 Andrews during the 1970 put forward the six keys to normal

occlusion.
 Six keys to normal occlusion are considered –
1. molar inter –arch relationship
2. Mesio-distal crown angulation
3. Labio-lingual crown inclination
4. Absence of rotation
5. Tight contacts
6. Curve of spee
 Normal occlusion
 Class I (neutroclusion)
 Class II (distoclusion)
 Class III (mesioclusion)
 Angle’s concept of Normal occlusion is essentially the description of an
ideal occlusion.
 Normal molar relationship.
 Line of occlusion. (caternary curve)
 Normal anteroposterior relationship between maxillary and mandibular
dental arches.

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 Normal Class I molar relationship:

1.The mesiobuccal cusp of the mandibular first molar occludes in the

embrasure area between the maxillary second premolar and first molar.
2.The mesiobuccal cusp
of the maxillary first molar
is aligned directly over the
buccal groove of the
mandibular first molar.
3.The ML cusp of the maxillary first molar is situated in the central fossa area
of mandibular first molar.

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 Line of occlusion (catenary curve)
Line of occlusion is a smooth curve passing
through the central fossa of each upper molar
and across the cingulum of the upper canine and
incisor teeth. The same line runs along the buccal
cusps and incisal edges of the lower teeth.

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 Normal class I molar relation.
 Normal muscle function.
 Line of occlusion is incorrect because of malposed
teeth, rotations or other causes.
 Normal anteroposterior relationship between
maxilla and mandible.

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 Class II molar relation.
 Line of occlusion not specified.
 There are 2 divisions in class II malocclusions
 Lower dental arch is in a DISTAL relation to the upper dental arch.

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 The mesiobuccal cusp of the mandibular first molar occludes in the
central fossa area of the maxillary first molar.
 The mesiobuccal cusp of the mandibular first molar is aligned with the
buccal Groove of the maxillary first molar.
 The DL cusp of the maxillary first molar occludes in the central fossa area
of the mandibular first molar.

5-Aug-19 17
 Class II molar relation.
 Proclined upper incisors.
 ‘V’ shaped maxillary arch.
 Supraversion of the lower anteriors.
 Abnormal muscle activity.

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 Class II molar relation.
 Lingually inclined upper centrals and labially tipped
upper lateral incisors.
 Wide maxillary arch.
 Exaggerated curve of spee.
 Closed bite.

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 Supraversion of mandibular incisors.

 Perioral musculature usually normal.

 Excessive interocclusal clearance.

 Forced retrusion of the mandible.

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 When the class II molar relationship occurs on one side of the dental
arch only, the malocclusion is referred to as a subdivision of its
division.
It can be-
 Class II div.1 subdivision
 Class II div.2 subdivision

5-Aug-19 21
 Mandibular dental arch in MESIAL
relation to the maxillary dental
arch.
 Class III molar relation.
 Line of occlusion not
specified.

5-Aug-19 22
 Mandibular incisors – cross bite, inclined lingually.
 Maxillary arch constricted.

5-Aug-19 23
 This is not a true class III malocclusion but the presentation is similar.
Here the mandible shifts anteriorly in the glenoid fossa due to a
premature contact of the teeth or some other reason when jaws are
brought together in centric occlusion.
 Lingually inclined maxillary incisors leads to anterior displacement of the
mandible.
 Can be due to premature loss of deciduous posteriors.
 It can also be due to occlusal prematurities or enlarged adenoids.

5-Aug-19 24
 Class III molar relation on one side & Class I on the other.

5-Aug-19 25
Dewey modified Class I malocclusion with-
Type I: Crowded anterior teeth.
Type II: Protrusive maxillary incisors.
Type III: Anterior crossbite.
Type IV: Posterior crossbite.
Type V: Mesial drifting of permanent molar.

5-Aug-19 26
Type I: Crowded anterior
teeth.

Type II: Protrusive maxillary incisors.

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Type III: Anterior crossbite.

Type IV: Posterior crossbite.

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Type V: Mesial drifting of permanent
molar.

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Dewey modified class III malocclusion
with-
 Type 1: Viewed separately, archs are normal, In occlusion – edge to edge
incisor alignment suggestive of forwardly moved mandibular arch.

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Type 2: Crowding and lingual relation of
mandibular incisors to maxillary incisors.

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 Lischer substituted Angle’s classes by-
 “Neutrocclusion” - Angle’s class I
 “Distocclusion” - Angle’s class II
 “Mesiocclusion” - Angle’s class III

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In addition, Lischer described nomenclature for individual tooth
malpositions by adding suffix “version” to a word indicating deviation
from normal position

1.Mesioversion:

2.Distoversion:

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3.Lingoversion:

4.Labioversion

5-Aug-19 34
 5.Infraversion:

6.Supraversion:

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7.Axioversion:

8.Transversion:

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9.Torsiversion:
(rotation)

Mesiolabial or Mesiolingual or
distolingual distolabial
rotation rotation

5-Aug-19 37
FRANKFORT HORIZONTAL
PLANE
ORBITAL PLANE
MID SAGITTAL PLANE
 BASED ON ITS ETIOLOGY –
 CLASS 1 –abnormal position of one or more teeth due to local
causes
 CLASS 2-abnormal formation of a part of whole of either arch
due to developmental defects of bone
 CLASS 3-Abnormal relationship between upper and lower
arches ,and between either arch and facial contour and
correlated abnormal formation of either arch.
 Etiology of malocclusion is the study of its
causes.
 Recognition and elimination of the
etiological factors is important so that one
can prevent and correct the malocclusion
and obtain a permanent result.
 Etiologic factor contribute to the variance
more often than they simply “cause” it.
 Etiology of malocclusion is the study of its
causes.
 Recognition and elimination of the
etiological factors is important so that one
can prevent and correct the malocclusion
and obtain a permanent result.
 Etiologic factor contribute to the variance
more often than they simply “cause” it.
 Narrow maxillary arch which predispose to posterior
crossbite.
 Psychological approach
 Mechanical aids –
REMOVABLE HABIT BREAKERS
FIXED HABIT BREAKER
CHEMICAL APPROACH-Pepper,quinine,asafetida.
 SIMPLE TONGUE THRUST

 COMPLEX TONGUE THRUST

Simple tongue thrust-normal tooth contact during the swallowing
act.
-presence of an anterior openbite
-abnormal mentalis muscle activity.
-tongue thrust is forward during swallo
wing to help establish an anterior lip seal.
 COMPLEX TONGUE THRUST-teeth apart swallow.
anterior openbite can be diffuse or absent.
absence of temporal muscle constriction during swallowing.
occlusion of teeth poor.
 Proclination of anterior teeth

 Anterior openbite

 Bimaxillary protrusion

 Posterior openbite in case of lateral tongue thrust.

 Posterior crossbite
 Habit breakers –both fixed and removable
 Child taught the correct method of swallowing.
 Muscle exercise
 Mouth breathing has been attributed as a possible etiologic
factor for malocclusion
The mode of respiration influences the posture of jaw ,the tongue
and to a lesser extent of head.
 OBSTRUCTIVE

 HABITUAL

 ANATOMIC
 Obstructive-complete or partial obstruction of nasal passage
can result in mouth breathing.
causes of nasal obstruction-
DEVIATED NASAL SEPTUM
NASAL POLYPS
CHRONIC INFLAMATION OF NASAL MUCOSA
LOCALIZED BENIGN TUMORS
 CONGENITAL ENLARGEMENT OF NASAL TURBINATES
 ALLERGIC REACTION OF NASAL MUCOSA
 OBSTRUCTIVE ADENOIDS
Habitual : Ahabitual mouth breather is one who continues to
breathe through his mouth even though the nasal obstruction
is removed.thus mouth breathing becomes a deep rooted habit
that is performed unconciously.
 Anatomic: an anatomic mouth breather is one whose lip
morphology does not permit complete closure of mouth ,such
as a patient having short upper lip.
 LONG FACE
 NARROW FACE
 SHORT AND FLACCID UPPER LIP
 CONTRACTED UPPER ARCH WITH POSSIBILITY OF POSTERIOR
CROSSBITE
 INCREASED OVERJET AS A RESULT OF FLARING OF THE INCISORS
 ANTERIOR MARGINAL GINGIVITIS CAN OCCUR DUE TODRYING OF
GINGIVA
 ANTERIOR OPENBITE CAN OCCUR
 Removal of nasal or pharyngeal obstruction
 Interception of the habit
 Rapid maxillary expansion
 Grinding of teeth for non functional purposes.
ETIOLOGY-emotional stresses,occlusion interference or
discrepancy between centric relation and centric occlusion
can predispose.
pericoronitis and periodontal pain
 Occlusal wear facets can be observed on the teeth.
 Fractures of teeth and restorations
 Mobility of teeth
 Tenderness and hypertrophy of masticatory muscles.
 Muscle pain when the patient wakes up
 Temporomandibular joint pain and discomfort can occur.
 Psychological counseling by psychiatrist
 Night guards or other occlusal splints that cover the occlusal
surface of teeth help
in eliminating occlusal interference.