FREQUENCY class II malocclusion, to improve the

















                                  Amina Malik ¹*, Ali Ayub2*, Afeef Umar Zia3*

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¹* Lecturer, Department
of Oral Biology, Foundation University College of Dentistry

2* 3* Department of
Orthodontics, Foundation University College of Dentistry



Corresponding author:
Amina Malik

Address: Department of Oral Biology,
Foundation University College of Dentistry,
DHA Phase 1, Islamabad, Pakistan.

Telephone: 00923219545688

Email: [email protected]


























Objective: The?present?study
aimed to establish the frequency?of?malocclusions?among?patients?attending
orthodontics department in a new teaching hospital

Design: Retrospective study
conducted in FUCD

Place and duration of
study: from
January 2014 to December 2016. Orthodontics department of Foundation University
College of Dentistry

& Methods:
We analyzed the records of 170 patients who came for orthodontic treatment from
January 2014 to December 2016. Microsoft Excel was used to calculate the frequency/percentages
of different types of malocclusion prevalent in these patients.

Results: The frequency of
Skeletal class I, II and III malocclusion was found to be 31.0%, 68.0% and 1.0%

Conclusion: The present study can
guide us for?planning better orthodontic?service and help educating and
training students in the management of all types of malocclusion, especially skeletal
class II malocclusion, to improve the overall quality of care for patients.


Key words: Malocclusion, Skeletal Class II,
Orthodontic patients.























Malocclusion is variation from ideal
occlusion which may be considered aesthetically unpleasing but it is not
unhealthy. 1,2 The etiology is multifactorial and both genetic and
environmental factors play a role. Numerous studies have been conducted in the past
to determine frequency of various malocclusions in different populations. 3-13A qualitative analysis with Angle’s classification
was  used to describe anteroposterior
relationship of maxillary and mandibular first molars.14 It describes
antero-posterior relationship of the maxillary and mandibular first molars
during maximum intercuspation. Cephalometric indicators are used to analyze the
maxillary and mandibular skeletal positions. 
Angular and linear measurements have been proposed in the assessment of
anteroposterior jaw-base relationship.


and method:

A retrospective study was conducted on 170
patients. To obtain the information, records of 170 patients were analyzed and
tabulated from January 2014 to December 2016. Patient’s records included dental
and medical history, Lateral Cephalogram, Orthopentomogram (OPG), pictures and dental
cast. Cephalometric analysis was done to determine the type of malocclusion.  Microsoft Excel was used to compile the
results of types of malocclusion.

The inclusion criteria used to select the
sample were:

having orthodontic casts taken in centric occlusion

having Lateral Cephalometric radiographs taken in natural head posture.

of OPG

of first permanent molar.

with no significant past medical history

with no history of trauma

with no previous orthodontic treatment


Cephalometric landmarks were marked on  each cephalogram. The points were identified
using definitions given in literature and skeletal?relations of jaws were established
by tracing Lateral Cephalometric X-rays.15 Skeletal?malocclusion was
determined?by?measuring the following angular and linear measurements


SNA: 80-84 degrees: Orthognathic Maxilla

<80 degrees: Retrognathic Maxilla ·        >84
degrees: Prognathic Maxilla

SNB: 78-82 degrees: Orthognathic mandible

< 78 degrees: Retrognathic mandible ·        >
82 degrees: Prognathic mandible

ANB : 0–4°: Skeletal class I

Skeletal class II

<0°: Skeletal class III   Figure-1 Horizontal cephalometric variables  (SNA, SNB, ANB, NAPg)   The?data?was gathered and analyzed using Microsoft Excel and the frequency/percentages of different types of malocclusion prevalent in these patients were calculated.   RESULTS: Total 170 patients reported from January 2014 to December 2016; 45 class I, 98 class II and 27 class III. The data analysis showed an increase in the number of patients from 2014 to 2016 (Figure 2). The highest percentage of malocclusion which reported was for class II (Figure 3)     Figure 2: percentage of malocclusion   Figure 3: types of malocclusion     DISCUSSION According to our results, Class II malocclusion was most prevalent category of malocclusion. These results are in accordance with previous studies conducted in Pakistan 16,17,18..Our results differed from some international publications. Our?data was not?in?agreement?with?Sari?et?al.,?who reported?that?61.7%?of?the patients?in Turkey?had?class?I,?28.1%?had?class?II and?10.2%?had?class?III?Angle?dental malocclusion 19. Our?results?were also in disagreement to those?of?Jones et al,?who?investigated?dental?malocclusion?in?132?Saudi?Arabian patients?referred?for?orthodontic?treatment?and?reported?that?53.8%?had?class I,?33.3%?class?II?and?12.9%?had?class?III Angle?dental?malocclusions?20. Another study carried out in Iranian population was also not in accordance with our study; the?prevalence?of?class?I,?II?and?III?malocclusion was?52.0%,?32.6%?and 12.3%?respectively.21   This study was conducted in Fauji Foundation Hospital Rawalpindi (Tertiary Care Facility) on the patients reporting to Orthodontic department from different multi ethnic backgrounds. The study indicates the current status of malocclusion in this region but this might not be the trend in the entire Pakistani population. The local community being catered for by this hospital will need to undergo orthodontic management of class II malocclusions according to the findings of this research to improve function and esthetics as well.         CONCLUSIONS: The study showed that skeletal Class II malocclusion was most frequently seen, whereas class III was the least frequent. This study might not certainly show the trend of the entire Pakistani population, however it provides a base line data for planning orthodontic treatments. Therefore orthodontics students?should?receive?more?education and?training?in?the?management?of?class II?malocclusion?to?improve?the?overall quality?of?care?for?patients.       REFERENCES: 1.  Proffit WR and Fields HW. Contemporary Orthodontics. 2nd ed. Chicago: Mosby Year Book;2000:1-15. 2.  A Textbook of Orthodontics Houston WJB, Stephens CD and Tulley WJ., Great Britain: Wright; 1992:1-13 3. Prevalence of malocclusion in seventh grade children in two North Carolina cities.Erickson DM, Graziano FW. J Am Dent Assoc. 1966;73:124–27. 4.  Malocclusion in Danish children with adolescent dentition: an epidemiologic study. Helm S. Am J Orthod 1968;54:352–66. 5. Malocclusion in the modern Alaskan Eskimo. Wood BF.  Am J Orthod 1971; 60:344–54. 6.  Prevalence of malocclusion in young adults of various ethnic backgrounds in Israel Krzpow AB, Lieberman MA, Modan M.. J Dent Res, 1975;54:605–08. 7.  Malocclusion in Black Americans and Nyeri Kenyans. An epidemiologic study. Garner LD, Butt MHAngle Orthod 1985;55:139–46. 8.  Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia. Al-Emran S, Wisth PJ, Boe OE. Community Dent Oral Epidemiol 1990;18:253–55. 9.  A review of the literature on the prevalence of Class III malocclusion and the mandibular prognathic growth hypotheses. Van Vuuren C.  Aust Orthod J 1991;12:23–28. 10.  Malocclusion and orthodontic treatment need of 15–74-year-old Dutch adults Burgersdijk et al, Truin GJ, F, H, Van't Hof M, J..Community Dent Oral Epidemiol 1991;19:64–67. 11. Malocclusion and Crowding need for orthodontic treatment Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014) 12. Prevalence of malocclusion in Senegal.  Diagne F, Ba I, Ba-Diop K, Yam AA, BaTamba A. Community Dent Oral Epidemiol 1993;21:325-26. 13  Malocclusion in 12-year-old sub-urban and rural Nigerian children. Otuyemi OD, Abidoye RO. Community Dent Health 1993;10:375–80. 14 Angle EH. Classification of malocclusion. Dent Cosmos 1899;41:248–64. 15   . The "Wits" appraisal of jaw disharmony. Jacobson A Am J Orthod 1975; 67(2):125-38.  16Prevalence of Malocclusion in orthodontic patients. A Hospital based study at Department of Dental Surgery Gul-e-Erum, Fida M.,The Aga Khan University Hospital Karachi. J Ayub Med Coll Abbottabad 2008;20:43-7. 17.  Prevalence of malocclusion in patients reporting in an orthodontic OPD of a teritary care hospital. Sakrani H, Hussain SS. Pak Orthod J 2010;2:8–13 18.  Assessment of occlusal traits in orthodontic patients reported at dental OPD of a tertiary care hospital Shah R, Memon Q., Pak Orthod J 2010;2:4-7 19. Orthodontic malocclusions and evaluation of treatment alternatives: an epidemiologic study. Z et al. Turkish Journal of Orthodontics, 2003, 16:119–126 20. Malocclusion and facial types in a group of Saudi Arabian patients referred for orthodontic treatment: a preliminary study Jones BW.. British Journal of Orthodontics, 1987, 14:143–146. 21.  Prevalence of malocclusions in school-age children attending the orthodontics department of Shiraz University of Medical Sciences Orthodontic Research Centre, Department of Orthodontics;  Department of Pedodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran EMHJ?•?Vol.?16? No.12?•?2010