Malocclusion and Dentofacial

Deformity

Burden of Disease and Its

Assessment
Edward H. Angle
1855-1930
• Father of Modern
Orthodontics
• Primarily a
Prosthodontist
• Established Orthodontics
Specialty
Angle’s Classification (1980)
• Normal Class I: Mesiobuccal cusp of upper 1st molar
occluded in the buccal groove of lower 1st molar
• Class I: Normal relationship of the molars, but line
of occlusion incorrect because of malposed teeth,
rotations, or other causes
• Class II: Lower molar distally positioned relative to
upper molar, line of occlusion not specified
• Class III: Lower molar mesially positioned relative to
upper molar, line of occlusion not specified
Mesiobuccal cusp of upper 1st molar occludesin
the buccal groove of lower 1st molar
• The line of occlusion is a
smooth (catenary) curve
Orthodontic Problems
Incisor’s Irregularity (Crowding)
• Irregularity Index
Spacing
Posterior Crossbite
Overjet
Overbite / Open bite
Overjet
• Only 1/3 of world population has normal overjet
• Another 1/3 of world population has only mildly
increased overjet
• Increased overjet is present in Class II malocclusion
• Decreased overjet is present in Class III malocclusion
Etiology of Malocclusion
 Why Crowding is More Common?
• Size of teeth is
reducing
Number of Teeth is Reducing
Why Crowding is More Common?
• The current human being have smaller jaws?
• Rural vs Urban population
• Hard vs Soft Diet
• Cooked vs Uncooked food
100,000 year old mandible
Interproximal Attrition
Why people need orthodontic
treatment?
• Social Discrimination because of facial appearance
• Problems with oral function
• Greater susceptibility to trauma / periodontal
disease/ caries etc.

• JACSON’s TRIAD
• Esthetics
• Function
• Stability
Trauma
• Every third child with protruding teeth will suffer
trauma
• Age <9 year has 8 times more risk of dental trauma
Function
• Mastication
• Speech
• TMJ
Demand of Treatment
• Who wants treatment?
• Who needs treatment?
Indices
• Index is an objective way of assessing a parameter
(severity of malocclusion, treatment need, etc.)

• Indices to assess severity of malocclusion

• Peer assessment rating (PAR) system
• American Board of Orthodontics (ABO) discrepancy
index
PAR System
• Measurements of maxillary and mandibular
anterior alignment (crowding and spacing)
• Buccal segment occlusion
• Anteroposterior, Class I, II, III
• Transverse – Crossbites
• Vertical – Posterior openbite/collapsed bite
• Overjet or reverse overjet
• Overbite
• Midline discrepancies
ABO – Discrepancy Index
• PAR parameters
• 3 cephalometric parameters
Index of Treatment Need (IOTN)
• Grades treatment need in 5 groups from “no need”
to “extreme need”
• Two parts
• Dental Health Component
• Esthetic Component
Esthetic
Component
Esthetic
Component
Eat the Frog!
Truths about Eating the Frogs!
• “If the first thing you do each morning is to eat a live frog,
you can go through the day with the satisfaction of knowing
that the worst possible is already over”
~ Mark Twain
Rule 1: If you have to eat 2 frogs, eat the ugliest one first
Rule 2: If you have to eat a live frog at all, it does not pay to sit
and look at it for a very long time
Dental Health Component
• Grade 1 - IHAMPS
• Grade 2 – ABCDEF -HLMTX
• Grade 3 - ABCDEF
• Grade 4 - ABCDEFG
• Grade 5 - 1
Questions?