LAWRENCE F.

ANDREWS

SIX KEYS
TO
 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
lingually.
 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 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 ofo
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
the incisal portion.
 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
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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