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Morphologic, functional, and occlusal

characterization of mandibular lateral
displacement malocclusion
Kyoko Ishizaki, Koichi Suzuki, Tomofumi Mito, Eliana Midori Tanaka, and Sadao Sato
Yokosuka, Japan, and Bogotá, Colombia

Introduction: Mandibular lateral displacement EDITOR’S COMMENT

(MLD) is clinically characterized by deviation of the
chin, facial asymmetry, dental midline discrepancy,
crossbite in the posterior region, and high prevalence
of internal derangement of the temporomandibular
joint. Morphologic and functional characteristics of
MLD should be clarified to correct and prevent this mal-
occlusion.
Methods: We examined the morphologic features,
occlusal scheme, and functional behavior of MLD in
116 patients. Facial morphology was examined with
posteroanterior cephalograms, occlusion guidance on
the articulator after face-bow transfer, and condylar
movement with the condylograph.
Results: The superiorly inclined occlusal plane was
associated with mandibular deviation in the same direc-
tion. The posterior occlusal plane on the shifted side was
significantly steeper than that on the nonshifted side.
Functional analysis of condylar movement showed
a close relationship between the direction of MLD and
the direction of condylar lateral shift during opening
and closing, and protrusion and retrusion. The occlusal
guidance inclination in the buccal segment of the non-
shifted side was steeper than that in the shifted side.
Conclusions: The results suggested that reduced
vertical height of the dentition on 1 side induced man-
dibular lateral adaptation with contralateral condylar
shift (asymmetry); this leads to condylar lateral shift
during functional movement.
Read the full text online at: www.ajodo.org,
pages 454.e1-454.e9.
Although orthodontists realize the importance of
correcting posterior crossbites in the mixed dentition
or even earlier if possible, do we know why it is so crit-
ically important? What happens to the condyle, the de-
veloping dentition and adaptive alveolar bone, and even
the cant of the posterior occlusal planes when this im-
balance is not corrected? The authors of this study fig-
ured out how to retrospectively evaluate 116 patients
with the morphologic features, occlusal schemes, and
functional behaviors of MLD. Each patient’s MLD
was examined with posteroanterior cephalograms and
occlusal guidance on an articulator after face-bow trans-
fer. Condylar movement was assessed with a condylo-
graph. To completely understand the thoroughness of
this investigation, read the entire description of this
methodology online.
It was demonstrated that MLD is not due to simple
mandibular lateral shift, but, rather, the mandible was
3-dimensionally rotated along with condylar displace-
ment to the contralateral side. Therefore, it was specu-
lated that decreasing or increasing the dental vertical
height on 1 side because of several factors, such as pos-
tural habits, posterior discrepancy resulting in differ-
ences in eruption between the sides, or a difference in
restorative heights between the sides leading to occlusal
interferences, can be a risk factor for dysfuntional lat-
eral shift of the mandible to the side of less vertical di-
mension. However, the etiology of skeletal asymmetry
is multifactorial and a distinction can be drawn.
In concluding remarks, the authors noted, ‘‘Our re-
sults suggest that MLD is a problem that involves
many factors such as occlusal vertical dimension, occlu-
sal plane inclination, internal derangement of TMJs,
functional DY shift of the condyle during function,
occlusal guidance, and facial asymmetry.’’

Am J Orthod Dentofacial Orthop 2010;137:454-5

0889-5406/$36.00
Copyright Ó 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2009.12.005

454
American Journal of Orthodontics and Dentofacial Orthopedics Ishizaki et al 455
Volume 137, Number 4

Fig 2. Functional points and occlusal guidance in the

dentition. Functional points F1 and F2 are located on
the mesial and distal marginal ridges of the incisors
and the mesial marginal ridges of the maxillary lateral in-
cisors, canines, premolars, and first molars. The F1s are
created while in maximum intercuspation and are the
starting points for eccentric movements. The F2s are
the most eccentric contacts right before disocclusion.
Fig 1. Measurements on posteroanterior cephalograms
in MLD subjects: OP, frontal occlusal plane; AG, frontal
mandibular plane; MA, mastoid plane; CI, condylar incli- spatial resolution and is highly reliable for morpho-
nation; ZP, zygomatic plane; Z, point at lateral border of logic measurements. Therefore, it would definitely
center of zygomatic arch; Co, condylion: most postero- be a valuable diagnostic tool for studying statically
superior point of condylar process; Ar, articulare: point the developing anatomic features associated with
of intersection of the dorsal contour of the mandibular MLD and its structural relationships in the long
condyle and the temporal bone. term, considering the low radiation dose and high-
resolution imaging, especially the status of the
temporomandibular joints that are often affected.
Q&A
However, dynamic evaluation of condylar movement
Turpin: What was the most difficult aspect of this
by condylograph is also complementary to the func-
study?
tional prognosis and therapeutic approach for MLD
Tanaka: More than difficult, I would say that under- patients.
standing the interaction of the dynamic aspects that
Turpin: How will this information change the way
can be involved in the development of an MLD mal-
orthodontists practice in the future?
occlusion, such as occlusal vertical dimension, oc-
clusal plane inclination, occlusal guidance, and so Tanaka: Our research provides valuable information
on, is crucial in the treatment approach to this type in understanding 2 possible mechanisms for the de-
of malocclusion. Noteworthy is the behavior of the velopment of MLD malocclusions and their clinical
DY (lateral shift of the condyle during opening and functional implications. From diagnosis to treat-
movement) that can vary according to occlusal and ment planning, orthodontists must consider the po-
functional conditions in MLD. tential risk factors that could lead to a difference in
the occlusal vertical dimension or occlusal guidance,
Turpin: Would the long-term use of cone-beam im-
which results in inclination of the frontal occlusal
ages serve to clarify this issue, if such records were
plane and induced concomitant mandibular adapta-
available?
tion. An early therapeutic approach based on occlu-
Tanaka: In recent years, cone-beam computed to- sal plane control and regularization of the vertical
mography has enabled 3-dimensional evaluation of dimension is necessary to reestablish the structural
anatomic dentomaxillofacial structures with higher and functional balance of the orofacial region.