How to Overcome Malocclusion and Achieve a Perfect Smile Part-1
Malocclusion: its causes, symptoms, treatments, and more. Learn how this common dental condition affects bite alignment and oral health.
Table of Contents
Introduction
Dewey’s Modification of Angle’s Classification further divides Class I and III malocclusions into specific types based on tooth alignment. Andrew’s keys focus on correct molar relationship, crown angulations. The British Institute’s Classification includes incisor and canine relationships. Ackerman-Profitt System of Classification involves steps to assess malocclusion. Crowding, spacing, cross-bite, open bite, deep bite, bimaxillary protrusion, rotations, and other dental problems are discussed, along with their causes and management options.
Dewey’s Modification (1915)
- It is a modification of Angle’s Classification.
- Martin Dewey divided Angle’s class I & III into further types:
- CLASS I:
- Type 1: Crowded maxillary anterior teeth. Canines may be abnormally positioned.
- Type 2: Proclined or labioversion of maxillary incisors.
- Type 3: Anterior cross bite present.
- Type 4: Posterior cross bite present.
- Type 5: Mesioversion of molars.
- Class III:
- Type 1: Well aligned teeth & dental arches. Edge-edge relationship.
- Type 2: Crowded mandibular incisors.
- Type 3: Crowded maxillary incisors, underdeveloped maxilla. Anterior cross bite present.
Andrew’s keys to Angle’s classification
- Correct molar relationship.
- Correct crown angulations.
- Correct crown inclination, i.e., Class I incisor relationship.
- No rotation is present.
- Teeth in tight contact with no spacing.
- The occlusal plane or curve of the spee should be flat, i.e., it should not be deeper than 1.5 mm.
- There were no tooth size discrepancies. (Bannet & McLanghlan’s).
Intra-arch problems (Individual or groups of teeth)
- Sagittal Problems:
- Labioversion or labial inclination
- Linguoversion or lingual inclination
- Mesioversion or mesial inclination
- Distoversion or distal inclination
- Vertical Problems:
- Supraversion or supra-occlusion: tooth that has over-erupted as compared to other teeth in the arch.
- Infraversion or Infra-occlusion: tooth that ha not erupted enough compared to the other teeth in the arch
- Rotated Teeth: refers to tooth movements along its long axis.
- Transposition of Teeth: term describes condition where two teeth have exchanged places.
Inter-arch problems
- Sagittal:
- Class II Malocclusion
- Class III Malocclusion
- Transverse:
- Crossbites, Scissor bite
- Midline shift
- Vertical:
- Deep bite
- Open bite
The British Standards Institute’s Classification of Incisor Relationship
- Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.
- Class I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
- Class II: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
- Division 1 – the upper central incisors are proclined or of average inclination and there is an increase in overjet.
- Division 2 – The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
- Class III: The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.
Ackerman-Profitt System of Classification
Step 1: Alignment
Step 2: Profile
Step 3: Type
Step 4: Class
Step 5: Bite Depth
Common malocclusion and dental Problems
- Crowding of Teeth
- Spacing Cross-Bite
- Open Bite
- Deep Bite
- Bimaxillary Protrusion
- Rotations
Crowding of Teeth
overlap of teeth caused by insufficient space within the dental arch
Classification of dental crowding
- it can be difficult to define the difference between, mild, moderate, and severe levels of dental crowding.
- There are 2 components to consider in every case of crowding:
- mesiodistal overlap
- buccolingual overlap.
- minor to moderate mesiodistal and buccolingual discrepancies can be corrected by restorative means.
- The management of severe discrepancies solely by restorative care is contraindicated by required tooth mutilation and possibly extensive support compromising periodontal surgery.
Causes
- Genetic (inheritance) factors
- Extra teeth
- Lost teeth
- Impacted teeth
- Abnormally shaped teeth
- Ill-fitting dental fillings, crowns, appliances, retainers, or braces
- Misalignment of jaw fractures after a severe injury
- Tumors of the mouth and jaw
- Thumb sucking
- Tongue thrusting
- Pacifier use beyond age three, and prolonged use of a bottle
- Lack of masticatory stress during development.
Types of Crowding
- Mild Crowding:
- Resolves without extraction.
- Proximal stripping
- Alignment of teeth by labial bow or z- spring.
- Moderate Crowding:
- Arch expansion (quad helix appliance)
- Distalization of molars
- Severe Crowding
- Extraction of all 1st premolar
- Retract canine by canine retractor
- Align anteriors by labial bow.Retention by Hawley’s retainer.
Spacing
Gap between two teeth or many teeth Can be:
- Localized (space present in localized regions or areas)
- Generalized (space present in entire arch)
Genralized spacing
- results from hypodontia along with small teeth (microdontia) in well-developed arches.
- In the case of microdontia, eliminate spaces between the anteriors, leaving a space between the canine and the 1st premolar.
localised spacing
- It results from tooth loss due to trauma, hypodontia, or the presence of midline diastema.
- Intervention is required in cases with:
- diastema greater than 3 mm; no space for permanenet Lateral incisors to erupt.
- Permanent canines have erupted; diastema is still present.
- The labial frenum has not migrated to the labial attached mucosa.
- congenitally missing incisors.
- presence of supernumerary teeth.
Interventions include
- Eliminate cause i.e. high labial frenum attachment.
- Removable appliance:
- Finger spring
- Finger spring with labial bow
- Split labial bow
- Frenectomy
- Implants
- Fixed appliances:
- Pin and tube appliance
Cross-Bite
When the teeth are aligned correctly, the upper teeth will fit slightly over the lower teeth. In a crossbite, the opposite occurs: Some upper teeth are positioned inside the lower teeth.
Each person’s individual crossbite is unique. A crossbite can affect a single tooth or a group of teeth, and one or both sides of the jaw.
Types of Cross-Bite:
- Anterior Cross-Bite:
- Single tooth
- Multiple Teeth
- Posterior Cross-Bite:
- Single tooth
- Unilateral
- Bilatera
Management
- Anterior Cross-Bite:
- Single tooth: Z-spring
- Multiple teeth: Expansion screw
- Posterior Cross-Bite
- Single tooth: Cross elastics
- Unilateral Cross-Bite: Functional appliance:
- Quad helix
- W arch
- Coffin Spring
- Bilateral Cross-Bite
- Quad helix
- W-arch
- RME by Hyrax screw
Open Bite
- Open Bite is the failure of a tooth or teeth to meet antagonists in the opposite arch.
- Types of Open Bite
- Simple anterior open bite
- Simple posterior open bite
- Complex or Skeletal open bite
Management
- Simple anterior open bite:
- Habit breaking by tongue spikes
- Arch expansion
- Simple posterior open bite:
- Removal of ankylosed primary tooth
- Complex or skeletal open bite:
- Early management:
- Bionator
- Frankel appliance
- Adult skeletal open bite: Orthognathic surgery
Deep Bite
- It is a ‘condition of excessive overbite
- where the vertical measurement b/w maxillary and mandibular incisal margins is excessive when the mandible is brought into centric occlusion.’ (GRABER).
Management
- growing age:
- anterior bite planes
- intrude anteriors by:
- fixed appliance
- hooks vertical pull headgear
- erupt posterior
- non growing age:
- orthognathic surgery
Bimaxillary Protrusion
Clinically, the trait is associated with the presence of a protrusive anterior dentoalveolar segment of the maxilla and mandible. This produces an appearance of unsightly protruding anterior teeth, increased procumbence of the lips and a convex lateral facial profile.
Management
- Extract all 1st premolars.
- Treatment depends upon the angulation of canine:
- Distally inclined canine:
- Retract canine and align incisors using retainer.
- Mesially inclined canine:
- Fixed appliance
- Distally inclined canine:
- Rotations
- single tooth:
- removable appliances:
- double cantilever spring
- labial bow
- semi- fixed appliance:
- high labial bow with t- spring
- removable appliances:
- Multiple rotations:
- fixed appliance
- single tooth:
How to Overcome Malocclusion and achieve perfect smile Part – 3
Learn about treatment approaches for Class II Malocclusion, including non-extraction and extraction method
