6 Chei Andrews

The six keys of normal occlusion by Andrews LF (1972) The following is the characteristics
shared by all teeth to be within normal occlusion:

Key I. Molar relationship: The distal surface of the distobuccal cusp of the upper first permanent molar
made contact and occluded with the mesial surface of the mesiobuccal cusp of the lower second molar.
The mesiodistal cusp of the upper first permanent molar fell within the groove between the mesial and
middle cusps of the lower first permanent molar. (The canines and premolars enjoyed a cusp-embrasure
relationship buccally, and a cusp fossa relationship lingually.)
Key II. Crown angulation, the mesiodistal "tip": The term crown angulation refers to angulation (or tip)
of the long axis of the crown, not to angulation of the long axis of the entire tooth. As orthodontists, we
work specifically with the crowns of teeth and, therefore, crowns should be our communication base or
referent, just as they are our clinical base. The gingival portion of the long axis of each crown was distal
to the incisal portion, varying with the individual tooth type. The long axis of the crown for all teeth,
except molars, is judged to be the mid-developmental ridge, which is the most prominent and centermost
vertical portion of the labial or buccal surface of the crown. The long axis of the molar crown is identified
by the dominant vertical groove on the buccal surface of the crown.
Key III. Crown inclination (labiolingual or buccolingual inclination): Crown inclination refers to the
labiolingual or buccolingual inclination of the long axis of the crown, not to the inclination of the long
axis of the entire tooth. The inclination of all the crowns had a consistent scheme: a. Anterior teeth;
central and lateral incisors: Upper and lower anterior crown inclination was sufficient to resist
overeruption of anterior teeth and sufficient also to allow proper distal positioning of the contact points of
the upper teeth in their relationship to the lower teeth, permitting proper occlusion of the posterior
crowns. b. Upper posterior teeth; canines through molars: A lingual crown inclination existed in the upper
posterior crowns. It was constant and similar from the canines through the second premolars and was
slightly more pronounced in the molars.
Hussam M. Abdel-Kader Orthodontics for Undergraduate: 2009
23 c. Lower posterior teeth; canines through molars: The lingual crown inclination in the lower posterior
teeth progressively increased from the canines through the second molars.
Key IV. Rotations: The fourth key to normal occlusion is that the teeth should be free of undesirable
rotations. An example of the problem: a superimposed molar outline showing how the molar, if rotated,
would occupy more space than normal, creating a situation unreceptive to normal occlusion. Key V. Tight
contacts: The fifth key is that the contact points should be tight (no spaces). Persons who have genuine
tooth-size discrepancies pose special problems, but in the absence of such abnormalities tight contact
should exist. Without exception, the contact points on the non-orthodontic normals were tight. (Serious
tooth-size discrepancies should be corrected with jackets or crowns, so the orthodontist will not have to
close spaces at the expense of good occlusion.)
Key VI. Occlusal plane: The planes of occlusion found on the non-orthodontic normal models ranged
from flat to slight curves of Spee. Even though not all of the non-orthodontic normal’s had flat planes of
occlusion, I believe that a flat plane should be a treatment goal as a form of overtreatment. There is a
natural tendency for the curve of Spee to deepen with time, for the lower jaw's growth downward and
forward sometimes is faster and continues longer than that of the upper jaw, and this causes the lower
anterior teeth, which are confined by the upper anterior teeth and lips, to be forced back and up, resulting
in crowded lower anterior teeth and/or a deeper overbite and deeper curve of Spee. At the molar end of
the lower dentition, the molars (especially the third molars) are pushing forward, even after growth has
stopped, creating essentially the same results. If the lower anterior teeth can be held until after growth has
stopped and the third molar threat has been eliminated by eruption or extraction, then all should remain
stable below, assuming that treatment has otherwise been proper. Lower anterior teeth need not be
retained after maturity and extraction of the third molars, except in cases where it was not possible to
honor the musculature during treatment and those cases in which abnormal environmental or hereditary
factors exist. Intercuspation of teeth is best when the plane of occlusion is relatively flat. There is a
tendency for the plane of occlusion to deepen after treatment, for the reasons mentioned. It seems only
reasonable to treat the plane of occlusion until it is somewhat flat or reverse to allow for this tendency. In
most instances one must band the second permanent molars to get an effective foundation for leveling of
the lower and upper planes of occlusion. A deep curve of Spee results in a more contained area for the
upper teeth, making normal occlusion impossible. Only the upper first premolar is properly intercuspally
placed. The remaining upper teeth, anterior and posterior to the first premolar, are progressively in error.
A reverse curve of Spee is an extreme form of overtreatment, allowing
Hussam M. Abdel-Kader Orthodontics for Undergraduate: 2009
24 excessive space for each tooth to be intercuspally placed. The six keys to normal occlusion contribute
individually and collectively to the total scheme of occlusion and, therefore, are viewed as essential to
successful orthodontic treatment.

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The six keys of normal occlusion by Andrews LF (1972) The following is the characteristics

shared by all teeth to be within normal occlusion:

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