Multidisciplinary management of congenital and acquired compensated malocclusions: diagnosis, etiology and treatment planning.

Restoration of optimal occlusal function, consistent with desirable esthetics and a favorable long-term prognosis, is the clinical goal for management of compensated malocclusions in partially edentulous patients. An appropriate diagnostic work-up includes a careful assessment of etiology, relative to both genetic and environmental factors. Esthetic and cost-effective restoration of occlusal function often requires adjunctive orthodontic therapy, integrated into a comprehensive treatment plan. Alignment of abutments, management of edentulous space and enhancement of soft tissue contours are important preprosthetic objectives. Osseointegrated dental implants provide occlusal stops to open the vertical dimension of occlusion and serve as rigid anchorage for three-dimensional orthodontic alignment of the residual dentition. Carefully coordinated preprosthetic treatment to establish bilateral posterior occlusion (molars and/or implants) is an important goal for achieving a biomechanically-optimized restoration of occlusion. Fundamental diagnostic and treatment planning procedures are reviewed for the multidisciplinary management of partially edentulous, compensated malocclusions. Determining the probable etiology of a malocclusion is an important prerequisite for formulating a treatment plan with a reasonable probability of success. Diagnostic considerations are presented and clinical examples of specific orthodontic methods are illustrated. To demonstrate the application of fundamental principles at the clinical level, a case report is presented with a diagnosis and treatment plan for a malocclusion with both genetic and functional implications.