LAWRENCE F.

ANDREWS

SIX KEYS
TO
NORMAL OCCLUSION
 Discusses six significant characteristics. These
constants are referred as “SIX KEYS TO
NORMAL OCCLUSION”
 Observed in a study of 120 casts of non-
orthodontic patients with normal occlusion.
 Specifies that even with respect to molar
relationship ( as given by Angle) , the positioning
of the critical mesio-buccal cusp within the
specified space is inadequate ( Evaluated on the
basis of clinical experience and observation of
treatments exhibited at national meetings)
 According to Andrews :
Data if systematically
reduced to ordered, coherent paradigms, could
constitute a group of referents i.e. basic
standards against which deviations could be
recognized and measured.
IN BRIEF: If one knew what constituted
“right” he could then directly, consistently and
methodically identify and quantify what was
“wrong”
 Gathering of data: 120 non orthodontic normal
models were acquired over a
period of four years(1960-64)

Criteria for selection of data:

1) Had never had orthodontic treatment

2) Straight and pleasing in appearance

3) Bite which looked generally correct

4) Would not benefit from orthodontic treatment

 Findings after evaluation of data:
1) Molar relationship in the healthy normal models
exhibited two qualities when viewed buccally, not
just the classic one.
2) Angulations (mesiodistal tip) and Inclination
(labiolingual or buccolingual inclination) showed
predictable natures as related to individual tooth
types.
3) No rotations observed in 120 non-orthodontic
normals.
4) No spaces b/w teeth
5) Occlusal plane fell neatly into a limited range of
variation.
 1150 treated cases by American orthodontists were
displayed at national meetings and studied from
1965-71, for the purpose of learning to what degree
the six characteristics were present and whether the
absence of any one, permitted prediction of other
error factors such as: existence of spaces or poor
posterior occlusal relations.

 INFERENCE: Implied no adverse criticism.

Range of excellence reflecting the
present state of art
 So he made a comparison of the best in
treatment results (1150 treated cases) and the
best in nature (120 non orthodontic normals);
revealed differences which were identified
systematically and provided significant insight
on how to improve orthodontically.

 Differences sought were referred to as

“SIX KEYS”
 Six differential qualities validated were present in
each of the 120 non orthodontic normals; lack
of even one of the six was a defect predictive of
an incomplete end result in treated models.
 SIGNIFICANT CHARACTERISTICS
SHARED BY ALL
NON-ORTHODONTIC NORMALS
 Molar Relationship:
1) Distal surface of the disto-
buccal cusp of the upper first permanent molar made
contact and occluded with the mesial surface of the
mesio-buccal cusp of the lower second permanent
molar.
2) Mesio-buccal cusp of the upper
first permanent molar fell within the groove b/w the
mesial and middle cusps of the lower first permanent
molar
 Canines and Premolars enjoy a Cusp-Embrasure
relationship buccally and a Cusp-Fossa relationship
 Crown Angulation “The mesio-distal tip”:
 Refers to angulation / tip of the long axis of
the crown and not the entire tooth.
 Gingival portion of the long axis of each crown was
distal to the incisal portion (Varies with individual tooth type)
 Long axis of the crown of all teeth except molars is
judged to be the mid-developmental ridge.
(Most prominent & centermost vertical portion of the
labial/buccal surface of the crown)
 Long axis of the molar crown is identified by the
dominant vertical groove on the buccal surface of the crown.
 Crown Inclination “Labiolingual / Buccolingual
Inclination”
 Refers to labiolingual/ buccolingual inclination of the
long axis of the crown and not the entire tooth.
 Inclination of all the crowns had a consistent scheme:
A) U/L anterior teeth (Central and Lateral Incisors)-
1) Inclination sufficient to resist overeruption of
anterior teeth
2) To allow proper distal positioning of the contact
points of the upper teeth in there relationship to
the lower teeth, permitting proper occlusion of
the posterior crowns
B) Upper Posterior teeth (Canines through
Molars):
1) Lingual crown inclination in upper posterior
crowns from canines through second premolars
and slightly more pronounced in the molars.

C) Lower Posterior teeth (Canines through

Molars):
1) Lingual crown inclination increases
progressively from canine through the second
molars
 Rotations: No rotations present

 Spaces: No spaces; Contact points were tight.

 Occlusal plane: Varied from generally flat to a

slight curve of Spee.

“ The six keys to normal occlusion contribute

individually and collectively to the total scheme of
occlusion and therefore are viewed as essential to
orthodontic treatment ”
 TOTAL SCHEME OF OCCLUSION
TO
ANDREWS SIX KEYS
Key I- Molar relationship:
 Consistent demonstration of the distal surface
of the disto-buccal cusp of the upper first
permanent molar occluding with the mesial
surface of the mesio-buccal cusp of the lower
second molar- Seen in all his 120 non
orthodontic normals without exception.
 Specifies it as normal molar relationship.
Key II- Crown Angulation (mesio-distal tip):
 Crown tip expressed in degrees; +ve or –ve.
 Degree of crown tip is the angle b/w the long
axis of crown (viewed from labial or buccal
surface) and a line bearing 90 degrees from
occlusal plane.
 +ve: When the gingival portion of long axis of
the crown is distal to incisal portion.
 -ve: When the gingival portion of long axis of the
crown is mesial to incisal portion
 Distal inclination of gingival portion of each
crown in his non orthodontic normals was found
constant
 Suggests proper distal crown tip as key to normal
occlusion.
 Degree of tip of incisors determines
1) the amount of mesiodistal space they consume
and hence has a considerable effect on
posterior occlusion
2) Anterior esthetics
Key III- Crown Inclination (labio/bucco lingual):
 Expressed in terms of degrees; +ve/-ve
 Degree represents the angle formed by a line
which bears 90 degrees to the occlusal plane and
a line that is tangent to the bracket site (placed in
the middle of the labial or buccal long axis of the
clinical crown; viewed from the mesial or distal)
 +ve: Gingival portion of the tangent line is lingual
to
the incisal portion.
 -ve: Gingival portion of the tangent line is labial to
 ANTERIOR CROWN INCLINATION
 Complimentary and significantly affect:
1) Overbite
2) Posterior occlusion
 Insufficient inclination of upper anteriors:
 1) Upper posterior crowns are placed forward of
there normal position.
2) Even if exists a proper occlusion b/w upper and
lower posteriors; undesirable spaces result b/w
anterior and posterior teeth
 Increase in +ve upper anterior inclination; contact
points move more distally
POSTERIOR CROWN INCLINATION- UPPER
 Pattern was consistent in non orthodontic normal
models.
 Minus inclination existed from upper canine
through second premolar.
 Slightly more negative inclination in upper first and
second molars.

POSTERIOR CROWN INCLINATION- LOWER

 Also consistent.
 Progressively greater crown inclination existed from
canines to second molars.
 AFFECT OF TIP AND TORQUE
ON ANGULATION AND INCLINATION
i.e. IInd and IIIrd KEY TO OCCLUSION

 Anterior portion of the upper rectangular arch

wire if lingually torqued; proportional amount
of mesial tip of anterior crown occurs.
 Ratio:- 4:1; i.e. for every 4 degree of lingual
crown torque, 1 degree of mesial convergance
of central and lateral occurs.
KEY IV- Rotations:
 Teeth should be free of undesirable rotations.
 Superimposed molar outline depicts rotation of
the molar which occupies more space than
normal (Situation unreceptive to normal
occlusion)
Key V- Tight contacts (No spaces b/w teeth) :
 In the absence of genuine tooth size
discrepancies tight contacts must exist.
 Consistently present in Andrews 120 subjects.
 Stresses to correct serious tooth size
discrepancies with jackets and crowns and not
at the expense of a good occlusion.
Key VI- Occlusal Plane:
 On non orthodontic normal models ranged
from flat to slight curves of Spee.
 Curve of spee deepens with time as lower jaw
grows downward and forward.
 When it grows more than that of upper jaw;
lower anterior teeth are confined by upper anterior
teeth and lips; hence teeth are forced back and up:
 Deeper overbite & Deeper curve.
 If third molars push forward after growth has
stopped: result same as above- SOLUTION-----
 Lower anterior teeth stabilized until growth ceases and
third molar threat eliminated either by extraction or
eruption.
 Plane of occlusion deepens after treatment hence flat
plane should be the treatment goal as a form of over
treatment.
 Reverse curve is an extreme form of over treatment;
allows excessive space for each tooth to be intercuspally
placed.
 Intercuspation is best when occlusal plane is relativly flat.
 One must band the second permanent molars to get an
effective foundation for leveling of upper and lower
planes of occlusion.
 CONCLUSION AND COMMENT
 120 non orthodontic models shared all the six
characteristics; absence of one or more is
proportionally less than normal.
 Need for caps; preventing proper contacts are dental
problems not orthodontic ones.
 Compromise treatment should be done if patient co-
operation and genetics demand.
 Nature’s non orthodontic models provide a
consistent & beautiful guideline which should be
used as a measure of the static relationship for a
SUCCESSFUL ORTHODONTIC TREATMENT
 “Achieving the final desired
occlusion
is the purpose of attending
to the
SIX KEYS OF OCCLUSION”
 Rev. Dent. Press Ortodon. Ortop.
Facial vol.11 no.1 Maringá Jan./Feb.
2006
ABSTRACT
AIM: due to the large use of Andrews's six keys to
normal occlusion concept as a tool for diagnosis and
treatment planning, we carried out this study with the
purpose to evaluate the prevalence of such
characteristics in a brazilian sample.
METHODS:
61 cast models of untreated subjects with normal
occlusion were evaluated. The frequency that the six
keys were found in each subject, as well as which were
the most or least frequent keys, was observed. The
results showed that most of the subjects presented
one to three keys and none presented all the six keys.
RESULTS AND CONCLUSIONS:
The characteristics more frequently observed were: flat
curve of Spee (100%), tight interproximal contacts
(42,6%) and correct tippings (34.4%). The low
prevalence of untreated normal occlusion that
achieves Andrews's requirements lead us to reflect on
the search for such rigid patterns.
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