1.

Force 0f occlusion
2. Value 0f study cast and radiograph in diagnosis. ******
3. Trajectories 0f force in mandible
4. Buttresses 0f maxilla
5. Important 0f retention
6. Factors maintain normal occlusion.
7. Limitation 0f ortho movement
8. Role 0f tongue in normal occlusion
 Preventive orthodontics
The phase that concerned with preserve integrity 0f what appear normal at this time to
allow future normal development.
The procedure:
1. Predental procedures
2. Patient oral hygiene
3. Proximal caries
4. Premature loss
5. Prolonged retention
6. Prevention 0f milwauke brace damage
7. Supernumerary teeth
8. Space control
9. Ectopic eruption
10. Oral habits
11. Occlusal equilibrium
12. Ankylosed teeth
13. Muscle exercise
14. Tongue tie
15. Deeply locked 1st permanent molar
Procedure in interceptive orthodontics
the phase that concerned with elimination 0f irregularity and malposition in the developing
dentofacial complex
the procedures:
1. Developing anterior cross bite
2. Anterior diastema – abnormal labial frenum
3. Developing basal dysplasia
4. Cleft palate problems
5. Habit control
6. Slicing and proximal striping (slicing 0f C to accommodate with the eruption 0f
incisors)
7. Space regainer (premature loss 0f E with mesial drifting 0f 6)
8. Muscle exercise
9. Serial extraction
 Serial extraction
When it predicted at an early stage there will be lack 0f space to accommodate all 0f the
permanent teeth
Indication:
Depend on
1. leeway space (difference between sum 0f MD diameter 0f primary canine, molar and
permanent canine, premolar.
2. Actual change in arch size that occur during change from primary to permanent
dentition.
3. Individual variation in arch size and leeway spaces
4. Relative position 0f 1st permanent premolar and permanent canine.
Extract 0f first deciduous molar indicated before extracting the deciduous canine to prevent
canine from erupt before 1st permanent molar.
Contraindication:
Class I (when slight lack 0f space) – Class III – class II division II
Oligodontia – Midline diastema – deep overbite
Open bite should be treated before
Benefits:
1. Avoid loss 0f labial alveolar bone.
2. Reduce treatment time.
3. Reduce malposition 0f individual teeth.
4. Encourage eruption 0f teeth in correct position.
Stage in serial extraction
❖ Dewel method:
1. Early extraction 0f deciduous canine (to provide space for incisors)
2. Extraction 0f 1st deciduous molar (to permits early eruption 0f 1st premolars)
3. Extraction 0f 1st premolar (to provide space for permanent canine)
Varies from 6 months to a year.
❖ Tweed methods:
When diagnosis show that the discrepancy present between tooth and basal bone and the
patient is between 7 – 8 Y serial extraction is performed.
1. At 8 Y all 4 deciduous 1st molar are extracted
2. When 1st premolar erupts to level 0f alveolar mucosa they are extracted – extract
deciduous canine
 Space maintainer
Appliance maintain the MD dimension 0f the lost primary teeth
Type:
1. Removable – fixed – semifixed
2. With band – without band
3. Functional – nonfunctional
4. Active – passive
5. Combination 0f the above
Indication:
1. Restore function – esthetics.
2. Prevent space loos – tooth drifting – ectopic eruption.
3. Prevent sequela 0f PD and caries problem.
Contraindication:
1. When MD dimension 0f underlying permanent teeth is less than the present space
2. When tooth near the crest 0f the ridge
3. Missing underlying permanent teeth
4. When we went molar to drift forward
Requirement:
1. Simple – strong
2. Maintain space.
3. Functional
Advantage 0f removable appliance:
1. Less stress on remaining teeth
2. Tissue stimulation therapy accelerate tooth eruption.
3. More esthetics than fixed appliance
4. Easier to clean.
5. Easier to fabricate.
6. Prevent tongue thrust.
7. Maintain vertical dimension.
8. Provide room for erupting teeth.
Disadvantages:
• May be lost.
• May be broken.
• May not wear by patient.
• May irritate soft tissue.
• May restrict lateral growth 0f the Jaw.
Space maintainer design:
• Simple acrylic base plate
• R.P.D
• Band – loop
• Band – bar
• Crown – bar
• Distal shoe extension: when premature loss 0f “E” and 6 inclined mesially
• Stainless steel crown
• Broken stress functional
• Appliance with labial bow
 Ideal ortho movement
The ideal force should not exceed capillary blood pressure (32mmHg 0f 50 – 75 gm/Cm2
Depend on the size and shape 0f the tooth and size number 0f the roots.
Tissue reaction
Light force:
1) Hyperemia and appearance 0f osteoclast and osteoblast in PDL
2) Bone resorption under the area 0f pressure in the PDL side
3) Bone apposition under the area 0f tension in the opposite to socket surface (calcified by
about 10 days)
4) Remodeling to the socket surface to remain the integrity 0f the socket wall as the tooth
moves through alveolar bone. Bone apposition to endosteal surface under area 0f
pressure and resorption 0f bone from endosteal surface under area 0f tension
5) Reorganization 0f the PDL fiber then progressive attachment occur by production 0f
new fiber and attachment 0f existing intermediate bone fibers.
Heavy force:
1) Occlusion 0f the blood capillaries in the area 0f pressure and dilatation in area 0f
tension, occlusion with excessive tension occur.
2) Appearance 0f cell free zone (hyalinization)
3) Period 0f stasis, because no frontal resorption occurs.
4) Under mining resorption: increase endosteal vascularity and resorption 0f alveolar bone
under cell free area.
5) Rapid movement 0f the tooth accompanied by bone apposition within the socket
beneath area 0f tension.
6) Healing 0f PDL – reorganization 0f fiber and remodeling 0f socket occur after removal
0f the force, take longer time than light force.
Orthopedic or excessive heavy force:
• Necrosis 0f the PDL
• Root resorption – Undermining resorption
• Devitalization 0f the tooth
• Healing by ankylosis
 Factor affecting tooth movement.
1) Manner 0f force application
2) Amount 0f force application
3) Direction 0f force application
4) Duration 0f force application
5) Occlusal function
6) Age: biologic response in adult slower than in the child due to increased bone density
7) Sex
8) individual variations
Manner 0f force application
Continuous: its steady force applied to the tooth remain unchanged during application
period. e.g. Super elastic spring
Intermittent: its force applied with multibed period 0f complete release 0f the force. e.g.
removable appliance
Dissipating: its force decreases gradually and increase again by activation 0fforce
component. E.g. elastic bands.
Amount 0f force application
Light: it is the force that not sufficient to occlude blood capillary in PDL
Heavy: it is the force that sufficient to occlude blood capillary in PDL
Orthopedics: force intended to move one rather the dentition usually ranges from 100 –
400gm.
Direction 0f force application
1) Tipping:
the simplest movement, applied at one point on the crown 0f the tooth, will tilt away from
the force.
the incisal edge moves in one direction and the apex on opposite direction.
2) Translation or bodily:
its movement 0f all part 0f the tooth in the same direction
force must be directed to more than one point.
require 3times force used in tipping movement.
3) Rotation:
the tooth rotates around its long axis in the sockets by use 0f couple force.
Applying 2 equal forces in opposite direction
There is great tendency to relapse.
4) Intrusion:
Its movement 0f the tooth along the long axis toward the apex.
Require light force to avoid root resorption and devitalization.
 5) Extrusion:
Its movement 0f the tooth along the long axis toward the occlusal plane
Require light force to avoid root resorption.
6) Torque:
The root is moved with little movement 0f the crown to opposite direction.
Contrary to tipping movement
Applying couple force to the crown and restrict the crown movement to opposite direction.
 Anchorage
Its resistance used to withstand the applied force.
The teeth are the most used – palate – mandibular lingual alveolar bone – occipital part 0f
the skull – track 0f the neck.
Source 0f anchorage:
1. The skull: occipital – cervical anchorage.
2. The face: chin – forehead – zygomatic arch.
3. Root area 0f the tooth
4. Alveolar bone
5. Stabilizing plates
6. Cuspal interlocking.
7. Direction 0f force exerted on anchor units.
8. Muscular pressures
Reinforcement 0f the anchorage
1) Using stabilizing plates
2) Using lingual – transpalatal or nance holding arch
3) Combined labiolingual arch.
4) Edgewise arch with 3 bends
5) Heavy rectangular arch
6) Band’s 2nd molar in addition to 1st molar on each side
7) Use low frictional brackets.
8) Reduce number 0f teeth to be moved at one time
9) Extraoral anchorage.
 retention
indicate biological and mechanical preservation 0f post treated tooth position.
common relapse problems:
1) Appearance 0f crowding and rotation.
2) Reappearance 0f space after space closure specially in extraction site
3) Return 0f class II molar relationship with overjet after reduction 0f class II division I.
Etiology:
1) Bad oral habits:
• As thumb sucking
• Abnormal swallowing
• Abnormal muscular habits specially mentalis muscle .
2) Growth
3) Bone: alveolar bone surrounding the treated teeth in functionally tissue respond to
force.
4) Tooth position:
The tooth contact can generate forces.
The teeth must be well aligned in proximal contact and axial position.
Should resemble class I pattern with maximum intercuspation and centric relation.
No overjet or overbite, the maxillary incisors should not overlap more than 1/3 0f the lower
tooth
5) Soft tissues:
There s 3 soft tissue influence tooth stability in its new position
• PDL
• The muscles
• Superalveolar (gingival grooves 0f fibers)
Treatment criteria
1) Proper axial inclination
2) Good root paralleling
3) Good buccal intercuspation
4) Good arch form
5) Good arch alignment
6) Good overjet – overbite
7) Flat occlusal plane
8) Correction 0f rotations
9) Continuity 0f tooth contact
 Difference between adult and adolescent orthodontics
Growth is the factors that can be ignored in all practice in adults.
PD disease is rarely seen in growing child, may determine the course 0f treatment in
adults.
Modification in treatment
Extraction VS non extraction:
Non extraction is preferred because increase the distance that the teeth must be moved
increase treatment time – discomfort – possibility 0f PD problems.
Intrusion vs non intrusion:
The choice must be intrusion.
Intruding the tooth lead to reattachment 0f the PD fiber and formation tight epithelial cuff
that improve the position 0f gingiva relatively to the crown.
Light VS heavy force:
Light force is mandatory.
1. Flexible arch wire
2. Segmental mechanotherapy
3. Two step space closure with frictionless mechanics
Banded VS bonded attachment:
1. Ortho appliances consists of bonded kind and esthetic brackets.
2. Molar band are best when PD condition allows.
 Causes 0f median diastema.
1. Abnormal labial frenum
2. Physiologic spacing 0f permanent central incisors (ugly duckling stage)
3. Familial pattern
4. Peg shaped lateral incisors.
5. Malposed lateral incisors
6. Mesiodens
7. Small teeth size I large jaw
8. tongue tie
9. median cyst
premature loss of deciduous teeth
2nd deciduous molar:
1) forward shift and mesial tilting 0f lower 1st permanent molar.
forward shift and mesio – palatal rotation 0f upper 1st permanent molar.
Impaction 0f upper and lower 2nd premolar or maxillary canine.
2) Falling in and flattening 0f lower anterior segment
Unilateral loss lead to shift 0f the midline to the affected side.
May lead to increase overbite – crowding 0f upper incisors due to splinting effect 0f
lower arch.
3) Prenormal occlusion – pseudo class III – pseudo mesiocclusion result from premature
loss 0f upper lower 2nd molar.
Because the child protrude mandible to bring lower posterior part in contact with the
upper.
Pseudo class III distinguish from true class III by:
1. Mandible assume normal MD relation by manual retrusion.
2. Condyle in forward position outside the glenoid fossa with teeth in occlusion.
3. Lingual inclination 0f upper incisors – labial inclination 0f lower incisors due to pulling
action 0f muscle to retrude mandible to normal position.
Prolonged retention 0f deciduous
1. Nutritional disturbances
2. Endocrinal disturbances
3. Cleidocranial dysostosis
4. Incomplete resorption 0f the root
5. Absence 0f the permanent successors
6. Ankylosis 0f deciduous teeth.
 Delayed eruption 0f permanent teeth
1) Trauma 0f tooth germ
2) Infection 0f tooth germ
3) Displacement 0f tooth germ
4) Malformation 0f the tooth
5) Ankylosis 0f the tooth
6) Ectopic position 0f the tooth
7) Supernumerary tooth
8) Systemic disease.
Abnormal eruptive path
Severe crowding – trauma – ectopic position – supernumerary teeth – coronal cyst
Loss 0f permanent teeth
st
Loss 0f 1 permanent molar:
1) Mesial shift 0f 2nd and 3rd molar
In maxilla associated with mesiopalatal rotation
In mandible associated with mesial tilting only.
2) Distal shift 0f lower premolar more prominent than upper
3) Midline shift toward the affected side
4) Collapse 0f anterior teeth in lower arch
5) If lower 1st permanent molar lost before eruption 0f the 2nd premolar it cause large space
between 1st and 2nd premolar due to fail 0f forward development or backward drift.
 Abnormal pressure habits
Its habits related to orofacial region considered as general factors 0f malocclusion, may
originate due to:
• Physiologic factors
• Emotional factors
• Conditioned learning
1. Thumb sucking
2. Tongue thrusts
3. Lip sucking and lip biting.
4. Nail biting
5. Mouth breathing
6. Abnormal swallowing.
7. Postural habits
Thumb sucking
Def: it is repeated forceful sucking 0f the thumb with strong contraction 0f buccal and lip.
Phase I: normal subclinical thumb sucking – 2Y
Phase II: clinically significant thumb sucking – 2 / 4Y result in temporarily damage
confined to primary tooth
Phase III: active thumb sucking – further 4Y result in malocclusion.
*Damage depends on position 0f thumb – position 0f mandible – muscle contraction.
Effects:
1. Protrusion 0f upper anterior – retrusion 0f lower anterior.
2. Contraction 0f maxillary arch – high vault palate.
3. Anterior open bite
4. Hypotonic upper lip
 Tongue thrusting
Simple:
• Associated with anterior open bite as in thumb sucking, tongue thrust forward to
maintain anterior seal with lips during swallowing.
• It the most important etiological factors 0f open bite, as the tongue prevent normal
vertical development 0f anterior alveolar structure anteriorly.
Complex:
• Originate from tonsilitis and pharyngitis.
• Called complex open bite, all anterior and posterior teeth involved except last
permanent molar.
• In normal swallowing the tooth brought together – lip close – tongue held against the
palate at the back 0f anterior teeth.
• In case 0f tonsilitis or pharyngitis the tongue interrupts the enlarged pillar 0f fauces
cause pain and reflex anterior displacement 0f the tongue.
• Hence, the mandible is dropped – the teeth become separated, and tongue thrust
between them during last stage 0f swallowing.
Mouth breathing
Def: any interference of normal respiration, affect the growth 0f the face – mouth breathers
have high incidence 0f malocclusion.
Mouth breathing prevented by 3 sphincters:
Anterior sphincter: lip
Intermediate sphincter: tongue – hard palate
Posterior sphincter: soft palate – dorsum 0f the tongue.
Causes:
• Nasal obstruction
• Bad habits
• Increase in freeway space (true mouth breathing)
• Presence 0f air hunger
Effects:
1. Hypertrophy 0f lower lip
2. Hypotonic – short upper lip
3. Class II molar relationship
4. Crowding 0f anterior teeth
5. Contraction 0f maxillary arch
6. Protrusion 0f upper incisors.
 Etiology 0f malocclusion
Local factors:
1. Anomalies in tooth size – shape – number
2. Abnormal labial frenum
3. Prolonged retention – premature loss of deciduous teeth
4. Delayed eruption – abnormal eruptive path – loss 0f permanent teeth
5. Trauma – dental caries – improper restoration – pathologic factors.
General factors:
1. Evolution – Congenital – Heredity – Environmental
2. Malnutrition – predisposing disease
3. Posture – trauma – abnormal pressure habits.
Cleft lip – palate:
• Concave profile
• Retruded maxilla – Retruded chin point
• Lingual tipping 0f incisors
• Inter occlusal clearance.
Unfavorable sequela 0f malocclusion
1. Poor appearance
2. Improper deglutition
3. Improper breathing
4. Improper speech
5. Improper mastication
6. Improper muscle function
7. Mal occlusion – dental caries.
8. Impacted – unerupted teeth.
9. TMJ disorder
10. PD disease
Aim 0f orthodontics.
1. Restore function – esthetics.
2. Elimination 0f caries incidence – pathologic condition – bad habits
3. Correction 0f speech defect – TMJ disorder – malposed teeth.
 Growth 0f the nasomaxillary complex
Maxilla develop by intramembranous bone formation postnatally.
Maxillary growth occurs by:
1. Surface modeling and remodeling
2. Bone apposition at the suture (that connect maxilla to cranium and cranial base).
Growth pattern require downward forward distance between maxilla and cranium – cranial
base obtained by:
1. Push from behind created by growth 0f cranial base. (The maxilla attached to anterior
end 0f cranial base)
2. By growth at the sutures, after growth 0f cranial base is stopped, it’s the only
mechanism for bringing maxilla forward.
Suture attach to the maxilla posteriorly and superiorly allow for downward forward
growth
Growth 0f the mandible
• Mandible is mixed endochondral and intramembranous bone formation, resembles
curved bar containing tooth buds.
• The coronoid process & condyle & gonial angle & alveolar process are poorly
developed.
• The mandible is formed originally 0f two halves joined at mental symphysis by fibro
cartilage.

The main sites 0f mandibular growth:

1. The mandibular condyle:
• Cartilaginous growth 0f the mandible occurs by apposition and interstitial growth.
• Growth occurs outward – backward – upward, mandible translate downward –
forward.
2. Apposition 0f bone on the upper and posterior surface 0f the coronoid process leads to
increase in upward and backward direction.
3. Surface apposition at the posterior surface 0f mandible, lead to lengthening the
mandible and decrease the gonial angle from 170 to 120.
4. Bone resorption at the anterior border 0f ramus lead to lengthening the alveolar bone.
5. Generalized surface apposition at the outer surface 0f the mandible lead to increase
thickness, mental foramen translated from under M cusp 0f 1st primary molar to
between root 0f 1st and 2nd premolar.
 stomatognathic system
def: its closed functional system consists of orofacial muscle and skeleton, the function
governed by neural reflex.
Function:
Mastication – speech – respiration – swallowing – maintaining the posture.
Area 0f functional tolerance governed by:
1. Size – form – relationship 0f basal arch
2. Lip – check – tongue morphology and behavior
Maxillary basal arch:
Does not cover extensive area as mandibular basal arch.
Its border continuous with outer and inner cortical plates at the level 0f hard palate
Mandibular basal arch:
The heaviest part lies under tooth bearing area in the body 0f the mandible.
Occupies rectangular cross section between outer and cortical plates, contain medullary
and spongy bone.
Lip morphology:
• Orbicularis oris consist 0f numerous muscle fiber surrounding the orifice 0f the mouth
having different direction
• Number 0f fiber derived from buccinator and form the deep stratum 0f the orbicularis.
• Some buccinator fiber decussate near the angle 0f the mouth.
• The fiber arising from maxilla pass to lower lip and vice versa, The uppermost and
lowermost fiber passes without decussating.
• Superficial to these strata is layer formed by caninus and triangularis.
• Fiber from caninus passing to lower lip and those from trinagularis passing to upper lip
and insert into the midline.
Competent lip:
• The lips are sealed together without active contraction 0f orofacial muscle
• Lip habitually apart without dental interference and the mandible in rest position (mouth
breathing)
• The lip habitually apart due to dental interference and mandible in rest position as in
excess overjet
Incompetent lip:
The lips are apar and mandible in rest position and to approximate them there will be
active muscle contraction.
May be due to
1. Short lips
2. Increase distance between anterior nasal spine and gnathion.
3. Skeletal class II or class III
Idle swallowing
Not associated with food or drink, it performed voluntarily every few minute in days or
night for swallowing saliva
During normal adult swallowing the tongue exert pressure on the dental arches and palate
thus maintain the balance between the pressure 0f lips, checks muscles
 Predental stage
• The ridges covered by segmental elevation called gum bad, arch develop in 2 distinct
parts: labiobuccal – lingual.
• The labiobuccal portion divide into 10 segments separated by transverse groove each
corresponding to deciduous teeth.
• The lingual portion separated from labiobuccal portion by dental groove, which is the
site 0f origin 0f dental lamina, and limited by gingival groove on lingual side.
• The gingival groove separate gum bad and the palate in the upper jaw and define the
limits 0f the palate anteriorly and laterally by 3 straight borders forming part 0f oblong.
• Gingival grooves connect to dental groove at the region 0f canine.
Relation 0f gum pads to each other:
• At rest gum bad separated by tongue, on approximation there’s contact on 1st molar
region only.
• No definite relationship between gumpads when occluded
• The upper is wider than the lower so there is complete overjet.
• Vertical space present occupied by the tongue, not related to open bite.
• The incisor crowded and rotated in there crypt because gum pad not wide enough.
• Later the gum pad increase in width to accommodate for developing incisors, and the
second molar segment become clearly defined.
Character 0f normal occlusion:
1. Normal overjet and overbite
2. Normal relation 0f dental arch to each other
3. Correct axial inclination 0f the teeth.
4. Common occlusal plane for the teeth
 Deciduous dentition stage
• Calcification 0f primary teeth begin in 4th I.U by 3 Y all roots 0f primary teeth are
completed, at birth ½ 0f crown are formed.
• Eruption begins in 6/7 M and completed between 2.5 / 3Y and teeth are in full function,
the jaw contain calcifying crown 0f all permanent with exception 0f the 3rd molar.
Spacing 0f the deciduous teeth:
Primary teeth usually spaced in incisor region to allow for the difference in size between
primary and permanent, absence 0f space lead to crowding 0f permanent successor.
Two distinct space called primate space present between maxillary lateral and primary
canine – between primary canine and 1st primary molar.
Incisor’s relationship:
The upper incisors overlap the lower, deep overbite and overjet.
The deep overbite reduced by eruption 0f deciduous molars, and the primary teeth wear
and end to edge to edge bite.
Occlusal relationship:
Cuspal relationship similar to that 0f permanent dentition and cusp to cusp relation may be
normal.
MB cusps occlude in buccal groove 0f lower 1st molar – upper canine occlude in the
embrasure between lower canine and 1st molar.
Terminal plane and variation:
Flash terminal plane: Distal surface 0f upper and lower 2nd primary molar may end at
same vertical plane.
The occlusal relationship remains unchanged till the eruption 0f permanent teeth.
Distal step: distal surface 0f mandibular 2nd primary molars is more distal to distal surface
0f maxillary 2nd primary molar.
Mesial step: distal surface 0f mandibular 2nd primary molars is more mesial to distal
surface 0f maxillary 2nd primary molar.
Arch length or arch circumference:
• It’s the distance from the distal surface 0f 2nd deciduous molar alongside to distal
surface 0f 2nd deciduous molar on other side.
• It decreases with age from 3/6Y due to mesial migration 0f 2nd deciduous -
interproximal attrition – decay.
 Mixed dentition stage
All permanent teeth start to be calcified after birth except first molar
Sequence 0f eruption:
In maxilla: 6 – 1 – 2 – 4 – 5 -3 – 7.
In mandible: 6 – 1 – 2 – 4 – 3 – 5 – 7.
Leeway space:
• It is the difference between the sum 0f the MD dimensions 0f deciduous canine and
molars, and that 0f their permanent successors.
• MD dimensions 0f deciduous greater than that 0f permanent by 0.9 to 1.3mm in maxilla
and 1.7 to 3.1mm in the mandible.
• The prime importance 0f leeway space is adjustment 0f normal occlusion 0f permanent
first molar.
Occlusal adjustment:
There are two different mechanism 0f normal occlusal adjustment during mixed dentition
stage:
1. When the distal surface 0f maxillary 2nd primary molar is distal to distal surface 0f
lower 2nd primary molar, the permanent first molar erupt directly into proper occlusion
without altering the position 0f deciduous teeth.
2. When distal surface 0f upper lower 2nd primary molars are on the same vertical planes
normal occlusion reached by:
• Closing the primate space through early mesial shift 0f the deciduous molars
distal to the mandibular deciduous canine.
• Utilizing leeway space through late mesial shift 0f the mandibular first permanent
molar after shedding 0f the 2nd deciduous molar and eruption 0f 2nd.
Ugly duckling stage:
• Named due to bad esthetics.
• The incisors erupt fanning out with median diastema due to pressure exerted on their
root from developing permanent canine, the incisor position improved with eruption 0f
permanent canine.
• Permanent mandibular incisors show crowding at time 0f eruption, and the lateral
incisor overlap deciduous canine.
• The crowded condition overcome by leeway space and increase in intercanine width
that active during eruption 0f permanent canines and incisors.
• The increase is 2.5to 3.5 mm from 6 – 8Y, after 10Y no change in intercanine width.

Permanent dentition = = pdf

 Malocclusion
Definition: it’s a deviation from normal relation 0f the teeth to teeth in same or opposing
arch.
Malocclusion associated with:
1. Malposition 0f dental arch and jaws (normally related to each other).
2. Malrelation 0f dental arches to each other upon bony basis (themselves normally
related).
3. Malrelation 0f dental bases.
Malrelation 0f dental arch
Variation from normal relation 0f dental arch to each other in horizontal (anteroposterior &
lateral) and vertical plane.
Horizontal:
1. Anteroposterior:
• Post normal occlusion: the lower dental arch lies too far distally in relation to upper
arch when the teeth in centric occlusion.
• Pre normal occlusion: the lower dental arch lies mesially in relation to upper arch
when the teeth in centric occlusion.
• Postural pre normal occlusion: the lower arch is postured forward into pre normal
relationship.
• Over jet: the distance between labial aspect 0f lower and the palatal 0f upper incisors
when arch in centric occlusion.
The abnormality is:
Increase overjet – edge to edge bite – reversed overjet or anterior cross bite.
2. Lateral:
• Cross bite:
The buccal cusp 0f maxillary teeth occlude in the central fossa or may be completely inside
or outside the tooth, may be unilateral or bilateral.
Bi lateral usually due to skeletal, unilateral may be soft tissue behavior or skeletal.
• Scissor’s bite:
indicate total maxillary buccal or (mandibular lingual) crossbite, with tire mandibular teeth
completely contained within maxillary teeth when teeth are in centric occlusion.
Vertical Malrelation:
1. Overbite:
• Abnormal axial inclination 0f upper and lower incisor lead to loss 0f normal centric
stops lead to increase vertical development 0f dentoalveolar structure (overeruption 0f
lower incisors)
• Abnormal dental base relation ship
• True overclosure at first 0f the mandible with increase in freeway space, the mandible
close forward upward until incisors occludes and due to abnormal sliding contact, it
overdoses upward and backward due to continued contraction 0f elevators muscles.
2. Open bite:
Indicate Localized absence 0f occlusion while remaining teeth are in occlusion.
Commonly in anterior part, may be due to soft tissue behavior or skeletal pattern.
Soft tissue behavior prevents dentialveolar structure from closing intermaxillary space.
Abnormal skeletal pattern as the vertical development 0f dentialveolar structure reach
maximum without closing intermaxillary space because 0f high Frankfort mandibular
plane angle. These cases have class III relationship and abnormal mandible.
Skeletal pattern
Skeletal pattern: describe anteroposterior relationship 0f the apical base when the jaws are
closed, and the teeth are in full occlusion.
Skeletal 1:
normal anteroposterior relationship 0f the apical bases, produce satisfactory occlusion by
normal development or by orthodontic tooth movement.
Skeletal 2:
where the mandibular apical base is post normal to the maxillary dental base either due to
maxillary protrusion or mandibular retrusion.
Skeletal 3:
where the mandibular apical base is pre normal to the maxillary dental base either due to
maxillary retrusion or mandibular protrusion.
 Classification 0f malocclusion
Angle classification
• The classification based on the relation 0f upper and lower teeth, arch, and jaw in
anteroposterior plane, using the upper 1st permanent molar as the key 0f occlusion
Angle classified malocclusion according to relation between upper and lower 1st
permanent molar.
• At the present time the angle classification used as a base 0f occlusion 0f dentoalveolar
structure alone, not used as comprehensive picture 0f dentofacial complex and skeletal
pattern.
• It shows the relationship 0f teeth themselves but not determine the relation 0f the
alveolar bone
• When 1st molar is missing the relation determined by canine or premolar relation.
Class 1:
The upper and lower dental arch are in normal anteroposterior relation, the MB cusp 0f
upper occludes in buccal groove 0f lower 1st molar.
The malocclusion may be due to:
1. Local abnormalities:
• Anterior cross bite – posterior cross bite
• Crowding 0f upper lower incisors
• Labial Inclination 0f upper incisors
• Premature loss 0f deciduous molar and forward tilting 0f permanent molar – loss 0f
space in premolar region
2. Vertical Malrelation:
Excessive or deficient overbite
3. Disproportion in size between teeth and basal bone:
Apical base may be too large result in spacing or too narrow result in crowding.
 Angle class II
The lower dental arch is in distal relation to the upper dental arch the MB cusp 0f upper 1st
permanent molar occluding in embrasure between the lower 2ndpremolar and 1st molar.
Division 1:
• Proclination 0f upper incisors.
• Short upper lip. (Failure 0f anterior lip seal)
• V – shaped upper arch
• Increase overjet.
• Deficient mandible and underdeveloped chin.
Division 2:
• Lingual inclination 0f upper incisors (overlapped by lateral incisors)
• Normal upper lip. (deep mental groove)
• Broad upper arch.
• Deep overbite.
• Mandible is 0f a good size.
Angle class 3 malocclusion
• The lower dental arch is in mesial relation to the upper dental arch the MB cusp 0f
upper 1st permanent molar occludes in the embrasure between the lower 1st and 2nd
permanent molar.
• The teeth are in centric occlusion and mandibular condyle is within glenoid fossa, the
mandible cannot be Retruded manually.
• In some cases, the mandible may assume a position 0f comfort by producing postural
mesiocclusion *false class III*
• The incisors may occlude edge to edge & the lower incisors may be in advance to the
upper incisors.
• The lower incisors incisal tips may still present lingually to the upper if there are great
degree 0f incisors tilting.
• The Prenormal occlusion may result from excessive large mandible or lack 0f forward
growth 0f maxilla or combination 0f both.
 Simon classification
Simon classification based on the theory that the dental arches are related to three planes 0f
space.
Frankfort horizontal planes:
A plane connects the lowest point 0f orbit and the superior point 0f external auditory
meatus.
Orbital planes:
Is a perpendicular plane dropped at right angle to Frankfort plane from the orbital?
Median sagittal plane:
Is a perpendicular plane to the Frankfort plane and divides the skull into two halves?
❖ Anterior posterior relationship:
In normal arch relationship the orbital plane passes through the distal aspect 0f upper
canine known as (low 0f canine)
• Protraction:
When the dental arch or part 0f it is placed more anteriorly than normal in relation to
orbital plane.
• Retraction:
When the dental arch or part 0f it is placed more posteriorly than normal in relation to
orbital plane
❖ Lateral relationship:
• Contraction:
When dental arch or part 0f it is nearer to midsagittal plane than normal position.
• Distraction:
When dental arch or part 0f it is away from midsagittal plane than normal position.
❖ Vertical relation:
• Attraction:
When the dental arch or part 0f it is nearer to the Frankfort plane than normal position.
• Abstraction:
When the dental arch or part 0f it is away from the Frankfort plane than normal position.
 Reliability and validity 0f angle classification
Reliability: is the extent to which an experiment, tests or measuring device yields the same
result on repeated trials
Validity: is a conformity to accept biological principles.
Angle classification is widely used, it is a highly reliable, however the validity is a
questionable due to:
• The theory 0f classification is invalid because the first permanent molar position not
fixed point in skull anatomy.
• Its possible to have dental arch in one relation and basal bone in another relation (class
II dental arch &class I skeletal) according to cephalometric studies.
• In class II classification does not differentiate between true mand retrusion or max
protrusion, in class III between true max retrusion or mand protrusion.
• Classification is incomplete as it classifies anomalies in anteroposterior direction only
not include vertical transverse direction.

Lischer modification 0f angle classification:

Introduced these terms.
❖ Neutrocclusion or angle class I
❖ Distocclusion or angle class II
❖ Mesiocclusion or angle class III

Value 0f Study cast

• View the occlusion from every aspect.
• Assessment 0f prognosis
• Help in Explain treatment planning.
• Assist another dentist if patient referred.
Value 0f radiograph
- Determine root length – root resorption – pattern 0f eruption.
- Determine presence or absence 0f permanent successors – axial inclination.
- Study supporting alveolar bone – skeletal – dental structure.
Value 0f cephalometric
• Skeletal pattern – Soft tissue morphology
• Teeth relation to each other and to bones
• Serial head plates to Study growth