How to Overcome Malocclusion and achieve perfect smile Part – 2
Dive into Dewey’s Modification of Angle’s Classification, Andrew’s keys, intra-arch problems, and the British Institute’s Classification.
Table of Contents
- Malocclusion is a misalignment or incorrect relationship between the teeth of the upper and lower dental arches when they approach each other as the jaws
- The word malocclusion derives from occlusion, and refers to the manner in which opposing teeth meet (mal + occlusion = “incorrect closure”).
- Malocclusion typically happens when your teeth are crowded — meaning your teeth are too large for your mouth — or are crooked. But it can also happen if your upper and lower jaws aren’t aligned.
Types of malocclusion:
- Crowded teeth
- Crossbite
- Overbite
- Underbite
- Open bite
Causes
- There is not one single cause of malocclusion; it is multifactorial, with influences being both genetic and environmental.
- There are three generally accepted causative factors of malocclusion:
- Skeletal factors include the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate.
- Muscle factors: the form and function of the muscles that surround the teeth. This could be impacted by habits such as finger sucking, nail biting, pacifiers and tongue thrusting.
- Dental factors: size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration, causing crowding, abnormal eruption path or timing; extra teeth (supernumeraries), or too few teeth (hypodontia).
- Behavioral and dental factors: In the active skeletal growth, and other habits greatly influence the development of the face and dental arches and leads to malocclusion.
- Mouth breathing,
- Finger sucking,
- Thumb sucking,
- Pacifier sucking,
- Onychophagia (nail biting),
- Dermatophagia (the condition of an individual with a compulsion or habit, either conscious or subconscious, that results in that person biting their own skin.)
- Pen biting,
- Pencil biting,
- Abnormal posture,
- Deglutition disorders
- Pacifier sucking habits are also correlated with otitis media.
- Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.
Signs and Symptoms
- Tooth decay (caries): misaligned teeth will make it more difficult to maintain oral hygiene. Children with poor oral hygiene and diet will be at an increased risk.
- Periodontal disease: irregular teeth would hinder the ability to clean teeth meaning poor plaque control. Additionally, if teeth are crowded, some may be more buccally or lingually placed, there will be reduced bone and periodontal support. Furthermore, in Class III malocclusions, mandibular anterior teeth are pushed labially which contributes to gingival recession and weakens periodontal support.
- Trauma to anterior teeth: Those with an increased overjet are at an increased risk of trauma. A systematic review found that an overjet of greater than 3mm will double the risk of trauma.
- Masticatory function: people with anterior open bites, large increased & reverse overjet and hypodontia will find it more difficult to chew food.
- Speech impairment: a lisp is when the incisors cannot make contact, orthodontics can treat this. However, other forms of misaligned teeth will have little impact on speech and orthodontic treatment has little effect on fixing any problems.
- Tooth impaction: these can cause resorption of adjacent teeth and other pathologies for example a dentigerous cyst formation.
Methods of Malocclusion Classification
- Quantitative and Qualitative types of Malocclusion.
- Intra-arch and Inter-arch problems.
Qualitative Methods | Quantitative Methods |
Angle’s Classification | The PAR Index |
Modification of Angle’s Classification | The IOTN Index by Shaw |
Simon’s Classification | Massler and Frankel |
Bennet’s Classification | Malalignment Index by van Kurt and Pennel |
Skeletal Classification |
|
Ackermann-Profit Classification |
|
WHO/FDI Classification |
|
Aetiological Classification |
|
Incisor Classification |
|
Canine Classification |
|
Dr. Edward Angle
- first defined three classes of jaw relationships in 1887.
- Each class of occlusion is defined by the relationship between the first teeth to erupt in the adult dentition (maxillary and mandibular first molars) or, if the first molars are absent, the relationship between the maxillary and mandibular canines
Class 1
- Molar relationship
The mesiobuccal cusp of the maxillary first molar is occluding in line with the buccal groove of the mandibular first molar
the maxillary first molar is slightly posteriorly positioned relative to the mandibular first molar.
- Canine relationship
- The mesial incline of the maxillary canine occludes with the distal incline of the mandibular canine.
- The distal incline of the maxillary canine occludes with the mesial incline of the mandibular first premolar .
Class 2
- Molar relationship
- The mesiobuccal cusp of the maxillary first molar occluding anterior to the buccal groove of the mandibular first molar
- This most commonly causes a retrognathic facial profile.
The Class 2 molar relationship can be divided into 2 further parts:
- Class 2 Division 1: Class 2 molars with normally inclined or proclined maxillary central incisors
- Class 2 Division 2: Class 2 molars with retroclined maxillary central incisors
- Canine Relationship:
- The mesial incline of the maxillary canine occludes ANTERIORLY with the distal incline of the mandibular canine.
- The distal surface of the mandibular canine is posterior to the mesial surface of the maxillary canine by at least the width of a premolar.
Class 3
- Molar relationship
- The mesiobuccal cusp of the maxillary first molar occluding posterior to the buccal groove of the mandibular first molar
- the maxillary first molar is severely posteriorly positioned relative to the mandibular first molar.
- This causes a prognathic facial profile.
TRUE class III malocclusion (SKELETAL), which is genetic in origin due to an excessively large mandible or a smaller than normal maxilla.
- PSEUDO Class III malocclusion (false or postural), which occurs when the mandible shifts anteriorly during the final stages of closure due to premature contact of the incisors or the canines,. Forward movement of the mandible during jaw closure can also result from premature loss of deciduous posterior teeth.
- Canine Relationship:
- Distal surface of the mandibular canines are mesial to the mesial surface of the maxillary canines by at least the width of a premolar .
- Mandibular incisors are in complete crossbite.
Merits of Angle’s Classification:
- Easy and most practical method.
- Rapid method of classification.
- Requires no instrumentation.
- Easy to communicate.
- Widely used for teaching purpose.
Demerits of Angle’s Classification:
- Incorrect hypothesis.
- Angle considered only sagittal dimension.
- Not applicable in primary dentition.
- Not applicable when first permanent molars are missing.
- Skeletal problems are not considered.
- Did not elaborate the etiology of malocclusion
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