CLASS 1 TYPE 5
Occlusion The manner in which the upper and lower teeth come
together when the mouth is closed.
Malocclusion Malocclusion is a problem in the way the upper
and lower teeth fit together in biting or chewing. The
word malocclusion literally means "bad bite." The
condition may also be referred to as an irregular
bite, crossbite, or overbite.
Definition
DEWEY’S MODIFICATION OF
ANGLE’S MALOCCLUSION
Class I modifications
Type 1: Class I malocclusion with bunched or crowded
anterior teeth.
Type 2 : Class I with protrusive maxillary incisors.
Type 3 : Class I malocclusions with anterior cross bite.
Type 4 : Class I molar relation with posterior cross bite.
Type 5 : The permanent molar has drifted mesially due to
early extraction of second deciduous molar or
second premolar.
Class II modification
Class II, Division I
Proclined upper incisors with a resultant increase in overjet.
Class II, Division 2
Overbite is quite excessive (closed bite).
Class II, subdivision
Exhibits a Class II molar relation on one side and a Class I relation
on the other.
Class III modifications
Type 1 : The upper and lower dental arches when viewed separately
are innormal alignment. But when the arches are made to
occlude the patient shows an edge to edge incisor alignment
suggestive of a forwardly moved mandibular.
Type 2 : The mandibular incisors are crowded and are in lingual
relation to the maxillary incisors.
Type 3 : The maxillary incisors are crowded and in crossbite in relation
to the mandibular teeth.
CLASS 1 TYPE 5
CASE PRESENTATION
PATIENT PROFILE
Name: Charlotte Laboc
Birthdate: January 10, 2002
Age: 9 yo
Gender: Female
Address: #117 SENATORIAL ST. BATASAN HILLS QUEZON CITY
PATIENT HISTORY
Prenatal and Postnatal History
The patient was a healthy baby when she was
delivered. She had no abnormalities or
illnesses after her birth.
Dental History
The patient had oral prophylaxis and topical
fluoride application last August 28,
2010.
Medical History
The patient is physically healthy.
Family History
The child’s father smoke and drinks but her
mother does not smoke and drinks
occasionally only.
CLINICAL EXAMINATION
INTRAORAL EXAMINATION
• Lips – normal
• Gingiva:
– Gingivitis – none
– Gingival recession – none
– Fistula - none
• Oral Hygiene – average
• Tonsils and adenoids – normal
• Tongue – normal
• Mucosa – normal
• Tooth mobility – zero degree
CAST ANALYSIS
Classification of Malocclusion: Class 1 Type 5
Overjet: 3 mm: normal
( extension of the incisal or buccal cusp ridges of the
upper teeth labially or buccally to the incisal margins
and ridges of the lower teeth when the jaws are closed
normally.)
Overbite: 3 mm: normal
(increased vertical overlapping of the lower teeth by
the upper teeth, usually measured perpendicular
to the occlusal plane.)
Upper to lower arch midline:
the lower arch midline is deviated to the right from the upper arch midline.
Palatal Contour:
Sagittal: normal
Transverse: normal
Teeth clinically present:
16 55 14 53 12 11 21 22 63 24 25 26
46 x 84 83 42 41 31 32 73 74 x 36
Tooth measure (mesiodistally)
9.5mm 7.9mm 7.4mm 7.3mm 6.8mm 8.7mm 8.8mm 6.9mm 7.4mm 7.3mm 7.7mm 9.6mm
9.6mm x 8.3mm 6.4mm 6.2mm 5.8mm 6mm 5.7mm 6.2mm 8.2mm x 9.5mm
Arch form
Upper: ovoid Lower: ovoid
Mesial displacement of the buccal segments:
upper left: none lower left: none
upper right: none lower right: none
Incisor Midline by to Jaw Midline
Upper: upper incisor is deviated to right from the jaw midline
Lower: lower incisor is deviated to left from the jaw midline
Vertical tooth malposition:
Upper: none
Lower: none
Horizontal Tooth Malposition:
Upper right: none
Upper left: none
Lower right: 36
Lower left: 46
Abnormal tooth morphology
Upper: none
Lower: none
ARCH DIMENSIONS
Intercanine perimeter
Upper : 52mm Lower: 39mm
Intercanine width:
Upper: 36 mm Lower: 30mm
Arch length:
Upper: 33mm Lower: 26mm
Arch perimeter: Upper: 82mm Lower: 68mm
Arch width:
Upper: 46mm Lower: 39mm
PHOTO ANALYSIS
Hairline to Glabella : 17mm
Glabella to base of the nose : 23mm
Base of the nose to chin : 17mm
The inner canthus of
the eye both left and
right coincides with
the ala of the nose,
and the median
limbus of the eye also
coincides with the
corner of the mouth
FACIAL TYPE:
MESOCEPHALIC
Left side :
Convex profile
Right side :
Convex profile
MIXED DENTITION ANALYSIS
UPPER LEFT: UPPER RIGHT:
AS= 22mm AS= 24mm
RS= MDI + 11.6 RS= MDI + 11.6
2 2
= 26.9 + 11.6 = 26.9 + 11.6
2 2
= 25.05 mm = 25.05 mm
SP=AS-RS SP=AS-RS
=22-25.05 = -3.5 mm = 24-25.05 = -1.0 mm
Prediction: Insufficient Prediction: Insufficient
LOWER LEFT: LOWER RIGHT:
Tooth # 31+32+41+42 Tooth# 31+32+41+42
= 5.7mm+6mm+5.8mm+6.2mm = 5.7mm+6mm+5.8mm+6.2mm
RS= 23.7 mm RS= 23.7 mm
AS= 23 mm AS= 22.3 mm
SP=AS-RS SP=AS-RS
=23mm-23.7mm =22.3mm-23.7mm
= -0.7 mm = -1.4 mm
Prediction: Insufficient Prediction: Insufficient
Radiographic Analyis
PANORAMIC RADIOGRAPH
Tooth # Nolas Classification
11 9
12 8
13 7
14 7
15 5
16 7
17 6
18 0
Tooth # Nolas Classification
41 9
42 8
43 7
44 6
45 6
46 9
47 6
48 1
Tooth # Nolas Classification
21 9
22 8
23 7
24 7
25 6
26 8
27 6
28 0
Tooth # Nolas Classification
31 9
32 9
33 8
34 7
35 6
36 9
37 6
38 1
53 - 1/3 0f root is resorbed83 - 1/3 0f root is resorbed84 - 1/3 0f root is resorbed63 - 1/3 0f root is resorbed73 - 1/3 0f root is resorbed74 – no root resorption
Pathologic Findings- carious lesion on tootn # 74 and 84- no other pathologic condition is shown on the radiograph
CEPHALOMETRIC ANALYSIS
Angle Patient Norm Difference Range
SNA 85° 84.5° +0.5° ±5.3
Interpretation
The maxillary denture
base is in normal position in
relation to the cranial base.
Angle Patient Norm Difference Range
SNB 83° 82° +1 ±4.9
Interpretation
The mandibular
denture base is in normal
position in relation to the
cranial base.
Angle Patient Norm Difference Range
ANB 2.5° 2.5° 0 ±2.5
Interpretation
The maxilla is in normal
position in relation to the
mandible.
Angle Patient Norm Difference Range
FH/NP/ Facial Angle
92.5° 85.5° +7 ±3.0
Interpretation
The chin is protruded
in relation to the Frankfurt
Horizontal Plane.
Angle Patient Norm Difference Range
I/SN 98° 103.0° -5 ±5.0
Interpretation
The maxillary central
incisor is in normal position in
relation to the cranial base.
Angle Patient Norm Difference Range
I/I 131° 122.8° +8.2 ±8.7
Interpretation
The maxillary central
incisor is in normal position in
relation to the mandibular
central incisor.
Angle Patient Norm Difference Range
IMPA 90° 96.0° -6 ±7.4
Interpretation
The mandibular
central incisor is in normal
positon in relation to the
mandibular plane.
Angle Patient Norm Difference Range
FMIA 73° 55.2° +17.8 ±6.9
Interpretation
The mandibular central
incisor is protrusive in relation to
the cranial base.
Angle Patient Norm Difference Range
FMA 27° 28.7° -1.7 ±5.8
Interpretation
The mandible is going
forward in relation to the cranial
base.
Angle Patient Norm Difference Range
Y-axis 57° 65° -8 ±2.8
Interpretation
The mandibular is
growing forward or in a
horizontal manner.
ETIOLOGIC FACTORS
1. Early loss of primary tooth
Early loss of teeth will lead to dental arch collapse, but it’s
not the only cause for crowding & malalignment.
Collapse will be due to :
1. Mesial drifting of posterior teeth.
2. Distal drifting of incisors a/f canine & 1st decidious molar
loss.
2. Congenitally missing tooth
It results from disturbance during initial stages of tooth
formation ,initiation and proliferation. Missing of teeth can be:-
a. Complete (Anodontia).
b. Many teeth (oligodontia)
(Both are rare & are associated with ectodermal dysplasia (systemic abnormality).)
c. Few teeth (hypodontia) is more common.
3. Traumatic displacement of teeth
Dental trauma can lead to development of malocclusion in
3 ways:
1. Damage to permanent tooth buds from injury to
primary teeth.
2. Drift of permanent teeth a/f premature loss of
primary teeth.
3. Direct injury to permanent teeth.
APPLIANCEUSED
Split Saddle Space Regainer
The appliance differs from the free and spring type, in that
the functional part of the appliance consists of an acrylic
block that is split buccolingually and joined by a wire in
the form of a buccal and lingual loop. The appliance is
activated by periodic spreading of the loops. The activator
block is split with a disk after the appliance has been
processed.
OTHER APPLIANCE THAT
CAN BE USEDLOOPED COIL SPACE
REGAINERS
Designed to move
a Bicuspid mesially. It is
not recommended for
moving more than one
tooth or for moving a molar
distally. The appliance is
adjusted in the mouth by
flattening the loop.
SLIDING LOOP SPACE
REGAINER
This appliance
uses coil springs to move a
bicuspid mesially with
some distal movement of
the molar.
JACKSCREW SPACE
REGAINER
This appliance is
used for moving a molar
distally without tipping or
rotation. The first nut is
adjusted against the tube
and the second is
tightened against the first
to act like a lock
HALTERMAN APPLIANCE
This appliance is
used when an erupting molar
is trapped the distal of “E”.
Chain elastics connect the
hook to the bonded button on
the molar.
TISSUE REACTION
In the PDM there are 2 types of cells present :
1.osteoblasts (builders)
2.osteoclasts(wreckers)
-When a tooth is tipped with a conventional continuous force, the PDM is compressed in that area close to the alveolar crest. This area becomes cell free and blood vessels are occluded. On the tension side fibers are stretched which leads to the formation of the new bone building cells or osteoclasts.
Resorption will happen on the area that the tooth is moving towards and osteoclasts proliferate, tunneling into the bone behind necrotic pressure site to remove the bone and the dead cells.
Tissue building fibroblasts invade that area as well to restore continuity of the periodontal tissues. This process is called the UNDERMINING RESORPTION.
Apposition or deposition will take place as well in the area that the force is receiving the pressure,.
Principal bundle fibers are anchored in both cementum of the tooth and the alveolar bone and they run towards the center of the PDM. They are almost perpendicular at the alveolar cresty and become oblique farther down the root.
HOME CARE
Proper tooth brushing and flossing.
Avoid chewy candy and gum.
Should not be pressed or pushed with the tongue or fingers.
Regular check up of appliance to the dentist.
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