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Aetiology of Malocclusion

Mohammad Eesayi

Emad Maayta

Aetiology of malocclusion
o Its really important to know the cause of any problem in-order to solve it. o Malocclusion is multifactorial which mean that it can be caused by many factors all together not only one, so it can be:

Genetic

Environmental

Developmental

Congenital

Functional

Aetiology of malocclusion are: Skeletal factors, Soft tissue factors or Local (dental) factors o Each of those factors may have: - Specific causes (known). - Genetic influences. - Environmental influences.

Skeletal factors : Specific causes -known causes- (accounts for 5% of causes)

I. Disturbances in utero : During embryologic development Very rare >1% Causes: A. Genetic disturbances

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B. Teratogens: chemicals or other agents capable of producing embryologic defects at low level and lethal at higher doses. II. Skeletal growth disturbances: Foetal moulding and birth injuries:

-Intrauterine moulding: pressure against developing parts of face.

=Maxillary deficiency. =Pierre Robin syndrome (a result of mandibular deficiency which it should be
controlled by the tongue, and the mandibular deficiency results in cleft palate by lacking of the tongue to rest on its proper place, creating force on the palate, that lacking the palate shelves to join leading to the cleft palate ).

-Trauma to mandible during birth (it used to be in a high level because they were
using forceps in the delivery).

Childhood fracture of the jaw: it depends on the area of fracture whether if it will
effect on the future growth or not e.g. condyle so fracture in the condyle is unnoticeable lead to fibrosis and also it results in ankylosis of the condyle resulting in asymmetrical face.

III.

Acromegaly and hemimandibular hypertrophy Acromegaly: (anterior pituitary tumour) - Increase growth hormones increase growth of mandible class III. Hemimandibular hypertrophy: - Unilateral excessive growth of mandibular results in asymmetry.

Genetic causes
I. II. Some malocclusion are inherited (same family). Skeletal pattern is genetically determined: Anterio-posterior : small maxilla, small mandible, large maxilla, large mandible or combination of any (class I, II or III ). Vertical: high angle, low angle, increase facial height, decrease facial height. Transverse: wide maxilla, narrow maxilla, wide mandible, narrow mandible or combination of any of them will lead to malocclusion.

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III. IV.

Disproportions between jaw sizes: - Improper occlusion relationship (class II,III). Disproportions between jaw size and teeth size: -If the jaw is large and the teeth are normal spacing, whereas if the jaw is small while the teeth are normal crowding.

Soft tissue factors :Involved: - cheeks/ lips -Tongue -Muscle of mastication

Cheeks/lips: Lip line:

-Lower lip should cover 1/3rd to of the upper incisor. -If more retroclination of upper incisors Class II div 2. -If less class II div 1.
Lip competence:
- A competent lips are in contact at rest while incompetent lips arent in contact at rest. - A potential competent lips are in contact but not at rest. -Incompetent lips can not control the anterio-posterior position of incisors class II div I or bimaxillary proclination.
Neutral zone or equilibrium theory where the lips and cheeks forces are equal to the tongue force to keep the teeth in its correct position.

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Lip trap: (rabbit teeth) lower lip trapped behind upper incisors these will increase the overjet Class II div 1.

Effect of lips: in presence of class II malocclusion: o Short upper lip might contribute to development of class II div 1. o High lip line might contribute to the development of class II div 2.

Tongue: At rest: size and position of the tongue affects the teeth position and so
occlusion thats why people with big tongue associated with big jaws and bimaxillary proclination.
For the tooth movement there should be a continues force for at least 6 hours, tongue at rest are more important than at function.

At function :

- Adaptive tongue thrust to achieve anterior oral seal:

In case of anterior overbite AOB or increase Overjet OJ, anterior oral seal is achieved by pulling the tongue between upper and lower incisors. - Endogenous tongue thrust (congenital): rare and difficult to treat (has no
relation to the OB & OJ, it will relapse whenever you try to treat it).

Muscle of mastication:
These muscle can have an effect on dimension of the jaw and dental arch (if
the muscles of mastication are hardly functioning and strong the size of the jaws will be big, meanwhile if the muscles are weak by neural problem paralysis- the jaws will be small ).

Less use may lead to underdevelopment of arches and crowding (teeth never change in size). Biting force have an influence on the vertical eruption of posterior teeth and so affecting lower facial height and OB (over eruption of the posterior teeth
will lead to decrease the AOB and vise versa, so if the main mastication muscles such as masseter and medial pterygoid muscles are strong this can cause relative intrusion which will prevent further eruption of posterior teeth increase OB -deep bitdecrease the facial height and vise versa).

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 Periodontal ligaments affects equilibrium and position of teeth as a third party of the lip/cheek and tongue forces which they are usually not equal. Frenum: if its thick it will cause midline diastema. Muscle dysfunction: Facial muscles affect jaw growth in 2 ways: - Formation of bone at the point of muscle attachment depends on activity of the muscle. - Muscle is an important part of the soft tissue matrix whose growth caries the jaws with it (Moss functional matrix theory). Damage to motor nerve results in muscle atrophy. Decrease in tonic muscle activity result in excessive jaw displacement: - Increase vertical growth. - Excessive eruption of posterior teeth. - AOB.

Specific causes of soft tissue factors:

Muscle dysfunction. Lower motor nerve palsy / facial palsy.

Excessive muscle contraction (e.g. scarring ). jnjn

Soft tissue factors and habits: o Thumb sucking: this habit will lead to malocclusion by: - Proclination of upper incisors. - Retroclination of lower incisors.

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- AOB by restriction the eruption of the incisors and over eruption of the posterior teeth. - Crossbite and deep palate by lacking the tongue from forming the equilibrium theory on the maxilla which will be pushed down by the thumb. o Mouth breathing: as a result of enlarged tonsils and adenoids (nasal obstruction) will lead to **adenoid face**: - AOB because the mouth will be opening for breathing and this will lead to supra
eruption of the posterior teeth.

- Crossbite and high palatal vault because the tongue will be sticking on the floor of the mouth giving a path for the airway. - Increase lower face height. o Tongue thrust: adaptive tongue thrust.

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