Prevalence of class I skeletal malocclusion in an orthodontic population: a cross-sectional study
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.168Keywords:
orthodontics, dental occlusion, skeletal class I malocclusion, cephalometryAbstract
Introduction: Skeletal malocclusions result from diverse craniofacial growth patterns. Even individuals with an apparently balanced skeletal relationship (Class I) can present significant dental discrepancies, impacting aesthetics and function.
Objectives: This cross-sectional study aimed to determine the prevalence and distribution of skeletal Class I malocclusions in orthodontic patients at the Fernando Pessoa University Teaching Hospital, Gondomar, and to evaluate clinical variability and its relationship with other diagnostic variables.
Methodology: A retrospective analysis was conducted on 143 lateral cephalometric radiographs (89 females, 54 males; aged ≥ 9 years; mean age 23.6 ± 14.5 years). Skeletal classification was assessed using Ricketts analysis via WebCeph, an AI-based platform requiring careful manual verification of cephalometric landmarks. Skeletal Class I was defined by a facial axis angle of 87° ± 3°. Occlusal variables—Angle’s Classification of molar and canine relationships, overjet, overbite, transverse bite, and dental anomalies of number and form—were evaluated using orthopantomography, intraoral photographs, and study models.
Results: Skeletal Class II was the most prevalent (49.6%), followed by Class I (37.8%) and Class III (12.6%). High occlusal variability was observed within the Class I group, confirming that skeletal balance does not guarantee ideal occlusion. Most Class I patients showed jaw positions within normal parameters.
Conclusions: Skeletal Class I was the second most prevalent pattern, displaying marked occlusal heterogeneity. These findings confirm the lack of direct correspondence between skeletal pattern and dental occlusion, highlighting the need for individualized orthodontic planning even in skeletally balanced patients.
References
Angle EH. Classification of Malocclusion. [Volume: 41, Issue: 3, March, 1899, pp. 248-264]. 1899;41(3):248-264.
Salzmann JA. Orthodontics in Daily Practice. Lippincott; 1974.
Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics. Sixth edition. Elsevier; 2019.
Andrews LF. The six keys to normal occlusion. Am J Orthod. 1972;62(3):296-309. doi:10.1016/S0002-9416(72)90268-0
Ackerman JL, Proffit WR. The characteristics of malocclusion: A modern approach to classification and diagnosis. Am J Orthod. 1969;56(5):443-454. doi:10.1016/0002-9416(69)90206-1
Mageet AO. Classification of Skeletal and Dental Malocclusion: Revisited. Stomatol EDU J. 2016;3(3-4):205-211. doi:10.25241/stomaeduj.2016.3(3-4).art.11
Graber LW, Vanarsdall RL, Vig KWL, Huang GJ, eds. Orthodontics: Current Principles and Techniques. Sixth edition. Elsevier; 2017.
Cakan DG, Ulkur F, Taner TU. The genetic basis of facial skeletal characteristics and its relation with orthodontics. Eur J Dent. 2012;06(03):340-345. doi:10.1055/s-0039-1698971
Enlow DH, Kuroda T, Lewis AB. The morphological and morphogenetic basis for craniofacial form and pattern. Angle Orthod. 1971;41(3):161-188. doi:10.1043/0003-3219(1971)041<0161:TMAMBF>2.0.CO;2
Joshi N, Hamdan Ahmad M., Fakhouri WD. Skeletal Malocclusion: A Developmental Disorder With a Life-Long Morbidity. J Clin Med Res. Published online 2014. doi:10.14740/jocmr1905w
Sassouni V. A classification of skeletal facial types. Am J Orthod. 1969;55(2):109-123. doi:10.1016/0002-9416(69)90122-5
Enlow DH, Kuroda T, Lewis AB. Intrinsic craniofacial compensations. Angle Orthod. 1971;41(4):271-285. doi:10.1043/0003-3219(1971)041<0271:ICC>2.0.CO;2
Qamaruddin I, Alam MK, Shahid F, Tanveer S, Umer M, Amin E. Comparison of popular sagittal cephalometric analyses for validity and reliability. Saudi Dent J. 2018;30(1):43-46. doi:10.1016/j.sdentj.2017.10.002
Ricketts RM. A foundation for cephalometric communication. Am J Orthod. 1960;46(5):330-357. doi:10.1016/0002-9416(60)90047-6
Stăncioiu AA, Motofelea AC, Hușanu AA, et al. Associations of Digital Measurements: Analysis of Orthopantomography Versus Lateral Cephalograms for Evaluation of Facial Asymmetry. J Clin Med. 2025;14(4):1296. doi:10.3390/jcm14041296
Leonardi R, Giordano D, Maiorana F, Spampinato C. Automatic Cephalometric Analysis. Angle Orthod. 2008;78(1):145-151. doi:10.2319/120506-491.1
Yassir YA, Salman AR, Nabbat SA. The accuracy and reliability of WebCeph for cephalometric analysis. J Taibah Univ Med Sci. 2022;17(1):57-66. doi:10.1016/j.jtumed.2021.08.010
Abirami S, George AM, Varghese RM. Prevalence of Skeletal Malocclusions and the Associated Contributing Factors. Int J Pharm Res. 2020;12(sp2). doi:10.31838/ijpr/2020.SP2.268
Ahangar-Atashi MH, Dabaghi-Tabriz F, Ahangar-Atashi S, Rahbar M. Prevalence of Dental Malocclusions in Patients admitted to the Department of Orthodontics, School of Dentistry, Tabriz, in 2016. J Contemp Dent Pract. 2017;18(11):1034-1039. doi:10.5005/jp-journals-10024-2171
Almasri M. The Prevalence of Skeletal Malocclusion in the Southern Aseer Region of Saudi Arabia. Am J Med Sci Med. 2014;2(1):13-15. doi:10.12691/ajmsm-2-1-3
Boeck EM, Lunardi N, Pinto ADS, Pizzol KEDC, Boeck Neto RJ. Occurrence of skeletal malocclusions in Brazilian patients with dentofacial deformities. Braz Dent J. 2011;22(4):340-345. doi:10.1590/S0103-64402011000400014
Borja Espinosa DM, Ortega Montoya EA, Cazar Almache ME. Prevalencia de las maloclusiones esqueletales en la población de la provincia del Azuay - Ecuador. Res Soc Dev. 2021;10(5):e24010515022. doi:10.33448/rsd-v10i5.15022
Caccianiga P, Mantovani LG, Baldoni M, Caccianiga G. Distribution of Malocclusion Traits in the Pediatric Population of Milan: An Observational Study. Int J Environ Res Public Health. 2022;19(21):14199. doi:10.3390/ijerph192114199
Erum G e, Fida M. PATTERN OF MALOCCLUSION IN ORTHODONTIC PATIENTS: A HOSPITAL BASED STUDY. J Ayub Med Coll Abbottabad. Published online 2008.
Halwai HK, Gautam V, Pandey M. Distribution of different Skeletal pattern in Patients seeking Orthodontic Treatment in Mid-western Nepal. Orthod J Nepal. 2016;6(2):7-9. doi:10.3126/ojn.v6i2.17412
Kassis A, Serhal JB, Nassif NB. MALOCCLUSION IN LEBANESE ORTHODONTIC PATIENTS: AN EPIDEMIOLOGIC AND ANALYTIC STUDY. 2010;1(1):34-43.
Oshagh M, Ghaderi F, Pakshir HR, Baghmollai AM. Prevalence of malocclusions in school-age children attending the orthodontics department of Shiraz University of Medical Sciences. East Mediterr Health J. 2010;16(12):1245-1250. doi:10.26719/2010.16.12.1245
Ota S, Hirakata C, Endo T. Prevalence and patterns of tooth agenesis among malocclusion classes in a Japanese orthodontic population. J Oral Sci. 2019;61(4):504-507. doi:10.2334/josnusd.18-0319
Tokunaga CS, Katagiri KM, Elorza PH. Prevalencia de las maloclusiones en el Departamento de Ortodoncia de la División de Estudios de Postgrado e Investigación de la Facultad de Odontología de la Universidad Nacional Autónoma de México. Rev Odontológica Mex. 2014;18(3):175-179. doi:10.1016/S1870-199X(14)72068-3
Tsai ZZ, Chang M, Tseng YC. Distribution of Different Skeletal and Dental Relations Among Orthodontic Patients in Recent 5 Years: A Retrospective Study. Taiwan J Orthod. 2023;35(3). doi:10.38209/2708-2636.1342
Zia AU, Qazi HS, Khan WU. The pattern of skeletal representation at Islamabad Dental Hospital: An estimate of their minimum reporting frequency to aid in planning areas of future research. 2013;3(1):11-15.
Al Jadidi L, Sabrish S, Shivamurthy P, Senguttuvan V. The prevalence of malocclusion and orthodontic treatment need in Omani adolescent population. J Orthod Sci. 2018;7(1):21. doi:10.4103/jos.JOS_44_18
Aldrees AM. Pattern of skeletal and dental malocclusions in Saudi orthodontic patients. Saudi Med J. 2012;33.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Athena Health & Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of published papers is assigned to the Journal, but all content is licensed under the terms of Creative Commons Non-comercial 4.0 International License. Thus users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
