Lina Hadi, drg., Sp. Ort.

, FISID
 What causes a
Researches have grouped the common
Malocclusion
etiologic factors associated with
???
malocclusions & presented various
classifications that help us in
understanding the etiology of a
malocclusion.
Specific Causes of Malocclusion:
- Distrubances in Embriologic Development
- Growth Distrubances in the Fetal and
Perinatal Period
- Progressive Deformities in Childhood
- Distrubances Arising in Adolescence or
Early Adult Life
- Disturbances of Dental Development
Etiology of Malocclusion
Classifications
General Factors
Local Factors
Etiology of Malocclusion – Classifications
White and Gardiner’s classification
• make a distinction between the skeletal & dental etiologic
factors, distinguish between pre- & post- eruptive causes.
Salzmann’s classification
• 3 stages in which malocclusions are likely to manifest:
1.Genotypic, 2.Fetal environment, 3.Postnatal environment
Moyer’s classification
• included: a) craniofacial skeleton, b) dentition, c) orofacial
musculature, & d) other ‘soft tissues’ of the masticatory system.
Graber’s classification
• divided the etiologic factors as general or local factors and
presented a very comprehensive classification.
Dental Base Abnormalities

Pre-Eruption Abnormalities

Post-Eruption Abnormalities
 1. Antero- 4. Disproportion of
2. Vertical 3. Lateral 5. Congenital
posterior size between teeth
malrelationship malrelationship abnormalities.
malrelationship and basal bone
 1. Abnormalities in position of
Pre-Eruption
Abnormalities
developing tooth germ
2. Missing teeth
3. Supernumerary teeth and teeth
abnormal in form
4. Prolonged retention of deciduous
teeth
5. Large labial frenum
6. Traumatic injury.
 • 1. Muscular
• Active muscle force
• Rest position of musculature
Post-Eruption • Sucking habits
Abnormalities • Abnormalities in path of closure
• 2. Premature loss of deciduous
teeth
• 3. Extraction of permanent teeth.
Back to
Classification
 Pre Post Environmental
Functional
Natal Natal or Acquired
 PreNatal
2. Differentiative— 3. Congenital—
malocclusions that are can be
1. Genetic— inborn, engrafted in the hereditary or
included body in the prefunctional acquired but
malocclusions embryonic developmental existing at
transmitted by stage. Can be subdivided birth. Can be
genes, where into: subdivided as:
the dentofacial
anomalies may • a. General—effect the • a. General or
or may not be body as a whole constitutional
in evidence at • b. Local—effect the face, • b. Local or
birth. jaws and teeth only. dentofacial.
 POST NATAL
Developmental
A. General
a. Birth injuries d. Endocrine disturbances which may modify
b. Abnormalities of relative rate of growth in the growth pattern and eventually affect
different body organs dentofacial growth
c. Hypo- or hypertonicity of muscles which e. Nutritional disturbances
may eventually affect the dentofacial f. Childhood diseases that affect the growth
development and function pattern
g. Radiation.
B. Local
a. Abnormalities of the dentofacial complex: b. Abnormalities of tooth development:
1. Birth injuries of the head, face and 1. Delayed or premature eruption of the
jaws deciduous or permanent teeth
2. Micro- or macrognathia 2. Delayed or premature shedding of
3. Micro- or macroglossia deciduous teeth
4. Abnormal frenal attachments 3. Ectopic Eruption
5. Facial hemiatrophy. 4. Impacted teeth
5. Aplasia of teeth
 Functional
A. General
1. Muscular hyper- or
hypotonicity
2. Endocrine disturbances
3. Neurotrophic
disturbances
4. Nutritional deficiencies
5. Postural defects
6. Respiratory disturbances
(mouth breathing).
B. Local
1. Malfunction of forces exerted by the
inclined planes of the cusps of the teeth
2. Loss of forces caused by failure of
proximal contact between teeth
3. Temporomandibular articulation
disturbances.
4. Masticatory and facial muscular hypo- or
hyperactivity
5. Faulty masticatory functions, especially
during the tooth eruption period
6. Trauma from occlusion
7. Compromised periodontal condition.
 Environmental or Acquired
A. General
• 1 Disease can affect the
dentofacial tissues directly or
by affecting other parts of the
body indirectly disturb the teeth
and jaws
• 2. Nutritional disturbances
especially during the tooth
formation stage
• 3. Acquired endocrine
disturbances that are not
present at birth
• 4. Metabolic disturbances
• 5. Trauma, accidental injuries
• 6. Radiation.
• 7. Tumors.
• 8. Surgical pathologies.
B. Local
• 1. Disturbed forces of occlusion
• 2. Early loss of deciduous teeth
• 3. Prolonged retention of
deciduous teeth
• 4. Delayed eruption of permanent
teeth
• 5. Loss of permanent teeth
• 6. Periodontal diseases
• 7. Temporomandibular articulation
disturbances
• 8. Infections of the oral cavity
• 9. Pressure habits
• 10. Traumatic injuries including
fractures of the jaw bones.
Back to
Classification
1. Heredity

2. Developmental defects of unknown

origin

3. Trauma:

• a. Prenatal trauma and birth injuries

• b. Postnatal trauma

4. Physical agents:

• a. Premature extraction of primary teeth

• b. Nature of food
5. Habits:
• a. Thumb sucking and finger sucking d. Posture
• b. Tongue thrusting e. Nail biting
• c. Lip sucking and lip biting f. Other habits

6. Diseases:
• a. Systemic diseases
• b. Endocrine disorders
• c. Local diseases:
• i Nasopharyngeal diseases
• ii Gingival and periodontal disease
• iii Tumors
• iv Caries:
• Premature loss of deciduous teeth
• Disturbances in sequence of eruption of permanent teeth
• Early loss of permanent teeth

7. Malnutrition. Back to
Classification
GENERAL FACTORS
• 1. Heredity
• 2. Congenital
• 3. Environment:
– Prenatal (trauma, maternal diet,
German measles, material
maternal metabolism, etc).
– Postnatal (birth injury, cerebral
palsy, TMJ injury)
• 4. Predisposing metabolic
climate and disease:
– a. Endocrine imbalance
– b. Metabolic disturbances
– c. Infectious diseases
(poliomyelitis, etc).
5. Dietary problems (nutritional
deficiency)
6. Abnormal pressure habits and
functional aberrations:
a. Abnormal sucking
b. Thumb and finger sucking
c. Tongue thrust and tongue sucking
d. Lip and nail biting
e. Abnormal swallowing habits
(improper deglutition)
f. Speech defects
g. Respiratory abnormalities
(mouth breathing, etc.)
h. Tonsils and adenoids
i. Psychogenetics and bruxism
7. Posture
8. Trauma and accidents.
LOCAL FACTORS • 4. Abnormal labial
• 1. Anomalies of frenum: mucosal barriers
number: • 5. Premature loss
– a. Supernumerary teeth • 6. Prolonged retention
– b. Missing teeth • 7. Delayed eruption of
(congenital absence or
loss due to accidents,
permanent teeth
caries, etc.). • 8. Abnormal eruptive path
• 2. Anomalies of • 9. Ankylosis
tooth size • 10. Dental caries
• 11. Improper dental
• 3. Anomalies of restorations. Back to
tooth shape Classification
 Etiology of
Malocclusion –
General Factors

Lina Hadi, drg., Sp. Ort., FISID

Etiology of Malocclusion –
General Factors
 Introduction
 Hereditary
 Congenital Factors
 Predisposing Metabolic Climate and Disease
 Dietary Problems (Nutritional Deficiency)
 Abnormal Pressure Habits and Functional
Aberrations
 Posture Back to

 Trauma and Accidents Etiology

General Factors - Introduction
• Graber divided the etiologic factors as
general or local factors and presented
a very comprehensive classification.
• This classification is one of the most
detailed and comprehensive.
• The section on malocclusion caused
due to trauma has been subdivided into
prenatal, at birth and postnatal.
Back to
General
Factor
General Factors - Hereditary
• Hereditary causes of malocclusion include
all factors that result in a malocclusion and
are inherited from the parents by the
offspring.
• These can be those influencing the
– Neuromuscular system
– Dentition
– Skeletal structures
– Soft tissues (other than the neuromusculature).
General Factors - Hereditary
• Neuromuscular system
– Include deformities in size, position, tonicity,
contractility, and in the neuromuscular
coordination pattern of facial, oral, and tongue
musculature.
– Certain malocclusions may be associated with
tongue size or lip length and tonicity.
– May be found to reoccur within a family over
generations
– May be inherited.
General Factors - Hereditary
• Dentition
– Size and Shape of the Teeth
– Number of Teeth
– Primary Position of Tooth Germ and the
Path of Eruption
– Shedding of Deciduous Teeth and
Sequence of Eruption
– Mineralization of teeth
 Dentition
Size and Shape of the Teeth

 Studies on twins have proved that the size and

relative shape of the teeth is inherited.
 Notice the similarities in size and shape of teeth
among twins:
 Dentition
Size and Shape of the Teeth

 Peg shaped lateral are the most commonly

seen and noticed abnormally shaped teeth
encountered clinically.
 Dentition
Number of Teeth
 The number of teeth is a partially inherited
characteristic, especially in cases with cleft
palate and cleidocranial dysostosis.
Hypodontia is more widely
seen as compared to
hyperdontia.
The most frequently missing
teeth  maxillary lateral
incisors (the third molars not
being considered).
 Dentition
Shedding of Deciduous Teeth and
Sequence of Eruption

The position of tooth germs and the

path of eruption are considered by some
researchers to be inherited.
Ectopic teeth have shown to occur
more frequently in some families
collaborating the theory that these
anomalies are genetically determined.
 Dentition
Primary Position of Tooth Germ and the
Path of Eruption

 These two parameters are not only

correlated but are the ones most
commonly mentioned by the parents
themselves.
 Dentition
Mineralization of Teeth

Inherited defects of the tooth structure differ

from exogenic-induced defects in mineralization as
they are present in both the deciduous dentition
as well as permanent dentition and are localized in
the enamel or the dentine.

Exogenic-induced enamel defect.

Generally seen as horizontal lines as
compared to inherited defects, which
are seen as vertical or irregularly
located defects
 Dentition
Mineralization of Teeth

These may result in malformed teeth and

contribute towards producing a malocclusion.

Indogenic-induced enamel defect.

Generally seen as horizontal lines as
compared to inherited defects, which
are seen as vertical or irregularly located
defects
 General Factors - Hereditary
Skeletal Structures
• The underlying basal bone & other associated
cranial bone structures are partially inherited.
• The class III skeletal pattern is most commonly
associated with familial tendencies.

Class III skeletal

pattern tendencies
as seen in a father
and his two children
 General Factors - Hereditary
Soft Tissues (Other than the Neuromusculature)
• Include the size and shape of the frenums especially
the maxillary labial frenum
• Microstomia and ankyloglossia is capable of causing
or at least contributing towards a malocclusion.

Abnormal
thickness of Ankyloglossia
the
maxillary
frenum Back to
General
Factor
General Factors - Congenital Factors

• Congenital defects • The most frequently

include those associated
malformations that malformations are:
are seen at the time – Micrognathism
of birth. – Oligodontia
• These are generally – Anodontia
maldevelopments of – Cleft Lip and Palate
the 1st and the 2nd
branchial arches.
 Congenital Factors

A. Bilateral cleft lip and palate in an infant. The separation

of the premaxilla from the remainder of the maxilla is
shown clearly.
B. Same child after lip repair.
Back to
General
Factor
 General Factors – Predisposing
Metabolic Climate and Disease
• Three separate conditions need
to be stressed upon:
– a. Endocrine imbalance
– b. Metabolic disturbances
– c. Infectious diseases.
Predisposing Metabolic Climate and
Disease - Endocrine imbalance
Disease Features
Predisposing Metabolic Climate and
Disease - Endocrine imbalance
Disease Features
Predisposing Metabolic Climate and
Disease - Endocrine imbalance
Disease Features
Predisposing Metabolic Climate and
Disease - Endocrine imbalance
Disease Features
Predisposing Metabolic Climate and
Disease - Endocrine imbalance
Disease Features

Back to
General
Factor
General Factors – Dietary Problems
Nutritional imbalances in the pregnant mother
have been associated with certain malformations
in the child as:
General Factors – Dietary Problems
• In a growing child nutritional imbalances can
further accentuate an existing problem or may by
themselves be capable of producing certain
malformations, which may lead to malocclusions.
• These include:
– Protein deficiency
– Vitamin A deficiency
– Vitamin B complex deficiency
– Vitamin C deficiency
– Vitamin D deficiency ( Rickets)
– Hypervitaminosis D
General Factors – Dietary Problems

Back to
General
Factor
 General Factors – Abnormal Pressure
Habits & Functional Aberrations
• These are possibly the – e. Abnormal swallowing
most frequently habits (improper
encountered causes of deglutition)
malocclusion. – f. Speech defects
• These include: – g. Respiratory
– a. Abnormal sucking abnormalities (mouth
– b. Thumb and finger breathing, etc.)
sucking – h. Tonsils and adenoids
– c. Tongue thrust and – i. Psychogenic habits
tongue sucking and bruxism.
– d. Lip and nail biting
General Factors – Abnormal Pressure
Habits & Functional Aberrations
Abnormal Pressure Habits & Functional Aberrations

Prevalence of anterior open

bite, thumbsucking, and
tongue thrust swallowing as
a function of age.
Open bite occurs much more
frequently in black than in
whites.
Note that the prevalence of
tungue thrust swallowing
and is also less than then
prevalence of thumb
sucking.
General Factors – Abnormal Pressure
Habits & Functional Aberrations

Patient with a
thumb sucking
habit

Patient with a
finger sucking
habit
General Factors – Abnormal Pressure
Habits & Functional Aberrations

Tongue thrust
habit because of
an abnormally
large tongue

Lip Lip
sucking biting
General Factors – Abnormal Pressure
Habits & Functional Aberrations
Typical features
of a mouth
breather.
Note the
gingival
inflammation in
the maxillary
anterior region

Patient suffering
from enlarged
adenoids
General Factors – Abnormal Pressure
Habits & Functional Aberrations
All other corrections tend to camouflage
the underlying skeletal component by
orthodontic movement of the dentition.

Pre-treatment and post-treatment

results of a case of tongue thrust
with dental compensation of a mild
skeletal deformity
 Abnormal Pressure Habits &
Functional Aberrations
• In contrast to forces from mastication, light
sustained pressures from lips, cheeks, and
tongue at rest are important determinants
of tooth position.
• The intermittent short-duration pressures
created when the tongue and lips contact
the teeth during swallowing or speaking
would have any significant impact on tooth
position.
Abnormal Pressure Habits & Functional Aberrations

As with masticatory
forces, the pressure
magnitudes would
be grat enough to
move a tooth, but
the duration is
inadequate.

Back to General Factor

General Factors – Posture

• Abnormal postural habits are said to

cause malocclusions. Though not
directly. They may be associated
with other abnormal pressure or
muscle imbalances increasing the
risk of malocclusion.

Back to
General
Factor
 General Factors –
Trauma and Accidents
• Trauma and accidents can be further
subdivided into three categories
depending upon the time at which the
trauma occurred, as:
o Prenatal trauma
o Trauma at the time of delivery
o Postnatal trauma
General Factors – Trauma and Accidents

Traumatized permanent tooth

Maxillary incisiors erupting

palatally due to trauma in the
region before the eruption of
permanent teeth
 General Factors – Trauma and Accidents

Ankylosed 21,
following an apicectomy

Distortion of the root (termed dilaceration) of this lateral incisor

resulted from trauma at an earlier age that displaced the crown
relative to forming root. This is a more severe dilaceration than
what is usually observed, but even in this child, the tooth
erupted-dilaceration does not prevent eruption.

Back to General Factor

 Etiology of
Malocclusion –
Local Factors

Lina Hadi, drg., Sp. Ort., FISID

Etiology of Malocclusion –
Local Factors
 Anomalies of number deciduous teeth
 Anomalies of tooth  Delayed eruption of
size permanent teeth
 Anomalies of tooth  Abnormal eruptive
shape path
 Abnormal labial  Ankylosis
frenum  Dental caries
 Premature loss of  Improper dental
deciduous teeth restorations
 Prolonged retention of
Local Factors –
Anomalies of Number
 The anomalies in the number
of teeth can be of two types
i. Increased number of teeth or
supernumerary teeth and,
ii. Less number of teeth or missing
teeth.
Anomalies of Number
Supernumerary Teeth
 vary remarkably in size, shape & location.
 Supernumerary teeth, which bear a close
resemblance to a particular group of teeth &
erupt close to the original sight of these teeth 
supplemental teeth.
 Most commonly  premolar / lateral incisor
region.
 Most commonly seen  “mesiodens”.
 Can be erupted or impacted, singular or in
parts.
 Usually conical in shape with a short root &
Anomalies of Number

Supernumerary Supplemental teeth in Supplemental tooth in

tooth seen in the mandibular pre- the maxillary lateral
the maxillary molar region incisor region
pre-molar
region
Anomalies of Number

An
impacted
inverted
maxillary
mesiodens
Erupted mesiodens

A mandibular
mesiodense
Anomalies of Number
Supernumerary teeth can cause
 Noneruption of adjacent teeth.
 Delay the eruption of adjacent teeth.
 Deflect the erupting adjacent teeth into
abnormal locations.
 Increase the arch perimeter (increasing
the over jet if in the maxillary arch or
decreasing the over jet if seen in the
mandibular arch.
 Crowding in the dental arch.
Anomalies of Number

Decreased space for

the eruption of the
An inverted mesiodens
lateral incisor causing a
preventing the eruption
delay in its eruption
of the left maxillary
central incisor Close-up of the region,
with the outline of the
mesiodens drawn in
blue colour

Supernumerary tooth on the maxillary

molar region has deflected the
second permanent molar
Anomalies of Number

Missing Teeth
 Themost commonly congenitally missing
teeth are the third molars, followed by the
maxillary lateral incisors

Missing maxillary laterals

Anomalies of Number

Congenitally Missing Teeth can

lead to:
a) Gaps between teeth
b) Aberrant swallowing patterns
c) Abnormal tilting/axial inclination
or location of adjacent teeth
d) Multiple missing teeth can cause
a multitude of problems.
Anomalies of Number

Tongue thrust habit developing due to

the congenital absence of the maxillary
Spacing between teeth due to lateral incisors
missing maxillary lateral incisors

Abnormal position of the

maxillary right central
incisor in contact with the
right canine due to the
absence of the right
lateral incisor
Anomalies of Number

Multitude of problems caused due to missing mandibular central incisors.

Retrognathic mandible, convex profile, anterior deep bite, maxillary
anterior crowding and end-on molar relationship
Local Factors –
Anomalies of Tooth Size
 Two anomalies of tooth size are of interest
to an orthodontist  microdontia &
macrodontia, involving one or more teeth.
 Associated with cases of pituitary dwarfism
The teeth are larger than normal  pituitary
gigantism.
 The most commonly seen form of localized
microdontia involves the maxillary lateral
incisors. The tooth is called a ‘peg lateral”.
The root may be shorter and more
cylindrical than normally seen.
Anomalies of Tooth Size

Relative generalized
Peg-shaped maxillary
microdontia.
lateral incisors
Here the jaws are too big for
normal sized teeth
Local Factors –
Anomalies of Tooth Shape
 Anomalies of tooth shape include:
 truefusion,
 gemination,
 concrescence,
 talon cusp, and
 ‘dens in dente’.

 Dilaceration is also an anomaly of the

toothshape in which there is a sharp bend or
curve in the root or crown  does not effect
orthodontic treatment planning but may
complicate the extraction of the affected
tooth.
Local Factors –
Abnormal of Labial Frenum
 Midline diastema may persist even after the “ugly
duckling stage” or close simultaneously depending
upon the amount of fibers crossing over interdentally.
 A midline diastema can exist due to various causes:
 Deciduous dentition
 Ugly duckling stage
 Racial predisposition, Negroids
 Microdontia
 Congenital absence of lateral incisors
 Supernumerary tooth in the midline
 Abnormal frenal attachment
 Abnormal pressure habits (digit sucking and tongue thrust
habit)
 Trauma
 Impacted tooth in the midline
Local Factors –
Premature Loss of Deciduous Teeth
 The premature loss of a deciduous tooth 
malocclusion.
 In case an anterior deciduous is lost prematurely,
there is a tendency for spacing to occur between
the erupted anterior teeth.
 If one of the posterior deciduous teeth is lost,
especially the deciduous second molars  the first
permanent molars erupt mesially.
 Compensatory extraction for anterior deciduous
tooth loss and space maintainer or the use of
space regainers is highly recommended in case of
the early loss of deciduous tooth.
Premature Loss of Deciduous Teeth

Midline shift towards the right

in mandibular arch after the Labially erupting maxillary
loss of the deciduous right canines
canine due to a lack of space in the
arch

Mesial tilting of the mandibular

1st permanent molars leading
to a decreased space for the
eruption of the 2nd premolars
Local Factors –
Prolonged Retention of Deciduous Teeth
 Whatever the reason for the prolonged retention of
deciduous teeth, have significant impact on the
dentition.
 Which ever deciduous tooth may be retained
beyond the usual eruption age of their permanent
successor, is capable of causing:
i. Buccal/labial or palatal/lingual deflection in its path of
eruption; or
ii. Impaction of the permanent tooth
 A palatal deflection in the maxillary arch might
lead to the permanent tooth erupting is a crossbite
, which might be difficult to treat at a later stage.
 Most commonly impacted tooth  maxillary C (M3
not taken into account).
Prolonged Retention of Deciduous Teeth

Labially erupting maxillary

Lingually erupting
canines, due to the
mandibular lateral incisors,
retained deciduous
due to over retained
canines
deciduous teeth

Left maxillary
central incisor
deflected
palatally into
cross-bite
Local Factors –
Delayed Eruption of Permanent Teeth
 As a result the tooth whose eruption has been
delayed might get displaced or impacted.
 The reasons for the delay in eruption is important
from a clinicians point of view to maintain and if
required to create space for its eruption.

Retained roots of the deciduous Ankylosed deciduous canines, which

2nd molar deflected the erupting did not expoliate on time, resulted in
2nd pre-molar buccally labially erupting permanent canines
Local Factors –
Abnormal Eruptive Path
 Generally each tooth travels on a distinct path since
its inception to the location at which it erupts.
 The tooth that most frequently erupts in an abnormal
location is the maximally canine.

Abnormal path of Abnormal path of Abnormal location of

eruption of the eruption of the the erupting maxillary
mandibular maxillary canines canine (arrow)
canines
Local Factors – Ankylosis
 Ankylosis is a condition which involves the
union of the root or part of a root directly to
the bone, i.e. without the intervening
periodontal membrane
 Ankylosis or partial ankylosis is encountered
relatively during the mixed dentition stage.
 Commonly associated with certain infection
endocrine disorders and congenital disorders.
 Generally be suspected in cases where there
is a past history of trauma, or a mobile tooth
has regained stability or apicoectomy has
been performed.
Local Factors – Dental Caries
Proximal caries are especially to
blame for the reduction in arch
length.
This might be brought about by
migration of adjacent teeth and/or
tilting of adjacent teeth into the
space available and/or supra-
eruption of the teeth in the opposing
arch.
Caries can also lead to the
Dental Caries

Mesial migration of the left

Right third molar tipped
posterior segment due to
into the extraction
the presence of a grossly
space of the second
decayed deciduous 1st
molar
molar
Local Factors –
Improper Dental Restorations
 Malocclusions can be caused due to improper
dental restorations.
 Under contoured proximal restoration  decrease
in the arch length especially in the deciduous
molars.
 Over contoured proximal restorations  bulge into
the space to be occupied by a succedaneous
tooth and result in a reduction of this space.
 Overhang or poor proximalcontacts  predispose
to periodontal breakdown around these teeth.
 Premature contacts on over contoured occlusal
restoration  functional shift of the mandible
during jaw closure.
 Under-contoured occlusal restorations  the
 ETIOLOGY OF CLASS I
MALOCCLUSSION
 The problems associated with Class I malocclusions are
primarily dental in nature, i.e. associated with the teeth or the
surrounding soft tissue.
 If protrusion or crowding is present, the aesthetics are
compromised.
 Such malocclusions are often also referred to the
orthodontists due to a lack of oral hygiene maintenance.
 Hence, periodontal complications are very frequently seen.
 ETIOLOGY OF CLASS I
MALOCCLUSSION

• Unless the malocclusion is a skeletal bimaxillary

protrusion, the profile is usually straight or slightly
convex.
• The lips may be competent or incompetent
depending upon the protrusion of the jaws/teeth.
• The teeth may show all kinds of individual
malpositions.
• Most common forms  bimaxillary proclination &
crowding.
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Though it may be difficult to know the precise
etiological factor for any given type of
malocclusion, the possible contributing factors
related to the presence of Class II malocclusion are:
• Prenatal Factors
• Natal Factors
• Postnatal Factors
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Prenatal Factors
• 1. Genetic and congenital : Studies done on parents
and children having the same type of malocclusion
indicate that the facial dimension are principally
determined by heredity through genes. Hence, the
dimensions of the basal bones which can contribute
to skeletal Class II malocclusion can be inherited.
• 2. Certain drugs when administered during
pregnancy have a potential of producing abnormal
development, leading to Class II malocclusions. Such
drugs which have teratogenic potential are called
teratogens.
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Prenatal Factors
• 3. Irradiation therapy during fetal life can also be a
causative factor for the Class II malocclusion.
• 4. Intrauterine fetal posture like hands placed across
the face also seems to influence the craniofacial
growth especially that of the mandible.
Natal Factors
• Improper forceps application during delivery can
lead to condylar damage/fracture thereby causing
internal hemorrhage into the joint area. The joint
area may later become ankylosed or fibrosed
leading to under development of mandible.
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Postnatal Factors
• 1. Sleeping habits (e.g. stomach way), can affect the
normal growth of the jaws. A retarded mandibular
growth as compared to the maxillary growth can
manifest as Class II malocclusion.
• 2. Traumatic injuries during play. Any injury to the
mandible with potential damage to the condylar
region has the potential to retard mandibular
growth.
• 3. Long term irradiation therapy has similar
potential and can affect normal growth of the jaws.
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Postnatal Factors
• 4. Certain infectious conditions like rheumatoid
arthritis, can also adversely influence the growth of
the mandible.
• 5. Other infectious conditions that predispose and
may alter the normal growth pattern include acute
tonsillitis, allergic rhinitis, nasal polyp.
• 6. Pernicious habits such as mouth breathing, digit
sucking or lower lip biting are capable of causing a
Class II malocclusion.
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Postnatal Factors

Intra-and
extra-oral
photographs
of a thumb
sucker
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Postnatal Factors
• 7. Anomalies of the dentition can contribute towards
establishing a Class II malocclusion. These include:
• a. Congenitally missing teeth; most commonly lateral
incisors can allow the upper molars to migrate mesially.

Class II
malocclusion
due to
congenitally
missing
maxillary lateral
incisors
 ETIOLOGY OF CLASS II
MALOCCLUSSION
Postnatal Factors
• 7. b. Malformed teeth like peg laterals have a reduced
mesiodistal dimension can also allow the buccal upper
segment to migrate mesially .
• c. Premature extraction in the upper buccal segment can
produce a similar effect.
• d. Over retention of lower deciduous teeth, ectopic
eruption, supernumerary teeth can also produce a Class II
malocclusion.
• 8. In Class II Division 2 condition mandible is completely
imprisoned due to retrocline upper incisors and thereby
preventing the further mandibular growth (lid effect).
 ETIOLOGY OF CLASS III
MALOCCLUSSION

Heredity is considered to be the main etiologic

factor in a Class III skeletal dysplasia.

 Functional factors and soft tissue can also have

some influence on malocclusion pattern.
 ETIOLOGY OF CLASS III
MALOCCLUSSION
• A flat, low, anteriorly positioned tongue, which lies
low in the oral cavity, is to be a local epigenetic
factor in Class III malocclusion.
• A unilateral or bilateral hyperplasia of mandibular
condyle can cause the Class III malocclusion.
• Occlusal forces created by the abnormal eruption
may produce unfavorable incisal guidance and
promote a Class III relationship.
• This may present initially as a pseudo Class III but if
unattended can lead to a true skeletal Class III
dysplasia.
 ETIOLOGY OF CLASS III
MALOCCLUSSION

• Premature loss of deciduous molars may also

cause mandibular displacement with an
occlusal guidance from teeth that are not in
proper occlusion or favor a Class III
malocclusion.
• A vertical as well as anteroposterior
deficiency of the maxilla can occur in cases of
cleft lip and palate with a normal mandible.
• The same is true in cases of trauma to the
mid-face during the growth Phase.
 ETIOLOGY OF CLASS III
MALOCCLUSSION

Underdeveloped maxilla in a case of Class III features in a patient who

cleft lip and palate causing a Class III suffered trauma to the mid-face at the
malocclusion age of 9 years