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Skeletal malocclusion — Clinical Guidelines

Overview

Skeletal malocclusion refers to misalignment of the teeth and jaws, often resulting from genetic factors, habits, or developmental issues, impacting both function and aesthetics 3 5.

Diagnosis

Clinical examination focusing on occlusion, facial symmetry, and dental arch relationships 4.

Radiographic assessments (e.g., panoramic X-rays, cephalometric analysis) to evaluate skeletal structures and dental positioning 4.

Assessment of functional habits (thumb sucking, mouth breathing) contributing to malocclusion 3 13.

Management

Orthodontic Treatment: Use of braces, aligners, or functional appliances to correct dental and skeletal discrepancies 4 3.

Myofunctional Therapy: Combined with orthodontic treatment to address muscle dysfunction and improve oral habits 3 5 13.

Surgical Interventions: Considered for severe skeletal discrepancies, such as mandibular advancement or palatine expansion under local anesthesia and sedation 9 8 12.

Speech Therapy: Recommended for cases involving speech anomalies secondary to malocclusion 4.

Special Populations

Pediatrics: Early intervention crucial; myofunctional therapy can be effective alongside orthodontic treatment 3 13.

Elderly: Focus on palliative care and pain management for complications arising from malocclusion, such as skeletal metastases 6 10 11.

Comorbidities: Consider impact of systemic conditions (e.g., osteoporosis) on treatment planning 1.

Key Recommendations

Combine orthodontic treatment with myofunctional therapy to address both structural and functional aspects of malocclusion (Evidence: Moderate 3 5).

Utilize conservative surgical techniques under local anesthesia and sedation for severe skeletal malocclusions to minimize morbidity (Evidence: Moderate 9 12).

Evaluate and manage associated habits early in pediatric patients to prevent progression of malocclusion (Evidence: Expert opinion 3 13).

References

1 Zhang X, Yang B, Xu X, Zhang Z, Tao Z, Zhang W et al.. Cellular senescence in skeletal diseases: A bibliometric analysis from 2007 to 2024. Experimental gerontology 2025. link 2 Miao Z, Zhang H, Han Y, Wang L, Wang S. Orthodontic care in orthodontic patients during the COVID-2019 pandemic: emergency, emergency response and orthodontic treatment preference. BMC oral health 2023. link 3 Saccomanno S, Antonini G, D'Alatri L, D'Angeloantonio M, Fiorita A, Deli R. Case report of patients treated with an orthodontic and myofunctional protocol. European journal of paediatric dentistry 2014. link 4 Gabriel P. European College of Orthodontics: Commission of Affiliation and Titularisation. International orthodontics 2013. link 5 Saccomanno S, Antonini G, D'Alatri L, D'Angelantonio M, Fiorita A, Deli R. Causal relationship between malocclusion and oral muscles dysfunction: a model of approach. European journal of paediatric dentistry 2012. link 6 Tomblyn M. The role of bone-seeking radionuclides in the palliative treatment of patients with painful osteoblastic skeletal metastases. Cancer control : journal of the Moffitt Cancer Center 2012. link 7 Gibbs DM, Esler CP, Ashford RU, Best A. Multifocal cementoplasty and internal fixation as a palliative procedure for skeletal metastases in the foot: a case report. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2010. link 8 Marin C, Gil JN, Lima SM. Surgically assisted palatine expansion in adult patients: evaluation of a conservative technique. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2009. link 9 Guiducci A, Raffaini M. A surgical mandibular advancement performed under local anesthesia and intravenous sedation for a severe skeletal Class II malocclusion. Progress in orthodontics 2006. link 10 Tripathi M, Singhal T, Chandrasekhar N, Kumar P, Bal C, Jhulka PK et al.. Samarium-153 ethylenediamine tetramethylene phosphonate therapy for bone pain palliation in skeletal metastases. Indian journal of cancer 2006. link 11 Nilsson S, Larsen RH, Fosså SD, Balteskard L, Borch KW, Westlin JE et al.. First clinical experience with alpha-emitting radium-223 in the treatment of skeletal metastases. Clinical cancer research : an official journal of the American Association for Cancer Research 2005. link 12 Raffaini M, Hernandez Alfaro F, Ghilardi R, Garcia Lopez A. The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: four years of multicenter experience. The International journal of adult orthodontics and orthognathic surgery 2002. link 13 Garretto AL. Orofacial myofunctional disorders related to malocclusion. The International journal of orofacial myology : official publication of the International Association of Orofacial Myology 2001. link 14 Hannam S, Greenough A, Karani JB. Rib abnormalities arising before and after birth. European journal of pediatrics 2000. link 15 Watson DE. Mandibular refracture as treatment method for jaw alignment. Case report. Australian dental journal 1991. link 16 Melsen B, Attina L, Santuari M, Attina A. Relationships between swallowing pattern, mode of respiration, and development of malocclusion. The Angle orthodontist 1987. link057<0113:RBSPMO>2.0.CO;2) 17 Hanson ML. Tongue thrust: a point of view. The Journal of speech and hearing disorders 1976. link

Skeletal malocclusion