ORTHODONTICS 2 (LEC 1)

Course Description:
● Prevention and interception of
malocclusion through timely
diagnosis of orthodontic ● Deep bite - You can still
problems. see the cervical third of the
lower therefore it is a deep
Course objectives: bite. If you cannot see the
Upon completion of the course, the lower anymore especially
students should be able to: on the posterior area, it is
1. Analyze different orthodontic therefore called collapsed
records and formulate the bite.
treatment plan.
2. Develop awareness in the
hazards of improper force
application during orthodontic
tooth movement.
3. Perform preventive and
interceptive orthodontic ● Cross bite
measures.
*Extra information: All of the cases here
Learning Outcomes: has an Overbite which is defined as the
1. Describe and differentiate normal vertical relationship of the upper and the
occlusion from ideal occlusion. lower. Since all has an overbite you
2. Recall the six keys to normal cannot say that it is abnormal here. The
occlusion. normal measurement of an overbite is
3. Appreciate the importance of 1.5 to 2mm.
identifying normal and ideal * Over jet is the horizontal relationship of
occlusion. the upper and lower.

NORMAL OCCLUSION VS. NORMAL OCCLUSION

ABNORMAL OCCLUSION
The occlusion: Normal occlusion
- Range : not specific because your
normal may not be normal to
someone and someones’ normal
may not be normal to you.
- One that is functionally &
esthetically acceptable.

● Normal bite - You can see the

overbite is about 1mm.
CHARACTERISTICS: ABNORMAL OCCLUSION
1. Correct axial position of teeth - It’s not functionally and
2. Normal overbite and overjet esthetically acceptable.
- Normal overbite and
overjet is 1.5 - 2mm
3. Normal position and relation of
individual tooth to each other.
- The cusp should fall on the
fossa.
4. Normal relationship of dental
arches to each other and to face
and cranium.
- Relationship of the upper
jaw and lower jaw;
Relationship to the face - Case: OPEN BITE
and the head. - Causes are thumb sucking,
thumb thrusting, finger
6 KEYS: sucking.
1. Molar relationship
- It should be in Class I IDEAL OCCLUSION
2. Crown angulation (tip) ● A point
- The tips of the upper to the - It is specific; hindi
tips of the lower. gumagalaw kaya andun
3. Crown inclination (torque) lang siya.
- Torque means the ● Perfect arrangement of teeth
movement of the root when jaws are closed and
without movement of the condyles are at rest in the glenoid
crown fossa.
4. No rotations - Maganda ang
5. No spaces pagkakaayos just like you
6. The occlusal plane - slight curve of need in your complete
Spee dentures.
- Occlusal plane of a ● Found only in mechanical works.
complete denture is Example: Complete Denture
COMPENSATING - Kasi dun mo lang
CURVE. magagawa yan, even
orthodontists can do ideal
occlusion but there are
certain factors like the
muscles you have to
 consider; the age, size of groove of the mandibular first
the teeth, etc. That’s why permanent molar.
we cannot attain the ideal
that we want. But that is our
goal, to have an ideal
occlusion.

MALOCCLUSION
● Any deviation from the normal.

CLASSIFICATION OF
MALOCCLUSION

LEARNING OUTCOMES:
1. Enumerate and describe the
different groups of malocclusion
2. Classify the malocclusion and
identify its various characteristics
3. Appreciate the limitations of each
system of classification.

Systems of Classification:
1. ANGLE’S SYSTEM
- Describes the antero-
posterior relationship of the
maxilla and mandible with
each other based on the
position of the first
permanent molars. (Class
I, Class II, Class III;
Depending on the position
of the mesiobuccal cusp of
first permanent molars)

❖ CLASS I (NEUTROCCLUSION)
- The mesiobuccal cusp of
maxillary first permanent molar
occludes on the mesiobuccal
- Based on the lip positioning of the
patient, convex siya.

- The relationship of the upper and

lower lip pag Class II, pasok ang
lower.

➢ CLASS II DIVISION I
- Along with the molar relation as
seen in typical Class II
malocclusion the maxillary incisor
teeth in are in labio-version.

- Relation on the tongue, it is a

Class I.

❖ CLASS II (DISTOCLUSION)
- The mesiobuccal cusp of 1st
permanent molar occludes on the
embrasures between mandibular
- There is a division according to
1st permanent molar and 2nd
Dewey-Anderson, there is a
premolar.
modification with the Class II
Division I. Kung ang Class II ay
molar relationship, Division I is on
the ANTERIOR.
- Based on the picture, estimated is
beyond 5-7mm overjet.
➢ CLASS II DIVISION 1
SUBDIVISION
- Unilateral distoclusion with
labioversion of the maxillary
anterior teeth.
- It is a Class II Division I, but then
only ONE SIDE is Class II.
- Unilateral distoclusion.
- If right side is Class II, left side is
Class I. Because we classify the - The actual model of ortho cast
classification based on the model.
severity of the case. - A severe case

➢ CLASS II DIVISION 2
- Bilateral distoclusion with
linguoversion of the maxillary
central incisor
- Maxillary central incisors =
linguoversion / linguoverted
Maxillary lateral incisor =
labioversion / labioverted

➢ CLASS II DIVISION 2
SUBDIVISION
- Unilateral distoclusion with
linguoversion of the maxillary
central incisor
- Class II only on one side

- Relationship of the upper and the

- Position of the tongue kapag
lower: Having curve on the
Class II with incompetent lower lip,
mentalis muscle or chin
mentalis muscles.
 ● CLASS III DIVISION -
BILATERAL MESIOCLUSION
(both sides)
● CLASS III SUBDIVISION -
UNILATERAL MESIOCLUSION
(one side only; one side class III
and one side class II or I)

➢ CLASS III
- The mesiobuccal cusp of the
maxillary 1st permanent molar
occludes on the distobuccal
groove of the mandibular 1st
permanent molar or on the
embrasure between the
mandibular 1st and 2nd molars.
- Mesiobuccal cusp occludes on the
distobuccal groove. If in the ● CLASS I: A & B
embrasures of the 6th and 7th, the ● CLASS II: C
mandible arch is more forward. ● CLASS III: D
Painful for the TMJ.
- Dental Class III = Orthodontic
treatment (braces: bracket &
wires)
- Skeletal Class III = Surgical
Intervention (Surgery by an oral
maxillofacial surgeon)

NORMAL OCCLUSION
CLASS I MALOCCLUSION
CLASS II MALOCCLUSION
CLASS III MALOCCLUSION
DEWEY - ANDERSON MODIFICATION
OF THE ANGLE’S CLASSIFICATION
➢ CLASS I - mesiobuccal cusp of
the 1st permanent molar,
maxillary 1st permanent molar
occludes with the mesiobuccal
groove of the mandibular 1st
permanent molar
● TYPE 1 - CROWDING OF
ANTERIOR TEETH
● TYPE 2 - PROCLINED OR
LABIOVERSION OF MAXILLARY
INCISOR
- In Class I type 2 - find the class I
first (mesiobuccal cusp occludes
with the mesiobuccal groove)
before saying it’s type 2
(labioversion or proclination of
maxillary incisor)
● TYPE 3 - MAXILLARY TEETH
ARE LINGUAL IN RELATION TO
THE LOWER
> PSEUDO CLASS III
> ANTERIOR CROSSBITE
- Molar is Class I but anterior teeth
are crossed bite
● TYPE 4 - POSTERIOR
CROSSBITE
 ● TYPE 5 - MESIAL DRIFTING OF Question: How do you get the Frankfurt
MOLARS Horizontal plane?
- Happens during EDENTULOUS Answer: From orbitale to orion. The ala
SPACE (pag may bakante) tragus line.

➢ CLASS II - NO MODIFICATION

➢ CLASS III -
● TYPE 1 - Edge to edge bite
● TYPE 2 - Maxillary incisors
are labial to the lower.
There is crowding of the
mandibular incisors.
ACKERMAN-PROFITT’S
- Anterior labial shift labially,
CLASSIFICATION
crowning in the mandibular
● TYPE 3 - Maxillary incisors
A. Alignment - If it is crowding, ideal
are lingual to the lower.
or spacing
Sometimes, crowding of
B. Profile - side view photos
the maxillary incisors are
C. Abnormalities in the transverse
present.
or lateral direction - Anterior
crossbite
SIMON’S SYSTEM
D. Abnormalities in the sagittal or
- Utilizes the 3 anthropological
antero-posterior direction -
planes based on the cranial
Posterior Crossbite
landmarks.
E. Abnormalities in the vertical
A. Orbital/Frontal planes
direction - If Overbite, Big Bite or
- PROTRACTION: Near from the
Scissors Bite
orbital plane
- RETRACTION: Away from the
orbital plane
B. Midsagittal Planes
- CONTRACTION: Near
- DISTRACTION: Far
C. Frankfurt Horizontal Planes
- ATTRACTION: Near
- ABSTRACTION: Far
VENN DIAGRAM OF ACKERMAN-
PROFITTS
Orthognatic face - facial angle
approximately 90 degrees. (STRAIGHT
PROFILE)
Posterior divergent face - the facial
angle is low. (CONVEX PROFILE)
Anterior divergent face - the facial
angle is high. (CONCAVE PROFILE)
*WHAT IS THE PROFILE OF THE
PATIENT?
- Is it straight, convex or concave?
*WHAT IS THE FACIAL ANGLE OF
THE PATIENT?
- Is it an orthognathic, posterior or
anterior divergent face?
If the facial angle is high?
Answer: Anterior Divergent Face
If the patient is Anterior Divergent
Face, what will be the profile?
Answer: Concave
COMPONENTS/CORRELATES OF
HUMAN DENTAL OCCLUSION
1. Tooth/Dental System
2. Bone System
3. Neuromuscular System (Nerves and
Muscles)
GROUPS OF MALOCLUSSION
1. Dental Dysplasia
- Tooth System is involved
- Abnormalities are concentrated
on the alignment of the teeth.
- Class III are just dental, once you
correct the teeth, the profile will be
normal.
2. Skeletal Dysplasia
- Involves the bone & may or may
not involve the tooth system.
- Sometimes it is because of the
bones (SKELETAL), Class III,
once you correct it through
surgical intervention, the teeth
follows. (It will become Class I)
- There are abnormalities in the
maxillary and mandibular
relationships.
- Neuromuscular system may be
involved since nerves are
connected to the tooth. *Even if it
is skeletal, it still have nerves &
muscles.
3. Skeletodental Dysplasia
- The 3 systems are abnormal
- The tooth, the dental &
neuromuscular
ORTHODONTICS 2 LEC (CANVAS)
Introduction to the Course
This is Orthodontics 2 lecture. It is a two-
unit subject and has a laboratory
component which is one unit. This
course includes malocclusion and its
classification, diagnostic records and
analyses, biomechanical principles of
orthodontic tooth movement and
measures for preventive and interceptive
orthodontics.
Module 1:
Normal Occlusion
Introduction:
• Normal occlusion occurs when
the mesiobuccal cusp of the upper
first molar occludes in the
mesiobuccal groove of the lower
first molar.
• It also implies a situation
commonly found in the absence of
disease. It should include not only
a range of anatomically
acceptable values but also
physiological adaptability.
• It is always a range not a point.
M1 Objectives
Specific Learning Objectives:
At the end of the module, the students
will be able to:
1. Differentiate normal occlusion from
ideal occlusion
2. Describe the six keys to normal
occlusion
3. Value the importance of identifying
normal occlusion and ideal
occlusion.
M1 Lesson 1 The Six Keys to Normal
Occlusion
While Task:
This lecture will be facilitated by your
professor in the virtual classroom.
Normal occlusion: The mesiobuccal
cusp of the upper first molar occludes
with the buccal groove of the lower first
molar. Class I malocclusion: Same
as normal occlusion but characterized by
crowding, rotations, and other positional
irregularities
Lesson 1: The Six Keys to Normal
Occlusion
Key 1: Molar relationship. The non-
orthodontic normal models consistently
demonstrated that the mesiobuccal cusp
of the upper first permanent molar
occluded with the mesiobuccal groove of
the lower first molar.
Key 2: Crown angulation (tip) - The
gingival portion of the long axes of all
crowns was more distal than the incisal
portion
Key 3: Crown inclination (torque) -
Crown inclination refers to the
labiolingual or buccolingual inclination of
the long axis of the crown, not to the
inclination of the long axis of the entire
tooth.
Key 4: No rotations - The fourth key to
normal occlusion is that the teeth should
be free of undesirable rotations. Figure
below shows superimposed molar
outline showing how the molar, if rotated,
would occupy more space than normal,
creating a situation unreceptive to normal
occlusion.
Key 5: No spaces - The fifth key is that
the contact points should be tight (no
spaces). Persons who have genuine
tooth-size discrepancies pose special
problems, but in the absence of such
abnormalities tight contact should exist.
Without exception, the contact points on
the nonorthodontic normals were tight.
(Serious tooth-size discrepancies should
be corrected with jackets or crowns, so
the orthodontist will not have to close
spaces at the expense of good
occlusion.)
Key 6: The occlusal plane – slight
curve of Spee. The planes of occlusion
found on the nonorthodontic normal
models.
 important in visualizing and
understanding a problem, to come up
with proper diagnosis and treatment
planning.

M1 Lesson 2 Difference with Ideal

Occlusion

Lesson 2: Difference with Ideal

Occlusion
Normal occlusion is when the
mesiobuccal cusp of the upper first molar
occludes with the buccal groove of the
lower first molar. Class I malocclusion:
Same as normal occlusion but
characterized by crowding, rotations, and
other positional irregularities.
Ideal occlusion is perfect occlusion. It is
never attained in nature. It is a
hypothetical goal of orthodontists.
The relationship existing when all teeth
are perfectly placed in the arcades of the
jaws and have a normal anatomic
relationship to each other. When the
teeth are brought into contact the cusp-
fossa relationship is considered the most
perfect anatomic relationship that can be
attained.
M2 Introduction
Module 2:
Classification of Malocclusion
Introduction:
Classification is the structural
illustration of the dental, skeletal and soft
tissue variation from the
norm. Classification of malocclusion is
M2 Objectives
Specific Learning Outcomes:
1. Describe the different groups of
malocclusion
2. Relate the characteristics of an
occlusion to the different
classification of malocclusion
3. Critique the limitations of each
system of classification
M2 While Task
While Task:
Malocclusion is defined as an abnormal
occlusion in which teeth are not in a
normal position in relation to adjacent
teeth in the same jaw and or the
opposing teeth when the jaws are closed.
It is also defined as an appreciable
deviation from ideal occlusion.
Malocclusions are most often inherited,
but may also be acquired. Inherited
conditions include too many or too few
teeth, too much or too little space
between teeth, irregular mouth and jaw
size and shape, and atypical formations
of the jaws and face, such as a cleft
palate. Malocclusions may be acquired
from habits like finger or thumb sucking, ✓ Angle’s Classification
tongue thrusting, premature loss of teeth - Maxillary first permanent
from an accident or dental disease, and molar- “key to occlusion”
medical conditions such as enlarged - Relationship of first molars
tonsils and adenoids that lead to mouth - Anteroposterior relationship of
breathing. Malocclusions may be dental arches.
symptomless or they may produce pain
from increased stress on the occlusal Normal occlusion
structures. Class I (neutroclusion)
Class II (distoclusion)
The different classification of
Class III (mesioclusion)
malocclusion will be discussed in detail
using power point presentation.
Classification of Malocclusion
Importance:
CENTRO ESCOLAR UNIVERSITY FOR
INTERNAL CIRCULATION ONLY 2018
▪ Visualizing and understanding
problem associated with
malocclusion
▪ Diagnosis and treatment planning
▪ Communication
▪ Comparison Angle’s Class I Malocclusion:

Malocclusion Groups: • Normal anteroposterior

relationship
Dental dysplasia • Normal Class I molar relation.
- deals with the tooth system

Skeletal dysplasia
- deals with the bone system

Neuromuscular immaturity
(habits)
- Deals with the neuromuscular
system
Classification Systems of
Malocclusion
1. Angle’s Classification
2. Dewey’s Modification
3. Simon’s Classification
4. Ackerman-Proffit Classification
Angle’s Class II Malocclusion: • Division 2 Subdivision -
unilateral distoclusion with
• The mesiobuccal cusp of upper linguoversion of the maxillary
first permanent molar occludes in central incisors
the embrasure between the lower
second premolar and first
permanent
molar.
• There are 2 divisions in Class II
malocclusion

Class III molar relationship

• The MB cusp of the maxillary first
molar is situated over the
embrasure
between the mandibular first and
second molar.
Class II Division 1
• Division 1 - bilateral distoclusion
with labioversion of the maxillary
anterior teeth
• Division 1 Subdivision -
unilateral distoclusion with
labioversion of the maxillary
anterior

✓ Dewey’s Modification of
Angle’s Classification:
Class II - No Modification
Modified Class I malocclusion with-
• Type 1: Crowded anterior teeth.
• Type 2: Protrusive maxillary
incisors.
• Class II Division 2 Division 2 - • Type 3: Anterior crossbite.
bilateral distoclusion with • Type 4: Buccoversion or
linguoversion of the maxillary linguoversion of posterior teeth.
central incisors
 • Type 5: Mesial or distal drifting of > Type 4: Posterior crossbite.
posterior teeth.

Dewey’s Modification of Angle’s Class

I
> Type 1: Crowded anterior teeth.

> Type 5: Mesial drifting of permanent

molar.

> Type 2: Protrusive maxillary incisors. Dewey’s Modification of Angle’s Class

III
Type 1: Viewed separately, arches are
normal, In occlusion – edge to edge
incisor alignment suggestive of forwardly
moved mandibular arch.

> Type 3: Anterior crossbite.

Type 2: Crowding and lingual relation of
mandibular incisors to maxillary incisors.
Type 3: Crowding and cross bite relation
of maxillary incisors to mandibular
incisors.

✓ Simon’s Classification
- Craniometric classification
- Relates dental arches in three
anthropometric planes
o Frankfurt Horizontal
o Orbital ❖ ORBITAL PLANE
o Midsagittal - Perpendicular to FH plane
- Distal third of the upper canine
o PROTRACTION
o RETRACTION

❖ MIDSAGITTAL PLANE
- Malocclusion in transverse
plane
o DISTRACTION
o CONTRACTION

Basis for classification

- Based on deviation of dental
arches from their normal
position in relation to
these planes

❖ FRANKFURT HORIZONTAL
PLANE
- Malocclusion in Vertical Plane
o ATTRACTION
o ABSTRACTION
 ✓ Ackerman-Proffit Classification Group 2
• Profile
• major sets
o straight
o convex
o concave
- glabella, subnasale and
chin
Group 3
• Lateral or transverse
• types of posterior
crossbites
o contraction
o distraction

Ackerman-Proffit Classification
- all 3 planes of space and Group 4
influence of dentition on the • Sagittal or anteroposterior
profile • Angle’s classification
are considered o anterior crossbites
- differentiation between o protraction
skeletal and dental problems is o retraction
made
at appropriate level
- embodies 5 characteristics of Group 5
malocclusion in Venn diagram
1. alignment and • Vertical
symmetry of teeth • bite depth
2. profile o deep bite
3. transverse/lateral o open bite
deviation o attraction
4. sagittal/ anteroposterior o abstraction
deviation
5. vertical deviation Group 6
Group 1 • intersects 3 & 4
• Alignment • transagittal direction
• common to all dentitions example:
• universe ▪ Class II with posterior
o ideal crossbite
o crowded ▪ Class II – sagittal
o spacing ▪ posterior crossbite –
o mutilated transverse
Group 7
• Intersects 4 & 5
• Sagitto-vertical direction
examples:
o Class II overbite of 4 mm
o Class II – aneroposterior
plane
o Overbite – vertical

Group 8
• intersects 3 & 5
• transvertical direction
• ex. Deep bite with posterior
crossbite

Group 9
• Intersects 3, 4 & 5
• trans-sagitto-vertical direction
example:

o Class II w/ posterior
crossbite and excessive
openbite
o Class II – anteroposterior
plane
o post. crossbite –
transverse
o openbite – vertical

Classification of Malocclusion:
➢ Lesson 1 Importance
➢ Lesson 2 Malocclusion Groups
➢ Lesson 3 Systems
3.a Angle
3.b Dewey’s modification
3.c Simon’s Classification
3.d Ackerman-Proffit