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Etiology of Malocclusion

Etiology of Malocclusion

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Published by Gilani Syed Sohaib

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Published by: Gilani Syed Sohaib on May 25, 2011
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A malocclusion is a  misalignment of teeth  incorrect relation between the teeth of the two dental arches.  The term was coined byEdward Angle, the byEdward Angle, "father of modern orthodontics", as a derivative of occlusion, which refers to the manner in occlusion, which opposing teeth meet.

Malocclusion is not a disease, but a spectrum representing biological variability/diversity  When the deviation from the normal reaches a certain degree of severity (threshold), then it is (threshold), termed malocclusion  What is of relevance is ³clinically significant´ deviation from normal occlusion

35% 5% 20% 20% 20%

WHY ETIOLOGY?     Better understanding of the condition Prevention Prediction Management .

ETIOLOGY OF MALOCCLUSION  The various classifications proposed are: are: ‡ White and Gardiner's classification ‡ Salzmann's classification ‡ Moyer's classification ‡ Graber's classification. classification. .

 It tried to make a distinction between the skeletal and dental etiologic factors.White and Gardiner's classification  This was one of the first attempts to classify malocclusion. . factors. malocclusion. causes.  It also tried to distinguish between pre-eruptive and prepostpost-eruptive causes.

DENTAL BASE ABNORMALITIES      1. . Lateral mal relationship 4. Antero-posterior mal relationship Antero2. Disproportion of size between teeth and basal bone 5. Congenital abnormalities. Vertical mal relationship 3.

Abnormalities in position of developing tooth germ 2. Missing teeth 3. Traumatic injury. Supernumerary teeth and teeth abnormal in form 4. . Prolonged retention of deciduous teeth 5.PRE·ERUPTION ABNORMALITIES       1. Large labial frenum 6.

Extraction of permanent teeth. Rest position of musculature c. . Muscular a. Premature loss of deciduous teeth  3. Abnormalities in path of closure  2. Sucking habits d.POST·ERUPTION ABNORMALITIES  1. Active muscle force b.

. The genotypic  2. postnatal.SALZMANN'S CLASSIFICATION Salzmann defined three definite stages in which malocclusions are likely to manifest: manifest:  1. environment. acquired. The fetal environment  3. the division of the etiologic factors into prenatal. The postnatal environment. functional and environmental or acquired.  Since different factors effect these different stages hence.

 2.  3. where the dentofacial anomalies may or may not be in evidence at birth. into: a. Local-effect the face.can be hereditary or acquired but existing at birth. Localonly. jaws and teeth only. birth. General or constitutional b. .included malocclusions transmitted by genes. Genetic . Local or dentofacial. engrafted in the body in the prefunctional embryonic developmental stage. Congenital . Differentiative . Can be subdivided into: stage. as: a. Can be subdivided as: birth. dentofacial. General-effect the body as a whole Generalb.PRENATAL  1.malocclusions that are inborn.

Nutritional disturbances f. Abnormalities of relative rate of growth in different body organs c. Birth injuries b. Childhood diseases that affect the growth pattern g. . General a.or hypertonicity of muscles which may eventually Hypoaffect the dentofacial development and function d. Radiation. Radiation. Endocrine disturbances which may modify the growth pattern and eventually affect dentofacial growth e.POSTNATAL  Developmental  A. Hypo.

Aplasia of teeth. B. Delayed or premature shedding of deciduous teeth  3. Abnormalities of the dentofacial complex: complex:  1. face and jaws  2. Abnormalities of tooth development: development:  1. Ectopic eruption  4. Micro.or macrognathia Micro 3.or macroglossia Micro 4. teeth. Facial hemiatrophy. . Impacted teeth  5. hemiatrophy. Delayed or premature eruption of the deciduous or permanent teeth  2. Birth injuries of the head. Abnormal frenal attachments  5. Local a. Micro. b.

Endocrine disturbances  3. Muscular hyper. Respiratory disturbances (mouth breathing). General  1. Nutritional deficiencies  5.or hypotonicity hyper 2. Postural defects  6.FUNCTIONAL A. . Neurotrophic disturbances  4.

disturbances. Temporomandibular articulation disturbances. Faulty masticatory functions.B. Local  1. Loss of forces caused by failure of proximaI contact between teeth  3. Compromised periodontal condition. especially during the tooth eruption period  6. Malfunction of forces exerted by the inclined planes of the cusps of the teeth  2. condition.  4. Masticatory and facial muscular hypo. . Trauma from occlusion  7.or hypohyperactivity  5.

Radiation. stage. Nutritional disturbances especially during the tooth formation stage. Acquired endocrine disturbances that are not present at birth  4. Radiation.  3. Trauma. accidental injuries Trauma.  7. jaws.  6. Disease can affect the dentofacial tissues directly or by affecting other parts of the body indirectly disturb the teeth and jaws. Tumours. Tumours. Metabolic disturbances  5. General  1.  2.ENVIRONMENTAL OR ACQUIRED A. .

bones. bones. . Periodontal diseases  7. Prolonged retention of deciduous teeth  4. Local  1. Traumatic injuries including fractures of the jaw 10. Loss of permanent teeth  6.B. Pressure habits  10. Infections of the oral cavity  9. Delayed eruption of permanent teeth  5. Temporomandibular articulation disturbances  8. Disturbed forces of occlusion  2. Early loss of deciduous teeth  3.

included: included: A)the A)the craniofacial skeleton. These sites arise. system. C)the C)the orofacial musculature. B)the B)the dentition. . individually. and D)other D)other 'soft tissues' of the masticatory system. He based his classification on the premise that various factors may contribute to cause variations at these sites. variations were expected to arise. from where the sites. more often in groups rather than individually.MOyER'S CLASSIFICATION  Moyer identified etiologic sites.

Heredity  2. Habits: Habits: a. Developmental defects of unknown origin  3. Prenatal trauma and birth injuries b. Other habits . Posture  e. Thumb sucking and finger sucking b. Premature extraction of primary teeth b. Lip sucking and lip biting  d. Physical agents: agents: a. Nail biting  f. Tongue thrusting c. 1. Trauma: Trauma: a. Postnatal trauma  4. Nature of food  5.

Endocrine disorders c. Diseases: Diseases: a. Malnutrition. Local diseases: diseases:  ‡ Nasopharyngeal diseases and disturbed respiratory function  ‡ Gingival and periodontal disease  ‡ Tumours  ‡ Caries: Caries: .Early loss of permanent teeth  7. . 6.Disturbances in sequence of eruption of permanent teeth . Malnutrition.Premature loss of deciduous teeth . Systemic diseases b.

classification. factors.  This helped in clubbing together of factors which make it easier to understand and associate a malocclusion with the etiologic factors. .GRABER'S CLASSIFICATION  Graber divided the etiologic factors as general or local factors and presented a very comprehensive classification.

etc). German measles. material maternal metabolism. Heredity  2. b. TMJ injury)  4. Congenital  3. cerebral palsy. Infectious diseases (poliomyelitis. etc). Predisposing metabolic climate and disease: disease: a. etc). Metabolic disturbances c. Prenatal (trauma. maternal diet. . Environment: Environment: a. Postnatal (birth injury. etc). Endocrine imbalance b.GENERAL FACTORS  1.

) h. 5. Abnormal pressure habits and functional aberrations: a. Tonsils and adenoids i. Trauma and accidents. Dietary problems (nutritional deficiency)  6. . Psychogenetics and bruxism  7. etc. Tongue thrust and tongue sucking d. Abnormal swallowing habits (improper deglutition) f. Abnormal sucking b. Respiratory abnormalities (mouth breathing. Posture  8. Thumb and finger sucking c. Lip and nail biting e. Speech defects g.

Prolonged retention . Missing teeth (congenital absence or loss due to accidents. Anomalies of number: number: a. etc.). Premature loss  6. Anomalies of tooth size  3. Anomalies of tooth shape  4. Supernumerary teeth b. caries. Abnormal labial frenum: mucosal barriers frenum:  5. LOCAL FACTORS  1.  2. etc.

Improper dental restorations. Dental caries 11. Abnormal eruptive path 9. . Delayed eruption of permanent teeth 8. restorations. 11. 10.     7. Ankylosis 10.




Infectious diseases .














DIGIT SUCKING HABIT Threshold ± 6 hrs .



ETIOLOGY IN CONTEMPORARY PERSPECTIVE  Etiology of most malocclusions are unknown  Role of genetic and environmental influences  Skeletal traits have greater genetic influence  Dental traits have relatively greater environmental influence .


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