ETIOLOGY OF MALOCCLUSION

DR. TASNIMA FAHMIDA OYSHI

INTERN DOCTOR
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL
ORTHOPEDICS
UPDATE DENTAL COLLEGE AND HOSPITAL
 CONTENT

Introduction
Classification of etiology of malocclusion
Graber’s Classification
Moyer’s Classification
Conclusion
INTRODUCTION

In orthodontics a malocclusion is a
misalignment or incorrect relation between the
teeth of upper and lower dental arches when
they approach each other as the jaw closed.
NORMAL OCCLUSION
Classification of Etiology of
Malocclusion
CLASSIFICATION
Graber’s classification of etiology of
malocclusion:
General Factors:
1.Heredity
2.Congrnital
3.Environmental
- Pre-natal: trauma, Maternal diet, German
measles, maternal metabolism
04. Predisposing metabolic climate and disease.
-Endocrine imbalance
-Metabolic disturbance
-Infectious disease
05. Dietary problem
-Nutritional deficiency
06. Abnormal pressure habits and functional aberrations
-Abnormal sucking
-Thumb and finger sucking
-Tongue thrust and tongue sucking
- lip and nail biting
-Abnormal swallowing habit
- speech defect
- Respiratory abnormalities
-Psychogenetics and bruxism
07.Posture
Local factors:
01. Abnormalities of number
-Supernumerary teeth
-Missing teeth(congenital or accidental)
02. Abnormalities of tooth size
03. Abnormalities of tooth shape
04.Abnormal labial frenum: mucosal barriers
05. Premature loss of deciduous teeth
06. Delayed eruption of permanent teeth
07. Abnormal eruptive path
08. Ankylosis
09. Dental caries
10. Improper dental restoration
11. Prolonged retention of deciduous teeth
Moyers classification of etiology of malocclusion:
1. Heredity
. -Neuromuscular system
- Bone
-Teeth
-Soft part
02. Developmental defects of unknown origin
03. Trauma
- Prenatal trauma (birth injury)
- Postnatal trauma
04. Physical agents
-Premature extraction f primary teeth
- Nature of food
05. Habits
- Thumb sucking and finger sucking
-Tongue thursting
-Lip sucking and lip biting
- Posture
- Nail biting
- Other habits
06. Diseases
- Systemic diseases
- Endocrine disease
-Local disease :
• Nasopharyngeal disease and disturbed
respiratory function
• Gingival and periodontal disease
• Tumors
•Caries
07. Malnutrition
01. Heredity :
Number of human traits that are influenced by the genes
includes –
(according to Lundstrom)
- Tooth size
- Arch dimension
- Crowding/Spacing
- Abnormalities of tooth shape
- Abnormalities of tooth number
- Overjet
- Inter arch variations
02.Congenital :
• Congenital defects or developmental defects are Malformation seen at the time
of birth. They may be caused by variety of factors including genetic, radiologic,
chemical, endocrine, infections and mechanical factors.
• Congenital abnormalities that causes malocclusion can be broadly classified as
general and local congenital abnormalities.
a. General congenital factors :
- Abnormal state of mother during pregnancy
- Malnutrition
- Endocrinopathies
 - Infectious disease
- Metabolic and nutritional disturbance
- Accidents during pregnancy and child birth
- Intra uterine pressure
- Accidental traumatization of the foetus by external forces
b. Local Congenital factors :
-Abnormalities of jaw development due to intra uterine position
-Clefts of the face and palate
-Macro and microglossia
-Cleidocranial dysostosis
03.Environmental
• Various prenatal and postnatal environmental factors can cause malocclusion.
• Pre-natal factors :
• The fetus is well protected against injuries during pregnancy but there are
certain factors can result in abnormal growth of Oro facial region thereby
predisposing to malocclusion. They are-
-Abnormal fetal posture during gestation may interfere with development of face..
-Maternal fibroids, amniotic lesions, maternal diet, and metabolism.
-Maternal infection such as German measles and use of certain drugs during
pregnancy such as Thalidomide can cause gross congenital deformities including
clefts.
CLEFT LIP AND PALATE
• Post natal factors :
• Forcep delivery can result in injury to the TMJ area, which can
undergo ankylosis.
• Cerebral palsy is a condition characterized by muscle incoordination,
this may occur due to birth injury.
• Traumatic injuries that cause condylar fracture can cause growth
retardation resulting in marked facial asymmetry.
• Presence of scar tissue such as those caused By burns or as a result of
cleft lip surgery may produce malocclusion due to their restrictive
influence on growth.
• 04.Predisposing metabolic climate and disease:
• • Endocrine Imbalance:
Certain endocrinal disorders may result in malocclusion, the following are some of the endocrinal
disturbance-
- Hypothyroidism: It is characterized by presence of one or more following features-
✓ Retention in rate of Calcium deposition in bones and teeth.
✓ Marked delay in tooth bud formation and eruption of teeth.
✓ Delayed carpal and epiphyseal calcification.
✓ The deciduous teeth are often over retained and permanent teeth are slow to erupt.
. ✓ Abnormal root resorption.
✓ Irregularities in tooth arrangements and crowding of teeth can occur.
• -Hyperthyroidism: This condition characterized by-
 Increase in the rate of maturation
 Increase in metabolic rate
 Premature eruption of deciduous tooth
 Disturbed root resorption of deciduous teeth
 Early eruption of permanent teeth
 Patient may have osteoporosis.
• -Hypoparathyroidism: this condition is associated with-
Change in calcium metabolism, may cause delay in tooth eruption
Altered tooth morphology
Delayed eruption of deciduous and permanent teeth.
 -Hyperparathyroidism: This condition characterized by:
✓ Increase in blood calcium
✓ Demineralization of bone and disruption of trabecular pattern .
✓ In growing child interruption of tooth development
✓ Tooth may become mobile due to loss of cortical bone and
resorption of alveolar process.
• Metabolic Disturbance:
Acute febrile disease are believed to slow down
the pace of growth and development. These conditions
may cause a disturbance in tooth eruption and shedding
thereby increasing the risk of malocclusion.
05.Dietary problems and Nutritional
deficiency:
• Nutritional deficiencies during growth may result in
abnormal development causing malocclusion.
• Nutrition related disturbance such as rickets, scurvey,
and beriberi can produce severe malocclusion and may
upset developmental time table.
06.Posture:
• Poor postural habits are said to be a cause for malocclusion.
• Children who support their head by resting the chin on their hand and those who
hang their head , so that the chin rests against the chest are observed to have
mandibular deficiency.

07.Trauma and Accident:

• Children are highly prone to injuries of the dentofacial region during early years
of life when they learn to walk an play, most of these injuries may responsible
for non vital teeth that do not resorb and deflecting of erupting permanent teeth
into abnormal position.
Local Factors
1. Abnormalities in number of teeth:
a. Supernumerary teeth-
teeth that are extra to the normal complement are termed
supernumerary teeth.
These teeth have abnormal morphology and do not resemble
normal teeth. Multiple supernumerary teeth are seen in cleidocranial
dysphasia. A frequently seen supernumerary tooth is the mesiodens,
that occur in the maxillary midline. These unerupted mesiodens is one
of the cause of midline spacing.
b.Missing teeth: ( congenital or accidental)
• Congenital absence of teeth are reffered to “hypodontia.” If all teeth are
missing from the arch then it is known as “anodontia.” If six or more
permanent teeth are missing then the term is “oligodontia”.
• Following are some of the commonly missing Teeth in decreasing order of
frequency –
• ° Third molars
• ° Maxillary lateral incisors
• ° Mandibular second premolars
• ° Mandibular incisors
• ° maxillary second premolars
02.Abnormalities in tooth size:
• In normal occlusion there should be harmony between tooth size and
arch length and also between the maxillary and mandibular tooth size.
a. Macrodontia: it refers any tooth is larger than normal for that
particular tooth type. Generalized Macrodontia is observed in cases of
pituitary gigantism and individuals with a small jaw. It affects most
often upper central incisors and second premolars and Lower third
molars.
b. Microdontia: it refers to tooth that appear smaller in size compared to
normal. Generalized Microdontia is rare but it may be associated with
congenital hypopituitarism or exposure of radiation or chemotherapy
Macrodontia Microdonti
a
03. Abnormalities in tooth shape:
• Abnormally shaped teeth predispose to malocclusion. Some examples
are-
• presence of peg shaped maxillary lateral incisors is often accompanied
by spacing and migration of teeth.
• congenital syphilis is often associated with peg shaped lateral incisors
and mulberry molars .
• • anomalies of shape can occur as a result of developmental defects like
amelogenesis imperfecta , hypoplasia of teeth, fusion and gemination.
• • presence of an abnormally large cingulum on maxillary incisors, that
Mulberry Molars Amelogenesis imperfecta
Peg shaped lateral incisor
04. Abnormal labial frenum :
• Abnormalities in maxillary labial frenum is associated with maxillary midline spacing. Prior
to eruption of teeth maxillary labial frenum is attached to the alveolar ridge with some fibers
crossing over lingualy to the region of incisive papilla, as tooth start erupting alveolar bone is
deposited and frenal attachment migrates into more apical position, rarely a heavy fibous
frenum is found attached to the interdental Papilla region.
• Midline diestema may occur in this type of case.
05.Premature loss of deciduous tooth:
• This refers to loss of a tooth before its permanent successor is sufficiently advanced in
development and eruption to occupy it’s place. Early loss of deciduous teeth can cause
migration of adjecent teeth into the space and can prevent the eruption of permanent
successor.
Abnormal labial frenum Effect of premature loss of deciduous teeth
06.Prolonged retention of desiduous tooth:
• This refers to a condition where there is undue retention of desiduous teeth beyond the usual eruption age o
their permanent successor. Prlonged retention of deciduous anteriors usually results in lingual or palatal
eruption of their permanent successor , prolonged retention of bucca teeth causes eruption of permanent
teeth either buccally or lingually or may retain impacted.

07. Delayed eruption of permanent teeth:

• There are some reasons that can delay erupting of permanent teeth. As follows –
• • Congenital absence of the permanent teeth
• • Presence of supernumerary teeth or pathology such as odontomes can block the erupting path.
• • presence of heavy mucosal barier
• •premature loss of desiduous teeth , due to formation of bone over the erupting permanent successor
• • endocrine disorders such as hypothyroidism
• • presence of deciduous root fragment, that are not absorbed can block the eruptive path.
Prolonged retention of deciduous teeth
08. Abnormal eruptive path:
One of the cause of malocclusion. It is caused by-
- arch length deficiency
- presence of supernumerary teeth
- impacted tooth
- Retained root fragment
- formation of a bony barrier.

09. Ankylosis:
This is a condition where a part or whole of the root surface is directly fused to the bone with the absence
of the intervening periodontal membrane.
Clinically these teeth fail to erupt to the noaml level and called submerged teeth, these are totally
submerged within the jaw and therefore cause migration of adjecent teeth into the space , the tooth is
immobile to manual rocking
Abnormal eruptive pathway Ankylosis
10. Dental caries:
• Caries can lead to premature loss of desiduous or permanent teeth thereby causing migration of
contiguous teeth, abnormal axial inclination, and supra eruption of opposing teeth.

11. Improper dental restoration:

• Improper dental restoration can cause malocclusion. Over contoured occlusal restoration cause
premature contacts leading to functional shift of the mandible during jaw closure. Under
contoured occlusal restoration can permit the opposing dentition to supra errupt..
• Proximal restorations that are under contoured result in loss of arch length due to drifting of
adjecent teeth to occupy the space.
• Poor proximal contact also cause food lodgement and periodontal weakening of the teeth.
Dental Caries Improper restoration
Thank you