MALOCCLUSION

DR. KIRTI SAXENA

LEARNING OUTCOMES

• To explain the normal and abnormal oro-facial growth patterns, growth prediction and
behavioral development of children
• To diagnose and classify malocclusion
• To explain the aetiology of malocclusion
• To identify the need for orthodontic treatment
 CONTENTS

• Introduction
• Epidemiology
• Aetiology of Malocclusion
• Classification
• Angle
• British Standards Institute
• Ackerman’s Classification
• Index of Orthodontic Treatment Need
• Andrew’s 6 keys of Occlusion in Permanent teeth
• Features of Deciduous Dentition
• Need for Orthodontic treatment
• Risks of Orthodontic Treatment
• References
 INTRODUCTION

• Ideal Occlusion: Anatomically perfect arrangement

of teeth
• Malocclusion:Variation from ideal occlusion which
has dental health and or psychological implications for
the individual.
TYPES OF MALOCCLUSION
 EPIDEMIOLOGY

• Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old

Malaysian school children. Esa R, Razak IA, AllisterJH.Community Dental Health 2001, March18(1), 31-36
About 7% had handicapping malocclusion that needed mandatory treatment as per Dental Aesthetic
Index

Assessment of orthodontic treatment need in 5,112 Malaysian children using the IOTN
and DAI indices. Abdullah MS, Rock WP. Community Dent Health. 2001 Dec;18(4):242-8.
The proportion of children in need of orthodontic treatment was 47.9% according to grades 4 and 5
of the dental health component of IOTN and 22.8% according to grades 8-10 of the aesthetic
component
 EPIDEMIOLOGY

• Prevalence of angle class III malocclusion: A systematic review and meta-

analysis. Daniel K. Hardy, Yltze P. Cubas, Maria F. Orellana. Open Journal of
Epidemiology 2 (2012) 75-82

• Chinese and Malaysian populations show a relatively higher prevalence of Angle class III
malocclusion 15.69% and 16.59%, respectively while Indian populations show a relatively
lower prevalence, as compared to other races.
 AETIOLOGY

• Genetically determined factors: Inherited, Environmental or Combination

• Inherited: Failure of eruption of 11 due to mesiodens, Hapsburg family
• Environmental: Failure of eruption of 11 due to dilaceration caused by 51trauma
habits, caries, trauma

• Evolutionary trends – decrease in size of teeth, decrease in number of

teeth and decrease in size of the jaws
• Disease of civilization – reduced use of masticatory muscles, less
proximal wear of dentition
• Genetic melting pot – Hawaiian melting pot, Polynesian, European and
oriental contributors
SPECIFIC CAUSES OF
MALOCCLUSION:

• Disturbances in Embryologic development: teratogens

• Skeletal Growth Disturbances: intrauterine molding
• Muscle Dysfunction: cerebral palsy, torticollis
• Acromegaly and Hemimandibular hypertrophy
• Disturbances of dental development:
• Congenitally missing teeth
• Interference with eruption
• Ectopic eruption
• Early loss of deciduous teeth
• Trauma
 CLASSIFICATION

• Describe a condition, assess its severity

• Documentation, communication, comparison

• Research, eg. prevalent malocclusion treatment need

ANGLE’S CLASSIFICATION

Based on the occlusal

relationship of the first molars
BRITISH STANDARDS INSTITUTE’S CLASSIFICATION

Based on
the
incisor
relation
ACKERMAN & PROFFIT’S CLASSIFICATION

• Alignment
• Profile
• Type
• Class
• Bite depth
 INDEX OF ORTHODONTIC TREATMENT NEED (IOTN)

• Determines impact of malocclusion on individual’s dental health and psyche.

Dental Health Component Aesthetic Component

Identify the occlusal traits which affect function and Psychosocial impact of malocclusion on patient
longevity of dentition
10 standard photographs are graded from 1(most
Single worst feature of malocclusion noted by esthetic) to 10 (least esthetic)
looking at MOCDO (Missing, Overjet, Crossbite,
Displacement, Overbite) Score 1,2 : none
Score 3,4 : slight
Grade 1: no need Score 5,6, 7 : moderate
Grade 2: little need Score 8,9,10 : definite
Grade 3: moderate need
Grade 4: great need
Grade 5: very great need

Average score can be taken, but Dental health component alone is more widely used.
DENTAL
HEALTH
COMPONENT
AESTHETIC COMPONENT

Psychosocial impact of
malocclusion on patient

10 standard photographs are

graded from 1(most esthetic) to
10 (least esthetic)

Score 1,2 : none

Score 3,4 : slight
Score 5,6, 7 : moderate
Score 8,9,10 : definite
ANDREW’S 6 KEYS OF OCCLUSION IN PERMANENT TEETH

1. Correct Molar relationship

2. Correct Crown Angulation
3. Correct Crown Inclination
4. No Rotations
5. No Spaces
6. Flat Occlusal Plane
FEATURES OF DECIDUOUS DENTITION

• Dental arches are normally ovoid.

• Deep bite present initially
• Developmental spaces present
• Shallow inter-cuspal contact
• Straight or vertical inclination of incisors
• Flat curve of spee
• Minimal overjet
NEED FOR ORTHODONTIC TREATMENT

Psychology Dental Health

• Caries
• Periodontal health
• Trauma to anteriors
• Mastication
• Speech
• Impacted teeth
RISKS OF ORTHODONTIC TREATMENT
 REFERENCES

• Orthodontics The Art and Science, 3rd edition by S.I. Bhalajhi

• An Introduction to Orthodontics, 3rd edition by Laura Mitchell
• Contemporary Orthodontics by William R Proffit
• Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian
schoolchildren. Esa R, Razak IA, Allister JH.Community Dental Health 2001, March18 (1), 31-36
• Assessment of orthodontic treatment need in 5,112 Malaysian children using the IOTN and DAI
indices. Abdullah MS, Rock WP. Community Dent Health. 2001 Dec;18(4):242-8.
• Prevalence of angle class III malocclusion: A systematic review and meta-analysis. Daniel K. Hardy,
Yltze P. Cubas, Maria F. Orellana. Open Journal of Epidemiology 2 (2012) 75-82