SPECIAL ARTICLE

A matter of Class: Interpreting subdivision in a

malocclusion
Molly A. Siegel, DDS
Yardley, Pa

Confusion exists in the orthodontic community regarding the meaning of subdivision in Angle’s classification
system. The purpose of this study was to survey orthodontic educators in the United States to determine
their viewpoint on the meaning of subdivision and to ascertain the criteria on which they base their
interpretations. Fifty-seven surveys were mailed to department chairs in the United States, asking them to
identify the definition to which their orthodontic residency program subscribes; 34 surveys were returned.
Twenty-two responses supported the notion that subdivision refers to the Class II side, 8 responses said that
it refers to the Class I side, 3 responses supported neither view, and 1 response indicated that not everyone
in the program could agree on the meaning of subdivision. Although the prevailing belief appears to be that
subdivision indicates the side with a molar malocclusion, the orthodontic community does not have a
consistent standard, and it is time to resolve this controversy. (Am J Orthod Dentofacial Orthop 2002;122:
582-6)

F
undamental concepts in orthodontics should be
consistent among practitioners. Classifying mal-
occlusions is one of them. The nomenclature
used by orthodontists across the globe must have a
universal interpretation. Edward Angle is a quintessen-
tial figure to whom people refer when discussing the
malocclusion of teeth. His definitions of Class I, Class
II, and Class III malocclusions established the basis of
orthodontic terminology. He further delineated his
classifications by dividing them into divisions and
subdivisions. Although very explicit in describing first,
second, and third division malocclusions, Angle left
much room for differing interpretations when he ex-
plained the definition of a subdivision malocclusion.
The confusing meaning of subdivision has resulted in a
disparity in the classification of a unilateral malocclu-
sion.
Since the turn of the 20th century, it has been
customary for orthodontists throughout the world to
follow Angle’s teachings when classifying a malocclu-
sion. In his original article,1 he states, “In the subdivi-
sion of the First Division one of the lateral halves only
is in distal occlusion, the relation of the other lateral
half of the lower arch being normal” (p. 40). Although
Angle says that a subdivision is the occurrence of a
From the Division of Orthodontics, Columbia University, New York, NY, in
fulfillment of a requirement for orthodontic certification.
Reprint requests to: Molly A. Siegel, DDS, 1802 Yardley Rd, Yardley, PA
19067; e-mail, drmollysiegel@hotmail.com.
Submitted, December 2001; revised and accepted, April 2002.
Copyright © 2002 by the American Association of Orthodontists.
0889-5406/2002/$35.00 ⫹ 0 8/1/129194
doi:10.1067/mod.2002.129194
582
unilateral malocclusion, whereby 1 side is normal and
the other is abnormal, he neglects to specify whether
the subdivision is the normal or the abnormal side. In
fact, throughout the entire chapter on classification and
diagnosis of malocclusion, he never specifically defines
subdivision; rather, he uses it as a means to further
restrict the definition of malocclusion. In looking at
Angle’s beliefs on malocclusion, one can surmise that
he developed his definitions to facilitate communica-
tion and treatment in the orthodontic specialty:
In order to diagnose any case of malocclusion cor-
rectly, it is necessary to be familiar with, first, the
normal or ideal occlusion of the teeth; second, the
normal facial lines. These must be so fixed in the
mind as to form the basis from which to reason, all
deviations from the normal being intelligently noted;
and it must follow that in the absence of clear, fixed,
and definite ideas as to the normal, the limits or
boundary lines of the abnormal must also be vague
and indefinite, and the line of treatment be the merest
empiricism (p. 34-5).1
In a sense, this reasoning reflects the apparent
confusion today. Some would support the conclusion
that subdivision is not well defined, and its meaning is
unclear. As a result, disagreement abounds in the
specialty. By the same token, if a normal or an ideal
occlusion were not well described, it would be impos-
sible for the specialty to achieve continuity in its
vernacular. Definitions and diagnoses would be mean-
ingless because the orthodontic community would have
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 122, Number 6
no systematic way to describe and interpret a maloc-
clusion. As Salzmann2stated, “To recognize the abnor-
mal, it is necessary to have knowledge of the normal”
(p. 389). This is exactly what Angle tried to achieve
when he developed his classification system and estab-
lished a uniform language. Unfortunately, uncertainty
exists regarding the precise nuance of subdivision.
After Angle, many others have written about the
classification of malocclusions. Orthodontists such as
Salzmann,2 Strang and Thompson,3 Moyers,4 Gra-
ber,5,6 and Proffit7 have all written about Angle’s
classification system, but it is evident no precise mean-
ing of subdivision exists.
As a result, orthodontists in the United States
cannot agree on the meaning of a Class II Division 1
subdivision malocclusion. For example, what does
“subdivision left” describe? Some orthodontists believe
that it refers to an asymmetrical occlusion, with a Class
II molar relationship on the patient’s left side and a
Class I molar relationship on the right side. Other
orthodontists perceive just the opposite. They contend
that “subdivision left” describes a Class I molar rela-
tionship on the patient’s left side. Consequently, the
right side has a Class II molar relationship. This
illustrates the basic confusion regarding an essential
component in classifying malocclusions. What does
subdivision define? The purpose of this study was to
survey orthodontic educators in the United States to
determine their viewpoints and ascertain the criteria on
which they base them.
MATERIAL AND METHODS
A survey was sent to the chairperson of each
orthodontic department in teaching facilities in the
United States. Fifty-seven surveys were mailed. The
survey consisted of a 1-page questionnaire that asked
whether, in the orthodontic residency program’s phi-
losophy, subdivision refers to the Class I side or the
Class II side. It then called for an explanation of the
basis of the teachings. Self-addressed return envelopes
were included; the responses were not anonymous.
RESULTS
Thirty-four surveys were returned (return rate about
60%) with mixed results (Figure). Twenty-two respon-
dents believe that subdivision refers to the Class II side,
8 believe it refers to the Class I side, and 3 teach their
students neither meaning for subdivision. One respon-
dent indicated that, although the chairperson supported
the Class II side definition, not all faculty members
agreed. From the responses received, fewer than 65%
of orthodontic educators agree on the meaning of
subdivision.
Siegel 583
Fig. Number of respondents who support specific
opinion on meaning of subdivision.
Normally, results are tabulated in a statistically
based format. However, this questionnaire was in-
tended to identify not only the ideology of the respon-
dent but also a specific reference for his or her belief.
Thus, the results cannot be presented in a conventional
manner. As stated, 34 questionnaires were returned
with a commensurate number of unique opinions.
Although there were only 2 options from which to
choose, the reasons for the conclusions were extremely
varied. Responses ranged from the citing of specific
sources and teachings to “divine guidance” and “tradi-
tion.” All replies are noted in Tables I, II, and III.
Although the responses were not anonymous, they are
presented as such in the Tables.
DISCUSSION
Students in academic institutions are exposed to
differing interpretations of subdivision. Some instruc-
tors teach that it refers to the normal side, and others
contend that it means the affected side. This discrep-
ancy provided the impetus to conduct a research project
on the correct application of subdivision.
Most orthodontists base their theories and descrip-
tions of maloccluded teeth and jaws on Angle’s stan-
dard.1 Nevertheless, many respondents to the survey
cited other sources as the bases of their viewpoints on
the interpretation of subdivision. Salzmann,2 mentioned
as a reference for classification, is quoted. He reiterates
Angle’s ambiguity when he states, “Class II, Division
2, Subdivision. A Class II, Division 2, malocclusion in
which the malocclusion is unilateral only” (p. 408).2
Salzmann does not specify to which side unilateral
refers or whether subdivision applies to the Class II or
the Class I side. His writing restates only the premise
that 1 side has a maloccluded jaw relationship, and the
other side has a normal jaw relationship. Again, orth-
odontists base their opinions on this type of ambiguous
statement, and, consequently, some orthodontic chair-
584 Siegel American Journal of Orthodontics and Dentofacial Orthopedics
December 2002

Table I. Explanations offered by respondents who say subdivision refers to affected side

Subdivision refers to Class II side, based on:

1. AAO Orthodontic Glossary-1993 edition5

2. Common usage. No documentation that I can find.
3. I learned it in school.
4. Divine Guidance-good project-I haven’t found but have looked for a reference in the past.
5. Moyers4
6. Angle’s definition. See p. 188 of Proffit7
7. Salzmann JA. Principles of Orthodontics. Philadelphia: J.B. Lippincott; 1943. p. 397.
8. Proffit7
9. Blank (no reason given)
10. Blank (no reason given)
11. The Cl II relationship on that side
12. Contemporary text book information
13. See Attached Article: CDABO case report, Asymmetric extraction treatment of a Class II Division 1 subdivision left malocclusion with
anterior and posterior crossbites. (Am J Orthod Dentofacial Orthop 1999; 115:410-7)
14. Our interpretation of Angle’s intent when he describes his malocclusion classification. On page 49 of his seventh edition, he describes
the subdivision of the Class II Division 1. He states that the subdivision has the same characteristics as the main division, except that the
distal occlusion is unilateral. He goes on to describe the distal occlusion of a case that is exhibited in figure 34. Since he is talking about
an anomaly of a Class II, Division 1 malocclusion, we make the assumption that the subdivision is on the Class II side.
I readily admit that I have looked through about 4 different texts, and I see nothing that states that the subdivision is on the Class II side.
It was taught to me this way 30 years ago, and I assume this is the way it has continued to be taught. . .It is merely our interpretation of
Angle’s malocclusion classification.
15. It is a Class II on one side-not a Class II on the other side. It excludes Class III; a matter of semantics
16. The word “Subdivision” refers to the fact that only one side is Cl II as opposed to Cl II div. 1 which affects both sides.
17. Convention (perceived and otherwise)
18. 1)The way I was taught. 2) Inference from Angle (p. 201)1—he distinguishes between normal side and subdivision side. Angle class are
Classes of Malocclusion. As a result the subdivision “Class II” must apply to the side that isn’t “Normal”
All occlusions

Malocc Normal

I II1 II2 III IV

19. By definition decided upon by our department.
20. The term itself classifies by describing the exception to the rule. The rule being Class I ⬖ Class II 3 I subdivision rt addresses the
affected side. Also, note Salzman (p. 405).2 Because of this continued confusion, we specifically classify both the left and right molar
and left and right cuspid positions.
21. “Common Sense” Class II Division 1, Class II Division 2 and Class III identify the defective occlusion. Subdivision identifies the
defective side.
22. My textbook, etc., plus common usage!

men interpret Salzmann to mean that subdivision re-
flects the Class II side, and others perceive it to identify
the Class I side.
One respondent referred to Strang and Thompson3
as the reference for his program’s teaching stance that
subdivision refers to the Class I side:
Class II, Division 1, Subdivision. -Cases of maloc-
clusion in which the body of the mandible and its
superimposed dental arch are in distal relationship to
cranial anatomy on one side only and in which the
maxillary incisors are in labial axial inclination (p.
86).3
Having located and studied this precise text edition
and reference, I found no direct mention in the passage
regarding the true meaning of subdivision. The conclu-
sion this respondent deduced is an inference based on
the inconclusive words of Strang and Thompson.3
Thus, the question is still “what does subdivision
denote?”
Two respondents referred to Moyers.4 Ironically,
like Salzmann, Moyers’ teachings represented 2 dis-
tinct forms of thought. One orthodontic chairperson
deemed that Moyers’ teachings support the belief that
subdivision reflects the Class I side, and the other
chairperson thought that his writings indicate the
Class II side. From Moyers’ text,4 it can be estab-
lished that he thought that, although many classifi-
cation systems were presented at once to the ortho-
American Journal of Orthodontics and Dentofacial Orthopedics Siegel 585
Volume 122, Number 6

Table II. Explanations offered by those who say subdivision refers to Class I side

Subdivision refers to Class I side, based on:

1. Strang and Thompson (p. 86-7)3

2. Cl II Div 1 defines the Class II side and subdivision is the Cl I side.
3. Tradition
4. Blank (no reason given)
5. 1) Moyers4 2) Salzmann2
6. Although it is not clear, it seems that the subdivision side should refer to the normal side, since “Class II” refers to the abnormal side.
7. In the judgment of clinician, patient is Cl II. The Class I molar occlusion is an anomaly, a deviation.
8. 1) The term “subdivision” is a modifier of the primary identifying malocclusion.
2) Traditional usage in program and in my private practice.

Table III. Responses that did not fit into definitive categories

Subdivision means. . .

1. I use subdivision to mean unilateral with respect to which side-

2. Neither: In the first year diagnosis course, I teach to clarify a Class II, Div. 1, subdivision without a R or L—the residents specify which
side is Class I and which is Class II—e.g. Class II, Div 1, Subdivision; R Class II, L Class I. Then there is no confusion!
3. I believe your answer is in the enclosed pages. We teach exactly what Angle taught as a definition. But in practice we somewhat ignore
Angle classification and look at all characteristics as either Class I-ish or Class II Div. 2-ish or C1 II Div. 2-ish. I hope this helps.
Respondent enclosed an article “Treatment of Malocclusion of the Teeth and Fractures of the Maxillae. Angle’s System”1
4. The word subdivision refers to the Class II side. 1) Survey of the faculty. Significant members of the faculty support this contention. 2) In
Proffit’s latest text (p. 188),7 he indicates that the subdivision side is the malocclusion. P.S. There is some discussion and argument for the
reverse opinion. Those in opposition read Proffit’s statement differently. Contact Proffit.

dontic community, only 2 are used with any
regularity. He stated, “One of these, the Angle system,
is preserved almost in toto as it first was promulgated”
(p. 165).4 Moyers reiterated Angle’s thought when he
affirmed the perception that subdivision refers to a
unilateral malocclusion: “Subdivisions—When the dis-
toclusion occurs on one side of the dental arch only, the
unilaterality is referred to as a subdivision of its
division.” (p. 166-7).4 Again, Moyers never articulated
his perception of the exact connotation of subdivision,
and any opinion expressed as such is pure conjecture.
In the analysis of these selected writings of Moyers,4
Salzmann,2 Strang and Thompson,3 and Angle,1,8 no
mention is ever made regarding the true nature of
subdivision; it is used only as a restrictive word in
classifying a malocclusion.
Only 1 respondent referred to the American Asso-
ciation of Orthodontists’ orthodontic glossary5 for the
solution to this dilemma. In this glossary, subdivision is
“used to describe unilateral malocclusion characteris-
tics of the affected posterior segmental relationships”
(p. 5).5 This statement, though vague, is used by the
respondent to support his opinion that subdivision
refers to the Class II side.
Several respondents turned to Proffit7 as a source:
The Angle classification, in its extended form, de-
scribes this well. Occasionally the molar occlusion is
Class II on one side, and Class I on the other. Angle
called this a Class II subdivision right or left, depend-
ing on which was the Class II side (p. 188).7
Proffit7 appears to directly support the assumption
that subdivision refers to the Class II side; however, he
clearly bases his statement on Angle’s classification
system, and, as acknowledged earlier, Angle never
unequivocally said what subdivision means. Further-
more, Proffit does not directly state that subdivision is
on the Class II side. As 1 respondent wrote, “There is
some discussion and argument for the reverse opinion.
Those in opposition read Proffit’s statement differently.
Contact Proffit.” (Proffit did not respond to the survey.)
Although many chairpeople clearly based their
reasoning on published literature, others acknowledged
that the meaning of subdivision has never been clearly
expressed. They, too, are bewildered by its definition
and usage. For example, several respondents conceded
that they cannot recall any noteworthy publication
supporting either ideology—“I haven’t found but have
looked for a reference in the past.” This puzzlement
compelled many to base their conclusions on other
factors. A number of orthodontists supported their
opinion of whether subdivision refers to the Class I or
the Class II side by looking at how things have always
been done and wrote statements such as “Tradition”
and “Convention (perceived and otherwise)” to explain
586 Siegel
their theories. Ironically, the tradition and the conven-
tion to which the respondents refer are disharmonious,
for the beliefs are at odds with each other. To some,
“tradition” is the historic practice that subdivision refers
to the Class I side, and, to others, it is the time-old
convention that subdivision refers to the Class II side.
“Convention” cannot exist if there are disputed historic
practices.
This research project validates the contention that
there are 2 distinct schools of thought in classifying
malocclusions, despite Angle’s well-intentioned efforts
to standardize this fundamental principle. A number of
respondents said that they “learned it in school.”
Consequently, the way one learns is generally the way
one teaches, and, as a result, misnomers are perpetuated
through the generations. For this reason, it behooves the
orthodontic community to resolve the meaning of
subdivision so that, in the future, all instruction, regard-
less of the institution, will promulgate a consistent
standard.
After interpreting and carefully analyzing the infor-
mation gathered and presented in this research project,
one naturally forms a point of view based on an
assessment of the replies. Subdivision can be perceived
(as one respondent so aptly stated) as “a modifier of the
primary identifying malocclusion.” Along those lines,
the Class I molar occlusion is interpreted as a deviation
from the identifying malocclusion. In this respect,
subdivision is a literary device that declares an excep-
tion to the rule. The designation of the Class II
malocclusion is not complete when a subdivision is
present, for an inconsistency exists that directs one’s
train of thought back to the normal. When a malocclu-
sion is classified, it is identified as an aberration from
the norm. Subdivision is a reminder that 1 side is
normal. For those who agree with 1 respondent and
believe that “Class II Division 1, Class II Division 2,
and Class III identify the defective occlusion; [thus]
subdivision identifies the defective side,” a question
remains: why not call the malocclusion Class I subdi-
vision R or L, depending on which side is abnormal?
Thus, subdivision would refer to the defective side in
the Class I malocclusion.
The only people questioned in this study who
accurately represent to their students the prevailing
uncertainty about the meaning of subdivision are those
American Journal of Orthodontics and Dentofacial Orthopedics
December 2002
who teach neither meaning or both meanings. As 1
respondent indicated,
Neither: In the first year diagnosis course, I teach to
clarify a Class II, Div 1, subdivision without a R or
L—the residents specify which side is Class I and
which is Class II— eg, Class II, Div 1, subdivision;
R Class II, L Class I. Then there is no confusion!
As things currently stand, this is the most accurate
depiction, for it leaves no room for misinterpretation.
CONCLUSIONS
Orthodontics is a detail-oriented specialty, but this
detail has slipped by us. It is vital for the accurate
diagnosis of patients, as well as the integrity of the
specialty, that the meaning behind the words we use to
classify a patient be uniform. As Angle8 stated in 1899,
“A definite nomenclature is as necessary in orthodontia
as in anatomy. . . . The terms for describing the various
malocclusions should be so precise as to convey at once
a clear idea of the nature of the malposition to be
corrected” (p. 255).8 For the sake of uniformity and
establishing an unassailable legal standard, every orth-
odontist must be able to consistently define and classify
a malocclusion. This ability is the cornerstone of our
specialty, and it is now time to resolve the controversy
about subdivision. No orthodontist should ever doubt or
question the meaning behind the nomenclature we use
to describe our cases!
REFERENCES
1. Angle EH. Treatment of malocclusion of the teeth and fractures
of the maxillae. Angle’s system. 6th ed. Philadelphia: S.S. White
Dental Manufacturing Company; 1900.
2. Salzmann JA. Practice of orthodontics, vol 1. Philadelphia: J. B.
Lippincott Company; 1966.
3. Strang RH, Thompson WM. Textbook of orthodontia. 4th ed.
Philadelphia: Lea and Febiger; 1958.
4. Moyers RE. Handbook of orthodontics for the student and
general practitioner. Chicago: Year Book Publishers; 1958.
5. Graber TM, editor. Glossary of dentofacial orthopedic terms.
Orthodontic glossary. 1993 ed. St. Louis: American Association
of Orthodontists; 1993.
6. Graber TM, Vanarsdall RL Jr. Orthodontics: current principles
and techniques. 3rd ed. St Louis: Mosby; 2000.
7. Proffit WR. Contemporary orthodontics. 3rd ed. St Louis:
Mosby; 2000.
8. Angle EH. Classification of malocclusion. Dental Cosmos 1899;
41:248-64.