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Dentofacial Deformity: Causes, Symptoms & Treatment
A dentofacial deformity is a misalignment of the jaws or bite. It can affect chewing, speech, and facial appearance, and is treated with orthodontics or corrective jaw surgery.
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A dentofacial deformity is a misalignment of the jaws or bite. It can affect chewing, speech, and facial appearance, and is treated with orthodontics or corrective jaw surgery.
What is a Dentofacial Deformity?
A dentofacial deformity (also referred to as dysgnathia) describes a misalignment or malfunction of the jaws, teeth, or bite. In this condition, the upper and lower jaws do not align correctly, meaning the teeth do not meet properly when biting. Dentofacial deformities can significantly affect both the appearance and the functional ability of the chewing system.
Types of Dentofacial Deformity
Dentofacial deformities are classified according to the position of the jaws and the nature of the bite discrepancy:
- Mandibular prognathism (underbite): The lower jaw protrudes too far forward.
- Retrognathia: One jaw -- usually the lower jaw -- is positioned too far back (overbite or receding chin).
- Maxillary prognathism: The upper jaw protrudes too far forward.
- Open bite: A gap remains between the upper and lower front teeth even when the mouth is closed.
- Deep bite (overbite): The upper front teeth excessively overlap the lower front teeth.
- Crossbite: One or more upper teeth bite inside the lower teeth.
Causes
The development of a dentofacial deformity is usually multifactorial, meaning several factors contribute:
- Genetic factors: Jaw size and shape can be inherited, leading to misalignment.
- Growth disturbances: Uneven growth of the upper and lower jaw during childhood or adolescence.
- Oral habits: Prolonged thumb-sucking, pacifier use, or mouth breathing can influence jaw development.
- Trauma: Injuries to the jaw can result in misalignment.
- Systemic conditions: Conditions such as acromegaly (excess growth hormone) or cleft lip and palate can cause dentofacial deformities.
Symptoms
Symptoms vary depending on the severity of the misalignment and may include:
- Difficulty chewing or biting food properly
- Speech difficulties, such as a lisp
- Jaw joint pain (temporomandibular disorder, TMD)
- Headaches and neck pain
- Aesthetic concerns about facial profile
- Excessive tooth wear (attrition)
- Difficulty opening or closing the mouth fully
Diagnosis
Diagnosis of a dentofacial deformity involves a thorough clinical and radiographic assessment:
- Clinical examination: Assessment of facial profile, tooth alignment, and bite by a dentist or orthodontist.
- Radiographic imaging: Lateral cephalometric X-rays and panoramic radiographs (OPG) to analyze jaw structure in detail.
- Study models: Dental impressions are taken for three-dimensional analysis of the dental arches.
- Digital planning: Cone beam computed tomography (CBCT) and digital simulation are increasingly used for precise surgical planning.
- Functional analysis: Evaluation of jaw joint function if temporomandibular disorder is suspected.
Treatment
Treatment depends on the type and severity of the deformity as well as the age of the patient:
Orthodontic Treatment
In children and adolescents, fixed or removable braces (such as brackets or clear aligners) and functional orthodontic appliances can guide jaw development and correct misalignments. Treatment outcomes are generally best when initiated during the growth phase.
Orthognathic Surgery (Corrective Jaw Surgery)
In adult patients with severe dentofacial deformity, surgical correction is often necessary. The procedure -- known as orthognathic surgery or osteotomy -- involves repositioning one or both jaws to achieve proper alignment and fixating them with titanium plates and screws. Surgery is typically performed in combination with orthodontic preparation and follow-up treatment.
Combined Therapy
In many cases, a combination of orthodontics and jaw surgery is the most effective approach. Orthodontic preparation usually takes 12 to 18 months, followed by the surgical procedure and a post-surgical orthodontic phase to fine-tune the bite.
References
- Proffit WR, Fields HW, Sarver DM: Contemporary Orthodontics. 6th Edition. Elsevier, 2018.
- Arnett GW, McLaughlin RP: Facial and Dental Planning for Orthodontists and Oral Surgeons. Mosby, 2004.
- World Health Organization (WHO): International Classification of Diseases (ICD-11) -- Dentofacial anomalies. www.who.int
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