Dr.

Assem Abbass
Anbar University/College Of Dentistry
Orthodontic Department
2023
WHAT IS ORTHODONTICS?
Orthodontics has been defined as that branch of dental science concerned with
the genetic variation, development and growth of facial form. It is also concerned with
the manner in which these factors affect the occlusion of the teeth and the function of
the associated organs.
Thus, whilst orthodontic techniques are concerned with the treatment of
irregularities of the teeth, the study of orthodontics, as a whole, includes the growth,
development and function of the total orofacial complex.
 Occlusion:
• Is the way the maxillary & mandibular teeth articulate.
• Is defined as "every contact of teeth of the maxilla with those of the
mandible“

Types:
-Ideal occlusion.
-Normal occlusion.
-Malocclusion.
Ideal occlusion: A theoretical concept of an ideal arrangement of the teeth
within the dental arches, combined with an ideal inter-arch relationship, which
concentrates optimal esthetic, function, and stability of the dentition and supporting
structures. But it is almost never found in nature.
Normal occlusion: is commonly described as 'An occlusion within the accepted
deviation of the ideal“, or “That occlusion which satisfies the requirements of function and
esthetic but in which there are minor irregularities of individual teeth.”. This vague
definition means that there are no clear limits to the range of normal occlusion. However,
in general, minor variations in the alignment of the teeth which are not of aesthetic or
functional importance might be considered as being consistent with a normal occlusion.
Malocclusion: is an irregularity in the occlusion beyond the accepted range of normal
(any deviation from the normal or ideal occlusion).
The fact that an individual has a malocclusion is not in itself a justification for treatment.
Only if it is possible to say with certainty that the patient will benefit aesthetically or
functionally, and only if they are suitable and willing to undergo treatment should
orthodontic intervention be considered.
 Normal permanent occlusion
(Six Keys of Occlusion by Andrews)
1. Molar relationship: Distal surface of the disto-buccal cusp of 6 contacts and
occludes with the mesial surface of the mesiobuccal cusp of lower 2nd molar.
The mesiobuccal cusp of 6 lies in the groove between the mesial and middle cusps
of lower 1st molar. The mesiolingual cusp of 6 seats in the central fossa of lower
1st molar.
2. Crown angulation: Gingival aspect of the long axis of each crown lies distal to its
incisal or occlusal portion. The degree of mesial tip depends of the type of the tooth.
3. Crown inclination (labio-lingual or bucco-lingual):
-The gingival aspect of the labial surface of the crown of incisors lies palatal to the incisal aspect.
-The gingival aspect of the labial or buccal surface of the crowns of upper posterior teeth lies labial
or buccal to the incisal occlusal aspect (molar teeth inclined slightly more than premolars).
-The lower posterior teeth inclined lingually progressively more from canine to molar.
4. No rotations.
5. No spaces between the teeth.
6. Occlusal plane: Flat or slightly increased (<_1.5mm) curve of
Spee.
The scope and aims of orthodontic treatment
These might be best summarized as follows:

1. The improvement of facial and dental aesthetics.

2. The alignment of the teeth to eliminate stagnation areas.
3. The elimination of premature contacts which give rise to mandibular displacements
and may contribute to later muscle or joint pain.
4. The elimination of traumatic irregularities of the teeth.
5. The alignment of prominent teeth which are liable to be damaged.
6. The alignment of irregular teeth prior to bridgework, crowns or partial dentures.
7. The alignment of periodontally involved teeth prior to splinting.
8. The alignment and planned positioning of teeth in the jaws prior to orthognathic
surgery.
9. To assist the eruption and alignment of displaced teeth.
Angle classification:
A classification of malocclusion introduced by E. H. Angle,
based on the anteroposterior relationship of the maxillary and
mandibular first permanent molars. Angle’s assumption when
formulating this classification was that the maxillary first
permanent molar always is in the physiologically correct position
and the variability comes from the mandible.
Angles classification
Class I (neutrocclusion) The mesiobuccal cusp of 6 lies in
the groove between the mesial and middle cusps of lower
1st molar.

Class II Malocclusion (Distoclusion): A malocclusion in

which the buccal groove of the mandibular first
permanent molar occlude posterior (distal) to the
mesiobuccal cusp of the maxillary first permanent molar.

Class III Malocclusion (mesioclusion): a malocclusion in

which the mesiobuccal cusp of upper first molar occlude
distal to buccal groove of lower first molar.
Class II malocclusion has two divisions:

Division 1 A class II malocclusion with proclined maxillary incisors,

resulting in an increased overjet .

Division 2 A class II malocclusion typically with the maxillary central

incisors tipped palatally .
Three types of Class II Division 2 malocclusion can be
distinguished:
• Type A: The four maxillary permanent incisors are tipped
palatally, without the occurrence of crowding.
• Type B: The maxillary central incisors are tipped palatally and
the maxillary laterals are tipped labially.
• Type C: The four maxillary permanent incisors are tipped
palatally, with the canines labially positioned.
Class III:
Canine classification:
• Class I: It is a normal canine relation, when the tip of the upper canines
located in the embrasure area between lower canine and first premolar
(or the mesial slope of the upper canine coincide with the distal slop of
lower canine) in occlusion.
• Class II:
• Abnormal canine relation in which the lower canine will be more
backward from normal canine relation in occlusion.
• Class III:
• Abnormal canine relation, when the lower canine will be more forward
than from normal canine relation.
Incisor classification:

• The incisor relationship does not always match the buccal segment
relationship. Since much of orthodontic treatment is focused on the
correction of incisor malrelationships, it is helpful to have a classification
of incisor relationships. The terms used are the same but this is not
Angle's classification, although it is a derivation.
• In clinical practice the incisor classification is usually found to be more
useful than Angle's classification.
• Class I:
• The lower incisor edges occlude with or lie immediately below the
cingulum plateau (middle part of the palatal surface) of the upper
central incisors.
• Class II:
• The lower incisor edges lie posterior to the cingulum plateau of the upper incisors. There
are two divisions to Class II malocclusion:
• Division 1: The upper central incisors are proclined or of average inclination, with an
increased overjet.
• Division 2: The upper central incisors are retroclined (less than 105° to the maxillary plane).
The overjet is usually of an average amount but may be increased, the over bite mostly
increased (deep bite).
• Class III:
• The lower incisor edges lie anterior to the cingulum plateau of the
upper incisors. The overjet may be either reduced or reversed.
Orthodontic definitions:

Incisal Overbite: is defined as vertical overlap of the incisors. Normally, the lower
incisal edges contact the lingual surface of the upper incisors at or above the cingulum
(i.e., normally there is 1 to 2mm overbite). In open bite, there is no vertical overlap,
and the vertical separation of the incisors is measured to quantify its severity.
Incomplete overbite: when there is no incisal contact and the lower
incisors are above the level of the upper incisal edges.
 Open bite
Types of open bite:
1. Anterior open bite: The lower incisors are not overlapped in the vertical plane by
the upper incisors and do not occlude with them.
2. posterior open bite: No contact between upper and lower posterior teeth.
Incisal Overjet: is defined as horizontal distance between the upper and lower
incisors in occlusion, measured at the tip of the upper incisor. Normally, the incisors
are in contact, with the upper incisors ahead of the lower by only the thickness of
their incisal edges (i.e., 2-3 mm overjet is the normal relationship). If the lower
incisors are in front of the upper incisors, the condition is called reverse overjet or
anterior crossbite.
Crossbite:
• An abnormal relationship of one or more teeth to one or more teeth of
the opposing arch, in the buccolingual or labiolingual direction. A
crossbite can be dental or skeletal in etiology.
Classification of crossbite:
Based on Location:
1. ANTERIOR CROSS BITE:
• According to no. of teeth involved:
A. Single tooth Cross bite. B. Segmental Cross bite.
2. POSTERIOR CROSS BITE:
• According to no. of teeth involved:
A. Single tooth Cross bite. B. Segmental Cross bite.
• According to side involved:
A. Unilateral. B. Bilateral.
• According to extent:
A. Single posture Cross bite. B. Buccal Non-occlusion (Scissor bite). C. Lingual Non-
occlusion (Buccal crossbite).
Based on the Etiologic Factor:
1. Skeletal crossbite.
2. Dental crossbite.
3. Functional crossbite.
Anterior crossbite: If the one or more of the lower incisors are in front of the upper
incisors, the condition is called reverse overjet or anterior crossbite.
Posterior crossbite: A crossbite due to buccal displacement of the affected
posterior tooth (or group of teeth) from its (their) ideal position relative to its (their)
antagonist(s). Subdivided into:
1. Unilateral posterior crossbite: Affect only one side of the dental arch.
2. Bilateral posterior crossbite: Caused by sever maxillary collapse or/ and mandibular
widening.
Skeletal crossbite: It is a crossbite with a skeletal basis (constricted
maxilla and/or wide mandible).
Dental crossbite: It is caused by distortion of the dental arch where the
jaws are of normal proportions.
Functional crossbite (False): It is a crossbite due to a functional shift
of the mandible, it should be treated early if recognized, because if
uncorrected, true crossbite may result by modification of growth.
Scissors-bite: Lower teeth occlude lingual to palatal cusps of upper
teeth. Also called lingual cross bite.
Space discrepancy: It is the difference between the space
needed in dental arch and the available space in that arch.

Spacing: A dental arch with spacing of more than accepted range (2 mm or more).
It is either localized and concentrated in the midline as a median diastema, or
generalized affecting the whole dental arch.
Crowding of the dentition: A dental arch with crowding of more than
accepted rang (2 mm or more), either caused by local factor like early extraction of
deciduous teeth or general factor like collapsed maxillary arch that lead to crowding of
the whole arch (loss of dental arch perimeter), this will lead teeth to slip over their
contact area with the resultant rotation and or displacement.
Dental retrusion: Posterior position of a tooth or group of teeth but keeping their
long axis with normal inclination.
Dental retroclination: Posterior positioning of a tooth or group of teeth but their
long axis are tipped labio-lingually. [Note: A tooth can be retrusive without being
retroclined, if it is positioned too far posteriorly but has a normal inclination].
Dental proclination: Anterior positioning of a tooth or group of teeth but their long
axis are tipped labially.
Dental protrusion: Anterior positioning of a tooth or group of teeth but keeping
their long axis with normal inclination.
Impaction of teeth: Occurs when eruption is completely blocked by other teeth due
to crowding, it tends to affect the last teeth to erupt in each segment (as in case of
canine).
Rotation of teeth: A type of malocclusion in which there is a rotation of a tooth
about its long axis, most evident when viewing the tooth from an occlusal perspective
mostly, caused by crowding and sub divided into:
1. Mild (less than 90°): Can be treated easily by removable orthodontic appliance
using couple force system.
2. Sever (more than 90°): Must be treated by Fixed orthodontic appliance only.
Overlapping of teeth: Abnormal position of the crown of the tooth in the dental
arch while there is normal position of root in the jaw.
Displacement of tooth: Abnormal position of the tooth (crown and root) in the
dental arch.