Correlation between the variation of head type and malocclusion: A Scooping Review

Ari Triwardhani; Alif Rakhman Effendi; I Gusti Aju Wahju Ardani; Raihan Nadia Utami

doi:10.4103/jioh.jioh_228_21

REVIEW ARTICLE

Year : 2023 | Volume : 15 | Issue : 1 | Page : 8-14

Correlation between the variation of head type and malocclusion: A Scooping Review

Ari Triwardhani, Alif Rakhman Effendi, I Gusti Aju Wahju Ardani, Raihan Nadia Utami
Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission	28-Aug-2021
Date of Decision	24-Oct-2022
Date of Acceptance	06-Nov-2022
Date of Web Publication	28-Feb-2023

Correspondence Address:
Dr. Ari Triwardhani
Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Mayjend Prof. Dr. Moestopo 47, Surabaya
Indonesia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jioh.jioh_228_21

Abstract

Aim: Examination of head type in orthodontics is pivotal. Examining the head type aims to monitor growth patterns and predict the outcome of an orthodontic treatment. Malocclusion is a disease with a complex etiology. Anomaly in the development pattern of the oral and maxillofacial region can be suspected as the etiology of malocclusion. A specific type of head will result from specific growth patterns. As a result, dental and skeletal malocclusion occurrences are linked to particular head forms. Materials and Methods: These articles’ literature sources were from various databases that described cephalic index correlation and cephalic index malocclusion. Results: A correlation is found between mesocephalic head type with skeletal and dental malocclusion class II, mesocephalic head type with skeletal and dental malocclusion class I, mesocephalic head type with skeletal malocclusion class I and dental class II, mesocephalic head type with skeletal malocclusion class I, and dental class III. Meanwhile, dolichocephalic head type correlates with dental and skeletal malocclusion class II, dolichocephalic head type with skeletal 111 class II, and dental class I, dolichocephalic head type with skeletal malocclusion class I, and dental class II. In addition, brachycephalic head type correlates to skeletal and dental malocclusion class II and the relationship between brachycephalic head type with skeletal malocclusion class III and dental class II. Class I malocclusion is associated with the mesocephalic head type because the mesocephalic head type favors balanced development of the craniomaxillofacial complex. Class II malocclusion is associated with dolichocephalic head type, selecting the face’s predominantly long morphology. Class III malocclusion is associated with brachycephalic head type, favoring the maxilla’s retrusion. Conclusion: Malocclusion classification correlates with variations in head types. Genetic and environmental variables, or possibly both, impact this disease.

Keywords: Brachycephalic, Dolichocephalic, Human and Health, Malocclusion, Medicine, Mesocephalic

How to cite this article:
Triwardhani A, Effendi AR, Ardani IW, Utami RN. Correlation between the variation of head type and malocclusion: A Scooping Review. J Int Oral Health 2023;15:8-14

How to cite this URL:
Triwardhani A, Effendi AR, Ardani IW, Utami RN. Correlation between the variation of head type and malocclusion: A Scooping Review. J Int Oral Health [serial online] 2023 [cited 2023 Apr 2];15:8-14. Available from: https://www.jioh.org/text.asp?2023/15/1/8/370750

Introduction

A head-type examination based on the cephalic index before orthodontic treatment is crucial to identify the correct diagnosis. The cephalic index can be used to determine the growth pattern of the person,^[1] as well as to evaluate and estimate how orthodontic therapy may finish out.^[2] The cephalic index described by Anders Retzius is classified into three main head types: dolichocephalic, mesocephalic, and brachycephalic.^[3]

Malocclusion is a multifactorial disorder, and one of the etiologies is the deviation of growth patterns. Particular growth patterns will result in corresponding head types.^[4] Based on this information, the study by Rajeshkumar et al. has associated specific head types with a particular classification of dental or skeletal malocclusion cases.^[5] Rauten et al. found a correlation between specific head types with dental anomalies such as dentomaxillary disharmony, maxillary compression syndrome, deep bite, and open bite.^[6]

Different classes of malocclusion can be observed in every patient that undergoes orthodontic treatment. Each patient has other head types. Examination of head type needs to be done before identifying a diagnosis and determining a treatment plan.^[7] Knowing which cephalic index is associated with certain malocclusion will help the clinician makes an accurate diagnosis and devise an appropriate treatment plan. Based on this information, the study of reviewing the correlation between head type and classification of malocclusion was conducted.

Materials and Methods

This study conducted a strategic literature search on several scientific journal databases such as Google Scholar, Science Direct, and Scopus using the keywords “cephalic index correlation” and “cephalic index malocclusion”. The gathered literature that contains information about the class of malocclusion and cephalic index of several patients was then selected to be included in this study. [Figure 1] illustrates the process flow for all of this literature search.

Figure 1: Literature search flow chart

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Literature search related to “cephalic index correlation” and “cephalic index malocclusion” from Google Scholar, Science Direct, and Scopus resulted in 213 articles identified from 1970–2020. Then, relevant papers were reviewed and determined based on their titles and abstracts. A total of 31 pieces were included in this literature study after the inclusion criteria for the literature were assessed by reading the full-text articles.

Primary inclusion criteria for the literature were the article types were reviews articles and research articles, study subjects included cephalic index correlation, study subjects had cephalic index malocclusion, and the article in English. The criteria excluded articles not related to the topic. The following study did not include reviews. The selected literature was analyzed using PICOS as P: patients with cephalic index correlation and cephalic index malocclusion who are planning a treatment, I: dental anomalies, C: patients treated with another therapy, O: international publication and describe the examination of the head type to monitor growth patterns and predict outcome of the orthodontic treatment, and S: a narrative literature review. [Figure 2] described the risk of bias assessed in this study.

Figure 2: Risk of bias

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Results

Two hundred thirteen kinds of literature were identified from Google Scholar, Scopus, and Science Direct based on keywords. Then 41 types of literature were screened by abstract. Many articles were excluded from the initial screening of the title and abstract as they did not qualify for the objective of the present review. Full-text articles assessed for eligibility were 37 articles. During the selection process, 31 relevant articles included reviewed and summarized criteria [Table 1].

Table 1: List of published research included in the present review, evaluating the correlation between cephalic index and the type of malocclusion and attributing characteristics of malocclusion

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Discussion

Examining head type based on the cephalic index is essential in orthodontic treatment to determine the patient’s growth pattern and predict orthodontic treatment results.^[1],[2] An unbalanced growth pattern will more likely result in dentoalveolar anomaly and cause malocclusion. Based on the study by Kageyama et al.,^[8] dolichocephalic individuals tend to have a narrow dental arch, and brachycephalic individuals tend to have a comprehensive dental arch. Research done by Kook et al.^[9] also shows similar results. At the same time, Gafni et al.^[10] show that mesocephalic individuals tend to have an ovoid arch form, and dolichocephalic individuals tend to have a tapered arch form.

Besides the arch form, several studies showed that head type also correlates with masticatory muscle properties. Arun et al. studied brachycephalic individuals’ higher masticatory and facial muscle tonicity. For comparison, Kim et al.^[11],[12] studied that dolichocephalic individuals with lower tonicity of masticatory muscle have lower than occlusal force. These findings are supported by a study by Custodio,^[13] which shows brachycephalic individuals have the highest occlusal force among all three head types because brachycephalic individuals tend to have thicker masseter and temporal muscle.

Several studies showed that head type also correlates with patients’ dental conditions. Marshall et al.^[14] studied the development of the curve of Spee among individuals with normal occlusion from primary dentition to mixed dentition phase with various head types. A study by Shung et al.^[15] also found that brachycephalic individuals tend to have a higher curve of Spee. Furthermore, Fastlicht^[16] studied that head type correlates with crowding conditions on dentition. They found that dolichocephalic individuals are more predisposed to dental crowding than mesocephalic and brachycephalic individuals. They confer that dolichocephalic also tends to have narrower dental arch providing less space for teeth eruption in their ideal position.

Several studies also showed that a particular head type correlates with particular molar relation (which reflects the class of malocclusion) and particular skeletal relation. Rajeshkumar et al.^[5] showed that dolichocephalic, mesocephalic, and brachycephalic tend to have class II skeletal and dental relation, class I skeletal and dental relation, and class III skeletal and dental relation, respectively. These findings are supported by Nakasima et al.,^[17] which also found that dolichocephalics tend to have class II malocclusion and brachycephalics tend to have class III malocclusion. The correlation between a particular head type and a particular dental or skeletal relation was probably caused by dominating specific germ layers during the growth phase.

Reviewing the correlation between head type and malocclusion based on a case-by-case report might also help this study. Valladares-Neto et al. and Saga et al.^[18],[19] reported that their patients have mesocephalic head type with class I skeletal and dental relation. These findings are similar to the several case reports that presented mesocephalic patients as having class I skeletal relations, albeit their dental relations are class II.^[20],[21] Moullas et al.^[22] also reported similar findings where the mesocephalic patient has class I skeletal but class III dental relation. These findings, however, contradict the cases of Saga et al., Park et al., and Park and Cho^{[19],[23],[24]} who reported that their mesocephalic patients have class II skeletal and dental relations. The difference between these observations was typically influenced by environmental or genetic factors that have a role in malocclusion development.

The cases reported by Maggioncalda, Ferreira, Epker and Fish, Coreil, and Epker and Fish^{[25],[26],[27],[28],[29]} of cases 2, 3, and 6 showed that the dolichocephalic patients have class II skeletal and dental relations. These findings are similar to the cases reported by Sabri and Epker and Fish (of cases number 1 and 6), which show dolichocephalic patients have class II skeletal relations even though they have class I dental relations.^[27],[30] These findings contradict the cases reported by Del Santo et al. and Cope and Sachdeva,^[31],[32] which shows their dolichocephalic patients have class I skeletal relations, albeit they still have class II dental relations. The contrast between the development of skeletal and dental malocclusion among dolichocephalic patients could be caused by genetic and environmental factors.

The cases reported by Park et al. show that brachyfacial patients have class III skeletal relations but class II dental relations. The cases reported by Bass, Emrich, Sabri, and Suri et al.^{[33],[34],[35],[36]} show that their brachycephalic patients have class II skeletal and dental relations. The cases reported by Park et al.^[23] show that brachyfacial patients have class III skeletal relations but class II dental relations. These contradictory findings showed that, albeit a particular head type is a predisposing factor to certain malocclusion, it is not the only factor. Other factors such as genetics and environment play a role in malocclusion development.

Based on these findings, class I malocclusion can generally be associated with mesocephalic head type, and class II malocclusion can be related to dolichocephalic head type. Class III malocclusion can be associated with brachycephalic head type. It is supported by research by Cope et al. (2013), which states that the retrognathic mandible, a characteristic of class II malocclusion, can be associated with the dolichocephalic head type that favors the development of a predominantly long morphology of the face.^[32] Moullas et al. (2013) also state that the brachycephalic head type would have a broader but shorter and more angular cranial base that causes relative retrusion of the maxilla, a characteristic of class III malocclusion.^[22]

This research is not without its limits. The evidence included in the review is not updated because of the limited research regarding this topic. The review process used is also limited, where the writer merely reviews the evidence narratively and not systematically.

Conclusion

Following what this literature review indicated, the mesocephalic head type tends to have class I skeletal or dental relations, the dolichocephalic head type tends to have class II skeletal or dental relations, and brachycephalic head type tends to have class III skeletal or dental relations. Moreover, genetic and environmental factors, or a combination of both, also play a role in developing malocclusion.

Acknowledgement

The authors would like to thank the Faculty of Dental Medicine, Universtas Airlangga.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors contributions

Not applicable.

Ethical policy and institutional review board statement

Not applicable.

Declaration of patient consent

Not applicable.

Data availability statement

The literature used in this review article was obtained from Google Scholar, Sciencedirect, and Scopus.

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