ORIGINAL ARTICLE

Relationship between molar occlusion

and masticatory movement in lateral
deviation of the mandible
Yuji Suzuki,a Katsuhiko Saitoh,a Ryutaroh Imamura,a Kaori Ishii,a Shinichi Negishi,a Ryuichi Imamura,b
Masaru Yamaguchi,a and Kazutaka Kasaia
Matsudo, Chiba, Japan

Introduction: The relationship between molar occlusion and chewing patterns was examined in subjects with
laterally deviated mandibles. Methods: Twenty-three patients with mandibular deviation from the midline
(4 mm or more) and skeletal Class I (0
#ANB #4
) were divided into 2 groups: normal bite and crossbite.
The chewing pattern was classified as normal, reversed, or crossover. Results: The normal bite group had a
normal chewing pattern on the affected side 100% of the time and a reversed chewing pattern on the affected
and unaffected sides 0% and 7.2% of the time, respectively. Additionally, the normal bite group showed no ev-
idence of a crossover chewing pattern and also had significantly less axial inclination of the mandibular teeth on
the affected side compared with the crossbite group; lingual inclination was also evident. The crossbite group
had a normal chewing pattern on the affected and unaffected sides 0% and 55.6% of the time, respectively,
and reversed and crossover chewing patterns on the affected side 55.6% and 44.4% of the time, respectively.
Conclusions: A normal chewing pattern tends to result in lingual axial inclination of the mandibular molars on
the affected side, as well as a more consistent chewing pattern. (Am J Orthod Dentofacial Orthop
2017;151:1139-47)

L
ateral deviation of the mandible in a person with
facial asymmetry can readily lead to esthetic and
functional impairment. In a study of 1460 patients
with a dentofacial deformity, Severt et al1 found that
34% had facial asymmetry. They reported that 74% of
the patients with facial asymmetry had lateral deviation
of the mandible. Additionally, lateral deviation of the
mandible presents a number of problems, such as differ-
ences in the inclination of the occlusal plane, incongru-
ity of the length of the body or rami of the mandible, and
telescopic occlusion or crossbite of the molars. Sato
et al2 reported that craniofacial development and
occlusion are closely related factors, leading to lateral
deviation of the mandible and skeletal crossbite.
From the School of Dentistry, Nihon University, Matsudo, Chiba, Japan.
a
Department of Orthodontics.
b
Department of Maxillofacial Orthodontics.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Address correspondence to: Yuji Suzuki, Department of Orthodontics, Nihon
University School of Dentistry, Matsudo, Chiba, Japan 271-8587; e-mail, yuji.
suzuki170704@gmail.com.
Submitted, July 2016; revised and accepted, November 2016.
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2016.11.023
Nakaminami et al3 reported that subjects with lateral de-
viation of the mandible have a shorter trajectory of
chewing than do those with normal occlusion, and
that those with lateral deviation of the mandible often
have a linear path of masticatory movement. These find-
ings indicate that a lateral deviation of the mandible
causes masticatory movements uncharacteristic of that
seen in normal occlusion, and this chewing motion
may affect stomatognathic function.2,3
In some instances, lateral deviation of the mandible
may cause a crossbite in the molars on 1 side of the
mouth. If a molar crossbite is evident, then chewing pro-
ceeds in a reverse sequence (the mandible moves laterally
and then downward), as reported in several studies.3-10
Nonetheless, a study has reported that treatment can
normalize the chewing pattern (the mandible will
move downward and then laterally) in children with a
reverse sequence from a crossbite.11 However, no au-
thors have fully examined the relationship between
masticatory movement in laterally deviated mandibles
and axial inclination of the teeth. In this study, we aimed
to examine the relationship between the presence or
absence of molar crossbite and molar occlusion and
chewing patterns in patients with a lateral deviation of
the mandible.

1139
1140
Fig 1. Reference points and measurement points on a
frontal cephalogram: ANS, Anterior nasal spine; deviation
in mental spine, vertical distance between VRL and Me;
GO, shifted-side gonion; GO0 , nonshifted side gonion;
LO, latero-orbitale (right side); LO0 , latero-orbitale (left
side); Me, mental spine; Mo, molar; NC, maximum thin-
ning of the crista galli; occlusal plane, angle formed by
Mo-Mo’ from x-axis; VRL, a straight line passing through
NC and orthogonal to a horizontal reference line.
This study was approved by the ethics committee of
Nihon University's School of Dentistry at Matsudo,
Chiba, Japan (number EC16-14-042-1).
MATERIAL AND METHODS
Patients with a dentofacial deformity who visited the
Department of Orthodontics at the Nihon University's
hospital within the past 8 years were considered for
enrollment. On a frontal cephalogram, a straight line con-
necting the crista galli and the anterior nasal spine served
as the midline of the face; a straight line connecting the
anterior nasal spine and the mental spine of the mandible
served as the midline of the mental spine.12 Candidates for
enrollment were patients with a lateral deviation of the
mandible, which was defined as a deviation of 4 mm or
more from the midline of the face to the mental spine. Pa-
tients with a lateral deviation of the mandible, who were
also classified as skeletal Class I (0
#ANB #4
), were
included. A model of the maxillary and mandibular den-
titions in occlusion was used to determine whether the
mandibular molars were located buccally with respect to
June 2017  Vol 151  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Suzuki et al
Fig 2. Reference points and measurement points on a
frontal cephalogram: Col-Go, Distance between condylar
(Col) and GO; Col’-Go’, distance between Col’ and GO’;
Col-Me, distance between Col and Me; Col’-Me, distance
between Col’ and Me; GO-Me, distance between GO and
Me; GO0 -Me, distance between GO0 and Me; VRL, a
straight line passing through NC and orthogonal to a hor-
izontal reference line.
the maxillary alveolar base; this resulted in a cohort of
23 patients. Additionally, the measurement points and
the items measured were selected based on studies by
Uesugi et al,12 Damstra et al,13 and Janson et al14 (Figs
1 and 2). The exclusion criteria were the following: (1)
patients with temporomandibular joint pain or
temporomandibular joint dysfunction (eg, trismus); (2)
patients who had previously received orthodontic
treatment; (3) patients with dental prostheses, dental
caries, or missing teeth; (4) patients with a congenital
deformity or syndrome, or previous trauma; and (5)
ptients with a functional crossbite.
If the maxillary and mandibular first molars on the
affected side (the side to which the mandible was devi-
ating) were in normal occlusion on the frontal sections,
the subject would be deemed as having a normal bite
(14 patients with a normal bite [NB group]: 2 men, 12
women; mean age, 19.5 6 4.5 years). If a crossbite was
evident on the affected side, the patient would be deemed
as having a crossbite (9 patients with a cross-bite [CB
group]: 1 man, 8 women; mean age, 25.1 6 5.1 years).
Suzuki et al 1141

Fig 3. Masticatory pattern classification, described as follows. CO, Centric occlusion. In the normal
pattern, from centric occlusion, the mandible moves downward and then laterally toward the chewing
side or the nonchewing side, before returning to centric occlusion along a concave, convex, or linear
path. In the reverse pattern, the reverse of normal chewing, the mandible moves laterally first before
moving downward and then returning to centric occlusion. In the crossover pattern, the mandible
moves slightly laterally, downward, slightly laterally again, and then returns to centric occlusion.

The Gnatho-Hexagraph II (GC Corporation, Tokyo
Japan) was used to measure masticatory movement. A
mandibular clutch was placed on the subject's mandib-
ular anterior teeth. The patient was then instructed to
relax in a seated position; the patient's head was not im-
mobilized. Once the Frankfort plane was horizontal, a
head frame and a facebow were attached. The upper
margin of the external acoustic meatus on each side
constituted a reference plane. The upper margin of
each external acoustic meatus and the inferior margin
of the left orbit constituted the Frankfort horizontal
plane. The mandibular condyles, the mesiobuccal cusp
of the mandibular first molars, and the point of contact
between the mandibular central incisors served as mea-
surement points.15 The patients were instructed to freely
chew the chewing gum. Once the gum softened, the
subject was instructed to start at the maximal intercus-
pal position and chew the gum on each side for 30 sec-
onds. This masticatory movement was recorded. The test
food used was a piece (1.5 g) of normal chewing gum
(100% xylitol chewing gum; Oral Care, Tokyo, Japan).
Masticatory movement was analyzed at the mandibular
incisal point, and a total of 10 chewing strokes (strokes
5-14) on the dominant chewing side were analyzed.6,16
The pattern of masticatory movement was analyzed
using the software that came with the equipment to
measure jaw movement.
Gum was chewed on the affected and unaffected
sides for 30 seconds each. The chewing pattern was
based on a total of 10 chewing strokes (strokes 5-14).
The chewing pattern was classified as normal (from
centric occlusion, the mandible moves downward and
then laterally toward the chewing side or the nonchew-
ing side, before returning to centric occlusion along a
concave, convex, or linear path), reversed (the reverse
of normal chewing; the mandible moves laterally first
before moving downward and then returning to centric
occlusion), or crossover (the mandible moves slightly
laterally, downward, slightly laterally again, and then re-
turns to centric occlusion) (Fig 3).17,18
The items in Figures 4 and 5 were measured using
the method of Eguchi et al.19 To model the dentition
before orthodontic treatment, the width of the maxil-
lary dentition, the width of the mandibular dentition,
the palatal width at the maxillary first molars, the axial
inclination of the maxillary first molars, and the axial
inclination of the mandibular first molars were
measured.20-23 A 3-dimensional scanner (Yasunaga
Computer Systems, Co., Inc., Fukui, Japan) was
used to obtain 3-dimensional data on the dentition,
and the data were analyzed using 3-dimensional anal-
ysis software (Medic Engineering Corporation; Kyoto,
Japan). The width of the maxillary dentition, width
of the mandibular dentition, palatal width at the
maxillary first molars, and buccolingual inclination
of the maxillary and mandibular first molars were
measured.22 A plane passing through the incisal ridge
and the cusps of the second premolars and first molars
served as the maxillary reference plane.
A straight line passing through the cusps of the sec-
ond premolars and the first molars served as the x-axis, a
straight line orthogonal to the x-axis served as the
y-axis, and a straight line orthogonal to the intersection
of the x-axis and y-axis in the reference plane served as

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1142 Suzuki et al

Fig 4. Maxillary and mandibular dentition measurements: the distance between the mesial cusps of
the maxillary first molars (U6-6CW), the maximum distance from the lingual groove of the maxillary first
molars to the neck of the tooth (U6GW), and the distance between the mesial cusps of the mandibular
first molars (L6-6CW).

Fig 5. Axial inclinations of the maxillary and mandibular first molars: a straight line passed through the
transition point from the groove on the buccal aspect of the first molar to the buccal groove on the
occlusal surface, and through to the transition point from the groove on the lingual aspect to the lingual
groove on the occlusal surface. The angle formed by this straight line and the z-axis served as the axial
inclination of the teeth, yielding an axial inclination on the affected side (AI-AS) and an axial inclination
on the unaffected side (AI-US).

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Suzuki et al 1143

Table I. Results of the measurement points on the Table II. Results of the measurement points on the
lateral and frontal cephalograms lateral and frontal cephalograms
NB group (n 5 14) CB group (n 5 9) Affected side Unaffected side

Mean SD Mean SD t test Mean SD Mean SD t test

ANB (
) 1.9 1.0 2.0 1.3 NS NB group (n 5 14)
Occlusal plane (
) 2.5 2.1 2.9 2.4 NS Col-Me (mm) 112.1 9.8 117.6 9.5 NS
Deviation in mental 7.3 2.2 8.9 4.2 NS Col-Go (mm) 60.9 5.3 64.1 4.0 NS
spine (mm) Go-Me (mm) 60.8 6.7 65.0 8.5 NS
CB group (n 5 9)
NS, Not significant. y
Col-Me (mm) 110.1 6.0 118.6 5.6
Col-Go (mm) 59.5 5.2 65.4 4.0 *
the z-axis. A plane passing through the incisal ridge of Go-Me (mm) 58.4 4.4 63.1 6.5 NS
the mandibular central incisors and the cusps of the NS, Not significant; Col-Me, distance between Col and Me; Col-Go,
mandibular deciduous second molars (second premo- distance between Col and GO; Go-Me, distance between GO and Me.
lars), and the cusps on the crown of the first molar served *P \0.05; yP \0.01.
as the mandibular reference plane.
A straight line was passed through the transition Table III. Masticatory patterns of subjects in the
point from the groove on the buccal aspect of the first normal bite (NB) and crossbite (CB) groups on the
molar to the buccal groove on the occlusal surface, affected side (AS) and unaffected side (US)
and through the transition point from the groove on
NB group (n 5 14) CB group (n 5 9)
the lingual aspect to the lingual groove on the occlusal
surface. The angle formed by this straight line and the AS US AS US
z-axis served as the axial inclination of the teeth, Normal 100% (14/14) 92.8% (13/14) 0% (0/9) 55.6% (5/9)
yielding an axial inclination on the affected side, and pattern
an axial inclination on the unaffected side. Reversed 0% (0/14) 7.2% (1/14) 55.6% (5/9) 33.3% (3/9)
pattern
Crossover 0% (0/14) 0% (0/14) 44.4% (4/9) 11.1% (1/9)
Statistical analysis pattern
The percentages of chewing patterns on the affected
and unaffected sides were calculated. The chewing pat- affected side for the NB group and the CB group. These
terns were normally distributed in each group. The Stu- findings indicated facial asymmetry (Tables I and II).
dent t test was used to test for significant differences Table III presents a tally of the chewing patterns
between the groups for the widths of the maxillary and observed among the patients. Patients in the NB group
mandibular dentitions, palatal widths, and axial inclina- had a normal chewing pattern on the affected side
tions of the maxillary and mandibular first molars on the 100% of the time and a normal chewing pattern on
affected and unaffected sides. the unaffected side 92.8% of the time. One subject
from the NB group had a reversed pattern of chewing
RESULTS on the affected side 0% of the time, and a reversed
Measurements from lateral cephalograms are shown in pattern of chewing on the unaffected side 7.2% of the
Tables I and II. Authors of previous studies have measured time. No patient in the NB group had a crossover chew-
the distances between condylar and mental spine, condylar ing pattern on either the affected or unaffected side. In
and gonion, and gonion and mental spine on the affected contrast, patients in the CB group had a normal chewing
and unaffected sides according to lateral cephalograms to pattern on the affected side 0% of the time and a normal
identify facial asymmetry.12-14,24 We analyzed lateral chewing pattern on the unaffected side 55.6% of the
cephalograms in accordance with the analysis of time. The patients in the CB group had a reversed pattern
Ricketts.25 The deviations in mental spine were of chewing on the affected side 55.6% of the time and a
7.3 6 2.2 mm (mean) for patients in the NB group and reversed pattern of chewing on the unaffected side
8.9 6 4.2 mm (mean) for patients in the CB group. Signif- 33.3% of the time. The patients in the CB group had a
icant differences in the deviation in mental spine were not crossover chewing pattern on the affected side 44.4%
noted. Similarly, significant differences in the occlusal of the time and a crossover chewing pattern on the un-
plane angle were not noted. The values for condylar- affected side 11.1% of the time.
mental spine, condylar-gonion, and gonion-mental spine Comparisons of the width of the maxillary and
were greater on the unaffected side compared with the mandibular dentitions, palatal width, and axial

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1144 Suzuki et al

another study reported that a typical chewing pattern

Table IV. Axial inclinations of the maxillary and
in patients with normal occlusion is one where the
mandibular first molars and arch widths of the first
mandible moves smoothly from centric occlusion,
molar
downward, and then laterally toward the chewing side
NB group (n 5 14) CB group (n 5 9) or the nonchewing side before returning to centric oc-
Mean SD Mean SD t test
clusion along a convex path.17 Various studies have
Linear measurements (mm) evaluated and classified the differences in chewing pat-
U6-6CW 53.3 3.5 50.0 3.7 * terns. Shiga et al16 assessed the relationship between
L6-6CW 45.8 3.0 46.1 2.6 NS occlusal contact during lateral movements and chewing
y
U6-L6CW 7.5 2.8 3.9 2.8 patterns, and classified them into 7 types. Proeschel27
U6GW 36.9 2.9 33.6 3.3 *
examined the chewing patterns of normal persons and
Angular measurements (
)
AIMx-AS 96.0 4.8 98.6 4.0 NS those of patients with Angle Class I or Class II malocclu-
AIMx-US 90.8 6.1 86.0 2.9 * sion, and derived 8 classifications of chewing patterns.
AIMa-AS 64.8 5.3 70.4 6.0 * Yano et al4 and Tomoyose et al28 both examined the
AIMa-US 74.1 8.1 70.8 6.5 NS chewing patterns of subjects with mandibular asymme-
NS, Not significant; NB, normal bite; CB, crossbite; U6-6CW, width try; Yano et al derived 5 classifications of chewing pat-
of the maxillary dentition; L6-6CW, width of the mandibular denti- terns, and Tomoyose et al derived 3 patterns. To
tion; U6-L6CW, width of the maxillary dentition and the width of ascertain the normal and particular patterns of chewing,
the mandibular dentition; U6GW, palatal width of maxillary first
molars; AIMx-AS, axial inclination of the maxillary teeth on the
we classified chewing patterns into 3 types (normal,
affected side; AIMx-US, axial inclination of the maxillary teeth on reversed, or crossover). Patients who chewed in a normal
the unaffected side; AIMa-AS, axial inclination of the mandible pattern moved their mandibles downward from centric
teeth on the affected side; AIMa-US, axial inclination of the occlusion and then laterally toward the chewing side
mandible teeth on the unaffected side. or the nonchewing side, before returning their mandi-
*P \0.05; yP \0.01.
bles to centric occlusion along a concave, convex, or
linear path. Thus, the patients had a chewing pattern
inclinations of the maxillary and mandibular first molars that was consistent with that of subjects with normal oc-
are shown in Table IV. The width of the maxillary denti- clusion.16 Patients who chewed in a reversed pattern (ie,
tion and palatal width were significantly greater in the in reverse sequence) moved their mandible laterally first,
patients in the NB group than in the patients in the CB before moving it downward, and then returning it to
group. The patients in the NB group had a significantly centric occlusion. This pattern is often noted in patients
greater difference between the width of the maxillary with a laterally deviated mandible or prognathism, where
dentition and the width of the mandibular dentition a molar crossbite is more likely to occur. Nakaminami
compared with that of the patients in the CB group. Sig- et al3 reported that a reversed chewing pattern tends
nificant differences in the width of the mandibular to be highly prevalent among patients with a molar
dentition were not noted. crossbite.
Significant differences in the axial inclination of the Patients in the NB group mostly had a normal chew-
maxillary teeth on the affected side were not noted. ing pattern; the molars on the affected and unaffected
Compared with the patients in the NB group, those in sides were normally covered. However, 1 subject in the
the CB group had significantly less axial inclination of NB group had a reversed chewing pattern on the unaf-
the maxillary teeth on the unaffected side. Additionally, fected side. When there is occlusal contact on the
patients in the NB group had significantly less axial incli- balancing side, chewing can proceed in reversed order
nation of the mandibular teeth on the affected side (the mandible will first move laterally and then down-
compared with patients in the CB group. Significant dif- ward).16 With a molar crossbite, chewing can proceed
ferences in the axial inclination of the mandibular teeth in a reversed sequence so that it does not interfere
on the unaffected side were not noted. with occlusion.27 Thus, the differences in occlusal con-
tact may lead to different chewing patterns because of
DISCUSSION their presumed associations with one another. Similarly,
The coverage of the first molars on the frontal sec- occlusion on the unaffected side is unobstructed by the
tions was classified into either 1 of 2 categories: normal return of the mandible to its original position; this may
coverage on the affected side (NB group) or evidence of a potentially account for the reversed pattern of chewing.
crossbite (CB group). Chewing patterns were also as- Patients in the CB group did not have a normal chew-
sessed. A previous study reported that chewing is regular ing pattern on the affected side; instead, they had a
and consistent with a normal occlusion,26 whereas reversed pattern (55.6%) or a crossover pattern

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Suzuki et al
(44.4%) of chewing. Patients in the CB group had a
normal chewing pattern on the unaffected side
(55.6%), a reversed pattern (33.3%), or a crossover
pattern (11.1%). Tomonari et al5 examined the relation-
ship between molar coverage and masticatory move-
ment; they reported that the sequence of chewing was
reversed in the CB group: ie, lateral movement followed
by downward movement of the mandible. In our study,
the presence of a molar crossbite interfered with the
cusps of the molars on the affected side during chewing,
hindering masticatory movement. This resulted in a
reversed or a crossover chewing pattern with a shorter
trajectory of chewing than the trajectory of chewing in
a normal chewing pattern.
A reversed or crossover pattern of chewing was noted
with malocclusion of the unaffected side. This led to
inconsistent chewing patterns on the unaffected sides.
Lateral deviation of the mandible involves asymmetry
of the rami or the body of the mandible and the mandib-
ular condyles, and asymmetry of the temporomandib-
ular joints and muscles.29 Thus, morphologic aspects,
such as the asymmetry of the mandibular condyles,
must be examined in future studies of patients with a
lateral deviation of the mandible.
In this study, the width of the maxillary dentition,
palatal width, and the difference between the width of
the maxillary dentition and the width of the mandibular
dentition were significantly greater among the patients
in the NB group than among those in the CB group. Au-
thors of 1 study found that persons with a normal chew-
ing pattern chew with grinding movements.30 Negishi
et al31,32 reported that subjects with a normal chewing
pattern chew with grinding movements, and that this
aids in the lateral expansion of the maxillary
midpalatal suture. Additionally, Cattaneo et al33
analyzed a finite element model of the adult maxilla
and reported that stress was concentrated around the
key ridge. Their findings were similar to those of Negishi
et al.32
Furthermore, authors of a study reported that major
changes in the development of the maxillary dental arch
result from the lateral expansion of the palate and not
from the axes of the teeth.22 Nonetheless, the expansion
of the maxillary midpalatal suture occurs primarily dur-
ing childhood.34 The patients in our study were adults,
so the differences in the width of the maxillary dentition
of the NB and CB groups had presumably resulted from
the changes in the axial inclinations of the mandibular
molars.
Significant differences in the axial inclinations of the
maxillary teeth on the affected side were not noted. The
maxillary teeth on the affected sude tended to be
buccally inclined in the patients in the CB group. A
American Journal of Orthodontics and Dentofacial Orthopedics
1145
comparison indicated that the patients in the CB group
had significantly less axial inclination of the maxillary
teeth on the unaffected side compared with the patients
in the NB group. It was also observed that the patients in
the CB group had lingual inclinations of the maxillary
teeth on the unaffected side, and that the patients in
the NB group had significantly less axial inclination of
the mandibular teeth on the affected side relative to
the patients in the CB group. Compared with the patients
in the CB group, the patients in the NB group had
lingually inclined molars on the affected side. A compar-
ison showed no significant differences in the axial incli-
nation of the mandibular teeth on the unaffected side.
The molars on the unaffected side tended to be buccally
inclined in the patients in the NB group, compared with
the patients in the CB group.
In this study, a lateral deviation of the mandible
caused the mandibular molars to be located more
buccally with respect to the maxillary dentition. Studies
of subjects with normal occulusion have reported that
stress is primarily placed on the lingual aspects of the
buccal cusps of the mandibular molars during normal
chewing.35,36 A study of patients with lateral deviation
of the mandible reported that the occlusal contact area
was significantly greater on the affected side of the
mouth.37 In subjects with normal occulusion, the buccal
cusps of the mandibular molars serve as functional
cusps, but a lateral deviation of the mandible may result
in lingual cusps of the mandibular molars serving as
functional cusps. In other words, normal masticatory
movements occur, and the mandibular molars may be
forced toward the tongue, presumably causing the
mandibular molars on the affected side to be lingually
inclined. Takada et al38 reported that intraoral pressure
was significantly correlated with the inclination of the
mandibular first molars in patients with facial asymme-
try; they found that an imbalance in intraoral pressure
distribution was related to the incidence of asymmetric
mandibular dentition and dental compensation. A
reversed or crossover chewing pattern with a shorter tra-
jectory of chewing presumably places less stress on the
lingual aspect of the mandibular dentition.
Dental compensation can lead to anteroposterior in-
congruity in the bones of the jaw and can cause horizon-
tal incongruity.39 In patients with facial asymmetry,
dental compensation is correlated to buccolingual pres-
sure on the affected and unaffected sides, the buccolin-
gual position of the mandibular molars, and the
inclination of those molars. Buccolingual pressure and
asymmetry in the dental arch are reported to be related
to the dental compensation of the molars.40 Ishikawa
et al40,41 reported that dental compensation was
involved in maintaining coverage of the molars.
June 2017  Vol 151  Issue 6
1146
Chewing with grinding strokes is reported to cause the
mandibular molars to incline to a more upright
position.31 Additionally, masticatory movement and
changes in the axial inclination are closely related.
Thus, a normal chewing pattern may cause lingual incli-
nation of the teeth on the affected side and lead to more
consistent chewing patterns.
CONCLUSIONS
Masticatory movement and axial inclination are
closely related. In subjects with lateral deviation of the
mandible and a normal chewing pattern, the width of
the maxillary dentition can increase as a result of the
changes (ie, the orientation) in the axes of the teeth. A
normal chewing pattern may lead to lingual inclination
of the mandibular molars on the affected side.
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