Orthodontic Diagnosis Based upon Alveolar Bone Clinical Morphology

Growing scientific evidence which directly refutes the basis for conventional diagnostic classification of malocclusion along with dramatic improvements in the design of orthodontic brackets and implementation of new orthodontic techniques clearly justify the need for biologically driven orthodontic diagnoses. Angle’s 120-year old classification of malocclusion [1] has remarkably endured and continues to be utilized as the main language of malocclusion among orthodontic specialists in spite of its lack of verifiable scientific validity [2-6]. In effect, an arbitrary or subjective concept of ideal occlusion based upon Angle’s classification of malocclusion serves as the basis for orthodontic treatment planning for a large majority of orthodontic providers around the world. Yet there is no evidence to suggest that this arbitrary “ideal” occlusion provides significant health benefits or that it significantly improves oral function. Furthermore, Angle’s classification is not based on a verifiable biologically based constant but relies on dental intercuspation or static occlusion which takes place between 15 to 30 minutes per day [7]. This only represents a static glimpse of a 24-hour cycle of dynamic occlusal function. Cusps of teeth do not possess an innate or preprogrammed function to articulate in a specific way or position. Furthermore, cusps do not know Angle’s classifications and adapt to a functional occlusion with maximum intercuspation irrespective of the anterior-posterior position of the mesiobuccal cusp of the maxillary first molar relative to the mandibular first molar. Angle’s classification of malocclusion can more appropriately be referred to as social observations rather than pathologic diseases. We therefore propose orthodontic diagnoses of malpositioned teeth based upon the pretreatment clinical morphology of the alveolar bone and accompanying orientation of tooth roots. The alveolar bone morphology is a biologically based constant and a logical element to utilize in the diagnostic process. Materials and Methods