DENTAL AND

FACIAL
ASYMMETRIES

 Stedmans Medical Dictionary defines Symmetry

as equality or correspondance in form of parts

distributed around a centre or an axis, at the two
extremes or poles, or on the two opposite sides
of the body.
Clinically, symmetry means balance while
significant asymmetry means imbalance.

ETIO LO G Y
1. Genetic Factors : These factors have been

implicated in certain conditions like :

. Neurofibromatosis, which has a familial
incidence
associated with a dominant gene
NF 1.
. Hemifacial microsomia, a congenital disorder
affecting the development of the lower half
of the
face, most commonly the ears, mouth and
the mandible.

2.
3.

Clefts of the lip and the palate.

Intra-uterine pressure during pregnancy and
significant pressure in the birth canal during
parturition can have the observable effects
on the bones of the foetal skull. Molding of
the parietal and the facial bones from these
pressure can result in facial asymmetry.
4. Pathologies like osteochondroma of the
mandibular condyle also result in facial
asymmetries, open bite on the involved site
and the deviation of the mandible.

5. Untreated fractures of the mandible.

6. Trauma and infection of TMJ resulting in ankylosis

of the
condyle to the temporal bone.

7.

Environmental factors like sucking habits or

asymmetrical chewing habits caused by dental
caries, extractions and trauma.

 According to Lundstrom, asymmetry can be

described as Qualitative (all or none) and

Quantitative.
From orthodontic point of view, Quantitative
asymmetries include differences in the number
of teeth on each side or the presence of cleft
lip and palate while Qualitative asymmetries
include difference in the size of the teeth, their
location in the arches, or the position of the
arches.

PREVALEN CE:
In general population:
Most people have an asymmetry in the face and

dentition, but it is usually mild (Shah and Joshi, 1978).

Vig and Hewitt (1975) showed an overall asymmetry
present in 36% of children in their study, with the left
side being larger.
No significant gender difference found( Melnik, 1991).
The mandible and the dentoalveolar region exhibited
the greatest degree of symmetry because of the
longest period of growth of the mandible.
History of trauma was found in only 14% of patients
with asymmetry.

 According to Sheats 1998(US),there is 12% of the facial

asymmetry and 21% of the non-coincidence of the dental

midlines. Among orthodontic patients, the most common
asymmetry trait was mandibular midline deviation from the
facial midline. This occurred in 62% of the patients, followed in
descending order of frequency, by lack of dental midline
coincidence 46%, maxillary midline deviation from the facial
midline 39%, molar classification asymmetry 22%, maxillary
occlusal asymmetry 20%, mandibular occlusal asymmetry 18%,
facial asymmetry 6%, chin deviation 4% and nose deviation 3%.

In orthognathic patients: (Server and Proffit

1996)
25% of class II have asymmetry.
40% of class III have asymmetry.
26% of orthognathic cases have facial asymmetry(Proffit 1996)

and 60% of them with asymmetry in the lower jaw and 80% of
them have chin deviation. The midface (primarily the nose)
also was affected in about 30% of the asymmetric patients.
Burden in 1999 showed that 56% of the lay person and 83% of

the orthodontist can recognise 2mm of midline discrepancy.