Malocclusion Rethought — Occlusal Dysmorphisms
Malocclusion Rethought
From “Malocclusion” to a broader paradigm: Occlusal Dysmorphisms.
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.
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.
- ↑ Attributed to Edward Angle, the father of modern orthodontics.
- ↑ Pubmed, Malocclusion
- ↑ 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.
- ↑ Pubmed, Interdisciplinary diagnostics of malocclusions
- ↑ 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.
- ↑ 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.