Classification

2. CLASSIFICATION

CLASSIFICATION OF VERTICAL DISCREPANCIES IN ORTHODONTICS.

I. CLASSIFICATION OF INCISOR RELATIONSHIPS IN THE VERTICAL
DIMENSION.2
Ballard and Wayman first gave a classification of the incisor occlusion
in 1964 2 , which in turn was based on the work of Backlund. 5 With the help
of lateral skull radiographs, in the Caucasian population, Backlund studied
the relation between the part of the lingual surface of the upper incisors on
which the lower incisors occluded. As a result, he divided the palatal or
lingual surface of the upper incisors into three equal parts. Brook and Shaw
gave the British Standard Institute Classification of Malocclusion,
considering incisor occlusion. This classification is considered superior to
Angle’s classification because the posterior teeth did not influence the
occlusion on the incisors.

The BSI-classification is as follows: (Fig-2.1)

Class I: the lower incisor edge precludes with or lies immediately below the
cingulum plateau of the upper central incisors.

Class II: the lower edges lie cervical to the cingulum plateau (middle part
of the palatal surface) of the upper incisors.
Class II has two subdivisions:
Div 1: there is an increase in overjet and the upper central incisors are
usually proclined.
Div 2: the upper central incisors are retroclined. The overjet is usually
minimal, but may be increased.

Class III: the lower incisor edges lie coronal to the cingulum plateau of the
upper incisors. The overjet is reduced or reversed.

Sanoubar Homayoun & Vida Kolahi 6 modified this classification of

the incisors, keeping in mind the difference in morphology of the incisors
between the Caucasian population and the Mongoloid population.

This was named as the Modified British Standards Institute for

incisor classification. 6
Class I: Lower incisor edge occludes with the middle part of the palatal
surface.

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 Classification

Class II: Lower incisor edge occludes with the cervical third of the palatal
surface

Class III: Lower incisor edge occludes with the incisal third of the palatal
surface.
Having understood the classification of occlusal pattern of the
maxillary and mandibular incisors, a classification of the discrepancies in
the vertical dimension follows.

II. CLASSIFICATION OF DEEP OVERBITE (DEEP BITE): 1

Depending on the etiology, overbite can be differentiated into

Developmental deep bite and Acquired deep bite. 1

• Developmental deep bite, also known as Genetically determined deep

overbites is further classified as:

1. Skeletal deep overbite.

There is a horizontal growth pattern observed in cases of skeletal deep
bite.
E.g. Class II Div1 malocclusion.

2. Dentoalveolar deep bite.

A dental deep bite is caused by supraocclusion of the incisors. In such
cases, the interocclusal clearance is usually small. i.e., the overbite is
functionally a pseudo over-bite.

• Acquired deepbite maybe caused by the following factors:

1. A lateral tongue thrust or the posture of the tongue.
This produces an infraocclusion of the posterior teeth, in turn leading
to a deep overbite.Eg. Class II div 2 malocclusion.

2. Premature loss of deciduous molars or early loss of permanent

posterior teeth, causing an acquired secondary deep overbite.

3. The wearing away of the occlusal surface or tooth abrasion can

produce an acquired, secondary deep overbite.

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 Classification

II.CLASSIFICATION OF OPEN BITE 1

The classification of an open bite is based on the etiology of the
malocclusion.

Therefore, in this case, the etiology and the classification go hand in hand.

Thomas Rakosi 1 , states two kinds of factors which are concerned with the
etiology of an open bite. They are:

1. Epigenetic factors.
These are factors which are related to an underlying cause. These
include- posture of the tongue, morphology and size of the tongue, skeletal
growth pattern of the maxilla and mandible, particularly the mandible and
the vertical relationship of the jaw bases.

2. Environmental factors
These include- improper respiration, abnormal function, etc. Rakosi’s
study showed that most children have an abnormal functional pattern or
potentially deforming habit during the growth phase.Tongue dysfunction,
disturbed or occluded nasal respiration can cause a change in the posture or
function of both the tongue and the mandible, which can lead to an open bite.
Andrew Richardson 7 , proposed an etiology-related classification:

1. Transitional open bite.

2. Open bite, due to habits.
3. Open bite, due to the presence of :
• Local pathology.
• Skeletal pathology.
4. Non-pathological or skeletal open bite.
a) Skeletal (ab initio)open bite
• Open bite that is improving.
• Open bite, which is deteriorating.
• Improving but later deteriorating type of open bite.
b) Skeletal (de novo) open bite
5. Open bite, due to the morphology and behaviour of the tongue and lips.

I. Transitional Open bite

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 Classification

They occur when the permanent incisor teeth are erupting, and are due
to incomplete growth of the dento-alveolar areas. Spontaneous correction is
brought about by the continued dento-alveolar development.

II. Open bite, due to habits. (DIGIT SUCKING,TONGUE

THRUST)(Fig-2.2)
This type of open bite is a continuation and accentuation of the
transitional open bite, where the eruption of the incisor teeth is impeded by
the digit. When a thumb or finger is placed between the anterior teeth, the
mandible has to be positioned downward to accommodate it. (fig-6) The
interposed thumb, or digit directly hinders with incisor eruption. At the same
time, the separation of the jaw alters the vertical dimension on the posterior
teeth, and as a result, there is more eruption of posterior teeth. Due to the
geometry of the jaws, 1mm of elongation posteriorly opens the bite about
2mm anteriorly, a powerful contributor to the development of anterior open
bite. The effect is limited to the dento- alveolar processes.

Such open bites occasionally exist in adult life. Spontaneous

correction is brought about by the continued dento-alveolar development.
Open bite due to tongue thrust habit is discussed under classification of open
bite due to the morphology and behavior of the tongue and lips.

III. Open bite, due to the presence of

❖ Local Pathology.
Supernumerary teeth (Fig-2.3), cysts, and dilacerations may obstruct
eruption of incisors. Spontaneous correction is brought about by the
continued dento-alveolar development

❖ Skeletal Pathological Open bite.

Conditions such as cleft palate, which are recognizable at an early
stage, and other conditions which become apparent towards the end of the
growth period, such as condylar hyperplasia and acromegaly.
Correction of the open bite can be achieved by gentle traction with
conventional appliances. But often in the case of a skeletal pathology, the
alveolar process may be a little deficient.

IV. Non pathological skeletal open bites

a. Skeletal (ab initio)open bite.

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 Classification

It is termed as ‘ab initio’ as it can be recognized very early. This

group consists of children in the pre-pubertal stage. Spontaneous correction
is brought about by the continued dento-alveolar development. In the pre-
pubertal and pubertal periods, closure of the open bite is brought about by
dento-alveolar growth compensating for increased vertical facial growth
present in a case of open bite, but in the post-pubertal period closure is most
frequently brought about by increasing mandibular prognathism with forward
rotation of the mandible. When there is a spontaneous closure of the open
bite in the pubertal stage of growth, it can be termed as an improving
skeletal open bite. This might reassert itself in the post-pubertal stage due
to an interplay between vertical facial growth and the simultaneous
compensating dento-alveolar growth. This can be termed as a
deteriorating skeletal open bite. In the pubertal stage, active dento-alveolar
growth is sufficient to close the open bite but in the post-pubertal stage,
continuing skeletal growth dominates, leading to an open bite at the end of
the post-pubertal period. This is termed as an improving but later
deteriorating open bite.

b. Skeletal (de novo).

It is termed as ‘de novo’ as they arise for the 1st time about the middle
of the pubertal stage and not in the beginning. Due to its late appearance, it
presents as a difficult clinical orthodontic malocclusion.

V. Soft tissue abnormalities.

Open bite, due to the morphology and behaviour of the tongue and lips.
It is commonly associated with abnormal tongue function, like in the
case of a tongue thrust habit. When there is an anterior open bite, as often
occurs from sucking habits, it is difficult to seal off the front of the mouth
during swallowing to prevent food or liquids from escaping. Therefore, a
tongue thrust swallow is a useful adaptation in a case of open bite, which is
why an individual with an open bite also has a tongue thrust swallow.After
a sucking habit stops, the anterior open bite tends to close spontaneously,
but the position of the tongue between the anterior teeth persists for a while
as the open bite closes. Until the open bite disappears, an anterior seal by
the tongue tip remains necessary. However, more than one factor may operate
in a patient. When a vertical discrepancy is combined with an
anteroposterior discrepancy, there are 4 kinds of facial types described by
Sassouni 8 :

1. Skeletal Class II open bite.

2. Skeletal Class II deep bite.

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 Classification

3. Skeletal Class III open bite.

4. Skeletal Class III deep bite.

Fig 2.1: BSI-classification. Class I, Class II and

Class III respectively

Fig 2.2:Illustrating digit sucking habit- thumb placed inside oral cavity.

Supernumerary
tooth

Fig 2.3: Illustrating pathological open bite.

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