Class II MalocclusionLinked to Posterior Rotation of the Temporal Bones

Loss of vertical facial dimension

Blocked primary cuspids

  • A Loss of vertical facial dimension (See Face Photo below)
  • Narrowing the Curve of Spee which can crowd the teeth (See Photo Before), and if severe enough
  • 'Block out' the emergence of the primary cuspids (See Photo Below)

Narrow Curve of Spee

Dental Imbalances Driven by the Foot (Foot Pathomechanics)

Reversing poor posture (postural distortions) in children over the age of 8-9 may require a multi-disciplinary approach even when the postural problem is initiated by abnormal foot motion.

In order to understand the inherent limitations of treating the foot only (e.g., Rothbarts Foot or PreClinical Clubfoot Deformity), a brief discussion of the pathodynamics engaging the feet and teeth is presented below.


Ascending Postural Pattern 

Postural distortions occur sequentially, from bottom to top.


  • Rothbarts Foot or the PreClinical Clubfoot Deformity will drive the innominates anteriorly (externally)
  • Anterior rotation of the innominates can drive the temporal bones into an posterior (external) rotation, the more pronated foot being ipsilateral to the more posteriorly rotated temporal bone (Rothbart, 2008).
  • Posterior rotation of the temporal bones can force the sphenoid bone into an extended and side bent position (unleveling the pupils).
  • This can unbalance the maxilla resulting in:

Type II and Type III Malocclusions  (Rothbarts Model)


The Pure ascending postural distortional patterns that result in Class II and Class III Malocclusions are due to the locked extension or flexion of the sphenoid bone.  Either the Rothbarts Foot or the PreClinical Clubfoot Deformity can result in a Class II Malocclusion.

Rothbarts Triad  (Pure ascending postural distortional pattern)

Foot Twist (pronation)

  • Posterior (External) Temporal Rotation 
  • Extension Sphenoid Bone
  • Class II Malocclusion 

Foot Twist (supination)

  • Anterior (Internal) Temporal Rotation
  • Flexion Sphenoid Bone
  • Class III Malocclusion

My January 2013 study based on 3D rendering of computer models suggests that
Class II  Malocclusions can be the direct result of abnormal pronation.

In October 2013, I published a paper in the Journal of Craniomanidublar and Sleep Practice
that radiographically demonstrates this foot to cranial link.

  • Abnormal foot pronation pulls the innominates bones forward and downward (external rotation) [Rothbart BA 2006 JAPA]
  • Anterior (External) rotation of the innominates drives the temporal bones into Posterior (External) rotation [Rothbart BA 2008 JAPA]
  • External rotation of the temporal bones pushes the sphenoid bone into extension 
  • Sphenoid extension results in a Class II Malocclusion


Reference

     Rothbart BA 2013. Prescriptive Insoles and Dental Orthotics Change the Frontal Plane Position of the Atlas (C1), Mastoid, Malar, Temporal and Sphenoid Bones: A Preliminary Study. Journal of Cranio Manidibular and Sleep Practice, Vol 31(4):300-308.

    Rothbart BA 2008.  Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association, 98(3):01-08, May.

    Rothbart BA 2006. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association; 96(6):499-507