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Etiology of Malocclusion
Etiology of Malocclusion
Etiology of Malocclusion
Dept. of Orthodontics
Ragas Dental College
ORTHODONTICS INCLUDES THE STUDY OF GROWTH AND
DEVELOPMENT OF JAWS AND FACE PARTICULARLY AND
THE BODY GENERALLY , AS INFLUENZING THE POSITION
OF THE TEETH ;THE STUDY OF ACTION AND REACTION
OF INTERNAL AND EXTERNAL INFLUENCES ON THE
DEVELOPMENT , AND THE PREVENTION AND
CORRECTION OF ARRESTED AND PEVERTED
DEVELOPMENT
Classification of Malocclusion
Etiology
ETIOLOGY
Specific Causes of M.O.
Disturbancesinembryologicdevelopment
Skeletalgrowthdisturbances
Muscledysfunction
AcromegalyandHemi-mandibularhypertrophy
Disturbancesofdentaldevelopment
GeneticInfluences
EnvironmentalInfluences
Equilibriumtheoryanddevelopmentofthedentalocclusion
Functionalinfluencesondentofacialdevelopment
EtiologyinContemporaryperspective
Changingviewsofetiologicpossibilities
EtiologyofcrowdingandMalalignment
EtiologyofSkeletalproblems
M.O.isadevelopmentalcondition
Moderatedistortionofnormaldevelopmentandnotbypathologicprocess
Complexinteractionamongmultiplefactorsthatinfluencegrowthand
developmentandoccasionallyasinglespecificcauseisapparent(eg)
Mand.DeficiencysecondarytochildhoodfractureoftheJaws.
M.O.
Specific causes
Disturbancesinembryologicdevelopment
Geneticdisturbancestospecificenvironmentalinsults.
Teratogens Effect
.Aspirin,cigarettesmoking
(hypoxia) Cleftlipandpalate
Dilantin,valium
Aminopterin Anencephaly
CMV Microcephaly,hydrocephaly,
Micropthalmia
Xradiation Microcephaly
Vitamin`DexcessPrematuresutureclosure
Ethylalcohol Mid-facedeficiency
Skeletal growth disturbances
Fetalmouldingandbirthinjuries.
Intra-uterinemoulding-
Pressureagainstthedevelopingface
Armpressedacrosstheface-Severemaxdeficiency
Decreasedamnioticfluidvolume-headtightlyflexed
againstchest-Mandibledeficiency
Extremesmallmandibleusuallyassociatedwithcleftpalate
(e.g.)pierrerobinsyndrome.
Pierrerobinsyndromewithdefectsincartilageformation-
SticklerSyndrome
Forcepsdelivery-MightdamageTMJ-Internalheamorrhage,lossof
tissueandasubsequentunder-developmentofthemandible.
Injurytothemandibleduringatraumaticdeliveryappearstobearare
andunusualcauseoffacialdeformity.
Hencechildrenwithdeformitiesinvolvingmandiblearemorelikelyto
haveacongenitalsyndrome(e.g.)TreacherCollinsandcruzons
syndrome.
Childhood fractures of the jaw
Condylarneckofthemandibleismorevulnerable.
Condylarprocesstendstoregeneratewellafterearlyfractures.
Prognosisisbetter,theearlierthecondylarfracture,becauseofthe
greatergrowthpotential-earlyinlife.
Itleadstoasymmetricgrowth.
ThoughitisapotentialcauseforsevereM.O.itdoesnotmakealarge
contributiontothetotalpoolofpatientswithmalocclusion.
MaxdownwardbyCranialbaseandforwardbyNasalseptum
Mandpulledforwardbysoft-tissuematrix.
Hence,enoughsoft-tissuescarring-Restrictsthegrowth-Asymmetrical
growth
Managementofcondylarfractures-
Surgicalreduction- Scarring
Conservativemanagement-Earlymobilizationofjawsto
Minimizeanyrestrictiononmovement
Oldcondylarfractures
Rheumatoidarthritis
Hemifacialmicrosomia
(congenitalabsenceoftissue).
Hence,condylar#atanearlyagegoodprognosis.
Muscle dysfunction
Itaffectsthejawgrowthbytwoways
1. Pointofmuscleattachment.
2. Importantpartofthetotalsofttissuematrix.
Apartofmusculaturelostdue
1. Unknowncause
2. Birthinjury
3. Motornervedamage
ExcessivemusclecontractionTorticollis-Sternocleido-Mastoid
muscle-Twistingofthehead-Restrictsthegrowth
Decreasedtonicmuscleactivity
1. Musculardystrophy
2. Cerebralpalsy
3. Muscleweaknesssyndromes
4. WillleadtoincreasedAnteriorfacialheight-Distortionoffacial
proportionsandmandform-Excessiveeruptionofpostteeth-Const
maxarchanterioropenbite.
Acromegaly and Hemi-mandibular Hypertrophy
Acromegaly -Anteriorpituitarytumor-increasedgrowthharmone-
Excessivegrowthofmandible-cIIIIM.O.
Tumorisremoved(or)irradiated.
Hemi-mandibular hypertrophy -
Unilateralexcessivemandibulargrowthoccursinpatients
(metabolicallynormal).
Etiologyunknown
Mostcommoningirls15-20years.
Condylarhyperplasia
Treatment
excessivegrowthmaystopspontaneously
removaloftheaffectedcondyle&Reconstruction
Multiplesupernumeraryteeth-(e.g.)cleidocranialdysplasia.
. Ectopic Eruption
Malpositionofthetoothbudwillleadtotheeruptionofthetoothina
wrongplace-EctopicEruption.
(e.g.) MaxIstMolartoomesial
MandIIndpremolarsEruptdistally-Endupinramus
Maxcanine -Longpathwayoferuption
Transposition
Early loss of primary teeth
-Mesialdriftofposteriorteeth-eruptsmesially&occlusally
-Distaldriftoftheanteriorteeth(e.g.)prematurelossofC
1. Activecontractionofthetrans-septalfibresingingiva.
2. Pressuresfromlipsandcheeks.
-Decreaseinthearch-perimeterandarch-lengthleadingto
crowdingandmal-alignment.
-Preventionbyspacemaintainer.
DentalTraumacanleadto
Damagetothepermanenttoothbudsfromaninjurytotheprimaryteeth.
Driftofthepermanentteethaftertheprematurelossoftheprimaryteeth.
Directinjurytopermanentteeth.
Traumatotheprimaryteeth
1.Duringpermanenttoothcrownformation-Enameldefects
2.Duringroofformationofpermanenttooth-Rootformationmaystop-
shortenedroots
- Dilaceration-Distortionofrootformatananglewhichaffects
theeruption
TREATMENT
Traumatically displaced tooth buds in children should be
repositioned as early as possible, so that, the root formation is
continuedwithoutanyobstruction.
Traumatothepermanentteeth
1. Damagetotheroots
2. Alveolusfracture
-Afteranaccidentortraumathetoothusuallycanbemovedtotheoriginal
position easily, because after healing (2-3 weeks) ankylosis may
develop.
Genetic Influences
M.O.couldbeinheritedbytwoways
1.Inheriteddisproportionsbetweenteethsizeandjawsize.
2. Inherited disproportions between size and shape of the U/L
Jaws.
1.Comparingthemono-zygoticanddizygotictwins.
2.Comparingthemother-child,father-childandsibling
pairs.
Lauwerynsetal,40%ofdental&facialvariations
leadingtoM.O.canbeattributedtohereditaryfactors.
Environmentalinfluencesduringgrowthanddevelopmentofface,
jaws and teeth consists largely of pressure and forces related to
physiologicactivity.
Relationshipbetweenanatomicformandphysiologicfunction.
Equilibrium theory
Tooth contacts
mastication very heavy very short
swallowing light very short
4. Major equilibrium influences for the teeth should be the light but
longlastingpressuresfromtongue,lipsandchecksatrest.
6. Themajorequilibriuminfluencesonthejawsshouldbepositional
changesaffectingthefunctionalprocess,includingthecondylarprocess.
Functional influences on Dentofacial development
MASTICATORY FUNCTION
Itcouldaffectintwoways
1. Greater use of the jaws, with higher (or) prolonged biting force
couldincreasethedimensionofthejawsanddentalarches.Lessuse
of the jaws might lead to under-development of dental arches and to
crowdingandirregularteeth.
(e.g) Eskimos with broad dental arches as an adaptation to
extremestress.
Theeffectonarchwidthisnotclear.
Difference in muscle strength - biting force is a etiology for long and
shortfaceproblems?
Itwasconcludedthat,theforceexertedbymasticatorymuscleis
notamajorenvironmentalfactorincontrollingtootheruptionandnotan
etiologicfactorformostpatientswithdeep(or)openbite.
-Sucking Habits
- Tongue thrusting
- Respiratory Pattern
ETIOLOGY IN CONTEMPORARY PERSPECTIVE
1. EdwardAngleandhiscontemporariesstatedthatM.O.wasadisease
ofcivilizationandblameitonimproperfunctionoftheJaws(19th
Century)
2. Classical(Mandelian)geneticsdevelopedrapidlyinthe1stpartofthe
20thCenturystatedthatM.O.isprimarilytheresultofinherited
dentofacialproportions.
3. Inthe1980'stherewasastrongswingbacktowardtheearlierview.
4. In21stCentury-Amorebalancedviewemerged.Itwasconcluded
thattheetiologyofmostorthodonticproblemsaredifficulttoisolate,
becauseseveralinteractingfactorsprobablyplayedarole.
Etiology of crowding and Alignment
-MinorClassIproblems,especiallynon-skeletalcross-bite,oftenare
causedprimarilybyalterationinfunction.Majorproblemsusuallyhave
anadditionalgenetic(or)developmentcomponent.
Malformation(or)MalrelationofJaws.
Inheritedpatterns,defectsinembryologicdevelopment,trauma,and
functionalinfluences.
Mandretrogandprog,Maxdeficiency-inheritanceplaysmajorrole
andtheconditionmadeworsebyenvironmentalefforts.
Altered function:VerticalgrowthproblemsusuallyAnterioropen
bite-Thumbsucking-TongueThrusting-Respiratory
problems.
Openbite-Blacksanddeepbite-whites.
MALOCCLUSION
GeneticComponent
OrInheritance
Developmentalproblems
Alteredfunction
ECTODERMAL DYSPLASIA
MASSETER MUSCLE DYSFUNCTION
ACROMEGALY-ANT PITUITARY TUMOR
ACHONDROPLASIA
EQUILIBRIUM THEORY
TREACHER COLLINS SYNDROME
HEMIFACIAL MICROSOMIA
ADENOID FACIES