Etiology of Malocclusion

Orthodontic Department
Etiology of
malocclusion
Prof. Dr. Mona Salah fayed
BDS, MSc, PhD (Cairo), DrMedDent (Bern)
Professor of Orthodontics (Cairo University)
Head of Department MSA University
LECTURE OUTLINE
• Hereditary:
Disproportion between tooth and arch size
• Congenital:
1- Cleft lip and palate.
2- Abnormal Labial Frenum.
3- Abnormalities in number of teeth.
4- Abnormalities of the tongue size
• Acquired:
1- Local
2- General
LECTURE ILOs
• By the end of this lecture each student should be able to:
1. Explain different etiological factors of malocclusion.

Congenital disorders are present from birth, and hereditary
disorders are transmitted from parents to their children through the genes.
Hereditary
Disproportion between tooth and arch
sizes
SPACING: where the size of the teeth is
bigger than the size of the arches
Hereditary
Disproportion between tooth and

arch sizes
Crowding: where the size of the teeth is
smaller than the size of the arches.
Size of the jaws
Habsburg jaw
II- Congenital
• 1-Cleft lip and palate.
• 2-Abnormal Labial Frenum.
• 3-Abnormalities in number of teeth.
Extra Teeth: supernumerary, supplemental teeth.
Missing Teeth: Anadontia: Oligodentia:, Missing of individual tooth.
• 4-Abnormalities of the tongue size
1- Cleft lip and palate
Without Surgical
correction
Before and after
surgical correction
Features of cleft lip and palate patients after correction…
1-Anterior cross-bite
2-Bilateral or unilateral posterior
cross-bite
3-Malpositioning and
rotation of maxillary
incisors
4-Maxillary lateral incisors
may be missed
2-Abnormal Labial Frenum
Definition: Low attachment of

the upper frenum due to
deficient apical migration of
tissues.
Leads to: mid-line diastema

between the upper central
incisors.
2-Abnormal Labial Frenum
Interdental septum
Diagnosis
1-Blanching test
2- Radiographically: the
appearance of a groove in the
alveolar crest between the
upper incisors.
3-Abnormalities in number of teeth
A- Extra Teeth: supernumerary, supplemental teeth
•Occurs in Maxilla more than

mandible
•Incidence in Permanent twice
deciduous
3-Abnormalities in number of teeth
A- Extra Teeth: supernumerary, supplemental teeth
Effects:
1) Cyst formation
2) Prevent or deflect eruption of permanent

incisors
3) Midline diastema
B-Missing Teeth:
Oligodentia:, Missing of individual tooth
(Missing lateral incisor is the most common
followed by lower second premolar)
Streeter’s syndrome (hereditary
Anhidrotic Ectodermal Dysplasia)
Either have either complete Anodontia

or Oligodontia…
Large tongue
Effects:
1) Widening of both dental
arches
2) Flaring of all teeth with
spacing
Broad and low lying
tongue
Effects:
1) Widening of the
mandible
2) Posterior cross-bite
Etiology
Hereditary Congenital Acquired

Acquired
Local acquired causes General acquired causes

A-Local acquired causes : only affect the oral cavity
1- Abnormal habits
a-Sucking habits b-Atypical swallow c-Mouth breather
2-Abnormal muscle activity
3- Problems of primary teeth
a-Premature loss of primary teeth
b-Prolonged retention of deciduous teeth
c-Ankylosed teeth
4-Problems of permanent teeth
a- Delay Eruption of permanent
b-Early loss of permanent teeth
c-Disorders in eruption and abnormal eruption path
5-Accident or trauma
6-Caries and improper restoration
7-Gengival and periodontal disease
8-Enlarged tonsil and adenoid
Abnormal Habit:
a-Sucking habits
Factors affecting the
degree of damage
1- Frequency
2-Duration
3- Intensity
4-Position
Thumb sucking habit
Clinical Features of Prolonged
Active Thumb-Sucking:
1) Finger habit opens mouth
beyond postural resting
position.
2) The resulted malocclusion
may be labial tipping of upper
incisors, lingual tipping of
lower incisors and creation
round well circumscribed
anterior open bite.
3) Constricted V- shaped
maxilla and high vaulted
palate.
Lip biting
1-Labioversion of maxillary
anterior teeth
2-Open bite
3-Linguoversion of mandibular
anterior teeth
Normal swallowing
Teeth in maximum contact

•Complete dental seal (no open bite)
•Tongue touches the anterior part of the palate
behind the incisors
• NO Contraction of the lips OR the peri-oral
muscles
•Teeth are in maximum inter-cuspation during
swallowing
b-Abnormal tongue thrust swallow
•Open bite
•Tongue protruded into open bite
•Contraction of the lips, mentalis
and peri-oral muscles
•Contraction of the mandibular
elevator muscles
Creation of a muscular seal
C- Mouth breathing
Effects
•Narrow V- shape maxilla with
high arched palate
•Protruded maxilla
•Broad mandible
•Increase over-jet
•Posterior cross-bite
•Open bite
•Gingival and periodontal disease
3-Premature loss of primary
teeth
Causes, effects
5-Prolonged retention
of deciduous teeth
Causes:
Congenital absence of permanent teeth
Displacement of permanent teeth
Caries or trauma (root resorption)
Ankylosis
Endocrinal disturbance (hypothyrodism)
Cleidocranial dysplasia
General diseases (TB)
(Lead to : deflection or impaction)
6-Ankylosed teeth
Ankylosed teeth
Definition: Is the fusion of the

cementum with the surrounding bone
of the jaw.
Etiology:
Defect in the periodontal ligament:
Deposition of bone in partially resorbed
roots:
Congenital absence of permanent teeth
Ankylosis of permanent teeth is seen due
to accident, trauma, endocrine disease,
and congenital diseases as cleidocranial
dysostosis or idiopathic without known
cause.
7- Delay Eruption of
permanent
• Endocrine disturbance
• Congenital absence of the
permanent teeth
• Presence of mechanical
interference
• Congenital and systemic
disorders (TB)
9-Accident or trauma
Ankylosis of TMJ
B- General acquired causes
General acquired
causes
Nutritional Hormonal
Diseases
Deficiency disturbance
Diseases
• Diseases of childhood period as measles, scarlet
fever…etc.
• Poliomyelitis.
• Muscular atrophy.
• Syphilis.
• Diabetes.
• T.B.
• Epilepsy.
• Scurvy
• Cleidocranial dysostosis.
Cleido cranial dysostosis
Cleido Cranial Dysostosis
Hyperdentition
General acquired
causes
Diseases
Rickets
•Wide mandible
•Narrow maxilla
•Flat gonial angle
•Enamel deficiency
•Deficient alveolar bone
•Delayed eryption of D&P
•Anterior open bite
•Class III
•Mouth breather Open bite secondary to Rickets
General acquired
causes
Diseases
Hormonal disturbance
• Thyriod gland
Hypothyrodism
Hyperthyrodism: Before puberty
• Early eruption of D&P
• Bone is fragile
• Disturbed resorption of the roots of D
Contraindicated orthodontic treatment

Hormonal disturbance
Hyperthyrodism: After puberty
• Increase the caries index
• Gingival inflammation
• Early loss of teeth and malocclusion
Acromegaly :
Hyperpitutiarism
References:
• MITCHELL, L., LITTLEWOOD, S. J., NELSON-MOON, Z.,

& DYER, F. (2013). An introduction to orthodontics

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Orthodontic Department

1. Explain different etiological factors of malocclusion.

Disproportion between tooth and

Definition: Low attachment of

Leads to: mid-line diastema

A- Extra Teeth: supernumerary, supplemental teeth

•Occurs in Maxilla more than

A- Extra Teeth: supernumerary, supplemental teeth

2) Prevent or deflect eruption of permanent

Either have either complete Anodontia

Hereditary Congenital Acquired

Local acquired causes General acquired causes

Teeth in maximum contact

Definition: Is the fusion of the

• Early eruption of D&P

• Disturbed resorption of the roots of D

Contraindicated orthodontic treatment

• MITCHELL, L., LITTLEWOOD, S. J., NELSON-MOON, Z.,

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