MORPHOLOGIC MALOCCLUSION

Classification The term malocclusion covers a number of different morphologic deviations which may occur as single traits or in various combinations. To specify the concept, methods have been developed to systematically describe morphologic malocclusions based on groupings of single traits of malocclusion in three main categories, subdivided as shown in table 16-1. A relatively simple, but very useful, classification to be employed in connection with diagnosis and treatment planning is to divide the malocclusions into two major groups: Dento alveolar malocclusions Skeletal (basal) malocclusions

Dento-alveolar malocclusions are primarily related to deviations within the dental arches and alveolar processes. Skeletal malocclusions are primarily caused by deviation in jaw relationships. Definitions of single malocclusions traits according to Bjork et al (2) will be given in the following. Sagittal malocclusion extreme maxillary overjet is defined as 4 mm in primary and 6 mm in permanent dentition (fig.16-1); mandibular overjet > 0 mm. In the latter, the presence of anteriorly forced bite should be recorded. Distal or mesial occlusion is defined as a cusp or more deviation form normal occlusion (figs.16-2, 16-3).d Vertical malocclusion deep bite is defined as 3 mm in primary and 5 mm in permanent dentition (fig. 16-4). Open bite measured at the central incisors > 0 mm. open bite in the lateral region is recorded for the canine, premolar and molar section on each side. Transverse malocclusion Crossbite is recorded on each side for the canines, premolars and molars if the buccal cusp of the upper teeth occludes lingually to the cusp of the corresponding lower tooth (fig. 16-5). Scissors bite is recorded if the lingual cusp of the upper tooth occludes buccally to the buccal cusp of the corresponding lower tooth (fig. 16-5B). crossbite and scissors bite are registered only when the cusp have passed each other. Transverse forced bite is registered if the lower jaw form first tooth contact to full occlusion is displaced laterally by at least 2 mm measured at the incisor. Space anomalies Crowding and spacing may be recorded after the primary dentition is fully erupted. The registration is made separately for the incisor section and for the lateral sections (canines and premolars). The incisor segment is demarcated by the distal contact points of the two lateral incisors when these teeth do not deviate labially or lingually in relation to the midline of the alveolar process. The lateral segments are limited by these points and mesial contact points of the first permanent molars. When a lateral incisor deviates, the demarcation point is taken at the mesial contact points of the first permanent molars. When a lateral incisor deviate, a point is used on the midline of the alveolar process between the two contact points. Crowding or spadcing is registered when there is a deviation from normal of at least 2

mm in a section. Before shedding of primary teeth, crowding and spacing is judged from the size of the primary teeth, after shedding form that of the permanent teeth. The maxillary medial diastema should be recorded separately.

Etiology Several factors are of significance in the etiology of malocclusions. A malocclusion may develop as a result of genetic and / or environmental factors. The genetic mechanisms may be simple, for example, autosomal dominant transmission, or more complicatedly, polygenic, where several different genes are acting. Such environmental factors as oral habits, hypertrophic tonsils and adenoids, dental trauma, early loss of primary teeth and severe, chronic diseases in childhood ( juvenile rheumatoid arthritis of the temporomandibular joint), may be of importance in the development of malocclusion. As discussed in chapter 4, the dento-alveolar compensatory mechanism may reduce the effects of aberrant jaw relations, in less extreme cases the dento-alveolar compensatory mechanism may be successful in maintaining normal occlusal relations in maintaining normal occlusal relations in spite of changing jaw relationships, however, often at the expense of the deterioration of the space condition. In children with extreme deviations in jaw relationship, the dento-alveolar compensatory mechanism may become insufficient leading to a socalled skeletal malocclusion. The presence of primary crowding, abnormalities in eruption, tooth migration, oral habits, mouth breathing and abnormal tongue posture may impair the deto-alveolar compensatory mechanism and thus lead to malocclusion. In conclusion, the development of malocclusions is most often caused by a nonfunctioning, incomplete or impaired dento-alveolar compensatory mechanism rather than by the actual discrepancy in jaw relationship.