عرض مصدر Malocclusion

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{{Infobox medical condition
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 |ICD9           = {{ICD9|524.4}}
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A '''malocclusion''' is a misalignment or incorrect relation between the teeth of the two [[dental arch]]es when they approach each other as the [[jaw]]s close. The term was coined by [[Edward Angle]], the "father of modern orthodontics",<ref name="Mouth">Gruenbaum, Tamar. <u>Famous Figures in Dentistry</u> ''Mouth – JASDA'' 2010;30(1):18</ref> as a derivative of ''[[occlusion (dentistry)|occlusion]]'', which refers to the manner in which opposing teeth meet (''[[wikt:mal-|mal-]]'' + ''occlusion'' = "incorrect occlusion").

==Signs and symptoms==
Malocclusion is a common finding,<ref>{{cite journal |vauthors=Thilander B, Pena L, Infante C, Parada SS, de Mayorga C |title=Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development.|journal=Eur J Orthod.|volume=23 |issue=2 |pages=153–167 |year=2001 |pmid=11398553 |doi=10.1093/ejo/23.2.153 }}</ref><ref>{{cite journal |vauthors=Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F |title=Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children. |journal=Eur J Orthod.|volume=31 |issue=5 |pages=477–484 |year=2009 |pmid=19477970 |doi=10.1093/ejo/cjp031}}</ref> although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of [[Craniofacial Anomalies]], may require [[orthodontic]] and sometimes surgical treatment ([[orthognathic surgery]]) to correct the problem. Correction of malocclusion may reduce risk of tooth decay and help relieve excessive pressure on the [[temporomandibular joint]]. Orthodontic treatment is also used to align for aesthetic reasons.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face and may be coupled with [[mastication]] or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.

==Classification==
Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. ''crowding of teeth'', not directly fitting into this classification.

Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: ''Review of Angle's system of classes'').

===Angle's classification method===
[[File:Class1type2.jpg|thumb|200px|right|Class I with severe crowding and [[Commonly used terms of relationship and comparison in dentistry|labially]] erupted [[Canine tooth|canines]]]]
[[File:Class II.jpg|thumb|200px|right|Class II molar relationship]]
[[Edward Angle]], who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the [[maxillary first molar]].<ref>{{cite web |url=http://www.unc.edu/depts/appl_sci/ortho/introduction/angles.html |title=Angle's Classification of Malocclusion |accessdate=2007-10-31 |work=|archiveurl=https://web.archive.org/web/20080213164657/http://www.unc.edu/depts/appl_sci/ortho/introduction/angles.html|archivedate=2008-02-13}}</ref> According to Angle, the [[Commonly used terms of relationship and comparison in dentistry|mesiobuccal cusp]] of the upper first molar should align with the [[Commonly used terms of relationship and comparison in dentistry|buccal groove]] of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and  in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

*'''Class I: Neutrocclusion''' Here the molar relationship of the occlusion is normal or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
*'''Class II: Distocclusion''' ([[retrognathism]], '''overjet, overbite''') In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar.  Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
**'''Class II Division 1:''' The molar relationships are like that of Class II and the anterior teeth are protruded.
**'''Class II Division 2:''' The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
*'''Class III: Mesiocclusion''' ([[prognathism]], '''negative overjet, underbite''') In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

=== Review of Angle's system of classes and alternative systems ===
A major disadvantage of classifying malocclusions according to Angle's system is that it only takes into consideration the [[two-dimensional]] viewing along a spatial axis in the [[sagittal plane]] in the terminal occlusion, even though occlusion problems are, in principle, three-dimensional. Deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features are not recognised. Another shortcoming is the lack of a theoretical basis of this purely [[descriptive]] classification system. Among the much discussed weaknesses of the system is the fact that it only considers the static occlusion, that it does not take into account the development and causes ([[aetiology]]) of occlusion problems and it disregards the proportions (or relationships in general) of teeth and face.<ref>Sunil Kumar (Ed.): Orthodontics. New Delhi 2008, 624 p., ISBN 978-81-312-1054-3, p. 127</ref> Thus, numerous attempts have been made to modify the Angle system or to replace it completely with a more efficient one,<ref>Sunil Kumar (Ed.): Orthodontics. New Delhi 2008, p. 123. A list of 18 approaches to modify or replace Angle's system is given here with further references at the end of the book.</ref> but Angle's classification continues to prevail mainly because of its simplicity and clarity.

Well-known modifications to Angle's classification date back to [[Martin Dewey]] (1915) and [[Benno Lischer]] (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), [[Jacob A. Salzmann]] (1950, with a classification system based on skeletal structures) and [[James L. Ackerman]] and [[William R. Proffit]] (1969).<ref>Gurkeerat Singh: Textbook of Orthodontics, p. 163-170, with further references on p. 174.</ref>

==Crowding of teeth==
''Crowding of teeth'' is where there is insufficient room for the normal complement of adult teeth.

===Causes===
Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of malocclusion. A small underdeveloped jaw, caused by lack of masticatory stress during childhood, can cause tooth overcrowding.<ref name="evolution"/><ref name="orthodontics"/> Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are other causes. Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle have also been identified as causes.<ref name="nlm">{{cite web| url=http://www.nlm.nih.gov/medlineplus/ency/article/001058.htm | work=Medline Plus | title=Malocclusion of teeth | date=2010-02-22 | accessdate=2012-02-06 | first1=Jack | last1=Rosenberg}}</ref>

In an experiment on two groups of [[rock hyrax]]es fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter [[Body of mandible|mandibles]] than animals fed hard food.<ref name="evolution">{{cite journal|url=http://www.fas.harvard.edu/~skeleton/pdfs/2004b.pdf|format=PDF|title=Effects of food processing on masticatory strain and craniofacial growth in a retrognathic face|year=2004|last1=Lieberman|first1=Daniel E|last2=Krovitz|first2=GE|last3=Yates|first3=FW|last4=Devlin|first4=M|last5=St Claire|first5=M|issue=6|journal=Journal of Human Evolution|volume=46|pages=655–677|doi=10.1016/j.jhevol.2004.03.005|pmid=15183669}}</ref> Experiments have shown similar results in other animals, including primates, supporting the theory that masticatory stress during childhood affects jaw development. Only one small study has investigated this effect in humans. Children chewed a hard resinous gum for two hours a day and showed increased facial growth.<ref name="orthodontics">{{cite journal|title=A pilot study of the effect of masticatory muscle training on facial growth in long-face children|year=1987|last1=Ingervall|first1=Bengt|last2=Bitsanis|first2=E|journal=European Journal of Orthodontics|volume=9|issue=1|pages=15–23|pmid=3470182|doi=10.1093/ejo/9.1.15}}</ref>

A 2011 paper suggested that "the changes in human skulls are more likely driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."<ref>{{cite journal|doi=10.1073/pnas.1113050108|laysummary=http://www.bbc.co.uk/news/science-environment-15823276|title=Global human mandibular variation reflects differences in agricultural and hunter-gatherer subsistence strategies|year=2011|last1=Von Cramon-Taubadel|first1=N.|journal=Proceedings of the National Academy of Sciences|volume=108|issue=49|pages=19546–51|pmid=22106280|pmc=3241821}}</ref>

===Treatment===
Crowding of the teeth is treated with [[orthodontics]], often with [[tooth extraction]], [[Invisalign]], or [[dental braces]], followed by growth modification in children or jaw surgery ([[orthognathic surgery]]) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.<ref name="nlm" />

==Tooth size discrepancy==

To establish appropriate alignment and occlusion, the sizes of upper and lower front teeth, or upper and lower teeth in general, need to be proportional. Inter-arch tooth size discrepancy (TSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches, which can be seen in 17% to 30% of orthodontic patients.<ref>{{cite journal |vauthors=GRAUER D, HEYMANN GC, ((SWIFT EJ Jr)) |title=Clinical Management of Tooth Size Discrepancies.|journal=J Esthet Restor Dent. |year=2012 |volume = 24 | pages = 155–159|PMID=22691075 |doi=10.1111/j.1708-8240.2012.00520.x}}</ref><ref>{{cite journal |vauthors=Bugaighis I, Karanth D, Borzabadi-Farahani A |title=Tooth size discrepancy in a Libyan population, a cross-sectional study in schoolchildren.|journal=J Clin Exp Dent. |year=2015 |volume = 7 | pages = e100-105|PMID=25810819 |doi=10.4317/jced.51819}}</ref>

==Other conditions==

[[File:Treat open bite.jpg|thumb|Open bite treatment after eight months of braces]]

Other kinds of malocclusions can be due to tooth size or horizontal,vertical, or transverse skeletal discrepancies, including skeletal asymmetries. Long faces may lead to ''open bite'', while short faces can be coupled to a ''deep bite''. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking), and likewise for deep bites. Upper or lower jaw can be overgrown or undergrown, leading to Class II or Class III malocclusions that may need corrective jaw surgery or [[orthognathic surgery]] as a part of overall treatment, which can be seen in about 5% of the general population.<ref>{{cite book | last1 = Posnick | first1 = Jeffrey C. | title = [[Orthognatic Surgery: Principles and Practice]]| publisher = [[Elsevier]]| pages = 61–68| location = Amsterdam | date = September 2013| ISBN = 978-145572698-1 | doi=10.1016/B978-1-4557-2698-1.00003-4 }}</ref><ref>{{cite journal |vauthors=Harrington C, Gallagher JR, Borzabadi-Farahani A |title=A retrospective analysis of dentofacial deformities and orthognathic surgeries using the index of orthognathic functional treatment needs (IOFTN).|journal=Int J Pediatr Otorhinolaryngol.|date=April 2015 |PMID=25957779|doi=10.1016/j.ijporl.2015.04.027|volume=79|pages=1063–6}}</ref><ref>{{cite journal |vauthors=Borzabadi-Farahani A, Eslamipour F, Shahmoradi M |title=Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN)|journal=J Plast Reconstr Aesthet Surg.| date= 2016|PMID=27068664|volume=69|pages=796–801|doi=10.1016/j.bjps.2016.03.008}}</ref>

==Cause==
Oral habits and pressure on [[tooth|teeth]] or the [[maxilla]] and [[Human mandible|mandible]] are causes of malocclusion.<ref>{{cite journal | doi = 10.1016/0002-9416(52)90025-0 | last = Klein ET. | first1 = E | title = Pressure Habits, Etiological Factors in Malocclusion | journal = Am. J. Orthod. | volume = 38 | pages = 569–587 | year = 1952 | issue=8}}</ref><ref>{{cite journal | last = Graber TM. | title = The "Three m's": Muscles, Malformation and Malocclusion | journal = Am. J. Orthod. | volume = 49  | pages = 418–450 | year = 1963 | doi = 10.1016/0002-9416(63)90167-2 | first1 = T | issue = 6}}</ref>

In the active [[skeletal]] [[human development (biology)|growth]],<ref>{{cite journal | last = Björk A., Helm S. | first1 = A | last2 = Helm | first2 = S | title = Prediction of the Age of Maximum Puberal Growth in Body Height | journal = Angle Orthod. | volume = 37 | pages = 134–143 | year = 1967 | url = http://www.angle.org/doi/pdf/10.1043/0003-3219%281967%29037%3C0134%3APOTAOM%3E2.0.CO%3B2| format = PDF | issue=2 | pmid = 4290545 | doi = 10.1043/0003-3219(1967)037<0134:POTAOM>2.0.CO;2}}</ref> [[mouthbreathing]], [[finger]] sucking, [[thumb]] sucking, [[pacifier]] sucking, [[nail biting|onychophagia]] ([[Nail (anatomy)|nail]] biting), [[dermatophagia]], [[pen]] biting, [[pencil]] biting, abnormal [[Human position|posture]], [[deglutition]] disorders and other habits greatly influence the development of the [[face]] and [[dental arches]].<ref>{{cite journal | doi = 10.1177/00220345430220041201 | last = Brucker M. | first1 = M. | title = Studies on the Incidence and Cause of Dental Defects in Children: IV. Malocclusion | journal = J Dent Res | volume = 22 | pages = 315–321 | year = 1943 | url = http://jdr.sagepub.com/cgi/reprint/29/2/148.pdf | issue = 4}}</ref><ref>{{cite journal | doi = 10.1177/00220345600390030501 | last = Calisti L. J. P., Cohen M. M., Fales M. H. | title = Correlation between Malocclusion, Oral Habits, and Socio-economic Level of Preschool Children | journal = J. Dent Res | volume = 39 | pages = 450–454 | year = 1960 | url = http://jdr.sagepub.com/cgi/reprint/39/3/450.pdf | pmid = 13806967 | first1 = L. J. | last2 = Cohen | first2 = M. M | last3 = Fales | first3 = M. H | issue=3}}</ref><ref>{{cite journal |author1=Subtelny J. D. |author2=Subtelny J. D. | title = Oral Habits – Studies in Form, Function, and Therapy | journal = Angle Orthod. | volume = 43 | pages = 347–383 | year = 1973 | url = http://www.angle.org/pdfserv/i0003-3219-043-04-0347.pdf | format =  | issue=4}} {{dead link|date=May 2010}}</ref><ref>{{cite journal | last = Aznar T., Galán A. F., Marín I., Domínguez A. | first1 = T | last2 = Galán | first2 = AF | last3 = Marín | first3 = I | last4 = Domínguez | first4 = A | title = Dental Arch Diameters and Relationships to Oral Habits | journal = Angle Orthod. | volume = 76 | pages = 441–445 | year = 2006 | url = http://www.angle.org/pdfserv/i0003-3219-076-03-0441.pdf | format =  | issue=3 | pmid = 16637724 | doi = 10.1043/0003-3219(2006)076[0441:DADART]2.0.CO;2}} {{dead link|date=May 2010}}</ref><ref>{{cite journal | doi = 10.2209/tdcpublication.44.43 | last = Yamaguchi H., Sueishi K. | first1 = H | last2 = Sueishi | first2 = K | title = Malocclusion associated with abnormal posture | journal = Bull Tokyo Dent Coll. | volume = 44 | pages = 43–54 | year = 2003 | url = http://www.jstage.jst.go.jp/article/tdcpublication/44/2/43/_pdf | issue=2 | pmid = 12956088}}</ref>

[[Pacifier]] sucking habits are also correlated with [[otitis media]].<ref>{{cite journal | doi = 10.1542/peds.109.2.351 |author1= Wellington M. |author2=Hall C. B. | title = Pacifier as a risk factor for acute otitis media | journal = Pediatrics. | volume = 109 | pages = 351–352 | year = 2002 | url = http://pediatrics.aappublications.org/cgi/reprint/109/2/351 | issue = 2 |pmid=11826228}}</ref><ref>{{cite journal | doi = 10.1093/fampra/cmn030 |title = Is pacifier use a risk factor for acute otitis media? A dynamic cohort study | journal = Fam Pract | volume = 25 | pages = 233–6 | year = 2008 | url = http://fampra.oxfordjournals.org/cgi/reprint/25/4/233 | issue = 4 |author1=Rovers MM |author2=Numans ME |author3=Langenbach E |author4=Grobbee DE |author5=Verheij TJ |author6=Schilder AG |pmid=18562333}}</ref>

[[Dental caries]], [[periapical abscess|periapical inflammation]] and tooth loss in the [[deciduous teeth]] alter the correct permanent [[tooth eruption|teeth eruptions]].

==See also==
* [[Maximum intercuspation]]
* [[Occlusion (dentistry)]]
* [[Elastics (orthodontics)|Elastics]]

==References==
{{reflist|2}}

{{Orthodontology}}
{{Dentofacial anomalies and jaw disease}}

[[Category:Jaw disorders]]
[[Category:Teeth]]