SYED SOHAIB DAUD GILANI

FINAL YEAR BDS

ROLL#303

MALOCCLUSION.
A malocclusion is a
misalignment of teeth
incorrect relation between the teeth of the two
dental arches.
The term was coined byEdward Angle, the
"father of modern orthodontics", as a derivative
of occlusion, which refers to the manner in
which opposing teeth meet.

WHAT IS
MALOCCLUSION?
Malocclusion is not a disease, but a spectrum
representing biological variability/diversity
When the deviation from the normal reaches a
certain degree of severity (threshold), then it is
termed malocclusion
What is of relevance is clinically significant
deviation from normal occlusion

35%
5%
20%
20%

20%

WHY ETIOLOGY?

Better understanding of the condition

Prevention
Prediction
Management

ETIOLOGY OF
MALOCCLUSION
The various classifications proposed are:
White and Gardiner's classification
Salzmann's classification
Moyer's classification
Graber's classification.

White and Gardiner's

classification
This was one of the first attempts to classify
malocclusion.
It tried to make a distinction between the skeletal and
dental etiologic factors.
It also tried to distinguish between pre-eruptive and
post-eruptive causes.

DENTAL BASE ABNORMALITIES

1. Antero-posterior mal relationship

2. Vertical mal relationship
3. Lateral mal relationship
4. Disproportion of size between teeth and basal bone
5. Congenital abnormalities.

PREERUPTION ABNORMALITIES

1. Abnormalities in position of developing tooth germ

2. Missing teeth
3. Supernumerary teeth and teeth abnormal in form
4. Prolonged retention of deciduous teeth
5. Large labial frenum
6. Traumatic injury.

POSTERUPTION ABNORMALITIES
1. Muscular
a. Active muscle force
b. Rest position of musculature
c. Sucking habits
d. Abnormalities in path of closure
2. Premature loss of deciduous teeth
3. Extraction of permanent teeth.

SALZMANN'S
CLASSIFICATION
Salzmann defined three definite stages in which
malocclusions are likely to manifest:
1. The genotypic
2. The fetal environment
3. The postnatal environment.

Since different factors effect these different stages

hence, the division of the etiologic factors into
prenatal, postnatal, functional and environmental
or acquired.

PRENATAL
1. Genetic - included malocclusions transmitted by genes,
where the dentofacial anomalies may or may not be in
evidence at birth.
2. Differentiative - malocclusions that are inborn,
engrafted in the body in the prefunctional embryonic
developmental stage. Can be subdivided into:
a. General-effect the body as a whole
b. Local-effect the face, jaws and teeth only.
3. Congenital - can be hereditary or acquired but existing
at birth. Can be subdivided as:
a. General or constitutional
b. Local or dentofacial.

POSTNATAL
Developmental
A. General
a. Birth injuries
b. Abnormalities of relative rate of growth in different body
organs
c. Hypo- or hypertonicity of muscles which may eventually
affect the dentofacial development and function
d. Endocrine disturbances which may modify the growth
pattern and eventually affect dentofacial growth
e. Nutritional disturbances
f. Childhood diseases that affect the growth pattern
g. Radiation.

 B. Local
a. Abnormalities of the dentofacial complex:
1. Birth injuries of the head, face and jaws
2. Micro- or macrognathia
3. Micro- or macroglossia
4. Abnormal frenal attachments
5. Facial hemiatrophy.
b. Abnormalities of tooth development:
1. Delayed or premature eruption of the deciduous or
permanent teeth
2. Delayed or premature shedding of deciduous teeth
3. Ectopic eruption
4. Impacted teeth
5. Aplasia of teeth.

FUNCTIONAL
A. General
1. Muscular hyper- or hypotonicity
2. Endocrine disturbances
3. Neurotrophic disturbances
4. Nutritional deficiencies
5. Postural defects
6. Respiratory disturbances (mouth breathing).

B. Local
1. Malfunction of forces exerted by the inclined planes
of the cusps of the teeth
2. Loss of forces caused by failure of proximaI contact
between teeth
3. Temporomandibular articulation disturbances.
4. Masticatory and facial muscular hypo- or
hyperactivity
5. Faulty masticatory functions, especially during the
tooth eruption period
6. Trauma from occlusion

ENVIRONMENTAL OR ACQUIRED

A. General
1. Disease can affect the dentofacial tissues directly or by
affecting other parts of the body indirectly disturb the teeth and
jaws.
2. Nutritional disturbances especially during the tooth
formation stage.
3. Acquired endocrine disturbances that are not present at
birth
4. Metabolic disturbances
5. Trauma, accidental injuries
6. Radiation.
7. Tumours.

B. Local
1. Disturbed forces of occlusion
2. Early loss of deciduous teeth
3. Prolonged retention of deciduous teeth
4. Delayed eruption of permanent teeth
5. Loss of permanent teeth
6. Periodontal diseases
7. Temporomandibular articulation disturbances
8. Infections of the oral cavity
9. Pressure habits
10. Traumatic injuries including fractures of the jaw
bones.

MOyER'S CLASSIFICATION
Moyer identified etiologic sites, from where the
variations were expected to arise. These sites
included:
A)the craniofacial skeleton,
B)the dentition,
C)the orofacial musculature, and
D)other 'soft tissues' of the masticatory system.
He based his classification on the premise that various
factors may contribute to cause variations at these
sites, more often in groups rather than individually.

 1. Heredity
2. Developmental defects of unknown origin
3. Trauma:
a. Prenatal trauma and birth injuries
b. Postnatal trauma
4. Physical agents:
a. Premature extraction of primary teeth
b. Nature of food
5. Habits:
a. Thumb sucking and finger sucking
b. Tongue thrusting
c. Lip sucking and lip biting
d. Posture
e. Nail biting
f. Other habits

 6. Diseases:
a. Systemic diseases
b. Endocrine disorders
c. Local diseases:
Nasopharyngeal diseases and disturbed respiratory
function
Gingival and periodontal disease
Tumours
Caries:
- Premature loss of deciduous teeth
- Disturbances in sequence of eruption of permanent teeth
- Early loss of permanent teeth
7. Malnutrition.

GRABER'S
CLASSIFICATION
Graber divided the etiologic factors as general or
local factors and presented a very comprehensive
classification.
This helped in clubbing together of factors which make
it easier to understand and associate a malocclusion
with the etiologic factors.

GENERAL FACTORS
1. Heredity
2. Congenital
3. Environment:
a. Prenatal (trauma, maternal diet, German measles,
material maternal metabolism, etc).
b. Postnatal (birth injury, cerebral palsy, TMJ injury)
4. Predisposing metabolic climate and disease:
a. Endocrine imbalance
b. Metabolic disturbances
c. Infectious diseases (poliomyelitis, etc).

 5. Dietary problems (nutritional deficiency)

6. Abnormal pressure habits and functional aberrations:
a. Abnormal sucking
b. Thumb and finger sucking
c. Tongue thrust and tongue sucking
d. Lip and nail biting
e. Abnormal swallowing habits (improper deglutition)
f. Speech defects
g. Respiratory abnormalities (mouth breathing, etc.)
h. Tonsils and adenoids
i. Psychogenetics and bruxism
7. Posture

 LOCAL FACTORS
1. Anomalies of number:
a. Supernumerary teeth
b. Missing teeth (congenital absence or loss due to
accidents, caries, etc.).
2. Anomalies of tooth size
3. Anomalies of tooth shape
4. Abnormal labial frenum: mucosal barriers
5. Premature loss
6. Prolonged retention

7. Delayed eruption of permanent teeth

8. Abnormal eruptive path
9. Ankylosis
10. Dental caries
11. Improper dental restorations.

Infectious diseases

DIETARY PROBLEMS
(NUTRITIONAL DEFICIENCY)

RESPIRATORY PATTERN

ADENOID FACIES THRESHOLD??

DIGIT SUCKING HABIT

Threshold 6 hrs

TONGUE THRUSTING

ETIOLOGY IN
CONTEMPORARY
PERSPECTIVE
Etiology of most malocclusions are
unknown
Role of genetic and environmental
influences
Skeletal traits have greater genetic
influence
Dental traits have relatively greater
environmental influence

THANK YOU