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   <h1 style="margin:.2rem 0; font-size:2.2rem; line-height:1.2;">Malocclusion Rethought</h1>
   <h1 style="margin:.2rem 0; font-size:2.2rem; line-height:1.2;">Malocclusion Rethought</h1>
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     From “Malocclusion” to a broader paradigm: <b>Occlusal Dysmorphisms</b>.
     From “Malocclusion” to a broader paradigm: <b>Occlusal Dysmorphisms</b>.
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== Malocclusion Rethought ==
== Malocclusion Rethought ==
"Malocclusion" (from Latin <i>malum</i> = bad) traditionally labels an improper “closure” of teeth. Yet modern clinical science shows that function cannot be reduced to mechanics alone. Electrophysiological findings (e.g., symmetry in motor-evoked potentials, jaw-jerk, and silent period) often reveal balanced trigeminal dynamics even in the presence of occlusal discrepancies. 


This challenges the conventional label “malocclusion” and supports a broader concept: <b>Occlusal Dysmorphisms</b>. Within a complex-systems view of mastication, neuromuscular coherence can coexist with occlusal asymmetries, urging interdisciplinary diagnostics that integrate occlusion with neurophysiology to achieve stable outcomes and reduce relapses.
The term "Malocclusion," derived from the Latin ''malum'' ("bad"), was first introduced by Edward Angle to define an improper “closure” of teeth.<ref>Attributed to [[:wpen:Edward Angle|Edward Angle]], the father of modern orthodontics.</ref> Yet, the notion of "bad closure" remains ambiguous in medical contexts.


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A PubMed search for "Malocclusion" yields over 33,000 articles,<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=%22malocclusion%22 Malocclusion]''</ref> but without clear consensus on its definition. Smaglyuk et al. stress the importance of an interdisciplinary approach in diagnostics,<ref>{{cita libro
| autore = Smaglyuk LV
| autore2 = Voronkova HV
| autore3 = Karasiunok AY
| autore4 = Liakhovska AV
| autore5 = Solovei KO
| titolo = Interdisciplinary approach to diagnostics of malocclusions (review)
| url = https://www.ncbi.nlm.nih.gov/pubmed/31175796
| opera = Wiad Lek
| anno = 2019
}} 72(5 cz 1):918-922.</ref> yet a query for "interdisciplinary diagnostics of malocclusions" returns only four articles,<ref>Pubmed, ''[https://www.ncbi.nlm.nih.gov/pubmed/?term=interdisciplinary+diagnostics+of+malocclusions Interdisciplinary diagnostics of malocclusions]''</ref> underscoring a major gap in the literature. This suggests a paradigmatic shift may be underway, as described in Kuhn’s phase 4 model.
 
{{q2|Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should consider the organism as a whole, particularly in children whose structures are still developing.}}
 
A clinical case illustrates this complexity: a patient presented with a unilateral posterior crossbite and anterior open bite. Literature suggests orthodontic appliances and sometimes orthognathic surgery are indicated.<ref>{{cita libro
| autore = Reichert I
| autore2 = Figel P
| autore3 = Winchester L
| titolo = Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?
| url = https://www.ncbi.nlm.nih.gov/pubmed/23949448
| opera = Oral Maxillofac Surg
| anno = 2014
}} Sep;18(3):271-7.</ref> Crossbite correction is equally important due to its functional link with open bite.<ref>{{cita libro
| autore = Miamoto CB
| autore2 = Silva Marques L
| autore3 = Abreu LG
| autore4 = Paiva SM
| titolo = Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life
| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962250/pdf/2176-9451-dpjo-23-01-00071.pdf
| opera = Dental Press J Orthod
| anno = 2018
}} Jan-Feb; 23(1) 71–78.</ref> In this case, however, the patient refused treatment, claiming function was unaffected.
 
Electrophysiological testing revealed functional symmetry in the masticatory system despite occlusal discrepancies. Findings included:
<gallery mode="slideshow">
<gallery mode="slideshow">
File:Occlusal Centric view in open and cross bite patient.jpg|'''Fig. 1a:''' Open bite and crossbite case (occlusal view).
File:Occlusal Centric view in open and cross bite patient.jpg|'''Figure 1a:''' Malocclusion with open bite and right posterior crossbite.
File:Bilateral Electric Transcranial Stimulation.jpg|'''Fig. 1b:''' Bilateral MEP symmetry in masseter muscles.
File:Bilateral Electric Transcranial Stimulation.jpg|'''Figure 1b:''' Motor-evoked potential symmetry in masseter muscles.
File:Jaw Jerk .jpg|'''Fig. 1c:''' Jaw-jerk reflex indicating functional symmetry.
File:Jaw Jerk .jpg|'''Figure 1c:''' Jaw reflex test confirming functional balance.
File:Mechanic Silent Period.jpg|'''Fig. 1d:''' Mechanical silent period (balanced neuromuscular dynamics).
File:Mechanic Silent Period.jpg|'''Figure 1d:''' Mechanical silent period indicating neuromuscular coherence.
</gallery>
</gallery>


<h3>📑 References</h3>
These results challenge the reductionist view of malocclusion, showing that **neuromuscular balance may coexist with occlusal asymmetries**. Hence, diagnostic strategies must integrate occlusion with neurophysiology to avoid oversimplification.
* [https://pubmed.ncbi.nlm.nih.gov/31175796/ Interdisciplinary diagnostics of malocclusions — Smaglyuk et al., 2019]
 
* [https://pubmed.ncbi.nlm.nih.gov/23949448/ Anterior open bite review — Reichert et al., 2014]
<blockquote>''Occlusal Dysmorphisms, not simply Malocclusion — an entirely different paradigm.''</blockquote>
* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962250/ Early crossbite protocols — Miamoto et al., 2018]


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Latest revision as of 19:24, 19 September 2025


Malocclusion Rethought

From “Malocclusion” to a broader paradigm: Occlusal Dysmorphisms. 

 
   👉 Read the full chapter


Malocclusion Rethought

The term "Malocclusion," derived from the Latin malum ("bad"), was first introduced by Edward Angle to define an improper “closure” of teeth.[1] Yet, the notion of "bad closure" remains ambiguous in medical contexts.

A PubMed search for "Malocclusion" yields over 33,000 articles,[2] but without clear consensus on its definition. Smaglyuk et al. stress the importance of an interdisciplinary approach in diagnostics,[3] yet a query for "interdisciplinary diagnostics of malocclusions" returns only four articles,[4] underscoring a major gap in the literature. This suggests a paradigmatic shift may be underway, as described in Kuhn’s phase 4 model.

«Diagnosis, treatment strategies, and prevention of anomalies and dento-facial deformities should consider the organism as a whole, particularly in children whose structures are still developing.»

A clinical case illustrates this complexity: a patient presented with a unilateral posterior crossbite and anterior open bite. Literature suggests orthodontic appliances and sometimes orthognathic surgery are indicated.[5] Crossbite correction is equally important due to its functional link with open bite.[6] In this case, however, the patient refused treatment, claiming function was unaffected.

Electrophysiological testing revealed functional symmetry in the masticatory system despite occlusal discrepancies. Findings included:

  • Figure 1a: Malocclusion with open bite and right posterior crossbite.

  • Figure 1b: Motor-evoked potential symmetry in masseter muscles.

  • Figure 1c: Jaw reflex test confirming functional balance.

  • Figure 1d: Mechanical silent period indicating neuromuscular coherence.

These results challenge the reductionist view of malocclusion, showing that **neuromuscular balance may coexist with occlusal asymmetries**. Hence, diagnostic strategies must integrate occlusion with neurophysiology to avoid oversimplification.

Occlusal Dysmorphisms, not simply Malocclusion — an entirely different paradigm.

Bibliography & references
  1. ↑ Attributed to Edward Angle, the father of modern orthodontics.
  2. ↑ Pubmed, Malocclusion
  3. ↑ Smaglyuk LV, Voronkova HV, Karasiunok AY, Liakhovska AV, Solovei KO, «Interdisciplinary approach to diagnostics of malocclusions (review)», in Wiad Lek, 2019».  72(5 cz 1):918-922.
  4. ↑ Pubmed, Interdisciplinary diagnostics of malocclusions
  5. ↑ Reichert I, Figel P, Winchester L, «Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?», in Oral Maxillofac Surg, 2014».  Sep;18(3):271-7.
  6. ↑ Miamoto CB, Silva Marques L, Abreu LG, Paiva SM, «Impact of two early treatment protocols for anterior dental crossbite on children’s quality of life», in Dental Press J Orthod, 2018».  Jan-Feb; 23(1) 71–78.
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