Aetiology of

malocclusion
Dr. M.O. Johnson
23/ 01/ 2007.

Definition
Malocclusion refers to an abnormality in

alignment of teeth or incorrect relation

between the upper and lower jaws which
results in aesthetic and functional (speech
and mastication) impairments.

 The aetiology of malocclusion may be

categorized into 2 main groups of factors:

General factors affect all or a greater part
of the occlusion and are largely genetically
determined.
Local factors affect 1 or 2 adjacent or
opposing teeth.

General factors : skeletal relationship

soft tissue form.

Skeletal relationship
This is the relationship between the basal
bones of the upper and lower jaws. Usually
assessed in 3 planes :

Antero-posterior plane

vertical plane

Lateral plane.

Antero-posterior plane :In this plane, occlusion is in 3 classes:

Class I- the mandible and maxilla are in a
balanced relation to each other.
Class II the mandible is posteriorly placed
relative to the maxilla.
Class III the mandible is anteriorly placed
relative to the maxilla.

Vertical plane:This assesses the anterior lower facial height in

relation to the posterior part.
increased anterior lower facial height relative to
the posterior Anterior open bite.
reduced anterior lower facial height deep
over bite.

Lateral plane
Assesses the width of the jaws in relation to
each other.
A narrow upper dental base cross bite
(unilateral or bilateral).
A narrow lower dental base scissors bite
or lingual cross bite.

Soft tissue form

Muscles around the orofacial region may play a
role in the development of abnormal
occlusion if they exert a profound effect
during the development of dentition.
The teeth lie within the dental arch between the
tongue on one side and the lips and cheeks
on the other side.

The tongue the size, resting posture and

function of the tongue play a secondary role
to the lips in determining the labio -lingual
position of the teeth.
Ideally the tongue should be conveniently
Accommodated within the dental arch in centric
occlusion, an increase in size outward
spread of the tongue bimaxillary
proclination.

The resting posture of the tongue should be

such that it is accommodated within the arch,
excessive spread into the gap between the
upper and lower anterior teeth at rest (tongue
thrust) anterior open bite.
Abnormal function of the tongue such as
thrusting during swallowing &/or speech has
the following effects on occlusion:
Proclination of upper incisors
Anterior open bite.

 The cheeks this is through the action of the

buccinator muscle and results in a posterior

cross bite, especially in cases where the
tongue or jaw lies in a low position and the
action of the buccinator is not opposed.
The lips if held apart at rest, the lips are
said to be incompetent and the following
abnormalities in occlusion may result:

 The upper incisors are proclined because

they rest on the lip which acts on them during

function.
The lower incisors are retroclined because
the lip is trapped behind the upper incisors.

Local factors:
A. Variation in tooth number
Supernumerary/supplemental teeth rotation,
displacement and crowding of teeth.
Hypodontia (oligodontia) spacing
Premature loss of primary teeth drifting of
adjacent teeth into the space created
.loss of space for permanent teeth/crowding
.midline shift.
Retained primary teeth occupy space for
permanent teeth.

B. Variation in tooth form/shape

Macrodontia(large teeth) crowding
Microdontia (small teeth) spacing
Additional cusps occlusal interference
between the upper and lower teeth.
C. Abnormalities in tooth position i.e.
transposition e.g. the canine being in place of
the lateral incisor.

D. Local soft tissue abnormalities

A prominent maxillary labial frenum ( i.e. attached to
the incisive papilla instead of 2-3mm above it) a
midline diastema.
E. Local pathology: cysts
cleft palate.
F. Habits: digit sucking
tongue thrusting
mouth breathing
G. Trauma.