CLINICAL

I M P L I C AT I O N S

Z a r i D a n i e l l e C . To r r e s
 Goal
Specific Causes of Malocclusion

• To correlate syndromes associated with each stage of embryonic development

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 Overview

Defects in embryogenic development usually result in death of the embryo

Genetic Environment Teratogen

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 Teratogens

LOW LEVELS C aI G
H uv seHe E
l esRtpheD
aclO
i feS
i fcEf edScetfse c t s

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 Teratogens Affecting Dentofacial
Development

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 Teratogens Affecting Dentofacial
Development

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Scientific findings 7
Scientific findings 8
 • Midface deficiency
• Delayed dental development matches
skeletal delay
Fetal Alcohol
Syndrome

• Due to deficiency of midline tissue of

the developing brain
• Caused by exposure to very high
maternal levels

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 Neural Crest Defects

Thalidomide
Drug-induced cell ITsroetarceht ienr oCi no l l i n s S y n d r o m e
death/impairment of their Genetic alteration
migration Z ir ka an ivoifraucsi a l m i c r o s o m i a
C
Te t r a l o g y o f F a l l o t

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 Treacher Collins Syndrome
Mandibulofacial Dysostosis

• Reduced levels of mesenchymal

tissue (lateral aspects of the
face)
• Due to mutations in TCOF1
gene

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 Craniofacial Microsomia
Hemifacial Microsomia

• Characterized by deficient development in

lateral facial areas
• Deformed external ear
• Deficient or missing ramus and associated
soft tissues (muscle,fascia)
• Facial asymmetry and facial/cranial structure
are affected

• Major cause: insult to cell populations that

are required for proper development of first
pharyngeal (mandibular) arch

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CLEFT LIP &
PA L AT E
 Cleft Lip/Palate

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 Cleft Lip/Palate
CAUSES
• Teratogens
• Insults to developing tissues
• Maternal smoking
• macrostomia

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 Craniosynostosis
Syndromes

Abnormally early closure of sutures can be caused by mutations involving

fibroblast growth factor receptor genes
 Crouzon’s
Syndrome
• Mutation in fibroblast growth factor
receptop 2 on Chromosome 10
• Underdevelopment of the midface and
eyes (bulging from their sockets)
• Arises because of the prenatal fusion of
the superior and posterior sutured o the
maxilla along the wall of the orbit

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 Crouzon’s
Syndrome
• Fusion in the orbital area prevents the
maxilla from translating downward and
forwards = severe underdevelopment of
the middle 3rd of the face

Scientific findings
HYPERTELORISM 22
THANK YOU
Proffit, Contemporary Orthodontics
Kharbanda, Orthodontic Diagnosis