Normocclusion
Local and general anomalies
Dr.Káldy Adrienn
Semmelweis Egyetem
Gyermekfogászati és Fogszabályozási Klinika
Angle classification system
 For malocclusions proposed by Angle is
widely used and serves as an excellent
means of general description that has
facilitated the communication about different
malocclusions within the profession
 The system basically describes
anteroposterior relationships of the upper and
lower first molars
Angle classification system
Angle Class I.
A Class I malocclusion is
associated with a normal
maxillomandibular
relationship in the saggital
plane
All ideal occlusions are Class
I, however not all the Class I
occlusions are ideal
Class I. malocclusions
Local anomalies
General anomalies
Single teeth: variations in
Vertical plane:
the positions of single teeth
-tilting,mesial, distal,labial,
lingual,infra,supra position,
rotation
-ectopic eruption of the first
molars
-median diastema
-anterior crossbite
-impacted teeth
-numerical deviations
-Deep bite
-Openbite
Transversal plane:
-crowding
-crossbite
Local anomalies
-tilting ( apical base in place)
-incorrect position( apical base not in the right
place)
-combination of these
Etiology
-lack of space
-functional problems
-hereditary factors
-trauma
-early extaction of the primary tooth
Axial deviation of the single teeth
Labial, buccal, palatinal, lingual, mesial, distal tilting of the teeth
Labial tilting of the upper incisors:
- genetic
- bad oral habits (thumb sucking, pacifying)
Palatinal tilting of the upper incisors:
-lack of place
-deepbite, coverbite
Therapy:
Elimination of cause factors
(disfunctions, persistent milk teeth)
Removable appliances, fixed
appliances
Ectopic upper canine
Lack of place
Therapy:
Creating place
-Expansion:
-removable expander plate („Y”
plate)
-fixed appliance
-Extraction
Maxillary midline diastema
Early mixed dentition
Diagnostic:
Oral observation, X-ray
Etiology:
Supernumerary teeth,
congenital missing teeth,
strong fraenum, hereditary
factors
Consequences:
Esthetical and phonetical
problems
Median diastema
Therapy:
Elimination of the trigger
factors
-Frenulectomy
-Extraction of the
supernumerary tooth
Space closing
-with fixed or removable
appliance
Retention phase!
Anterior cross-bite
Diagnostic
Oral observation, X-ray
Etiology
-Unfavourable axial inclination
-Crowding
-Hereditary factors
-Trauma
Consequences
-Traumatically occlusion
-Gingival irritation
-Periodontal problems
-Tooth lost
Anterior cross-bite
Therapy
Elimination of cause factors
-Creating space with fixed or
removable appliance
-Alignement of the tooth
Impacted teeth
Diagnostic
Oral observation, X-ray from two direction
Etiology
-Unfavourable axial deviation or postion of the germ
-Crowding
-Hereditary factors
-Trauma
-Early extraction of deciduous tooth
-Supernumerary teeth
Consequences
-Follicular cyst
-Root resorptoin of neighbouring teeth
Freuency
-8,3,5,1
Treatment of impacted teeth
-Orthodontic treatment with spontaneous
eruption
-Surgical-orthodontic treatment without
extraction
-Orthodontic treatment after surgical
intervention and extraction of the
impacted tooth
-Direct surgical reposition
Impacted canine
Prognosis
-Palato-buccal position
-Abnormality of teeth axial inclination ( 45o )
-Space discrepancy
-Patient age
Possible sideffects of the treatment
Loss of anchorage, loss of attachment
Intrusion of the neighbouring
Root resorption
Numerical deviations
Diagnostic
Oral observation, X ray
Etiology
-Hereditary factors
-Trauma
-Intrauterine injuries
-Cariological problems
Consequences
-Agenesia Diasthema,
-Supernumerary: crowding,follicular cyst,
-Periodontal problems
Frequency
-Agenesia: 8,2,5,1
-Supernumerary: mainly in the front area
Treatment of numerical deviations
-Orthodontic
-Orthodontic and prosthetic
-Prosthetic
-Surgical-Orthodontic
-Implantologic
Important factors:
Other orthodontic anomalies, oral
hygiene, age
Treatment of Angle class I.
General anomalies
Outline
 Deep bite
 Open bite
 Transversal anomalies
Lateral cross bite, Scissor bite,
Crowding
Deep bite
 Dento alveolar
Over eruption of incisors
Lack of laterals eruption
Multiple extraction
 Skeletal
Usually together with
Angle II/2
Analysis of the cephalogram
 ML-NL angle
 ML-NSL angle
 NL-NSL angle
 Gonion angle
Treatment of deep bite
 Intrusion of incisors
 Extrusion of molars
 Appliances:
Multiband or removable
appliance
Utility ív
Treatment with fixed appliance
Deep bite (Angle II/2)
Passive plate with bite raising block in the front
Open bite
 Anterior
 Lateral
Unilateral Bilateral
 Dento alveolar
Habitual dysfunction
 Skeletal
Vertical development of the
mandible
Analysis of the cephalogram
 ML-NL angle
 ML-NSL angle
 NL-NSL angle
 Gonion angle
Typical skeletal and dentoalveolar
open bite
Treatment of open bite
 Elimination of the
causes
 Correction of the
vertical relation
between the upper and lower
jaws
 Appliances:
Oral screen
Activator
Fixed appliance with
intermaxillary elastics
oral screen
ORAL SCREEN
Az aktivátor
 Andresen
 Häupl—funkciós
állcsontortopédia
 Merev akrilátblokk
 Labiálív
 Öntött kapcsok
 Aktiválás
 vertikális irányú
Dentoalveolar open bite due to habitual dysfunction
Treatment with tongue cribs
Tongue trust
swallowing
Treatment of the open bite with fixed appliance
Treatment of the open bite with fixed
appliance
Tongue trust swallowing
Utility arch
Transversal anomalies
Lateral cross bite
 Unilateral
 Bilateral
 Dentoalveolar
 Skeletal
Lateral scissors
Lateral cross bite
Analysis of the model
 Measurement of the
indexes
 Analysis of the
relation between the
apical and the
coronal base
Pont- and the Schmuth- index
Treatment alternatives of lateral
cross bite
 In the deciduas
dentition grinding and
functional training (bite
exercise)
 Functional appliance




with screw
Frankel I
Active plate
Quad-helix
Hyrax screw
Hasund-féle Hansa
készülék:
 --felső lemezrész
tágító csavarral,
torqueáló-rugóval,
Adams-kapoccsal
 Alsó lemezke
 -- speciális rugóval,
 -- ajakráccsal
Frankel appliance




--Buccális pajzs
--pelották
--transzpalatinális ív
--segédrugók
 Periosteum
viszkoelasztikus
elhúzódása
Upper and lower active plates
Unilateral cross bite
forced bite
Transversal widening
Treatment of scissors bite
 Closing the upper
arch
 Expanding the lower
arch
 Appliances: multiband,
activator (with screw) active
plate
Transversal anomalies
Crowding
 Primer:
Size of tooth arch
teeth
Size of
 Secounder:
Early deciduous extraction and its
consequence
 Tertier:
Eruption of the wisdom
Crowding
 Primary ⇐ Jaw size ⇒ Tooth dimension
 Secondary ⇐ Early extraction of deciduous
 Tertiary ⇐ Third molar
Treatment of crowding
Hyrax
 Prevention
 Space creation
Transversal and or sagittal
widening (help: Pont index )
 Tooth material
reduction
extraction or stripping of
enamel
(help: Bolton analysis)
Stripping
of enamel
Treatment of crowding
 Prevention
 Provision of space
Pont index sagittal and or
transversal expansion)
 Reduction of tooth
material
stripping)
(extraction
Non extraction treatment
 Crowding
 Large scale deep
bite
 (Angle II/1.)
persistant
decidous
After the treatment
After the treatment
Extraction treatment
 Consideration : Expansion ⇔ extraction
 The measure of the narrow: 0-5mm, 5-10mm,
10 Consideration of the protrusion
 Consideration of the vertical relation
systemic extraction
 Extraction of
deciduous canines
 Extraction of first
deciduous molars
 Extraction of first
premolar