Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
Published on: Mar 4, 2016
Transcripts - Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
International Journal of Public Health Research
2015; 3(5): 180-191
Published online June 20, 2015 (http://www.openscienceonline.com/journal/ijphr)
Prevalence of Malocclusion and Impacted Canine
in Arab Israelian Population (Arab48)
Muhamad Abu-Hussein1, *
, Nezar Watted2
, Abdulgani Azzaldeen3
, Mohammad Yehia4
, Obaida Awadi5
Department of Pediatric Dentistry, University of Athens, Athens, Greece
Clinics and Policlinics for Dental, Oral and Maxillofacial Diseases of the Bavarian Julius-Maximilian-University, Wuerzburg, Germany
Department of Conservative Dentistry, Al-Quds University, Jerusalem, Palestine
Triangle R&D Center, Kafr Qara, Israel
Center for Dentistry, Research and Aesthetics, Jatt, Israel
Statistics and Actuarial Faculty, University of Haifa, Haifa, Israel
firstname.lastname@example.org (M. Abu-Hussein), email@example.com (N. Watted)
To cite this article
Muhamad Abu-Hussein, Nezar Watted, Abdulgani Azzaldeen, Mohammad Yehia, Obaida Awadi, Yosef Abu-Hussein. Prevalence of
Malocclusion and Impacted Canine in Arab Israelian Population (Arab48). International Journal of Public Health Research.
Vol. 3, No. 5, 2015, pp. 180-191.
The maxillary canine is the second most frequently impacted tooth following third molars. The etiology of the impacted canine
is obscure, but probably multifactorial. There are some evidences that patients with a few certain features of occlusion may be
at higher risk to the development of impacted canine. The aim of this study was to investigate the association between
occurrence of canine impaction and other aspects of occlusion. This study was conducted with patients aged 10, 2 years or
older who consequently presented to Orthodontics clinic/jat, Israel. Prevalence of canine impaction in patients of an
orthodontic clinic were 3,7%. Angle's Class II was more prevalent occlusion, (61,36 %) malocclusion, Angle's Class I
(21,09%),whereas Angle's Class III (17,55%) malocclusion is the least prevalent among Arab population aged 10, 2-39, 5 in
Israel. Canine impaction showed no significant relationship with type of malocclusion.
Canine Impaction, Maxillary Canines, Malocclusion
Occlusion is the relationship of the teeth in the mandibular
arch to those in the maxillary arch as they are brought
together. The occlusion is examined and recorded as part of
the oral examination. Knowledge of the occlusion of each
patient can contribute significantly to complete care and
instruction (1). Recognition of malocclusion assists in the
referral of patients to the orthodontist, gives many valuable
points of reference for patient instruction, and determines
necessary adaptations in techniques (2).
Epidemiological studies on malocclusion have been
primarily concerned with its aetiology and distribution.
Entrenched in these studies is the typological concept that
suggests that all variants from a specified normal are
abnormal (2). The major flaw in this concept is that it is not
easy to define normality, due to the fact that there always
exists degrees of natural variation among individuals of a
In addition, most studies have considered the definition of
malocclusion to be largely synonymous with that of the
Angle’s classification (1,4). Difficulties, therefore, arise
when a continuous variable such as the molar relationship is
divided into a small number of ordinal categories (Class I,
Class II and Class II), which are then treated as a series of
independent variables (5). Angle’s classification, though
clinically useful, is inadequate for epidemiological studies
and as such, indices have had to evolve to focus on means of
uniformly evaluating malocclusion (6).
Occlusion has been defined as the interdigitation of
maxillary and mandibular teeth (7). This description is
misleading in that it implies that occlusion is a static contact
relationship or arrangement of teeth. The practical concept of
International Journal of Public Health Research 2015; 3(5): 180-191 181
occlusion is to recognize the interplay between the teeth,
temporomandibular joint and neuromuscular system (8).
Angle’s description of occlusion is based on the
relationship of the maxillary first permanent molar to the
mandibular first permanent molar. He noted that in normal
occlusion, the mesio-buccal cusp of the upper first molar
articulates in the buccal groove of the lower first permanent
molar (9). Although his concept of occlusion places primary
emphasis on the static relationship of the first permanent
molars, he did say that:“…the sizes, forms, interdigitating
surfaces, and positions of the teeth in the arches are such as
to give one another, singly and collectively, the greatest
possible support in all directions…” implying that the
functional aspect of occlusion is just as important as the static
relationship of teeth to each other. However, later authors still
tended to emphasise the arrangement and alignment of teeth
by anatomic standards without specific functional
considerations for occlusion. (9,10)
The definition of occlusion in terms of alignment of teeth
is not adequate to describe its functional aspect. Instead,
other factors should also be considered, such as excursive
movements, contacts, condylar activity and jaw relationships
during function to impart the view that occlusion is a
dynamic process (11,12). It was on this basis that Roth (1981)
advanced his concept of “gnathology” which incorporated
centric relation, cusp-fossa relationships and canine guidance.
According to this concept, the occlusal anatomy is designed
to guide the mandible to centric relation upon closure(8).
However, its practical application in orthodontics is rarely
feasible because of the difficulty of positioning the posterior
teeth so that every supporting cusp occludes in a fossa
(13,14). This concept is further complicated by and the
controversy surrounding the definition of centric relation
Within the distribution of occlusal forms are the conditions
somewhat arbitrarily designated as ideal, normal and
malocclusion, the precise differences of which are difficult to
Angle (1907) on ideal occlusion stated that, “…each dental
arch describes a graceful curve and that the teeth are so
arranged as to be in greatest harmony with their fellows in
the same arch, as well as with those in the opposite arch.”
From a functional point of view, an ideal occlusion needs to
be in complete harmony with the neuromuscular system and
temporomandibular articulation (9). According to Burdi and
Moyers (13) “ideal” denotes a hypothetical concept or
treatment goal rarely seen in nature. (17)
In a series of publications, Garber pondered with the
philosophical implications of the concepts of normal and
ideal occlusion. He asked,” What is normal occlusion? Does
it [normal] mean an ideal, a goal to be sought after but never
In the literature, there has been a tendency to use the word
“normal” to describe only ideal occlusions (14), thus all
deviations from perfection are labelled malocclusions. The
definition of normal occlusion is problematic.
The usual definition where normal occlusion is presumed
synonymous with ideal occlusion is based on typologic
concepts that require precisely defined ideal "types" which
are static and unchanging. Deviations from the ideal are
viewed as anomalies or degenerations. Typology is a
prestatistical way of thinking that does not recognize the
variation that describes natural phenomena. When typology
is applied to the dentition, hardly anyone has a normal
occlusion (18). The term “normal occlusion” is thus a broad
and vague concept, the boundaries of which are unclear
Figure 1. Angle's Classification Of Malocclusion.
Normal cannot be synonymous with ideal. A biologically
valid concept of normal occlusion includes a range of
occlusal traits that is compatible with health and unimpaired
function (21). It allows for minor deviation from the ideal
that is aesthetically satisfactory and functionally acceptable
and implies variations around an average or mean value
(13,21). The most rigorous definition of normal occlusion
would therefore be a statistical one with stated probabilities
Normal occlusion is generally accepted to be a Class I
molar relationship with good alignment of all the teeth. This
represents a situation that occurs in only 30-40% of the
population (17). (Figure.1)
Summers in 1971 postulated that in epidemiology, normal
occlusion is confusing and thus the term occlusion is
preferred, because it encompasses all variations from an ideal
occlusion to a malocclusion and implies a continuous
variability rather than just the invariable state. (17)
Andrews (1972) reported of six significant characteristics
consistently observed in 120 casts of non-orthodontics
patients with normal occlusion. He had used the centre of the
clinical crowns as reference points and measured the
thickness, tip and torque of each tooth (12). These constants
were referred to as the “six keys to normal occlusion”. The
significant features shared by all the patients were as follows:
a) Molar relationship: Corresponds with the mesiodistal
relationship of upper first permanent molars of Angle with
addition that the distal surface of the disto buccal cusp of the
182 Muhamad Abu-Hussein et al.: Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
upper first permanent molar should made contact and
occluded with the mesial surface of the mesio
buccal cusp of the lower second molar.
b) Correct crown angulation (mesodistal tip of the crown):
The angulation of the facial axis of every clinical crown
should be positive. The extent of angulation varies according
to tooth type. (positive means: the gingival part of the long
axis of each crown in the upper jaw is positioned distally to
the occlusal part of this axis).
c) Correct crown inclination (labiolingual or buccolingual
torque): In upper incisors, the gingival portion of the crown’s
labial surface is lingual to the incisal portion. In all other
crowns, including lower incisors, the gingival portion of the
labial or buccal surface is labial or buccal to the incisal or
occlusal portion. In upper posterior crowns (cuspids through
molars), the lingual crown inclination of the buccal surfaces
is slightly more pronounced in the molars than it is in cuspids
and bicuspids. In lower posterior crowns (cuspids through
molars), lingual inclination progressively increases.
d) Absence of rotations: Teeth should be free of
undesirable rotations. If rotated, a molar or bicuspid occupies
more space than it normally does. A rotated incisor may
occupy less space.
e) Tight proximal contacts: In absence of abnormalities
such as genuine tooth size
discrepancies, contact point should be tight.
f) Flat occlusal plane: The curve of Spee should have no
more than a slight arch with the deepest curve was 1.5 mm
(plane drawn from incisors to second molars). The convex
curve of Spee and mandibular core line bare excessive
potions of the occlusal surfaces.
Works by Roth (1981) had then added some functional
keys to the previous six keys to normal occlusion by
a) Centric relationship and centric occlusion should be
b) In protrusion, the incisors should disclude the posterior
teeth, with the guidance provided by the lower incisal edges
passing along the palatal contour of the upper incisors.
c) In lateral excursions of the mandible, th canine should
guide the working side whilst all other teeth on that and the
other side are discluded.
d) When the teeth are in centric occlusion, there should be
even bilateral contacts in the buccal segments.
Malocclusion has been described as any deviation from the
normal relation of the teeth in the same arch to each other
and to the teeth in the opposite arch (11).
The World Health Organisation (1962) defined
malocclusion as a dentofacial anomaly. A handicapping
dentofacial anomaly is one which causes disfigurement or
which impedes function and requires treatment if it is or is
likely to be an obstacle to the patient’s physical or emotional
well-being. Salzmann (1968) defined a handicapping
malocclusion as one that adversely affects aesthetics,
function or speech. However, measuring disability or
handicap associated with malocclusion is challenging
because the emotional impact of the malocclusion on the
individual does not always seem to be directly related to the
degree of disfigurement (22,23).
The term malocclusion is an imprecise and ambiguous
concept in that it can only be defined in reference to normal
occlusion. The definition of malocclusion originated within
the realm of corrective treatment and is thus biased (24). This
approach directs attention away from the variation normally
found among individuals thus suggesting that all variants
from a specified normal are abnormal (1). The determination
of the point at which normal variation becomes abnormal is
difficult (4) and has been cited as the main contributory
factor in the variation of the prevalence of malocclusion seen
in epidemiological studies (2).
Proffit (1986) elaborated that malocclusion might be
associated with one or more of the following (24):
a) Malalignment of individual teeth in each arch: a tooth in
an arch may occupy a position deviating from the smooth
curve of line by being; tipped, displaced, rotated, in infra-
occlusion, in supraocclusion and transposed.
b) Malrelationship of the dental arches relative to the
normal occlusion: may occur in any of the three planes of
spaces: anteroposterior, vertical or transverse.
A clearer concept of malocclusion would be obtained if the
occlusal variables that it comprises are brought into
consideration (Lombardi, 1982). Since malocclusion is
described as tooth malpositions and/or malrelationships
between arches, it represents a range of deviation from the
ideal (21), and therefore the developing trend has been to
speak of “occlusal variation” or “occlusal traits” in order to
avoid the handicapping connotation of the word
Today malocclusion occurs in the majority of the
population. It is neither a normal or unhealthy condition (14).
Malocclusion is an appreciable deviation from the ideal
occlusion that may be considered aesthetically unsatisfactory
(24) thus implying a condition of imbalance in the relative
sizes and position of teeth, facial bones and soft tissues (lips,
cheek, and tongue). It is important not to equate the
possession of malocclusion with the need for a treatment
instead it should be judged according to dental health,
aesthetic or functional criteria namely: chewing, speech,
breathing and swallowing (24,25).
The earliest published method of recording malocclusion
was Angle’s classification of malocclusion . He believed that
all teeth are essential, yet in function and influence, some
were of greater importance than others, the most important of
all being the first permanent molars, especially the upper first
molars, which were called the keys to occlusion;
a) They are the biggest teeth and their anchorage is
b) Their local position in the occlusal arch supports the
main masticatory duty and operation.
c) They influence the vertical distance of upper and lower
jaws, the occlusal height and aesthetic proportions.
d) As the permanent molars are the first erupting teeth of
permanent dentition, they have “mighty” control on the teeth
erupting later behind and in front of them, as they are forced
International Journal of Public Health Research 2015; 3(5): 180-191 183
to position to the already erupted and in occlusion
functioning first molars.
e) The anomalies in dental positioning are mostly due to a
more prominent dislocated position of the crowns of upper
permanent molars to normal, less and minor due to a
dislocation of their apex.
These findings lead Angle to postulate, that “the first upper
permanent molar, more than any other tooth or anatomical
point gives a precise scientific basis for defining occlusal
disharmony and occlusal anomalies”.
Graber (1992) described Angle’s classification as the only
internationally recognized classification and widely used in
epidemiological study of malocclusion. Despite such praises,
the classification has been criticized by a number of authors.
Graber pointed out that the Angle classification failed to
distinguish between malocclusion and anteroposterior
relationships(14). Rinchuse and Rinchuse (1988) proposed
that the classification was not clear about the description and
definition of different classes and Angle’s writing was
equivocal, leading to possibility of one class overlapping into
another. In addition to the above, several investigations had
provided data that question the reliability of Angle’s
Gravely and Johnson (1974) for example, had
demonstrated a poor intraexaminer and interexaminer
reliability for Angle’s classification, especially in
categorizing Class II division 2 malocclusion (26,27).
After the third molars, the maxillary canine is the second
most frequently impacted tooth in the dental arch. The canine
impaction prevalence ranging from 0.8 to 5.2 percent
depending on the population examined. The prevalence of
palatally impacted maxillary canines varies between 0.8%
and 2.8% .(28)
Maxillary canine impaction represents 2% of orthodontic
patients. In 70% to 85% of canine impactions, the canine is
Various studies have noted several factors associated with
canine impaction such as arch-length deficiency(labial canine
impaction), premaxillary skeletal deficiency (labial
impaction) , maxillary excess (palatal impaction), maxillary
lateral incisor agenesis (unilateral PDC), bilateral small
maxillary lateral incisors, absent of third molars and second
premolars, and peg-shaped maxillary lateral incisor with
absent of maxillary lateral incisor, deficiency in maxillary
The incidence of canine impaction and it’s relation with
Impaction canine has not down on Arab population (Arab48)
The aim of this study was to investigate the association
between occurrence of canine impaction and type of
occlusion in orthodontic seeking patients.
2. Material & Methods
All of the patients whom referred to orthodontic clinic of
Center For Dentistry, Research & Aesthetics, Jatt,
Almothalath, Israel, and Triangle R&D Center, Kafr Qara,
Israel. included in this study. Canine impaction were
confirmed with clinical method and use of panoramic
radiograph by an orthodontist. Patients with pathological
reasons for canine impaction, syndromic patients with
multiple impactions were excluded. An orthodontist selected
type of impaction and occlusal status of patients using
clinical method or panoramic radiographs and PA with Clark
occlusal technique.. The data for each patient was recorded.
The records of 2200 patients attending the Center For
Dentistry, research & Aesthetics, Jatt, Israel, between,
between Jan 2006 to Dec 2013 were examined by intraoral
examination, palpation, and patient records, followed by
panoramic radiographs for the study. Ethical clearance was
obtained from the Institutional Ethical Committee. A written
informed consent was obtained from all the patients. The age
of the patients ranged from 10.2 to 39.5years, with a mean of
The data collected for malocclusion was descriptively
analysed to determine the prevailing percentage of
malocclusion in the examined Arab population in Israel. The
related impacted teeth interferences with malocclusion data
were statistically analyzed using Pearson test and logical
regression for correlation and association by SPSS. (Table.1)
In this study 2200 patients older than 12years (846 male-
38,4% & 1354 female 61.6) assessed for canine
impaction.3,7% of these (82subject) had impacted canine and
96,3% were without impaction. (Table.2) (Table.3) (Fig.2)
The distribution of gender in patients was 36 male / 46
female (43,9% / 56,1%). malocclusion, 46,34% revealed C I
40,24 Cl II malocclusion, and 13,42 % had Cl III
malocclusion and there was not prove any correlation
between canine impaction and type of occlusion (p=0. 068).
(Table.4) (Fig.5) (Table.5) (Fig.6)
In patients with canine impaction 57,9% had agenesis. The
most prevalence of agenesis related to lateral incisor (80 case
in maxilla & 87 case in mandible) and in next sequences is
central incisor (1 case in maxilla & 7case in mandible),
second premolar (32 case in maxilla & 69case in mandible),
canine (2 case in maxilla & 1 case in mandible), first
premolar (5 case in maxilla & 3 case in mandible), second
molar (1 case in maxilla & 2 case in mandible). 21,7% of
impaction patients revealedcrowding. 20,6% of canine
impaction cases had small lateral incisor and there was
significant correlation between impaction and incisor size
(p=0.000). (Table.6) (Fig.7) (Table.7) (Fig.8) (Table.8) (Fig.9)
Many epidemiologic studies regarding the prevalence of
malocclusion have given a vast amount of information on the
different types of malocclusion; Different results have been
obtained by several authors showing the wide range of
184 Muhamad Abu-Hussein et al.: Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
variety in malocclusion between different ethnic races.
Emrich, and Blayney (1965), studied two age group from
Black and White America in USA, Group 1 consisted of 903
Black American aged 6-8-year-old; The result showed high
percentage of normal occlusion (70%) and very low
percentage of Angle Class II malocclusion (5%), Angle Class
I malocclusion found in (23%), and Angle Class III
malocclusion was only in (2%). In group 2 1,476 Black
American aged 12-14 years, the result revealed less
prevalence of normal occlusion (57%), Angle Class I
malocclusion (32%), Angle Class II malocclusion (7%) and
Angle Class III result indicated that the prevalence of
malocclusion as follows: normal occlusion (69%), Angle
Class I malocclusion (18%), Angle Class II malocclusion
(11%) and Angle Class III malocclusion was only in (1%).
whereas on 13475 white American aged 12-14years old, the
result exhibited less prevalence of normal occlusion (54%)
and the prevalence of Angle Class I and II malocclusion were
slightly high (30%) and (15%) respectively and only (1%) of
Angle Class III malocclusion was reported. (29)
Gardiner 1982 investigated 500 Libyan school children
aged 10-12 years and found that the majority had Class I
malocclusion (74%) while crowding was a very common
finding (31%). (30)
Steigman, Kawar, and Zilberman (1983) carried study on
803 Arabian children in Israel aged 13-15-year-old and
reported small percent of normal occlusion (0.3%), Angle
Class I the most common malocclusion ( 85%), followed by
Class II (10.2%) and Class III (1.3%) malocclusion. (31)
Farawana (1987) carried out a preliminary study on
occlusion in Iraq, and found a high percentage of Angle Class
II malocclusion (29.6%) combined with overjet (div I). (32)
El-Mangoury, and Mostafa (1990) studied 501 Egyptians
adults aged 18-24-year-old and recorded high prevalence of
normal occlusion (34.3%) followed by Class I malocclusion
in (33.3%), Class II in (21%) and Class III malocclusion in
(10.9 %) with higher prevalence among females. (33)
Al Emran (1990) studied 500 Saudi boys with a mean age
of 14 years, and concluded that the frequency of
malocclusion among Saudi children (62.4%) was either
dentition, occlusal, or space anomalies. (34)
Heidi Kerosuo, (1991), conducted two studies in Tanzania
and Finland. In the Finnish sample consisted of 205 Boys and
242 girls aged 12-18, and registered that the boys sample
showed that (77%) had Angle Class I malocclusion, Angle
Class II malocclusion in (22%) and Angle Class III
malocclusion in (1%). Further, in the girls sample he noticed
high percent (84%) of Angle Class I malocclusion, (15%)
Angle Class II malocclusion and the percentage of Angle
Class III malocclusion was the same as in boys (1%). (35)
Tipton and Rinchuse (1991) studied 101 dental school
populations in Pittsburgh USA aged 18-32-year-old and
reported normal occlusion in (52%), Angle Class I
malocclusion in (26%), Angle Class II malocclusion in (16%)
and Angle Class III malocclusion in (7%). (36)
Kerosuo, Laine, and Honkala (1991), conducted two
studies in Tanzania and Finland. In Tanzania investigated 340
Tanzanian Boys and 302 Girls aged 11-18-yearold, the result
showed that the boys had very high percentage of Angle
Class I malocclusion (96%), and had the same percentage of
Angle Class II and III malocclusion in (2%). The Girls also
had reported a high prevalence of Angle Class I malocclusion
(95%) and low percentage of Angle Class II and Class III
malocclusion (4%) and (1%) respectively. (35)
Tang, (1994) studied 201 Chinese adults in Hong Kong
aged 20 years old and observed that, (63.7%) were Angle
Class I malocclusion, Angle Class II malocclusion in (16.4%)
and a higher percentage of Angle Class III malocclusion
(19.9%) in the sample. (37)
Alphonso Trottman (1996) examined 99 Black American
in USA aged 3-5-year-old and 139 white American same age
and reported a higher prevalence of Angle CI III
malocclusion (17%) and a lower prevalence of Angle Class II
malocclusion (7%) among the Black American sample. In the
white American; Angle Class II malocclusion was found in
(14%) and Class III in (8%). (38)
Proffit, Fields, and Moray (1998), in the United States;
surveyed the prevalence of malocclusion on 14,000 American
population; in three age groups aged: 18-50-year-old, 12-17-
year-old and 8-11- year-old and observed the same
percentage of normal occlusion (30%), Angle Class I
malocclusion (50%) to (55%) and Angle Class III
malocclusion in (1%) in the three age group. Further he
found that Angle Class II malocclusion was higher in the
small age group (23%). (39)
Saleh (1999) carried out study on 851 Lebanese
schoolchildren aged 9-15-year-old, found that (40.3%) had
normal occlusion, (35.5%) had Angle Class I malocclusion,
(19%) had Angle Class II malocclusion and (5%) had Angle
Class III malocclusion. (40)
Sayin, and rkkahraman (2004) carried out study in 1356
Turkish children with the mean aged 13.57 ±3.16-year-old,
and noticed that the prevalence of Angle Class I
malocclusion was in (64%), Angle Class II in (24.9%) and
Angle Class III in (12%). (41)
Chukwudi (2004) investigated 636 Nigerian adolescents
12-17- year-old in Ibadan and found that (24%) had normal
occlusion. (50%) had Angle Class I malocclusion, (14%) had
Angle Class II, and (12%) had Angle Class III malocclusion.
Soh, Sandham, and Chan (2005), studied 339 Asian men in
Singapore aged 17-22-year-old and noticed a very high
percentage of Angle Class II malocclusion (48%). Angle
Class I malocclusion was found in (17%) and Angle Class III
malocclusion in (18%). (43)
Behbehani, Årtun, Al-Jame, and Kerosuoc, (2005) carried
out an epidemiological study of malocclusion in 1299
Kuwaitis school children aged 13-14-year-old. The result
showed high percentage of Angle Class II malocclusion
(31.2%), Angle class I malocclusion was in (57.8%) and
(11%) had Angle Class III malocclusion.(44)
Josefsson, (2007), conducted study in 263 Swedish and 64
Eastern European immigrant adolescents aged 12 and
13years the result revealed that Angle Class I malocclusion
International Journal of Public Health Research 2015; 3(5): 180-191 185
was found in (47.0%), Angle Class II in (48.8%) and Angle
Class III in (4.2%). On the other hand in the Eastern
European the result was (42.2%) had Angle Class I, (46.9%)
Angle Class II and (10.9%) had Angle Class III. further, the
result of 118 Asian samples, showed Angle Class I in
(54.6%), Angle Class II in (36.2%) and Angle Class III in
(9.2 %). the result of the sample of Other Countries, showed
that Angle Class I was in (47.9%), Angle Class II in (47.9%)
and Angle Class III in (4.2 %). (45)
Mohammad. (2007) studied 398 Iranian children aged 13-
15-yearold in Tabriz. The result showed small percentage of
the children had normal occlusion (4%) and high percentage
of the children had Angle Class III malocclusion (17.1).
Angle Class I malocclusion was found to be reported in (57%)
of the sample whereas Angle Class II malocclusion was
noticed in (21.9%). (46)
Gelgöra (2007), carried out study on 2329 adolescents in
Central Anatolia; aged 12-17-year-old and found the
prevalence of malocclusion as follows: normal occlusion in
(10.1%), Angle Class I malocclusion in (34.9%), Angle Class
II in (44.7%) and Angle Class III malocclusion in (10.3%).
Matilda, Åstrøm AN. (2008), performed study on 1601
Tanzanian Schoolchildren aged 12-14-year-old. The result
exhibited a high prevalence of Angle Class I malocclusion
(93.6%) and low prevalence of Angle Class II malocclusion
(4.4%) and Angle Class III malocclusion (2.0%) (48)
Bernabe, Sheihamb, and Oliveirac (2008), conducted a
research on 1675 Brazilian adolescents aged 15-16-year-old
and recorded the prevalence of malocclusion as follows:
normal occlusion in (12.4%), Angle Class I malocclusion in
(65.8%), Angle Class II malocclusion in (16.6%) and Angle
Class III malocclusion in (5.2%). (49)
AL-Hourani, (2008), conducted study on 58 untreated
subjects in Syria aged 7-13-year-old.the prevalence of Angle
Class I malocclusion was (51.7%), Angle Class II
malocclusion was (37.9%) and Angle Class III malocclusion
was (10.3%). (50)
Chu, (2009) performed study on 120 Chinese young adults
in Hong Kong aged 18-27-year-old. He assessed the
prevalence of malocclusion. The result showed that the most
common malocclusion was manifested Angle Class I in (48%)
Angle Class III in (21%), whereas normal occlusion was
found in (20%) and Angle Class II in (11%). (51)
Sidlauskas, (2009), did a study on 1681 Lithuanian
Schoolchildren aged 7-15-year-old the result indicated that
the prevalence of malocclusion as follows: Angle Class I in
(68.4%), Angle Class II in (27.7%) and Angle Class III in
The present research was the first large population based
study considering the prevalence of normal occlusion and
malocclusion for Arab population in Israel (Arab48). The
results of these and our study is not comparable because our
study accomplished on only orthodontic patients population.
In this study, the rate of canine impaction in women was
more than men (56,1% women, 43,9% men), but the
difference was not significant(p>0.05). Nagahara observed
that the frequency of too the impaction is not different
between men and women (53). Dachi and Howell stated that
girls are likely for canine impaction twice than boys (54).
In our study regarding type of malocclusion, the rate of
impaction was more in cl l, then cl II and cl III respectively.
But between type of malocclusion and canine impaction was
not signify cant difference (p> 0.05). AL Nimri etal found
that palatal canine impaction is more probable in individuals
with malocclusion cl II div2 (55). Basdra also found that the
prevalence of canine impaction is more in individuals with
malocclusion cl II div2 .In another study, this researcher
observed that the prevalence of canine impaction was not
different significantly between patients with cl III
malocclusion and cl II div1 (56,57) .Leifert reported that
Angle classification was not correlated to canine eruption
disorder (58) .
Table 1. Means age.
Age, Impacted Min Max Avg
10.2 39.5 16.2
Table 2. Gender distribution of patients treated without/with impacted
Treated (Orth.) N=2200 %
Female 1354 61.6%
Male 846 38.4%
Impacted 82 3.7%
Non Impacted 2118 96.3%
In general prevalence of malocclusion is considered to be
on increase with evolution and civilization. Although Angle’s
method has been used in recording the malocclusion it does
not reflect the actual orthodontic treatment needs of the
The findings of the present study were as follows:
-Angle's Class II was more prevalent occlusion, (61,36 %)
malocclusion, Angle's Class I (21,09%),whereas Angle's
Class III (17,55%) malocclusion is the least prevalent among
Arab population aged 10,2-39,5 in Israel .
-Prevalence of canine impaction in patients of an
orthodontic clinic were 3,7%
-Canine impaction was usually unilateral
-Canine impaction was not associated with gender.
-Canine impaction showed no significant relationship with
type of malocclusion,
crowding, anterior cross bite and posterior cross bite
-In relation to gender, females had significantly more
Angle's Class I normal occlusion than the males where as
males significantly had more Angle's Class I malocclusion
than the females.
-Canine impaction showed no significant relationship with
type of malocclusion
186 Muhamad Abu-Hussein et al.: Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
Fig. 2. Gender distribution of patients treated.
Fig. 3. Proportion of patients with retention (blue) and without retention (brown).
Fig. 4. Gender distribution in retention.
International Journal of Public Health Research 2015; 3(5): 180-191 187
Fig. 5. Frequency distribution on the type of occlusion.
Fig. 6. Frequency distribution on the type of occlusion im female.
Fig. 7. Frequency distribution on the type of occlusion im female.
188 Muhamad Abu-Hussein et al.: Prevalence of Malocclusion and Impacted Canine in Arab Israelian Population (Arab48)
Fig. 8. Frequency distribution of canine impaction based on the type of occlusion.
Fig. 9. Frequency distribution of canine impaction based on the type of occlusion in male.
Fig. 10. Frequency distribution of canine impaction based on the type of occlusion in female.
International Journal of Public Health Research 2015; 3(5): 180-191 189
Table 3. Prevalance of impacted maxillary canine.
Impacted N=82 %
Female 46 56.1% 2.1% 1.1%
Male 36 43.9% 1.6% 0.8%
Table 4. Frequency distribution on the type of occlusion.
Treated Ortho. N=2200 %
CL. I 464 21.09%
CL. II 1350 61.36%
CL. III 386 17.55%
Table 5. Frequency distribution on the type of occlusion im female.
Female N=1354 %
CL. I 300 22.16%
CL. II 826 61.00%
CL. III 228 16.84%
Table 6. Frequency distribution on the type of occlusion im male.
Male N=846 %
CL. I 164 19.38%
CL. II 524 61.94%
CL. III 158 18.68%
Table 7. Frequency distribution ofcanine impaction based on the type of
Impacted N=82 %
CL. I 38 46.34%
CL. II 33 40.24%
CL. III 11 13.42%
Table 8. Frequency distribution of canine impaction based on the type of
occlusion in male.
Impacted Male N=36 %
CL. I 14 38.89%
CL. II 16 44.44%
CL. III 6 16.67%
Table 9. Frequency distribution of canine impaction based on the type of
occlusion in female.
Impacted Female N=46 %
CL. I 24 52.17%
CL. II 17 36.96%
CL. III 5 10.87%
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