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Angle's Molar Classification Revisited

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Devanshi Yadav et al
Original Article
Angle’s Molar Classification Revisited
1
Devanshi Yadav, 2MS Rani, 3AM Shailaja, 4Dhruv Anand, 5Nikhil Sood, 6Rajat Gothi
ABSTRACT
Introduction: The Angle method for the classification of mal­
occlusion has been the gold standard in orthodontics for over
100 years, but many orthodontists find it difficult to apply this
system for the cases which lie in between the Class I and II
grey area.
Materials and methods: Five hundred pretreatment study casts
were included and assessed with the proposed classification.
In the modified classification ideal cusp-fossa occlusion is
designated as zero (0). Any deviation from the ideal, i.e. 0 is
graded in millimetres. A plus sign (+) designates Class II direc­
tion and a minus sign (–) designates Class III direction. The
right side is evaluated first, followed by the left side.
Results: Of the 500 pretreatment study casts assessed 52.4%
were definitive Class I, 23.6% were Class II, 2.6% were Class  III
and the ambiguous cases were 21%. These could be easily
classi­fied with our method of classification.
Conclusion: This improvised classification technique will help
orthodontists in making classification of malocclusion accurate
and simple.
Keywords: Malocclusion, Angle’s molar classification, Study
cast, Ambiguous molar relation, Borderline cases.
How to cite this article: Yadav D, Rani MS, Shailaja AM, Anand
D, Sood N, Gothi R. Angle’s Molar Classification Revisited. J
Ind Orthod Soc 2014;48(4):382-387.
Source of support: Nil
Conflict of interest: None
1
Postgraduate Student, 2Professor and Head
3
Assistant Professor, 4,6Senior Lecturer, 5Reader
1-3
Department of Orthodontics, VS Dental College and Hospital
Bengaluru, Karnataka, India
4
Department of Prosthodontics, School of Dental Sciences
Sharda University, Greater Noida, Uttar Pradesh, India
5 evaluate successful or unsuccessful treatment.2
Department of Conservative Dentistry and Endodontics
Vananchal Dental College and Hospital, Ranchi, Jharkhand
India
6
Department of Periodontology, Daswani Dental College and
Research Center, Kota, Rajasthan, India
Corresponding Author: Devanshi Yadav, Postgraduate
Student, Department of Orthodontics, B-280, Sector 26
Noida-201301, Uttar Pradesh, India, Phone: 9999743717
e-mail: devanshiyadav@gmail.com
382
10.5005/jp-journals-10021-1282
Received on: 24/1/14
Accepted after Revision: 11/2/14
INTRODUCTION
The classification of occlusion has been of interest to den­
tistry over a century. Arguably, Angle's classification is
the most widely used and accepted occlusal classification
system.1
In 1998, Morton Katz discussed Angle’s classification
of malocclusion and its importance and later proposed
its modification. He said that classification is an essential
communication tool between dental school Professor and
student, between practitioners and between practitioner and
insurance company or government bureaucracy. He pointed
out that everyone should speak the same language and also
that there was no difficulty classifying the extremes of a full
Class II and a full Class III but, the grey area of Class I is
subject to much confusion and inconsistency.
Secondly, classification has a significant effect on patient
treatment. Once a patient is classified, the practitioner will
tend to apply treatment mechanics appropriate to that classi­
fication. Even though model analysis, especially buccal
interdigitation, is but a small part of the complete orthodontic
diagnosis, the decision to use Class II or III mechanics
invariably is strongly influenced by the perceived Angle
classi­fication of the patient.
Thirdly, if one of the goals in the treatment of a patient
is to achieve Class I, there must be a mutual agreement
among orthodontists as to what constitutes ideal occlusion,
and Class I must be redefined to agree with the prototype
stan­dard. If every orthodontist has a different idea of what
ideal buccal interdigitation means, then the specialty of
orthodontics has no standardized method by which one can
A century ago Edward Angle published his ‘Classi­
fication of Malocclusion’ in 1899.3As described by Angle,
in Class I molar relation, the mesiobuccal cusp of upper
first permanent molar occludes with mesiobuccal groove
of the lower first permanent molar. The distobuccal
cusp of upper first permanent molar occludes with the
mesiobuccal groove of the lower first permanent molar in
the Class II and, in a Class III molar relation, the lower first

permanent molar lies mesial to upper first permanent molar
by a premolar width or a cuspal width.3
The original classification had Class II as a full premolar-
width distoclusion and 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. This
range was far too wide, and so in 1907, Angle revised his
definition, making Class II more than half a cusp distoclusion
and Class  III more than half a cusp mesioclusion.2 That
modification reduced the range from 14 mm to a 7 mm
range. However, 7 mm is still too wide a range to act as a
treatment goal if an orthodontist has to treat with precision.4
Criticism of Angle's classification has come from several
sources. First, there are those who have challenged Angle by
developing their own classification systems, most notable
of them being Dewey..2,5-8
Graber and Swain9 pointed out that Angle’s classification
failed to distinguish between malocclusions with analogs
anteroposterior relationships, which require different
treatment plans. Rinchuse and Rinchuse10 found Angle’s
classification limited because it is a system of discrete
classes. They further mentioned that Angle was not clear
about the description and definition of his classes and his
writings were equivocal, leading to the possibility of one
class overlapping into another. Last the validity of the
classification has been challenged because it only addresses
the sagittal dental dimension and does not address the
vertical and transverse dental dimensions; it also lacks a
consideration of the face.1
Angle never intended his classification to depict Class I
as a treatment goal or ‘ideal,’ but as a range of abnormality
between the extremes of full Class II and III.2 However, there
is no continuum in the classification and nothing can fall in
between. A researcher would have to define each category,
i.e Class I, II, III.3
Hence, the aim of the present study is to simplify and
quantify the range of ambiguous molar relationship and to
propose the modification in Angle’s classification to this
effect.
MATERIALS AND METHODS
Pretreatment casts of all the patients who have been treated
and are presently undergoing treatment in the Outpatient
Department of Orthodontics were included in the study.
The inclusion criteria included casts with permanent
dentition and casts in which all the permanent maxillary
and mandibular teeth are present. The exclusion criteria
included casts with mixed dentition, missing permanent
The Journal of Indian Orthodontic Society, October-December 2014;48(4):382-387
JIOS
Angle’s Molar Classification Revised
molars, cleft palate, grossly destructed teeth, presence of
prosthetic reconstruction and posterior crossbite.
The proposed modification designates ideal cusp-
fossa occlusion (as described by Angle) as zero (0). Any
deviation is from the ideal, i.e. 0 is graded in millimeters by
using a vernier caliper. A plus sign (+) designates Class II
direction and a minus sign (–) designates Class III direction.
The right side is evaluated first, followed by the left side.
Ideal occlusion on both right and left side is designated as
‘Class I (0, 0)’.
For example, if a patient presents with ideal Class I
on the right side, but a 2 mm Class II tendency on the left
side, then the modified classification would read (0, +2).
However, if another patient presents half a cusp Class II
(cusp-to-cusp occlusion) on the right side and a full cusp
Class II on the left side, then the modified classification
would read (+4, +8). A third patient who is 1.5 mm Class II
on the right and 3.5  mm Class III on the left side would
be classified (+1.5, –3.5).
Using the above method of classification, each pre-
treatment patient cast was assessed and recorded. The
study was also subjected to inter observer and intraobserver
assessment.
The proposed study was presented before the Institutional
Review Board Committee and ethical clearance was taken.
Table 1: Total distribution of malocclusion
Classification Distribution of
malocclusion
Class I 263
Class II 119
Class III 13
Ambiguous 105
Total 500
Fig. 1: Total distribution of malocclusion
383
Devanshi Yadav et al

Fig. 2: Distribution of males and females Fig. 3: Ambiguous classes

Table 2: Ambiguous classes ambiguous cases which did not fall into any of the definitive
Tendency No. of subjects category of Class I, II and III.
Class I and II 92 Figure 2 shows the distribution of males and females
Class III 2 in Class I (M-96; F-168), Class II (M-41; F-77), Class III
Class IV 4 (M-6; F-7) and ambiguous (M-39; F-66).
Table 2 and Figure 3 show the 105 ambiguous classes in
which 92 had a tendency toward a Class I and II, 2 toward
RESULTS
Class III and 4 toward Class IV which is a Class II on one
Table 1 and Figure 1 show in a sample size of 500 (182 males side and a Class III on another side.
and 318 females) study casts there were 263 Class I , 119 Figures 4 to 7 refer to definitive Class I, II, III and an
Class II and 13 Class III which were definitive and 105 ambiguous Class IV.

Fig. 4: Class I (0, 0)

Fig. 5: Class II (7, 7)

384
 JIOS

Angle’s Molar Classification Revised

Fig. 6: Class III (–9, –4)

Fig. 7: Class IV (5, –3)

Fig. 8: Ambiguous Class I and II (3, 6)

Fig. 9: Ambiguous Class I and II (2, 1)

The Journal of Indian Orthodontic Society, October-December 2014;48(4):382-387 385

Devanshi Yadav et al
Fig. 10: Ambiguous Class I and II (3, 2)
Figures 8 to 10 show the ambiguous casts having ten­
dency for Class I and II.
The statistical error according to kappa statistics
coeffi­cient, kappa = 0.99, showed an almost perfect agree­
ment in both the interobserver and intraobserver.
DISCUSSION
A convenient sample size of 500 study casts was included in
the study as it was intended to be an observational research.
This study can be taken as reference for similar research
work.
Of the 500 study casts included, 52.4% were definitive
Class I, 23.6% were Class II, 2.6% were Class III and the
ambiguous cases which did not fall into any definitive
category were 21%. One hundred and eighty-two males
and 318 females pretreatment study casts were included in
the study. Ninety-six males and 168 females had Class I,
41 males and 77 females had Class  II, 6 males and 7 females
had Class III and 39 males and 66 females had ambiguous
molar classification. In the 105 ambiguous classes, 92 had a
tendency toward Class I and II being the largest group, two
had Class III tendency and 4 had Class IV tendency which is
Class II on one side and Class III on another side. Class IV is
a rare occurrence but yet it exists and there are no set norms
for its classification. Hence, we proposed a modification
of Angle’s system that is similar to what Mortan Katz had
proposed but instead of using premolar derived classification
we prefer using a molar derived classification as used by
Angle. He emphasized using the maxillary first molars as
reference teeth for determining the classification10 because
they are the largest teeth and firmest in their attachment.
They also have a key location in the arches. The first molar
help to determine the dental and skeletal vertical proportions
due to length of their crowns occupy normal position in the
arches for more often than any other teeth because they are
the first permanent teeth and less restrained in taking their
386
position, it has the most consistent timing of eruption of all
permanent teeth.10
As seen in the results 21% of malocclusions fall into the
indiscriminate category which requires a need to develop
a new method of classification. Our proposed method of
classification fulfils this need.
The modified classification designates ideal cusp-fossa
occlusion (as described by Angle) as zero (0). Any deviation
is from the ideal, i.e. 0 is graded in millimeters. A plus
sign (+) designates Class II direction and a minus sign (–)
designates Class III direction. The right side is evaluated
first, followed by the left side.
Hence, the molar relation is quantified overcoming one
of the drawbacks of Angle’s classification.
The advantages of our proposed classification are as
follows:
• It classifies the ambiguous malocclusions which fall
into a grey area and cannot be designated as a full cusp
Class I, II or III.
• Establishes a treatment goal that is specific rather than
a range.
• It quantifies the malocclusion accurately in millimeters
and separately for each side.
• Allows the clinician to classify a Class III tendency on
one side and Class II tendency on one side.
Conclusion
We hope that this improvised classification technique will
help everyone in the profession of orthodontics in making
classification of malocclusion accurate and simple and also
help in teaching, research and treatment.
REFERENCES
1. Du Sinh Q, Rinchuse DJ, Zullo TG, Rinchuse DJ. Reliability of
three methods of occlusion classification. Am J Orthod Dentofac
Orthop 1998;113(4):463-470.

2. Katz MI. Angle classification revisited 2: a modified Angle classi­
fication. Am J Orthod Dentofac Orthop 1992;102(3):277-284.
3. Angle EH. Classification of malocclusion. Dent Cosmos
1899;41(3):248-264.
4. Katz MI. Angle classification revisited 1: is current use reliable?
Am J Orthod Dentofac Orthop 1992;102(2):173-179.
5. Dewey M. Classification of malocclusion. Int J Orthod
1915;1(3):133-147.
6. Dewey M, Anderson GM. Practical orthodontia. St Louis: CV
Mosby; 1935. p. 189-204.
The Journal of Indian Orthodontic Society, October-December 2014;48(4):382-387
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JIOS
Angle’s Molar Classification Revised
7. Ackerman JL, Proffit WR. The characteristics of malocclusion:
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1969;56(5):443-454.
8. Henry RG. A classification of Class II, division 1 malocclusion.
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9. Graber TM. Orthodontics: principles and practice. 3rd ed.
Philadelphia: WB Saunders; 1972. p.180-202.
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