harmonious relationship for the cusps interlock and
each incline plane serves to prevent each tooth from
sliding out of position.
Ideal occlusion :
The maximum intercuspal contact
(centric occlusion) and the
unstrained retruded position of the
mandible (centric relation) should
approximately coincide. There
should be a maximum of 2mm.
difference between the two.
Andrew describe 6 significant characteristic
observed in a study of 120 cases of non
orthodontic normal occlusions. The cases
were collected over a period of 4 years from
1960 to 1964. Criteria for selection were:-
Casts were of the people who never had
orthodontic treatment.
Teeth were straight and pleasing in
appearance
The casts occluded into a position that looked
generally correct.
The patient would not benefit from
orthodontic treatment.
According to Andrews:
1)molar relationship: the mesiobuccal cusp of upper
first molar occludes with the groove between the
mesiobuccal and middle buccal cusp of lower first
molar.
The mesio-lingual cusp of upper first molar should
occlude into central fossa of lower first molar.
The crown of upper first molar should be angulated
so that the distal marginal ridge occludes with the
mesial marginal ridge of lower second molar.

2) crown angulation: all tooth crown are angulated
mesially (mesiodistal tip)
3) crown inclination: refer to labiolingual or
buccolingual inclination of crown of teeth.
a) maxillary Incisors are inclined towards the buccal
or labial surface.(positive crown inclination)
b) Upper posterior teeth are inclined lingually,
similarly from the canine to premolar. Upper molar
are slightly more incline. (negative crown inclination).
c) lower posterior teeth are inclined lingually,
progressively more from canine to molars.
(negative crown inclination)
d) lower incisor are slightly lingually
incline.(negative crown inclination)
4) rotation: are not present
5) Spaces: are not present between teeth
6) Occlusal plane: plane is either flat or slightly
curved.( curve of spee)

7)Tooth size: both arches should have balance
tooth size, if not there would be spacing in
one arch and crowding in opposing arch.
Evaluation of tooth size discrepancy can be
done by Boltons analysis;-
The anterior ratio:- ( width of six lower
anterior teeth/ width of six upper anterior
teeth 100),

And overall ratio ( width of lower 12 teeth/ width
of upper 12 teeth 100).
Normal values=
for anterior ratio=77.2
for overall ratio=91.3
The most common anterior tooth size discrepancy
consist of small lateral incisor in upper arch and/ or
large lateral incisor in lower arch.
In buccal segment small upper second premolar is
most common discrepancy.
DEFINITION OF MALOCCLUSION
ANGLE - Malocclusion is defined as any
deviation from the ideal occlusion.

STRANG Malocclusion is any perversion of
normal occlusion of teeth.

T.C WHITE A condition where there is a
departure from the normal relation of teeth to
other teeth in the same arch and to teeth in the
opposing arch.
TYPES OF MALOCCLUSION
It can be divided into :

1. Intra-arch malocclusion

2. Inter-arch malocclusion

3. skeletal malocclusion

INTRA-ARCH MALOCCLUSION
It includes:-
variations in individual tooth position; and
malocclusion affecting a group of teeth.
These are :
Distal inclination or distal tipping .
Mesial inclination or mesial tipping.
Lingual inclination or lingual tipping.
Buccal inclination or buccal tipping.
Mesial displacement.
Distal displacement.
Rotation.
Distolingual or mesiobuccal rotation.
Mesiolingual or distobuccal rotation.
Transposition.

INTER-ARCH MALOCCLUSION
Sagittal plane malocclusion .
Prenormal occlusion .
Postnormal occlusion .
Vertical plane malocclusion .
Open bite, Deep bite
Transverse plane malocclusion.
buccal or lingual cross bite
SKELETAL MALOCCLUSION
Sagittal plane
prognathism
retrognathism
Transverse plane
narrowing of arch
widening of arch
Vertical plane
increase or decrease facial height
Various Types of classifications
systems
Angles classification
Deweys modification
Lischers modification
Angles classification revisited
Modified Angles classification
Simons classification
Bennetts classification
Ballard classification
Ackermann- Profit classification
British standard classification for incisors
WHO classification
Classification for Deciduous tooth.
Canine classification
Pseudo- class 1 malocclusion
Peck and Peck classification
Edward Hartley Angle -In 1899
SALIENT FEATURES

Based on molar relation.
Based on the mesio-distal relation of teeth.
Only maxillary first molar is the key to occlusion .

Angle classified malocclusion into 3
main classes designated by roman numerical class I,
class II & class III .


Clinician now use angle system in different
way than it was originally presented, now it
has shifted from the molar to skeletal relation.
Because class 2 molar relationship may result
in several different ways, each require a
different strategy in treatment, but skeletal
class 2 is not misunderstood, since it
dominates the occlusion and its treatment.
Angle originally presented his classification on the
theory that the maxillary first permanent molar
invariably in a correct position.
But later this hypothesis was discarded in
cephalometric studies.
In this usually clinician miss the malfunction of
muscles and problem in growth etc.
And even first molar relationship change during
various stages of development of dentition.
Despite of its criticism, it is still the most
traditional, most practical, and hence the
most popular classification at present.

Normal Occlusion: the mesio-buccal cusp
of the upper first molar occludes in the buccal
groove of the lower first molar.
If this molar relationship existed
and the teeth were arranged on a smoothly
curving line of occlusion, then normal
occlusion would result.

Class I

Mesio-buccal cusp of maxillary first molar falls
on to the mesio-buccal groove of mandibular
first permanent molar .
Patient may exhibit dental irregularities like:
crowding
spacing
rotation
missing tooth, etc.
Patient may exhibit
bimaxillary protrusion
bimaxillary retrusion
BIMAXILLARY DENTAL PROTRUSION
MAXILLARY-MANDIBULAR DENTAL
RETRUSION
Class II
Disto- buccal cusp of maxillary first molar
falls on the mesiobuccal groove of
mandibular first permanent molar.
It is divided into:
Class II Div 1: Upper incisors are proclined.
Class II Div 2: Upper laterals overlap
centrals and the centrals are retroclined.
Characteristic features of
Class II div 1
Upper lip is hypotonic and fail to form lip seal
Lower lip cushions the palatal aspect of upper
lip
Tongue occupy lower posture
Unrestrained buccinator activity result is
narrowing of upper arch at premolar and
canine region resulting in vshape arch
Hyper-active mentalis activity that
accentuates narrowing of arch.
Class II div 2
Variation;-
Lingually inclined central and lateral incisor
with canine labially tipped.
Give arch a squarish appearance.
Have normal perioral muscle activity.
May have abnormal path of closure due to
tipped incisor

Class II subdivision
When one side of arch have class I relation
and other have class II, refer as
subdivision
Ex. class II,div 1, subdivision
class II,div 2, subdivision

In this patient can exhibit abnormalities
like:-

MANDIBULAR
RETRUSION
MAXILLARY PROGNATHIC JAW
MAXILLARY PROGNATHISM & MANDIBULAR
RETROGNATHISM
Class III
Mesio- buccal cusp of maxillary first permanent
molar occludes in the interdental space between
mandibular first and second molars.
Types of class III
True:- skeletal due to:
excessively large mandible
forwardly place mandible
smaller than normal maxilla
retropositioned maxilla
combination of above

Types of class III
Pseudo : forward movement of mandible
during closure. Due to:
1) occlusal abnormalities
2)premature loss of deciduous teeth, so child tend to
move mandible forward to make contact.
3)enlarge adenoid, so child move tongue forward to
prevent contact of tongue to adenoid, thats bring the
mandible forward.(also know as adenoid faceses)

Subdivision: if class I on one side and class III on
other.
MANDIBULAR PROGRANATHIC JAW
MANDIBULAR DENTAL PROTRUSION
SALIENT FEATURES
Lower incisor tends to be lingually inclined.
The patient can present with:
Normal Overjet.
An edge to edge incisor relation.
Anterior cross bite.

The space available for tongue is
usually more. Thus, tongue occupies lower
position, resulting in a narrow arch.
Special points:-Usually molar position
are not fully class I , II or III, but rather in an
intermediate relationship.
So molar relationship between class I and
class II are called end-to-end malocclusion
(notation E).
And those between class I and class III are
called super I malocclusion( notation S1).
This help clinician to better describe the
occlusion.
They also reveals bilateral asymmetries,
severity of malocclusion, for example;
a mild class 2 occlusion(End to end)can be
differentiated from class2 ( fully developed).

Drawbacks of Angles classification
AJODO(1992); PROFFIT; GRABER;
INTERNET

1. Considers malocclusion only in antero-posterior
relations .
2. If molars are absent cannot classify.
3. Does not describe skeletal relationship.
4. Maxillary and mandibular molars are not fixed points
in the skull anatomy key ridge. Key ridge is out
line that represent zygomatic process of maxilla, its a
dense thickening of bone, it extent upward to join
dorsal limit of orbit and run parallel to lateral border of
orbit.
5. Cannot be applied to deciduous dentition.

6. Severity of malocclusion cannot be described.

7. Does not consider vertical/ transverse relation.

8. Individual tooth malrelation is not considered.

9. Does not differentiate skeletal/ dental mal-relation.

10. Didnt explain about
Soft tissues.
Saddle angle.
Gonial angle/cranial base rotation.
TMJ associated problems.


Deweys modification
(1935)

Given by Martin Dewey, initially Angles protg
but later his rival.
He modified Angles class I and III classifications.
Modification of class I
class I molar relation with :
Type 1; crowding of anterior teeth.
Type 2; proclined upper incisors.
Type 3; anterior cross bite .
Type 4; posterior cross bite.
Type 5; mesial migration of molars due to early loss
of teeth mesial to them.
Modification
of class III

class III molar relation
with
Type 1 edge to edge
incisor relationship.
Type 2 mandibular
incisor crowding
Type 3 incisors in
cross-bite.

MODIFIED ANGLES CLASSIFICATION
A Premolar Derived Classification

Class I: The most
anterior upper
premolar fits exactly
into the embrasure
created by the distal
contact of the most
anterior lower
premolar.

Class II : when one
upper second premolar
correctly opposes two
lower premolars.

Class III: when two
upper premolars
oppose one lower
premolar.
ANGLES CLASSIFICATION REVISITED: A
MODIFIED ANGLE CLASSIFICATION
HISTORY:

Original classification by Angle had Class II as a full premolar-
width distoclusion
Class III as a full premolar-width mesioclusion.
Assuming an average premolar width of 7.5 mm, then Class I
ranged from 7 mm.mesioclusion to 7 mm. distoclusion, for a
total range of Class I of 14 mm as given in 1900. This range
was far too broad, and hence in 1907, Angle revised his
definition, making Class II more than half of a cusp
distoclusion and Class III more than half of a cusp
mesioclusion. Angle's modification reduced the range from 14
mm. to a 7 mm. range.
GOAL OF REDIFINING ANGLES
CLASSIFICATION
Since many orthodontists
consider class I as goal of
successful treatment,
therefore, it was necessary
to redefine class I
malocclusion.
However, the large 7mm.
range of class I has been
discarded in this modified
version and all the teeth
visible from buccal view
must occlude with two
antagonist teeth as Angle
demanded for ideal
occlusion in old glory.
Lischers Modification
Used different terminologies for the same molar
relationships, described by Angle.
Nuetro - occlusion ; synonymous to Angles class I
malocclusion.
Disto - occlusion ;synonymous to Angles class II
malocclusion.
Mesio - occlusion ; synonymous to Angles class III
malocclusion.

Lischers Modification
He described individual tooth malpositions :
position version.
Lingo version/ labioversion.
Mesioversion/distoversion .
Infraversion/supraversion.
Torsiversion or rotation .
Perversion or impaction.
Transversion or transposition.
Lischers modofication

His nomenclature describe individual tooth
malpossition.
It simply done by adding suffix version to a
word to indicate the direction from normal
position.
Axiversion= the wrong axial inclination.
The terms combined when a tooth assume a
malpossition involving more than one
direction than normal. Ex: mesiolabioversion.

Bennetts classification, 1912
Classified based on the etiology.
It is always more useful, important , and practical to
classify according to their origin.
Some problem site of origin are
1) Osseous:- include problem in abnormal growth size,
shape, timing or proportion of any bone in
craniofacial region.
2) Muscular:-include all problem in malfunction of
dentofacial musculature. Like abnormal persistent
contraction of mandibular muscles can result in
retarded mandibular growth.

Another example is thumb sucking:- this itself
a complicated neuromuscular reflex involving
many muscles, temporomandibular
articulation, throat, tongue, and arms.
Continue sucking may narrow the maxillary
dental arch. This in turn give rise to
mandibular retraction because narrowing of
maxillary arch result in tooth interference, so
mandible shift posteriorly by muscles to a
position of better occlusion.
3) Dental:- involve the teeth and their
supporting structure. The malpossition of
teeth on bone is different from growth of
bone or muscular contraction.
This is usually the easiest to treat and
retain but care must be taken to determine
whether it is secondary to abnormal osseous
growth or malfunction of muscle.

This defect may involve :-
malpossition of teeth
Abnormal number of teeth
Abnormal size of teeth
Abnormal conformation or texture of
teeth etc.
Based on these Bennett classify malocclusion
in 3 groups.
Class 1:- Abnormal position of one or more
teeth due to local causes.
Class 2:- Abnormal formation of a part or whole
of either arch due developmental defects of
bone.
Class 3:- Abnormal relationship between upper
and lower arches due to abnormal formation
of either arch.

Ballards classification
(1964)
He gives a skeletal classification of
malocclusion
They are malocclusions caused due to
abnormality in maxilla and mandible .

The defects can be in
Size.
position .
relationship between the jaw.

It is divided the malocclusion into
Skeletal class I, II, III

Skeletal class I- The upward projection of axis
of lower incisors would pass through the crowns
of upper incisors.
Both bases are normal.

Skeletal class II- The lower apical base
is relatively too far back. The lower incisor
axis would pass palatal to the upper
incisor crown.

Skeletal class III- The lower apical base
is placed relatively too for forward, the
projection of lower incisor axis would pass
labial to upper incisor crown .

Assumptions made in classification
Inclinations of incisors within each arch
are normal.
If this is not so, then dental correction of
incisor inclinations are made such that the
lower central will make an angle of about
90 to the mandibular plane and to upper
centrals at an angle of 110 to Frankfort
Horizontal plane.
1930
--He put forward craniometric classification
--It is based on specific recording of vertical
orientation of jaw to cranium by what Simon
called Gnathostatic cast. In this top of
maxillary study model was parallel with F-H
plan.
--This permit more precious appraisal of jaw
relationship.
--After introduction of cephalometric radiography
Simons concept incorporated in routine
diagnosis although gnathostatic casts are
abandoned.
-

Simon gives classification based on
position of teeth to these three different
planes:
1. Frankfort horizontal plane.

2. Orbital plane .

3. Mid-Sagittal plane .

1) Frankfort horizontal plane ; explains the vertical
relationship of teeth to the plane.
Attraction close to the plane .
Abstraction away from the plane.
2) Orbital plane ; perpendicular plane dropped at
right angle to F-H plane from the lower most
border of the bony orbit. Show antero-posterior
relationship.
protraction; teeth are placed forward.
Retraction ;teeth are placed behind.

Law of cuspids: Normally the orbital plane
passes through the distal 1/3
rd
cuspid region but
its not always necessary for the plane to coincide
with the distal 1/3
rd
of cuspid hence , is not
reliable.
3)Mid Sagittal plane ; shows Transverse
relationship.
Contraction; teeth are placed closer to the plane.
Distraction; away from the plane .

Among these terms only three terms are in
common use: protraction, retraction, contraction.
Ex: Angle class 2 can be due to maxillary
protraction or mandibular retraction, or both.
The principal contribution of Simons system is its
emphasis on the orientation of dental arches to
facial skeletal. In addition it separate carefully
problem in malpossition of teeth from osseous
dysplasia.
This system is more precious than angle
system, and in three dimension.
But it is cumbersome, confusing at times ex:
attraction is intrusion of maxillary teeth or
extrusion of mandibular teeth.
So little use in practice
However it had a great impact on orthodontic
thinking and even have altered the fashion in
which the Angle system was used.
British standard 4492,
(1983)
classified incisor relationship into:

Class 1 incisor relationship.

Class 1:-
The incisal edges of lowers occlude or lie
immediately below the plateau of upper centrals.
Class 2: The lower incisal edges lie
posterior to the cingulum plateau of upper
incisors .
Division 1: upper incisors are proclined
and have increased Overjet.
Division 2: upper incisors are retroclined .

Class 3 : lower incisal edges lie anterior to
the cingulum, plateau of upper incisors
and Overjet is reduced/ reversed.

British standard classification
W.H.O Classification
(Geneva 1995)
Classified malocclusion in 6 groups which are again
divide in subgroups.
K07.0 - Major anomalies of the jaw size.
Excludes;
Acromegaly (E22.0).
Hemifacial atrophy or hypertrophy. (Q64.40),(Q64.41)
Robins syndrome .
Unilateral condylar hyperplasia. (k10.81)
Unilateral condylar hypoplasia.(k10.82)
K07.00 Maxillary macrogonathism
(maxillary hyperplasia)
(Geneva 1995)
K07.01 Mandibular macrogonathism
(mandibular hyperplasia).

K07.02 macrogonathism, both jaws.

K07.03 maxillary microgonathism
(maxillary hypoplasia).

K07.04 mandibular microgonathism
(mandibular hypoplasia). www.indiandentalacademy.com
(Geneva 1995)
K07.05 microgonathism, both jaws.

K07.08 other specified jaw size
anomalies.

K07.09 anomalies of jaw size ,
unspecified.

(Geneva 1995)
K07.1 anomalies of jaw -cranial base
relationships
K07.10 Asymmetries
Excludes
Hemifacial atrophy (Q64.40) .
Hemifacial hypertrophy (Q67.41) .
Unilateral condylar hyperplasia(k10.81)
Unilateral condylar hypoplasia(k10.82)
K07.11 mandibular prognathism.
KO7.12 Maxillary prognathism .
(Geneva 1995)
K07.13Mandibular retrognathism.

K07.14 Maxillary retrognathism .

K07.18 Other specified anomalies of
jaw- cranial base relationship.

K07.19 Anomaly of jaw -cranial base
relationship, unspecified .

(Geneva 1995)
K07.2 Anomalies of dental arch
relationship.
K07.20 Disto-occlusion .

K07.21Mesio-occlusion.

KO7.22 Excessive Overjet
(horizontal overbite).
K07.23Excessive over bite
(vertical overbite).

(Geneva 1995)
K07.24Open bite.

K07.25Cross bite.

K07.26 Midline deviation.

K07.27Posterior lingual occlusion of mandibular teeth.

K07.28 Other specified anomalies of dental arch
relationship.

K07.29 Anomaly of dental arch relationship,
unspecified.

(Geneva 1995)
K07.3 Anomalies of tooth position.

K07.30 Crowding.

K07.31 Displacement.

K07.32 Rotation.

K07.33 Spacing (Diastema).
(Geneva 1995)
K07.34 Transposition.

K07.35 Embedded or impacted teeth in
abnormal position.
Excludes Embedded or impacted teeth in
normal position.

K07.38 Other specified anomalies of
tooth position.

K07.39 Anomaly of tooth position,
unspecified.

(Geneva 1995)
K07.4 Malocclusion, unspecified.

K07.5 Dentofacial functional
abnormalities,
excluding bruxism (teeth grinding).

KO7.5O - Abnormal jaw closure.

KO7.51 Malocclusion due to abnormal
swallowing.
(Geneva 1995)
KO7.54 malocclusion due to mouth
breathing .

KO7.55 - malocclusion due to tongue ,lip
or finger habits.

KO7.58 - other specified dentofacial
functional abnormalities.

KO7 .59 - dentofacial functional
abnormality , unspecified .

Ackermann Profitt
Classification (1960)

J.L. Ackermann and W.R. Proffit develop a
diagrammatic classification, based on Venn
symbolic diagram to assist in describing more fully
the severity of malocclusion.
Venn proposed his diagram as a visual
demonstration of interaction among part of a
complex structure.

They identifies 5 major characteristic of malocclusion.
A) Group1:-Intra-arch alignment
since the alignment and symmetry are common to all
dentition, this represented as the outer or universal
group.
The possibilities are ideal, crowded, spacing and
mutilated teeth.
Individual tooth irregularities are described.
B) Group2:- profile
The profile is affected by many malocclusion so it become
second major set.
This may be anteriorly or posteriorly divergent with lips
being concave, straight or convex.


C) Group3:-Transverse skeletal and dental
relationships are evaluated .
Buccal and palatal cross bites (unilateral or bilateral)
or whether skeletal or dental cross bites.

D)Group4:- Involves assessment of the sagittal
relationship
It is classified as Angles malocclusion. Differentiation
is made between skeletal and dental malocclusions.

E) Group5:-Malocclusion in vertical plane -
Anterior or posterior open bite. Anterior deep bite or
posterior collapsed bite.
Ackermann Profitt
This approach overcome four major weakness
of Angles system:
1) incorporate an evalution of crowding and
asymmetry within dental arches and inclusion
of evaluation of incisor protrusion.
2) recognizes the relationship between
protrusion and crowding.
3)include the transverse and vertical as well as
antero-posterior plans of space
Ackermann Profitt
4) incorporate information about skeletal jaw
proportion at appropriate point, that is, in the
description of relationships in each of the
planes of space.

Patients with combination of problem in more
than one plane of space had more severe
malocclusion than patient having
malocclusion in one plane only.

These overlapping of groups is seen in the center of
venn daigram( group 6 to 9). These are more sever
problem, with characteristic from contiguous and
enveloping group. Group 9 would be the most
severe, with involvement of all groups (alignment,
profile, transverse, antero-posterior and vertical
problems).
This classification system is readily accepted for
computer processing and would require only a
numerical scale in programming for automated data
retrival.
This system help the orthodontist to organize a list of
problems for a patient and, in turn give the patient a
better understanding of length and difficulty of the
proposed treatment.
Classification For Deciduous
Dentition
Since Angles and many other system of
classification are based on permanent molar
relationship , so for purpose of decidious
dentition we require a different classification.
This classification is based on terminal planes.
Terminal planes:- they are the distal surface of
both upper and lower decidious second molar.
Based on there relationship we can classify
the decidious dentition.
Dentition
They are classified in three basic groups:-
1) Distal step:- here the distal surface of lower second
deciduous molar is more distal to distal surface of upper
deciduous second molar.
This usually allow the permanent molar to erupt in
class 2 relationship.
2) Flush terminal planes:- here distal surface of both upper
are lower deciduous molar are in one line only. This is normal
for deciduous dentition.
This usually allow the permanent molar to erupt in
End- End relationship but slowly can convert to class 1 molar
relationship.

Dentition
3) Mesial step:- here the distal surface of lower primary
second molar is more mesial to the distal surface of upper
primary second molar.
This usually result in class 3 relationship of permanent
dentition.
Forward movement of permanent molar occur by occupying
the primate space in early mesial shift, or by occupying
leeway space in late mesial shift, and due to forward growth
of mandible.
The amount of leeway space is total 1.8mm in maxilla and
3.4mm in mandible.
Dentition
According to position of canine we can also
classify the malocclusion.
It is classify in 3 groups:-
Class 1:- distal slope of lower canine occlude
with mesial slop of upper canine.
Class 2:- mesial slop of lower canine occlude
with distal slop of upper canine.
Class 3:- lower canine is too far mesially than
the upper canine.
For stable occlusion class 1 canine relationship
is recommended.
This classification is also helpful to classify
malocclusion in patient who have missing first
molars.
Pseudo Class 1 Malocclusion
A newly define type of malocclusion
According to Jan De Baets, and Martin
Chiarini, certain types of malocclusion develop
spontaneously from a crowded anterior
segment through the interaction of specific
environmental factors.
Pseudo- class 1 is clearly distinguishable from
Angles class 1 by mesial rotation of the upper
first molar and crowding of lower incisor.
P-C1 is in reality, is a mild dental class 2
malocclusion, but due to some changes it
appear class 1.
Most mature P-C1 malocclusion also have
overerupted lower second molars and anterior
deep bite.
So P-C1 have following features:-
1. Mesial rotation of upper first molars
2. Crowding of lower incisors
3. Lack of space for lower canine to erupt.

Development of P-C1
Step 1:- because of lower incisor crowding and
lack of space available for erupting lower
canine, these teeth erupt more mesially than
normal. The lower premolar than erupt
mesially as well. Further the distal migration
of lower canine is blocked by its class 1
relationship with its antagonist.
Development of P-C1
Development of P-C1
Step 2:- despite the available Leeway space,
the second premolar also erupt in Class 1
relationship i.e.- more mesial than normal.
Development of P-C1
Step 3:- the erupting lower second molars
rapidly close the leeway space, without
spontaneous decrease in incisor crowding,
while the mesially rotated upper first molar
rotate further into the space left by deciduous
molar.
Because of delayed eruption of upper second
molar and mesial rotation of upper first molar,
lower second molar over-erupt, and
permanently lock the occlusion.
Development of P-C1
Development of P-C1
Step 4:- now the occlusal force acting on
erupting teeth in a cusp-to-cusp relationship
will deliver mesially directed force vector to
lower arch, causing mesial drift and settling of
lower teeth into stable occlusal contact of P-
C1.
Lower crowding may increase, upper incisor
overerupt until they find an occlusal contact
with lower incisor.
Development of P-C1
The lower lip pushes the overerupted incisor
back, and thus overjet remain within normal
limits.
As a result, the dentition appear to be a Class
1 occlusion with lower incisor crowding, but in
reality, it is a mild dental Class 2.
Classification of Maxillary tooth
transpositions
Given by Sheldon Peck and Leena Peck, known
as Peck and Peck classification.
They collected published cases of
transposition involving maxillary teeth
worldwide, and with a sample of 201 cases ,
they find five common types of maxillary
tooth transposition:-

Peck And Peck Classification
1. Canine- first premolar(Mx.C.P1) 143 cases
2. Canine- lateral incisor(Mx.C.l2) 40 cases
3. Canine to first molar site(Mx.C to M1) 8 cases
4. Lateral incisor to central incisor(Mx.I2.I1) 6
cases
5. Canine to central incisor(Mx.C.I1) 4 cases.

Definition of transposition:- is the positional
interchange of two adjacent teeth, especially
their roots, or the developmental or eruption
of a tooth in a position occupied normally by
another tooth.
So we can say clearly the most frequently
reported type is Mx.C.P1 comprising 71% next
is Mx.C.I2 comprising 20% , and other three
types are comparatively rare.
Pseudo-transposition
These are cases that mimic transposition but
actually are not.
One type of this is a form of hyperdontia best
called supernumerary distal maxillary
premolar. In this a premolar like
supernumerary tooth erupt between maxillary
first and second molar.
Pseudo-transposition
One publish case reported transposition of maxillary
second premolar with first molar. But actually it was
a case supernumerary distal maxillary premolar
coupled with an absent or previously extracted
second premolar.
So this system help to clarify scientific understanding
of these rare and severe positional variations. So
clinical management of these problems improved
with this new awareness.
Summery
Angles classification still serves a very useful purpose
in describing the antero-posterior relationship of
maxillary and mandibular molars which usually
reflect the jaw relationship. Modified by our broad
knowledge of growth and development and role
played by function, the Angles classification is an
important tool of diagnosis for a dentist. Together
with the terms on the previous pages describing
individual tooth positions it is possible to
scientifically categorize malocclusion and
communicate this information accurately to others.

Summery
The angles classification is most useful and
effective mechanism when application is
restricted to tooth and dental arch
relationship.
The classification of Simon is most precise
description of dento-facial abnormalities.
The Ackermann and Profit classification
include all 3 planes vertical ,sagittal,
transverse, and also tell us about the severity
of malocclusion.

Summery
Because no unit of face and cranium are
immune to disturbance and the stability of all
related structure, the solution for perfect
classification may lie in first discovering the
fundamental proportional relationship to a
constant structure and than relate it with
other structure.

BIBLIOGRAPHY

1. AJO-DO, Volume 1992 Sep (277 - 284): VIEW POINT Katz.
2. T.C WHITE, J.H GARDINER,B.C LEIGHTON Orthodontic for
dental students,3
rd
Ed., MacMillan; page no.(58-80).(253-
254)
3. T.M GRABER, Orthodontic principal and practice, 3
rd
Ed., page
no.(226-252).
4. WILLIAM R.PROFIT, Contemporary orthodontics, 3
rd
Ed., (2-
10, 185-191).
5. SAMIR E.BISHARA, Text book of orthodontics ,page no (84-
93).
6. Dr. BHALAJHI SUNDARESA IYYER, orthodontic art and
science,3
rd
Ed.,page no(63-80)
7. ICD-DA World health organization Geneva 1995, page no(69-
71)

BIBLIOGRAPHY
8. John C Bennet, Richard P mcLanughlin,Orthodontic
management of the dentition with the preadjusted
appliance,pgge no.(202-203)
9. Graber, Vanaredal, Vig, orthodontic current
principles and techniques.
10. McLaughlin, Bennett, Trevisi, Systemized
Orthodontic Treatment Mechanics, page no.(285)
11. Alexander Jacobson, Radiographic Cephalometry,
page no.(59-60)
BIBLIOGRAPHY
13. Shobha Tandon, text book of pedodontics,
page no(112-113)
14. T.M. Graber, Orthodontic principles and
practice. page no(183, 250-252)
15. Angles orthodontics, jan 1942 vol 12 page
no(40-48)
16. JCO 1995 Feb, page no.(73-88)
17. AJODO 1995 May, page no. ( 505-517)

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