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DOI: https://doi.org/10.1590/2177-6709.23.6.40.e1-10.onl
Objective: Considering that the available studies on prevalence of malocclusions are local or national-based, this study
aimed to pool data to determine the distribution of malocclusion traits worldwide in mixed and permanent dentitions.
Methods: An electronic search was conducted using PubMed, Embase and Google Scholar search engines, to retrieve
data on malocclusion prevalence for both mixed and permanent dentitions, up to December 2016.
Results: Out of 2,977 retrieved studies, 53 were included. In permanent dentition, the global distributions of Class I,
Class II, and Class III malocclusion were 74.7% [31 – 97%], 19.56% [2 – 63%] and 5.93% [1 – 20%], respectively.
In mixed dentition, the distributions of these malocclusions were 73% [40 – 96%], 23% [2 – 58%] and 4% [0.7 – 13%].
Regarding vertical malocclusions, the observed deep overbite and open bite were 21.98% and 4.93%, respectively. Poste-
rior crossbite affected 9.39% of the sample. Africans showed the highest prevalence of Class I and open bite in permanent
dentition (89% and 8%, respectively), and in mixed dentition (93% and 10%, respectively), while Caucasians showed the
highest prevalence of Class II in permanent dentition (23%) and mixed dentition (26%). Class III malocclusion in mixed
dentition was highly prevalent among Mongoloids.
Conclusion: Worldwide, in mixed and permanent dentitions, Angle Class I malocclusion is more prevalent than Class II,
specifically among Africans; the least prevalent was Class III, although higher among Mongoloids in mixed dentition.
In vertical dimension, open bite was highest among Mongoloids in mixed dentition. Posterior crossbite was more preva-
lent in permanent dentition in Europe.
Keywords: Prevalence. Malocclusion. Global health. Population. Permanent dentition. Mixed dentition.
1
Jazan University, College of Dentistry, Department of Preventive Sciences, How to cite: Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C.
Division of Orthodontics and Dentofacial Orthopedics (Jazan, Saudi Arabia). Global distribution of malocclusion traits: A systematic review. Dental Press J Or-
2
Ibb University, Faculty of Oral and Dental Medicine, Department of thod. 2018 Nov-Dec;23(6):40.e1-10.
Orthodontics and Dentofacial Orthopedics (Ibb, Republic of Yemen). DOI: https://doi.org/10.1590/2177-6709.23.6.40.e1-10.onl
3
Jazan University, College of Dentistry, Department of Maxillofacial Surgery
and Diagnostic Sciences (Jazan, Saudi Arabia). Submitted: July 12, 2017 - Revised and accepted: June 01, 2018
4
Cairo University, Faculty of Oral and Dental Medicine, Department of
Orthodontics and Dentofacial Orthopedics (Cairo, Egypt). Contact address: Esam Halboub
5
University of Malaya, Faculty of Dentistry, Department of Pediatric Dentistry Department of Maxillofacial Surgery and Diagnostic Sciences
and Orthodontics (Kuala Lumpur, Malaysia). College of Dentistry, Jazan University, Jazan, Saudi Arabia
6
Kyoto University, Graduate School of Medicine, Department of Global Health E-mail: mhelboub@gmail.com
and Socio-epidemiology (Kyoto, Japan).
© 2018 Dental Press Journal of Orthodontics 40.e1 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
online article Global distribution of malocclusion traits: A systematic review
© 2018 Dental Press Journal of Orthodontics 40.e2 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C online article
M = male; F = female.
© 2018 Dental Press Journal of Orthodontics 40.e3 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
online article Global distribution of malocclusion traits: A systematic review
© 2018 Dental Press Journal of Orthodontics 40.e4 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C online article
Final included studies tic methods, had small sample, etc (321)
(n= 53)
© 2018 Dental Press Journal of Orthodontics 40.e5 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
online article Global distribution of malocclusion traits: A systematic review
Permanent dentition
Class'I 78.53 8.56 83.68 12.48 78.93 9.77 60.39 16.76 0.019*
Class'II 15.25 7.06 11.45 9.08 12.26 4.28 33.51 17.73 0.016*
Class'III 6.23 2.68 4.75 4.6 6.32 6.46 6.2 2.75 0.5
Antero-
posterior Increased
16.67 5.61 21.4 13.91 19.79 10.5 20.79 12.38 0.9
overjet
Reversed
2.26 2.17 3.47 2.89 6.09 7 4.37 4.96 0.829
overjet
Deep bite 11.13 6.41 25.83 18.96 23.83 12.95 21.56 13.33 0.227
Vertical
Open bite 5.03 4.32 6.34 3.12 4.01 3.86 4.92 4.82 0.378
Posterior
Transverse 7.08 2.24 7.9 1.78 8.27 2.65 13.08 7.93 0.029*
crossbite
Mixed dentition
Class'II 27.22 20.22 7.5 5.71 21.42 10.4 31.95 12.47 0.024*
Class'III 2.78 0.84 2.48 0.59 5.76 3.91 3.53 1.21 0.226
Antero-
posterior Increased
21.12 8.23 21.23 11.3 25.09 7.62 23.02 5.12 0.841
overjet
Reversed
3.9 5.01 5.25 4.22 4.35 3.63 1.33 0.9 0.348
overjet
Deep bite 14.98 7.73 23.3 15.5 22.09 9.97 37.4 17.62 0.122
Vertical
Open bite 5.57 3.09 8.3 5.31 4.5 7.79 4.18 5.79 0.077
Posterior
Transverse 10.67 8.26 12.13 6.62 17.77 8.47 12.45 6.54 0.832
crossbite
*: Significant at P ≤ 0.05.
© 2018 Dental Press Journal of Orthodontics 40.e6 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C online article
In permanent stage of dentition by ethnic groups, the but the lowest prevalence of Class II malocclusions
highest prevalences of Class I malocclusion and open bite (7.5%). The highest prevalence %gures of Class II,
(89.44% and 7.82%, respectively) were reported among Class III, and open bite malocclusions were reported in
African population, although the difference of the lat- Europe (31.95%), Asia (5.76%), and Africa (8.3%), re-
ter was not statistically signi%cant. However, the high- spectively. Deep bite was signi%cantly higher in Europe
est prevalence of Class II (22.9%) was reported among (37.4%) compared to other geographical areas.
Caucasians. Otherwise, no statistically signi%cant dif- In mixed dentition, African population showed the
ferences were found in prevalence of Class III, increased highest prevalence of Class I (92.47%), but the low-
overjet, reversed overjet, deep bite and posterior cross- est prevalence of Class II malocclusions (5.1%), while
bite between the three main populations (Table 5). Caucasians showed the lowest prevalence of open bite
The global distributions of Class I, Class II, and (3.7%). Mongoloid showed signi%cantly higher preva-
Class III in mixed dentition stage were 72.74%, 23.11% lence of Class III (10.95%). No signi%cant differences
and 3.98%, respectively. The prevalence %gures of in- in the prevalence of other malocclusions were found be-
creased and reverse overjet were 23.01% and 3.65%, re- tween different ethnicities (Table 5).
spectively. Deep overbite and open bite cases were report- The prevalence of Class II was observed less
ed in 24.34% and 5.29%, respectively. Posterior crossbite frequently in permanent than in mixed dentition
represented 11.72% of the total pooled studies (Table 3). (19.56 ± 13.76 and 23.11 ± 14.94%, respectively),
Regarding prevalence of malocclusion in mixed while the prevalence of Class III was observed more
dentition according to geographical location (Table 4), frequently in permanent than in mixed dentition
Africa showed the highest prevalence of Class I (90%) (5.93 ± 4.96 and 3.98 ± 2.75, respectively).
Permanent dentition
Variable Africans Caucasians Mongoloids P-value
Mean SD Mean SD Mean SD
Class'I 89.44 9.34 71.61 15.15 74.87 9.68 0.027*
Class'II 6.76 4.99 22.9 14.07 14.14 4.43 0.006*
Class'III 3.8 4.67 5.92 4 9.63 9.02 0.228
Antero-
posterior Increased
14.62 6.22 22.29 11.77 12.87 6.78 0.132
overjet
Reversed
3.5 2.93 3.99 5.11 10.87 6.68 0.122
overjet
Deep bite 19.02 15.81 22.95 14.07 19.5 16.6 0.587
Vertical
Open bite 7.82 2.24 4.52 4.17 3.27 2.89 0.074
Posterior
Transverse 7.2 1.61 10.08 5.64 7.53 0.31 0.149
crossbite
Mixed dentition
Class'I 92.47 4.41 70.39 14.78 66.75 1.77 0.02*
Class'II 5.1 3.8 25.91 14.86 22.1 0.85 0.028*
Class'III 2.4 0.69 3.53 1.86 10.95 2.33 0.045*
Antero-
posterior Increased
16.4 7.21 23.62 7.3 27.45 11.67 0.305
overjet
Reversed
3.9 3.97 3.15 3.59 8.5 1.77 0.217
overjet
Deep bite 26.37 17.43 24.35 15.13 21.25 10.11 1
Vertical
Open bite 10 5 3.7 3.77 14.15 15.49 0.035*
Posterior 16.2
Transverse 10.77 7.39 11.64 7.49 0.689
crossbite (one case)
*: Significant at P ≤ 0.05.
© 2018 Dental Press Journal of Orthodontics 40.e7 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
online article Global distribution of malocclusion traits: A systematic review
© 2018 Dental Press Journal of Orthodontics 40.e8 Dental Press J Orthod. 2018 Nov-Dec;23(6):40.e1-10
Alhammadi MS, Halboub E, Fayed MS, Labib A, El-Saaidi C online article
permanent dentition. Thilander et al,31 likewise, showed 3) Europe continent showed the highest prevalence
that increased overbite was more prevalent in the mixed of Class II among all continents.
dentition. Such an overbite reduction from the mixed to 4) Class III malocclusion was more prevalent in
the permanent dentition is due to both occlusal stabili- permanent dentition than mixed dentition, conversely
zation involving full eruption of premolars and second %nding for Class II, while all other malocclusions vari-
molars, and the more pronounced mandibular growth.35 ables showed no difference between the two stages.
This also explains the reduction in Class II cases as well
as the increase in Class III cases (reverse overjet as well)
during the period of changing dentition.
In addition to the importance of reporting global mal-
occlusion, it is of an equal importance to report the world-
wide orthodontic treatment needs. We planned to do so if Author’s Contribution (ORCID )
the included studies had covered both issues. This was not
the case, however, and hence we recommend addressing Maged S. Alhammadi (MSA): 0000-0002-1402-0470
this latter issue with a similar systematic review. Esam Halboub (EH): 0000-0002-1894-470X
Mona Saleh Fayed (MSF): 0000-0001-8124-6587
CONCLUSIONS Amr Labib (AL): 0000-0003-1387-9571
1) Consistent with most of the included individu- Chrestina El-Saaidi (CES) 0000-0002-3993-9029
al studies, Class I and II malocclusions were the most
prevalent, while Class III and open bite were the least Conception or design of the study: MSA, AL. Data ac-
prevalent malocclusions. quisition, analysis or interpretation: MSA, EH, MSF,
2) African populations showed the highest preva- AL, CES. Writing the article: MSA, EH, MSF. Critical
lence of Class I and open bite malocclusions, while revision of the article: MSA, EH, MSF, AL, CES. Final
Caucasian populations showed the highest prevalence approval of the article: MSA, EH, MSF, AL, CES. Over-
of Class II malocclusion. all responsibility: MSA, EH.
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