Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
UDC 616.31
Distal occlusion is one of the most common dentofacial anomalies, characterized by a distal position of the mandible in relation to the maxilla. This condition is associated with impaired chewing efficiency, difficulties in speech articulation, and significant aesthetic problems that can affect social adaptation and psychological well-being. The purpose of this review was to systematize current knowledge about the causes and mechanisms of distal occlusion development and to test the hypothesis that the condition has a multifactorial nature, in which genetic predisposition interacts with environmental and functional factors. The methodology included a structured search of scientific publications in PubMed, Google Scholar, and eLibrary databases over the past decade. Publications were selected according to inclusion criteria that required analysis of etiological factors, assessment of hereditary influences, evaluation of functional disturbances, and discussion of craniofacial growth patterns. In total, 75 sources met the criteria for detailed analysis, including clinical studies, experimental works, and observational research. The results of the review confirm that distal occlusion arises from a complex interaction of hereditary determinants, disturbances in the growth and development of the craniofacial skeleton, and external influences such as prolonged harmful oral habits, chronic nasal obstruction leading to mouth breathing, and uncorrected premature loss of deciduous teeth. The findings highlight the importance of early identification of risk factors, interdisciplinary diagnostic approaches, and timely orthodontic intervention. These conclusions substantiate the need for individualized preventive and therapeutic strategies, thereby improving treatment effectiveness and long-term outcomes.
distal occlusion, malocclusion, malocclusion pathogenesis, genetics, environment
1. Dikova A.A. Osobennosti ortodonticheskogo lecheniya pacientov s distal'noy okklyuziey 2 klassa 1 podklassa po Englyu: dis. … d-ra med. nauk. Samara: Samarskiy gosudarstvennyy medicinskiy universitet; 2022. 132 s. [A.A. Dikova. Features of orthodontic treatment of patients with distal occlusion, Angle Class II, Division 1: Dr. Sci. (Med.) Diss. Samara: Samara State Medical University; 2022. 132 p. (In Russ.)]. https://samsmu.ru/files/referats/2022/dikova/dissertation.pdf
2. Danilova B.G. Ocenka sostoyaniya zubochelyustnoy sistemy u pacientov s distal'noy okklyuziey s ispol'zovaniem vnerotovyh metodov diagnostiki: dis. … d-ra med. nauk. Moskva: Moskovskiy gosudarstvennyy mediko-stomatologicheskiy universitet; 2023. 94 s. [B.G. Danielova. Assessment of the dentoalveolar system in patients with distal occlusion using extraoral diagnostic methods: Dr. Sci. (Med.) Diss. Moscow: Moscow State University of Medicine and Dentistry; 2023. 94 p. (In Russ.)]. https://dissov.msmsuportal.ru/image/image/2023/10/02/Dissertaciya_Danielova_BG.pdf
3. Chen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC Pediatrics. 2015;15:46. doihttps://doi.org/10.1186/s12887-015-0364-1.
4. Knyazeva D.A. Kompleksnye metody lecheniya distal'nogo prikusa: vypusknaya kvalifikacionnaya rabota. Sankt-Peterburg: SPbGMU; 2017. 80 s. [D.A. Knyazeva. Complex methods of treating distal occlusion: Graduation thesis. Saint Petersburg: SPbSMU; 2017. 80 p. (In Russ.)]. https://dspace.spbu.ru/items/e80b12f4-7806-4b16-b309-cf034e0a2c42
5. Berezina D.D. Kompleksnye metody diagnostiki i lecheniya distal'nogo prikusa: vypusknaya kvalifikacionnaya rabota. Sankt-Peterburg: SPbGMU; 2022. 105 s. [D.D. Berezina. Complex methods of diagnosis and treatment of distal occlusion: Graduation thesis. Saint Petersburg: SPbSMU; 2022. 105 p. (In Russ.)]. https://dspace.spbu.ru/items/ef22e555-8a39-4b81-8279-bcb58e870f84
6. Moreno Uribe LM, Miller SF. Genetics of the dentofacial variation in human malocclusion. Orthod Craniofac Res. 2015;18 Suppl 1:91–99. doihttps://doi.org/10.1111/ocr.12083.
7. Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngol Ital. 2016;36(5):386–394. doihttps://doi.org/10.14639/0392-100X-770.
8. Thaler R, Khani F, Sturmlechner I, Dehghani SS, Denbeigh JM, Zhou X, Pichurin O, Dudakovic A, Jerez SS, Zhong J, Lee JH, Natarajan R, Kalajzic I, Jiang YH, Deyle DR, Paschalis EP, Misof BM, Ordog T, van Wijnen AJ. Vitamin C epigenetically controls osteogenesis and bone mineralization. Nat Commun. 2022;13(1):5883. doihttps://doi.org/10.1038/s41467-022-32915-8.
9. Kozioł-Kozakowska A, Maresz K. The Impact of Vitamin K2 (Menaquionones) in Children's Health and Diseases: A Review of the Literature. Children (Basel). 2022;9(1):78 doi:https://doi.org/10.3390/children9010078.
10. Shen Y., et al. Vitamin K2 deficiency associated with short stature in children: a cross-sectional study. BMC Pediatrics. 2025;25:56. doihttps://doi.org/10.1186/s12887-025-05699-1.
11. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, Wallace TC, Zemel BS. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis International. 2016; 27(4): 1281–1386. doi:https://doi.org/10.1007/s00198-015-3440-3.
12. Ghodasra R, Brizuela M. Orthodontics, Malocclusion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. https://pubmed.ncbi.nlm.nih.gov/37276298/
13. Profit U.R., Filds H.V., Sarver D.M. Sovremennaya ortodontiya. Per. s angl. Moskva: Medpress-inform; 2017. 687 s. [W.R. Proffit, H.W. Fields, D.M. Sarver. Contemporary Orthodontics. Russian ed. Moscow: MEDpress-inform; 2017. 687 p. (In Russ.)]. https://elibrary.ru/item.asp?id=32287612
14. Abate A, Cavagnetto D, Fama A, Maspero C, Farronato G. Relationship between breastfeeding and malocclusion: a systematic review of the literature. Nutrients. 2020;12(12):3688. doihttps://doi.org/10.3390/nu12123688.
15. Rapeepattana S, Thearmontree A, Suntornlohanakul S. Etiology of malocclusion and dominant orthodontic problems in mixed dentition: a cross-sectional study in a group of Thai children aged eight to nine years. J Int Soc Prev Community Dent. 2019;9(4):383–389. doihttps://doi.org/10.4103/jispcd.JISPCD_120_19.
16. Zaharova A.G. Kompleksnye metody lecheniya pacientov s distal'nym prikusom: vypusknaya kvalifikacionnaya rabota. Sankt-Peterburg: SPbGMU; 2016. 73 s. [A.G. Zakharova. Complex methods of treating patients with distal occlusion: Graduation thesis. Saint Petersburg: SPbSMU; 2016. 73 p. (In Russ.)]. https://dspace.spbu.ru/items/c1ae6661-6637-4244-8ea4-d214a00cd092
17. Festa P, Mansi N, Varricchio AM. Association between upper airway obstruction and malocclusion in mouth-breathing children. Acta Otorhinolaryngol Ital. 2021;41(5):436–442. doihttps://doi.org/10.14639/0392-100X-N1225.
18. Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C. Global distribution of malocclusion traits: a systematic review. Dental Press J Orthod. 2018;23(6):40.e1–40.e10. doihttps://doi.org/10.1590/2177-6709.23.6.40.e1-10.onl.
19. Abate A, Cavagnetto D, Fama A, Maspero C, Farronato G. Relationship between breastfeeding and malocclusion: a systematic review of the literature. Nutrients. 2020;12(12):3688. doihttps://doi.org/10.3390/nu12123688.
20. Sirotkina V.S. Effektivnost' ortodonticheskogo lecheniya distal'nogo prikusa u detey s suzheniem prosveta verhnih dyhatel'nyh putey: dis. … d-ra med. nauk. Nizhniy Novgorod: Privolzhskiy issledovatel'skiy medicinskiy universitet; 2020. 131 s. [V.S. Sirotkina. Effectiveness of orthodontic treatment of distal occlusion in children with narrowed upper airway: Dr. Sci. (Med.) Diss. Nizhny Novgorod: Privolzhsky Research Medical University; 2020. 131 p. (In Russ.)]. https://psma.ru/index.php?option=com_mtree&task=att_download&link_id=289&cf_id=24
21. Habilov N.L., Shomuhomedova F.A., Aripova G.E. Ortodontiya s detskim zubnym protezirovaniem. Tashkent: Adabiet Uchқunlari; 2016. 212 s. [N.L. Khabilov, F.A. Shomukhomedova, G.E. Aripova. Orthodontics with pediatric dental prosthetics. Tashkent: Adabiyot Uchqunlari; 2016. 212 p. (In Russ.)]. https://e-library.sammu.uz/uploads/books/Rus%20tilidagi%20adabiyotlar/Stomatologiya/Ortodontiya_s_detskim_zubnym_protezirovaniem_Uchebnik_Habilov_N_L.pdf
22. Vieira AR. Orthodontics and genetics. Dental Press J Orthod. 2019;24(2):92–97. doihttps://doi.org/10.1590/2177-6709.24.2.092-097.
23. Horoshilkina F.Ya. Diagnostika i funkcional'nye metody profilaktiki i lecheniya zubochelyustno-licevyh anomaliy. Moskva: Litterra; 2022. 312 s. [F.Ya. Khoroshilkina. Diagnostics and functional methods of prevention and treatment of dentofacial anomalies. Moscow: Litterra; 2022. 312 p. (In Russ.)]. https://elibrary.ru/item.asp?id=49011877
24. Dipalma G, Inchingolo AD, Pezzolla C, Sardano R, Trilli I, Di Venere D, Corsalini M, Inchingolo F, Severino M, Palermo A, Inchingolo AM. Head and cervical posture in sagittal skeletal malocclusions: insights from a systematic review. J Clin Med. 2025;14(8):2626. doihttps://doi.org/10.3390/jcm14082626.
25. Öztürk T, Topsakal U, Vahabova G, Yağcı A, Sheydayev E. Does cranial base angle make a difference in the effectiveness of functional orthopedic treatment? A retrospective cohort study. J Clin Med. 2025;14(1):96. doihttps://doi.org/10.3390/jcm14010096.
26. Shushlyapin O, Chichkova A, Ponomarev D. The effectiveness of orthodontic and osteopathic correction in patients with dental anomalies and musculoskeletal dysfunction of the temporomandibular joint in the presence of concomitant somatic dysfunctions [Internet]. ResearchGate; 2021 [cited 2025 Sep 23]. https://doi.org/10.32885/2220-0975-2021-4-63-74
27. Gershater E, Li C, Ha P, Chung CH, Tanna N, Zou M, Zheng Z. Genes and pathways associated with skeletal sagittal malocclusions: a systematic review. Int J Mol Sci. 2021;22:13037. doihttps://doi.org/10.3390/ijms222313037.
28. Šidlauskienė M, Papievis V, Šidlauskas A, et al. Genetic and environmental impact on variation in palatal dimensions in permanent dentition: a twin study. Sci Rep. 2024;14:19785. doihttps://doi.org/10.1038/s41598-024-70985-4.
29. Leal M, Lemos A, Costa G, Lopes Cardoso I. Genetic and environmental factors involved in the development of oral malformations such as cleft lip/palate in non-syndromic patients and open bite malocclusion. Eur J Med Health Sci. 2020;2(3):1–11. doihttps://doi.org/10.24018/ejmed.2020.2.3.262.
30. Tsang Tung M, Makaremi M, de Brondeau F. Neuromuscular environment and stability of transverse maxillary expansion. J Dentofacial Anom Orthod. 2017;20:406. doihttps://doi.org/10.1051/odfen/2017028.
31. Jia S, Kwon HE, Lan Y, Zhou J, Liu, Jiang R. Bmp4-Msx1 signaling and Osr2 control tooth organogenesis through antagonistic regulation of secreted Wnt antagonists. Dev Biol. 2016;420(1):110–119. doihttps://doi.org/10.1016/j.ydbio.2016.10.001.
32. Liang J, Von den Hoff J, Lange J, Ren Y, Bian Z, Carels CE. MSX1 mutations and associated disease phenotypes: genotype-phenotype relations. Eur J Hum Genet. 2016;24(12):1663–1670. doihttps://doi.org/10.1038/ejhg.2016.78.
33. Trybek G, Jaroń A, Grzywacz A. Association of polymorphic and haplotype variants of the MSX1 gene and the impacted teeth phenomenon. Genes. 2021;12(4):577. doihttps://doi.org/10.3390/genes12040577.
34. Meng L, Jiang Y, You J, et al. PRMT1-methylated MSX1 phase separates to control palate development. Nat Commun. 2025;16:949. doihttps://doi.org/10.1038/s41467-025-56327-6.
35. Wang Y-L, et al. Orodental malformations associated with human MSX1 sequence variants. J Am Dent Assoc. 2024;155(6):484–495.e21. doihttps://doi.org/10.1016/j.adaj.2024.02.010.
36. Gupta SP, Dahal S, Goel K, Bhochhibhoya A, Rauniyar S. Association between hypodontia and Angle’s malocclusions among orthodontic patients in Kathmandu, Nepal. Int J Dent. 2022;2022:9595920. doihttps://doi.org/10.1155/2022/9595920.
37. Bertl MH, Bertl K, Wagner M, Gahleitner A, Stavropoulos A, Ulm C, Mitteroecker P. Second premolar agenesis is associated with mandibular form: a geometric morphometric analysis of mandibular cross-sections. Int J Oral Sci. 2016;8(4):254–260. doihttps://doi.org/10.1038/ijos.2016.41.
38. Schieffer L, Klawitter T, Ulmer H, Nemec M, Schenz-Spisic N, Crismani AG. Curve of Spee and second mandibular premolar agenesis — present knowledge and future perspectives. Appl Sci. 2022;12(22):11747. doihttps://doi.org/10.3390/app122211747.
39. Jia S, Oliver JD, Turner EC, Renouard M, Bei M, Wright JT, D’Souza RN. PAX9’s interaction with the ectodysplasin signaling pathway during the patterning of dentition. Front Physiol. 2020;11:581843. doihttps://doi.org/10.3389/fphys.2020.581843.
40. Wong SW, Han D, Zhang H, Liu Y, Zhang X, Miao MZ, Wang Y, Zhao N, Zeng L, Bai B, Wang YX, Liu H, Frazier-Bowers SA, Feng H. Nine novel PAX9 mutations and a distinct tooth agenesis genotype-phenotype. J Dent Res. 2018;97(2):155–162. doihttps://doi.org/10.1177/0022034517729322.
41. Yin H, Duan L, Wang Z, Liu L, Shen J. Fibroblast growth factor 8: multifaceted role in development and developmental disorder. Genes Dis. 2025;12(5):101524. doihttps://doi.org/10.1016/j.gendis.2025.101524.
42. Zhao X, Erhardt S, Sung K, Wang J. FGF signaling in cranial suture development and related diseases. Front Cell Dev Biol. 2023;11:1112890. doihttps://doi.org/10.3389/fcell.2023.1112890.
43. Alam MK, Alfawzan AA, Srivastava KC, Shrivastava D, Ganji KK, Manay SM. Craniofacial morphology in Apert syndrome: a systematic review and meta-analysis. Sci Rep. 2022;12(1):5708. doihttps://doi.org/10.1038/s41598-022-09764-y.
44. Zorich M.E., Yackevich O.S., Ivanov S.Yu., Muraev A.A. Distal'naya okklyuziya II klassa: nekotorye aspekty diagnostiki i kompleksnogo ortodonticheskogo i hirurgicheskogo lecheniya. Stomatologiya. 2014;93(2):52–58. [M.E. Zorich, O.S. Yatzkevich, S.Yu. Ivanov, A.A. Muraev. Class II malocclusion: some aspects of diagnostics and complex orthodontic and surgical treatment. Stomatologiia (Mosk). 2014;93(2):52–58. (In Russ.)]. https://www.mediasphera.ru/issues/stomatologiya/2014/2/030039-17352014214
