What is malocclusion?

The faulty contact between the upper and lower teeth

when the jaw is closed.

A condition in which the opposing teeth do not mesh

normally.

Misalignment of teeth and or incorrect relation between

the teeth of the two dental arches.

Classification of etiology of malocclusion

Moyers Classification

Heredity
Developmental defects
Trauma
Physical agents
Habits
Diseases
Malnutrition

Contd

White and Gardiners Classification

Dental Base Abnormalities

Pre-eruption Abnormalities
Post-eruption Abnormalities

Grabers Classification

General factors
Local Factors

Local Factors

Anomalies of the Number

Supernumerary teeth
Missing teeth

Anomalies of Tooth Size

Anomalies of Tooth Shape
Abnormal Labial Frenum
Premature Loss of Deciduous Teeth
Prolonged Retention of Deciduous Teeth
Delayed Eruption of Permanent Teeth
Abnormal Eruptive Path
Ankylosis
Dental Caries
Improper Dental Restoration

Anomalies of tooth number

Supernumerary teeth: Extra do not resemble normal

teeth with abnormal morphology.

How?

Frequent mesiodens maxillary midline, conical shape produce

crowding.
If unerupeted, produce spacing

It also occurs in premolars and third molars area.

Supplemental teeth: Extra teeth but that resemble

normal teeth

Both super and supplement teeth cause noneruption of adjacent teeth can defect the erupting
adjacent teeth into abnormal location.

Supplemental Lateral Incisor

Fig. 1

Fig. 2
Supernumerary teeth

Fig. 3

Fig. 4

Classification of supernumerary teeth

On the basis of location

Mesiodens
Parapremolars
Paramolars

On the basis of shape

Incisors form
Canine form
Premolar form
Molar form.

Missing teeth

More common than supernumerary teeth.

Occurs in both jaws.

The order of frequency of absence

Maxillary and mandibular third molars.

Maxillary lateral incisors.
Mandibular second premolars
Mandibular incisor
Maxillary second premolars.

Congenital absence is more frequent in permanent then

deciduous dentition.

Fig. 1

Fig. 3

Fig. 2

Fig. 4

Anomalies of tooth size

Disproportionate the teeth size and arch length and also

between the maxillary and mandibular tooth size.

Cause: Heredity-positive family history

Major characteristics of dental malocclusion: Crowding

and spacing

In order to frequency of anomaly in size.

Larger teeth has greater tendency to crowding

Smaller teeth has greater tendency to spacing.
Maxillary lateral incisor-smaller- commonly seen anomaly.
Mandibular premolar.

Fusion between two adjacent teeth and between

supernumerary tooth and normal tooth may predispose
to malocclusion.

Anomaly of tooth shape

The order of greater variation in shape

Maxillary lateral incisor

Maxillary central incisor

Presence of large cingulam labioversion due to force of

occlusion.

Mandibular second premolar

Peg lateral often accompanied by spacing migration of teeth.

Additional lingual cusp, thereby increasing the mesiodistal

dimension of tooth

Other
In congenital syphilis

Peg lateral as well as mulberry molars

In cases of amelogenesis imperfecta, hypoplasia of

teeth, fusion and germination.
Dilacerated teeth fail to erupt to normal level and can
cause malocclusion

Abnormal labial frenum

Controversial - associated with midline diastema.

How?
At birth the frenum is attached to the alveolar ridge, with fibers
actually running into the lingual inter dental papilla. As the teeth
erupt and as alveolar bone is deposited, frenum attachment
migrates superiorly with respect to the alveolar ridge. When fiber
persist in between maxillary central incisors and in the V-shaped
inter maxillary suture notching the inter dental alveolar bone
produce the midline diastema.

Fig: Anterior Diastemas associated with labial frena

Contd

Study by Taylor
Age
Incidence of diastema
6
97%
6-7
88%
10-11
48%
12-18
7%(presence of high frenum
attachment)

Heavy fibrous frenum has positive blanching test

The frenum in not necessarily th cause of the spacing.

Fig: Heavy fibrous frenum, but no diastema

Premature loss of deciduous teeth

Deciduous teeth, not only as organs of mastication, but

also as space savers for the permanent teeth.

Premature loss of a deciduous incisor seldom leads to

malocclusion but second molars can cause a marked
forward shift of the permanent molars.

Extraction of the earlier the deciduous teeth before the

successional teeth are ready to erupt.

Arch length deficiency or crowding, the early loss of

deciduous teeth may worsen the existing malocclusion.

Prolonged retention of deciduous teeth

Improper, non-uniform or unscheduled

resorption of DT, the permanent successors may
be either withheld from eruption, or may be
deflected in malposition.

Reasons:

Absence of underlying permanent teeth.

Endocrinal disturbances such as hypothyroidism
Ankylosed deciduous teeth that fail to resorb.
Non-vital deciduous teeth that do not resorb.

Delayed eruption of permanent teeth

Reasons:

Endocrine disorder such as hypothyroidism

Congenital absence of the permanent teeth.
Presence of a supernumerary teeth
Deciduous root road block
Presence of a heavy mucosal barrier.
Premature loss of deciduous tooth

Abnormal Eruptive Path

Due to arch length deficiency, presence of

supernumerary teeth, retained root fragments, or
formation of a bony barrier.

Eruption of canine or premolar buccally, lingually or

transposition.

Ectopic eruption.: A form of abnormal eruptionis

Ankylosis

Occurrence: 6-12 yrs.

Associated with certain infections, such as endocranial

disorder, cleidocranial dystosis.

Absence of the intervening periodontal membrane

culminates the fusion of root surface to the bone directly.

Dental Caries

Considered among the many local causes of

malocclusion.

Causes:

Lead to premature loss of deciduous or permanent

teeth.
Proximal caries.

Improper dental restoration

Consequences:

Over-countered occlusal restorations cause

premature contacts.
Under-countered occlusal restorations permit the
opposing dentition to supra-erupt.
Proximal restorations under countered invariably
result in loss of arch length.

Conclusion

Conclusion of this seminar is that there are numbers of

local factors responsible for malocclusion. Among them
local factors are responsible for malocclusion produce a
localized effect confined to one or more adjacent or
opposing teeth. For comprehensive orthodontic
management it involves identification if the possible
etiologic factor and attempt to eliminate the same for the
development of normal dentition and occlusion.

Thank you!!!
-Kishor Gurung