Class 1 Type 5

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.