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Review

Factors influencing different types of malocclusion and arch form –

A review
M.A. Saghiri a,b,*, J. Eid c, C.K. Tang d, P. Freag c
a
Biomaterial and Prosthodontic Laboratory & Department of Restorative Dentistry, Rutgers School of Dental Medicine, NJ, USA
b
Department of Endodontics, University of the Pacific, Arthur-A.-Dugoni School of Dentistry, San Francisco, California, USA
c
Independent Researcher, Newark, NJ, USA
d
Biomaterial and Prosthodontic Laboratory, Department of Restorative Dentistry, Rutgers School of Dental Medicine, NJ, USA

A R T I C L E I N F O A B S T R A C T

Article history: Aim: This review intends to highlight malocclusion as a multifactorial issue and review the different
Received 24 June 2020 factors that influence different types of malocclusion and arch form.
Accepted 6 July 2020 Methods: An online article search was performed on the factors influencing malocclusion and arch form
from January 1990 through April 2020. The search was performed within the Google, Rutgers library,
Keywords: PubMed, MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH
Arch form headings for the English language published articles January 1990 through April 2020, which evaluated
Arch length
different factors that influence malocclusion and arch form.
Arch width
Malocclusion
Results: Of the 300 articles found in initial search results, 31 articles met the inclusion criteria set for this
Genetic and malocclusion factors review. These 31 studies were directly related to the factors that impact malocclusion and different arch
Behavioural factors malocclusion forms.
Conclusion: Genetic inheritance, genetic mutations, age, gender, ethnicity, dental anomalies like
macrodontia, congenital diseases, muscular diseases, hormone imbalance, and human behaviour are all
factors that influence malocclusion and arch forms. The elements within the individual’s control like
behaviours can aid in preventing malocclusion. However, it seems as if the underlying reason for most of
these factors indicates that malocclusion is a by-product of genetics and pathology.
Published by Elsevier Masson SAS.

1. Introduction arch width, therefore affecting arch form. The anterior–posterior

discrepancy is what is known as class II and III malocclusion.
Following dental caries and periodontal diseases, malocclusion is Normal occlusion, class I, is when the mesiobuccal cusp of the
the third most prevalent oral health defect, according to the World maxillary first molar is aligned with the buccal groove of the
Health Organisation [1]. Occlusion is defined as the interaction mandibular first molar. According to Andrew’s classification of the
between the upper (maxillary) and lower (mandibular) teeth as they malocclusion, the criteria for class I also requires that the distal
make contact. There are a few types of malocclusion discrepancies: marginal ridge of the maxillary first molar occludes with the mesial
Vertical, transverse, and anterior-posterior discrepancy, which can marginal ridge of the lower second molar [2]. However, there are
all influence arch form [2]. The vertical discrepancy can be presented many classes of malocclusion: Class II and III. Class II malocclusion
as a deep bite, which is a decrease in the vertical dimension of the is divided into two divisions: division I and II. Division I and
face. The vertical discrepancy can also be presented as an open bite, Division II are associated with overjet and overbite, respectively
increasing the vertical dimension between the maxilla and [2]. Malocclusion is essential to classify because of the treatment
mandibular arch. The transverse discrepancy is described as a plan of the patient; malocclusion becomes relevant in aspects such
crossbite, which is a decrease in intermolar width or classified as as function, aesthetics, and oral hygiene technique. Arch form is
‘‘scissor bite’’. The transverse discrepancy is most associated with also a factor of importance in such aspects that it is the shape of the
individual dental arch. These arches include shapes such as ovoid,
square, and tapering, as shown in Fig. 1. Different arch form can
also affect the facial E line, which is correlated with different arch
* Corresponding author at: Rutgers Biomedical and Health Sciences, MSB C639A,
185, South-Orange avenue, 07103 Newark, NJ, USA.
forms and get convex, concave or straight facial profile. Although
E-mail address: [email protected] (M.A. Saghiri). Omar et al. [3] suggested, there are findings that there are more

https://doi.org/10.1016/j.jormas.2020.07.002
2468-7855/Published by Elsevier Masson SAS.

Please cite this article in press as: Saghiri MA, et al. Factors influencing different types of malocclusion and arch form – A review. J
Stomatol Oral Maxillofac Surg (2020), https://doi.org/10.1016/j.jormas.2020.07.002
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Fig. 1. Lower jawbone manipulation between frontal and occipital bone that create different arch forms. Arch form shapes: Tapered, square, ovoid (left to right); E line facial
profiles: Convex, straight, concave (Left to right).

arch form classifications such as narrow ovoid and narrow tapering addition, the study identifies the factors that directly lead to the
[3]. As well as shapes, the arch form can be different sizes as well development of malocclusion.
measured in determining arch length and width. Thus, when the
arch length is decreased, the arch width is increased, as seen in a 2.2. Inclusion and exclusion criteria
square arch. Correlations between class II malocclusion and arch
shape has been found [3]. This indication indicates that there is a The inclusion criteria were studies accepted and published in
correlation in malocclusion and arch form and will be evaluated the English language from January 1990 through April 2020. The
collectively. inclusion criteria included the scientific in-vivo, in-vitro articles,
The USA National Health and Nutrition Examination (1988– reviews, systematic reviews, case reports, and clinical trials with
1991) showed that about 57% of the 7000 individuals that were controlled study design. The exclusion criteria were studies that
examined needed orthodontic treatment because of malocclusion or were published before 1990. Criteria also excluded the studies that
irregular arch shape. It was stated that the abnormality was critical did not mention malocclusion, occlusion, arch, or arch form.
in about 15% that both social aesthetics and function were greatly
affected. These individuals required major arch expansion or teeth 2.3. Search methodology
extractions to correct occlusion [4]. Individuals can be affected by
many from their aesthetics to the mastication function. Due to the An electronic search was performed in Google, PubMed and
high prevalence of malocclusion, it is crucial for medical and dental MEDLINE databases via OVID using the keywords mentioned in the
professionals to know the factors that influence malocclusion and PubMed and MeSH headings for the English language published
the different arch forms for diagnosis and treatment. Malocclusion is articles January 1990 through April 2020 that evaluate the
a multifactorial problem and is not caused by a single entity and contributing factors that affect. The electronic searching keywords
should be considered a condition that many factors influence. This in PubMed and MEDLINE databases included: arch form, arch
review aims to provide an overview of many factors that influence width, malocclusion, genetic and malocclusion factors, factors and
the arch form and occlusion of patient’s dentition, including genetic malocclusion, behavioural factors malocclusion, arch length, class I
inheritance, genetic mutations, age, gender, ethnicity, dental malocclusion, class II malocclusion, class III malocclusion.
anomalies like macrodontia, congenital diseases, muscular diseases,
hormone imbalance, and behaviour.
3. Results

2. Materials and methods Of the 300 articles found in initial search results, only 31 articles
met the inclusion criteria set for this review. These 31 studies were
2.1. The review’s purpose directly related in influencing malocclusion and arch form. The
relevant full-text articles and the reference lists of the related
The purpose of this study is to investigate the contributing articles were evaluated to supplement the search, as seen in
factors that affect the arch width, length, and perimeter. In Table 1. The assessment of the eligibility and finding of related data

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Table 1
Detailed list of factors related to malocclusion.

Factors related to malocclusion and different arch form

References Conclusion

Gender [5,6] Men was found to have a greater arch width than women [5]
Women have a greater vertical distance and palatal length [5]
Males have more square and ovoid shape arch forms [6]
Females more prevalent in tapered and ovoid arch shape [6]
Ethnicity [1] Caucasians were most prevalent of class II malocclusion
African Americans showed the highest prevalence of Class I and open bite malocclusions
Asians were the most prevalent for class III malocclusion
Dental anomalies Microdontia [7] Ectopia, microdontia, impaction, and hypodontia were more prevalent in patients with class I
malocclusion
Macrodontia [7] Class II division 1 showed association with macrodontia [7]
Impaction [7] Impaction and ectopia were associated with class III malocclusion in Brazilian orthodontic
patients [7]
Maxillary canine impaction linked to the decreasing of the arch width [16]
Hypodontia [2,7] Missing teeth for any reason cause the collapse and constriction of the arch width [2]
Ectopia, microdontia, impaction, and hypodontia were more prevalent in patients with class I
malocclusion [7]
Ectopia [7] Impaction and ectopia were associated with class III malocclusion [7]
Genetic inheritance [8–10] Arch width seems to be more environmentally influenced rather than genetically inherited [8]
Class malocclusion seems to be more genetically inherited [8]
Class III malocclusion is influenced clearly by genetic inheritance [9]
Class II Division II is also very genetically influenced [10]
A vertical growth pattern is more genetically influenced than a horizontal growth pattern [10]
Genetic mutation [2,11–17] A mutation in the Six1/EYA1 transcription complex results in velo-cardio-facial syndrome which
causes small jaw, small arch, cleft palate phenotypes, and the dysmorphogenetic of the midface [11]
A mutation in apoptotic genes BCL-x/MCL-I cranial facial anomalies such as malocclusion [12]
PAX-9 transcription factors influenced all the following changes which in turn influences
malocclusion and arch form:
have been linked to maxillary canine impaction [15]
maxillary canine impaction linked to the decreasing of the arch width [16]
shown to reduce size of teeth [14]
shown to cause missing teeth [13]
PTH1R gene mutation causes hypodontia (missing teeth) [17]. Missing teeth for any reason cause
the collapse and constriction of the arch width [2]
Pathology Juvenile Rheumatoid The arthritis can affect the temporomandibular joints, which in turn can result in a severe class II
Arthritis [10,18] malocclusion; in addition, can also cause the growth restriction of
the mandible [10]
The morphology in children with JRA exhibit a decelerated mandibular development and a
backward-rotating growth indicating an open bite [18]
Excessive growth Gigantism is paired with oral discrepancies such as an overgrowth of the mandible, maxillary
hormone [10,19] widening and tooth separation [19]
Patients with gigantism present with more prominent class III malocclusion [10]
Down syndrome [22] Maxillary and mandibular development such as underdevelopment of the maxillary arch with an
overall reduction of the cranium [22]
Delayed teeth eruption is exhibited resulting in multiple teeth impaction which consequence in
further collapse of the developing arches [22]
Rickets [23] Diseased individuals had a significant reduction in all transverse dimensions of the arches [23]
Cleft lip/palate [24] Can cause the anteroposterior dimension and vertical dimension of the jaw and can cause a class III
presentation and possible posterior crossbite [24]
Childhood fractures [10] If the fracture is bilateral, children can present with an open bite [10]
Healing is contingent on how young the child fractured the jaw [10]
Masseter muscle [25–28] Long faces are associated with decreased masseter muscle thickness, increased vertical growth,
thickness anterior open bite, and increased SN-MP angle
Short faces are associated with increased masseter muscle thickness, decreased vertical growth,
increased transverse growth, and a decreased SN-MP angle
Muscle pathology [10] Muscle dystrophy and myopathies are factors that contribute to arch form and occlusion
abnormalities. A loss of muscle can result in a mandibular downward and backward rotation [10].
This in turn can cause an anterior open bite and retrognathia
Behavioural factors Tongue thrusting [30]
Mouth breathing [30]
Asthmatic behaviours [32]
Thumb sucking [10]
Aging [33] There is a decrease in the upper and lower arch width, depth, and perimeter, especially in the
mandibular incisor area with an increase of age [33]

were performed by two reviewers independently. Table 1 shows sequence produces an abnormal facial profile was found in mice
that the most relevant article’s full texts and reference lists that specimens. Bcl-2 proteins and transcription factors were found to
were evaluated for eligibility to indicate malocclusion is an effect cause a significantly high amount of type II and III malocclusion.
of these factors. When examining pathologies, jaw bone damage, or joint defor-
In further analysis, genetics and pathological factors were found mation were found profoundly affecting malocclusion. Down
highly influential to a malocclusion. A mutation in a specific gene syndrome and rheumatoid arthritis have shown deformation to

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the bone and joint at the mandible and maxillary arch that further to be more prevalent in class II division I patients [7]. Ectopia is
cause different types of malocclusions. defined as the malposition of the teeth. Impacted teeth and ectopic
teeth are most prevalent with class III malocclusion, according to
4. Discussion Pedreira et al. [7]. Finally, other anomalies like microdontia and
hypodontia were highly prevalent in class I patients [7].
4.1. Gender
4.4. Genetics
The arch form can vary based on gender, as shown in Fig. 2. Arch
width and length can be measured to study further the difference 4.4.1. Inheritance of malocclusion
in shape and size of the arch. Al-Zubair et al. [5] have shown that Inherited malocclusion can be from the disproportion between
the maxillary arch width was greater in Yemeni men than in the size of the jaw and the size of teeth, or it can be from the
women. It was also found that the vertical distance and palatal disproportion between size and shape of the upper and lower jaw
length were greater in Yemeni women than in men [5]. Khatri et al. [2]. It is found that dental discrepancies can be inherited and can be
[6] reported that males have a more ovoid and square shape arch; influenced by the environment. Studies of siblings were done and
however, females are more prevalent in tapered and ovoid arch suggested that arch size and shape may be influenced more by the
shapes. Overall, it was found that in overall cause load, one should environment, whereas class malocclusion can be genetically
expect about 50% of ovoid arch forms, 27% of tapered arch form, inherited [8]. Class III malocclusion is closely related to genetic
and about 23% of square arch forms [6]. inheritance. Watanabe et al. [9] suggested a high genetic
There is an association between gender and specific arch forms, predisposition for class III malocclusion [9]. Class III can also be
indicating that it is one of the determining factors of arch forms. defined as mandibular prognathia, and it is highly influenced by
genetics. Class II division II is typified by an anterior growth
4.2. Ethnicity rotation with a high genetic tendency. A vertical growth pattern
has a high degree of genetic control as compared to a horizontal
A systemic review was done globally of 2977 retrieved studies growth pattern [10].
on the relationship of ethnicity malocclusion [1]. Class II division I
is the most prevalent that was seen. A positive correlation was 4.4.2. Mutation of specific genes
found between class II and overjet. The study compared three 4.4.2.1. Six1/EYA1. Developmental defects and specific mutations
major ethnicities of Caucasian, African American, and Asian. in pathways can influence craniofacial characteristics and abnor-
Caucasian was most prevalent in class II malocclusion. African malities. A genetic pathway involving the Six1/EYA1 transcription
American individuals showed the highest prevalence of class I and complex regulates cardiovascular but also craniofacial develop-
open bite malocclusions. Asian individuals were the most ment [11]. Guo et al. [11] found that a microdeletion of the
prevalent for class III malocclusion [1]. chromosome in which this transcription complex is located would
result in a syndrome called: Velo-Cardio-Facial Syndrome (VCFS).
4.3. Dental anomalies: Microdontia, macrodontia, hypodontia, Six1/Eya1 mutants of this transcription complex led patients to
impaction, and ectopia have micrognathia (small jaw, small arch), cleft palate phenotypes,
and the midface dysmorphogenesis. These traits indicate that the
There are associations between malocclusion and smaller sized mutation of these transcription factors can influence the arch form
teeth, larger teeth, missing teeth, impacted teeth, and abnormally and jaw formation.
located teeth. According to a Brazilian study by Pedreira et al. [7], a
few associations were described, and correlations concluded 4.4.2.2. BCL-x/MCL-I. In addition, Grabow et al. [12] report that
[7]. Macrodontia, which means gigantism of the teeth, was shown BCL-2 proteins, BCL-X, and MCL-I, which are anti-apoptotic genes,

Fig. 2. Female and male comparison of arch forms according to studies: [5,6].

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can influence craniofacial anomalies [12]. It was found that mice syndrome’s effects on craniofacial features in children by assessing
with a heterogeneity knock out of BCL-X () and MCL-I () induced the lateral cephalometric measurements to cross compare
malocclusion [12]. jawbone radiographs to perform a detail analysis. In their result,
27 of the 130 participants with Down syndrome present with class
4.4.2.3. PAX-9: missing teeth/crowding/smaller teeth. PAX-9 is a III malocclusion skeletal pattern and show a long, lower anterior
transcription factor required for tooth morphogenesis [13]. A facial height [21].
mutation within the PAX-9 gene can change the shape and size of DS patients exhibit a shorter and flatter cranial base, a reduction
the teeth, which can attribute to changing the arch and occlusion of in the frontal sinus, a flatter nasal bone [22]. DS patients present
the individual. The effect of macrodontia or microdontia can affect commonly with mouth breathing resulting in further malforma-
the arch parameters causing crowding or spacing, respectively. tion in the dental arches due to the development of macroglossia,
PAX-9 mutation has been seen to reduce the size of teeth which is an abnormal increase in the size of the tongue. These
[14]. Vitria et al. [15] did a study indicated that single nucleotide symptoms occurred in a decreased maxillary arch length and high
polymorphisms of the gene PAX-9 had been linked to maxillary palatal vault. Also, there is a delayed teeth eruption, which may
canine impaction. According to Vitria et al. [15], 4 SNPs were result in multiple teeth impaction and further collapse of the
identified with a group that has maxillary canine impactions, the developing arches [22].
essential polymorphisms being SNP 3, and SNP 4 of the PAX-9 gene
[15]. There is an association between impacted maxillary canines 4.5.4. Rickets
and maxillary transverse discrepancy, which affects the person’s A deficiency in vitamin D in children can cause rickets, which is
arch width. Ghaffar et al. [16] found that impacted maxillary osteomalacia in adults. Osteomalacia resulted in a reduction in the
canines decrease the individual’s arch width [16]. These individu- overall dimensions of the maxillary and mandibular arch. A study
als would have a more tapered arch form, and therefore, there is a by Al-Jundi et al. [23] compared healthy controls to those that who
link between the polymorphism of PAX-9 and arch form. A have rickets. When analysing arch forms from diseased individua-
mutation on chromosome 14 of the PAX-9 gene was found to cause ls, there was a significant reduction in all transverse dimensions of
tooth agenesis [13]. the arches [23]. The results were overall smaller in arch depth and
arch length in diseased individuals.
4.4.2.4. PTH1R: Missing teeth. A mutation in the PTH1R gene is
correlated with hypodontia. In a study by Aziz et al. [17] has shown 4.5.5. Cleft lip/Palate (CLP)
that a mutation of PTH1R has a role in the primary failure of The cleft lip and palate is a syndrome associated with genetic
eruption (PFE) of teeth [17]. Tooth loss, for any reason, or decrease and environmental factors. Teratogenic agents are known to be one
in tooth number affects arch and malocclusion. The decrease in of the causes, for example, drugs, alcohol, radiation, phenytoin, and
tooth number can cause a collapse and restriction in the dental thalidomide. It can induce a form of tooth agenesis or hypodontia
arch. Therefore, in cases classified with hypodontia, primary failure [10]. CLP can range from a simple notching of the lip’s soft tissue, or
of eruption, or tooth extraction can cause constriction in the arch it may involve the hard tissue (hard palate) and soft palate [10]. It
width [2]. can be unilateral or bilateral. The surgical treatment of the cleft
palate and lip may result in a decrease in dental arch development.
4.5. Pathology As the soft tissue undergoes fibrosis, it restrains the bone’s growth,
resulting in a decrease in the anteroposterior dimension and
4.5.1. Juvenile rheumatoid arthritis vertical dimension of the jaw that can cause a class III presentation
Juvenile rheumatoid arthritis (JRA) is a type of arthritis that [24]. CLP can also result in a decrease in the transverse dimension,
causes joint inflammation in children sixteen and younger. There which, in turn, causes a posterior crossbite [24].
are malocclusion discrepancies that are caused by JRA. Arthritis
can affect the temporomandibular joints, which can result in a 4.5.6. Childhood fractures of the jaw
severe class II malocclusion; besides, it can also cause restricted A fracture in the condyle of the jaw is the most common site of a
growth of the mandible [10]. The morphology in children with mandible fracture for a child. Children can present with an open
juvenile rheumatoid arthritis reflects a decelerated mandibular bite if the fracture is bilateral due to a decrease in the height of the
development and a backward-rotating growth indicating an open ramus [10]. Besides, the younger the child has fractures on the
bite [18]. Therefore, JRA can cause vertical discrepancies. condyle, the better the outcome from the condyle’s reparative
capability.
4.5.2. Excessive growth hormone
There is a correlation between excessive growth hormone 4.6. Masseter muscle thickness/SN-MP correlation
production and class III malocclusion [10]. In gigantism, there is an
overproduction of growth hormone from an anterior pituitary The masseter is the muscle that is mainly involved in chewing.
tumour. Excessive growth hormone causes gigantism in children It projects from the zygomatic arch and is responsible for the
and acromegaly in adults [10]. This condition is typified with oral elevation and protraction of the mandible. This muscle’s thickness
discrepancies, such as an overgrowth of the mandible, maxillary can be correlated with facial morphology, malocclusion, and arch
widening, and tooth separation [19]. Patients with gigantism form. A study by Rohila et al. [25] indicates that subjects with thick
presented with more prominent class III malocclusion from the muscles have broader faces and wider arches. A positive
result [10]. correlation was made between masseter muscle thickness and
craniofacial width [25]. Developmentally, when there is an
4.5.3. Down syndrome increased load on the jaw, the anatomy of the mouth tries to
Trisomy of chromosome 21 causes Down syndrome (DS) compensate, resulting in increased transversal growth of the
[20]. Patients diagnosed with Down syndrome exhibit issues with maxilla and broader bone bases for the dental arches [25]. Prasad
maxillary and mandibular development, such as underdevelop- et al. [26] performed a study with South Indian adult males and
ment of the maxillary arch with an overall reduction of the females and concluded that the dental arch width is associated
cranium [21]. Allareddy et al. [21] conducted a study on Down with gender, race, and vertical facial morphology, which include

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Fig. 3. Behavioural factors for malocclusions.

masticatory musculature [26]. The vertical facial form is essential tongue to make a seal with the lips during swallowing, increasing
for orthodontic assessment because it relates to vertical facial the open bite and further increasing the backward mandibular
height and dental arch width. The Sella-Nasion-Mandibular plane rotation. The open mandible position gives the chance of making
angle (SN-MP) correlates with a face being long or short. The the musculature of the jaw became weaker, thus resulting in a
shorter face profile is correlated with a reduced SN-MP angle, backward rotation increasing the vertical dimension of the face,
reduced vertical growth, and deep overbite [26]. Respectively, long and development of anterior open bite and lip incompetence [30].
faces have increased vertical growth, anterior open bite, and
increased SN-MP. 4.8.2. Sucking habits/thumb sucking
The conclusion of this study reported that as arch widths were Non-nutritive sucking habits like thumb sucks or toy sucking in
calculated, the arch width decreases as the SN-MP increases young children can influence developing arches and occlusion. If
[26]. Longer faces would have a smaller arch width. In supporting continued beyond the second year of life, there are effects of the
this, class II patients were studied, and Grippaudo et al. [27] ongoing habit, and effects get worse with an increased duration of
concluded that as SN-MP angles increased, the inter-canine width the habit. Effects seen are increased maxillary arch length, open
tended to be narrower [27]. The musculature is an essential bite, class II buccal segments, increased overjet, and posterior
correlation to arch width and jaw formation, and therefore can be crossbite [10]. Nutritive sucking habits, such as breastfeeding of
concluded that pathology in muscle can form irregularities in children with a long duration, are strongly associated with a
occlusion and jaw formation. Ardani et al. [28] found that there is a posterior crossbite [31].
correlation between class II malocclusion and vertical components,
indicating that a high SN-MP is most likely found in individuals 4.8.3. Asthmatic behaviours
with class II division 1 malocclusion [28]. Kumar et al. [32] studied asthmatic children using an inhaler
and concluded that the arch length and palatal depth of the
4.7. Muscle pathology asthmatic group were larger than those of non-asthmatic groups. It
was indicated that constant behavioural habits like inhaling
Different congenital diseases like myopathy can form irregular corticosteroids by mouth could cause different morphological
arch forms, malocclusion, and open bites. In diseases such as features of the jaw and arch. The results attained indicated that the
muscular dystrophy and some instances of cerebral palsy, there is a asthmatic group had a longer arch length and palatal depth [32].
deficiency in muscle tone. A loss of muscle can result in a
mandibular downward and backward rotation [10]. This, in turn, 4.8.4. Diet
can cause an anterior open bite and retrognathia. Becker et al. [29] There is an increase in the consumption of soft food and is
witnessed and preformed orthodontic treatment on patients with thought to be a possible cause of malocclusion or crowding
congenital myopathy. He observed that ‘‘the myopathy produces [10]. Strong mastication is known to stimulate the growth of the
and long and narrow face with an obtuse-angled mandible, open facial bones, especially in the transverse direction, widening the
bite and gross lip incompetence’’ [29]. maxilla arch and mandible arch. With hard chewing, there is an
increase in interproximal wear, which lessens the crowding of the
4.8. Behavioural teeth. Therefore, a soft diet may be the cause of a narrow arch along
with the crowding of the dentition [10].
Certain behaviours can influence jaw formation and in respect,
malocclusion, and arch form, as shown in Fig. 3. 4.9. Aging

4.8.1. Mouth breathing/tongue thrusting The dental arch changes, and it is a continuous process
4.8.1.1. Adenoid hypertrophy. Both behaviours of mouth breathing throughout life. A study by Dager et al. [33] shows that there is
and tongue thrusting are seen in a condition called adenoid a decrease in the upper and lower arch width, depth, and
hypertrophy – both of which impact occlusion, arch form, and perimeter, especially in the mandibular incisor area with an
different dental morphologies. One of the main reasons nasal increase of age [33]. In addition to the normal aging process and
breathing is obstructed is because of large adenoids, which leads to effects, periodontal disease is prevalent among the older popula-
mouth breathing. Mouth breathing significantly affects oral and tion. Alveolar bone continues to decrease as age increases. With the
facial development. Firstly, the tongue is displaced from its loss of alveolar bone with either increase of age or with periodontal
position in the hard palate, making the cheek pressure affect the disease, teeth can become mobile and increase in overjet and
upper molar’s inclination, causing a further constriction of the spacing [10].
upper, which results in the development of posterior crossbite and
high valet palate. In addition, tongue thrusting can cause anterior 5. Conclusion
teeth to be crowded, increasing the buccal canine impaction
tendency, and deforming the arch shape into a V-shaped arch, The contributing factors regarding malocclusion can be described
known as narrow tapered. It is shown as an association of the as factors that affect malocclusion, mainly in 3 dimensions. The first
development of tongue thrust, which is an action performed by the dimension is the anteroposterior parameter, classified as class I, II,

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G Model
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MAS is a recipient of the New Jersey health foundation Innovation Craniofacial features as assessed by lateral cephalometric measurements in
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Please cite this article in press as: Saghiri MA, et al. Factors influencing different types of malocclusion and arch form – A review. J
Stomatol Oral Maxillofac Surg (2020), https://doi.org/10.1016/j.jormas.2020.07.002