An overjet causes a rubbery smile

Misaligned teeth: types, causes & correction costs

What is misaligned teeth?

Tooth misalignment (dentoalveolar dysgnathia) is when one or more teeth in the upper or lower jaw are not correctly arranged. This means that they are, for example, crooked, twisted or do not grow out of the intended place.

Misaligned teeth can have aesthetic effects, but they do not necessarily have to be harmful to health. Are the upper incisors z. B. not exactly straight, eating, speaking and teeth cleaning can still function without restriction.

In many cases, however, even small deviations from the ideal tooth position lead to functional restrictions. This can make it difficult to bite off incisors that are tilted.

In addition, misaligned teeth often lead to a higher risk of tooth decay and periodontitis, because irregularly arranged teeth are difficult to maintain with toothbrushes and dental floss, and in many cases they are inadequately cared for. It is all the more important to have a professional teeth cleaning at the dentist twice a year. However, the statutory health insurance does not pay for this.

With DFV-ZahnSchutz you receive up to 200 euros per calendar year for your professional teeth cleaning. The four-time Stiftung Warentest test winner among the additional dental insurance also provides up to 100% reimbursement for the treatment of your tooth or jaw misalignment, regardless of age and KIG classification.

What is jaw misalignment?

If the jaw is misaligned (skeletal dysgnathia), the shape of the upper or lower jaw is impaired (e.g. the upper jaw is too narrow) or the position of the upper and lower jaw is incorrect. Jaw misalignments can lead, among other things, to pain and premature wear of the temporomandibular joints. In addition, they can seriously affect the appearance of the face, e.g. B. when the lower jaw is much smaller or larger than the upper jaw.

Angle classes

For the purpose of a comprehensible diagnosis and evaluation in orthodontics, tooth and jaw misalignments are divided into the classification system of the three Angle classes. Angle classes describe the position of the first large permanent molars (6-year molar) of the upper and lower jaw to one another.

Angle class I (neutral bite): The front cusp of the upper first molar tooth lies between the cusps of the lower first molar tooth when the jaw is closed.

Angle class II (distal bite): When the jaw is closed, the anterior cusp of the upper first molar tooth lies in front of the anterior cusp of the lower first molar tooth.

Angle class III (mesial bite): The front cusp of the upper first incisor lies behind the rear cusp of the lower first incisor when the jaw is closed.

What types of misaligned teeth are there?

Overbite (Angle Class II)

One speaks of an overbite (prognathy) if the upper jaw is too large in relation to the lower jaw (maxillary prognathy) or the lower jaw is too small (mandibular retrognathy), so that the upper jaw protrudes. In normal dentition, the distance between the upper and lower incisors is only about 2 mm. This distance is exceeded in the event of an overbite. As a result, the upper jaw protrudes very far beyond the lower jaw when the mouth is closed.

A slight overbite usually does not cause any problems, while a larger overbite can have consequences that should not be underestimated.

Possible consequences if no correction is made:

  • Respiratory infection
  • snoring
  • Visibly impaired facial profile (receding chin, "buck teeth")
  • Headache and temporomandibular joint pain
  • Muscle tension
  • In the event of falls and accidents, the incisors are particularly at risk, as they lack the hold of the lower incisors.
  • Strong bites, e.g. into an apple, are only possible with difficulty.
  • If the overbite is pronounced, the upper incisors are at great risk of caries due to the lower level of saliva.

Treatment:

In children, the overbite is usually treated with a fixed brace. This curbs the growth of the upper jaw or promotes the growth of the lower jaw. Whether the correction is carried out with a growth-inhibiting brace for the upper jaw or with an apparatus that promotes training for the lower jaw depends on the degree and severity of the misalignment of the front teeth.

Fixed braces to correct the overbite are rarely an option in adults because the jaw has already grown. In severe cases, combined orthodontic and maxillofacial treatment may be required. A slight overbite can be treated with a transparent dental splint.

Deep and cover bite (Angle class II)

Usually the upper incisors cover the lower incisors by about 2-3 mm when clenched. In the case of a deep bite, they reach too far down and cover the incisors in the lower jaw.

In the case of a cover bite (craniomandibular dysfunction), the upper incisors are also tilted inwards. The upper incisors can touch the gums (gingival contact), rub against them or injure them (traumatic gingival contact).

Possible consequences if no correction is made:

  • The roof of the mouth or gums below the lower incisors are injured.
  • The tissue recedes, which can lead to tooth loss.
  • The edges of the incisors can rub on the enamel of the lower row of teeth and thus promote tooth decay.
  • TMJ discomfort

Treatment:

If there is also an overbite, the growth of the upper jaw is inhibited or the growth of the lower jaw is promoted in children. In adults, additional oral surgery is often necessary.

Another treatment method for the deep or cover bite is to move the elongated upper incisors back into the jaw (intrude) or to move the sides that are too short and the lower incisors to grow out (extrude).

Undershot (Angle Class III)

If the lower jaw is too long in relation to the upper jaw (mandibular prognathy) or the upper jaw is too small in relation to the lower jaw (maxillary retrognathy), this is referred to as an undershot (progeny) or underbite.

The misalignment hinders the clenching of the teeth. The lower incisors bite over the upper incisors (frontal cross bite).

Possible consequences if no correction is made:

  • Impaired biting and chewing
  • TMJ discomfort
  • Negative effects on the shape of the face (chin appearing excessively large)

Treatment:

In the case of a very pronounced undershot bite, early treatment of the deciduous teeth makes sense. In childhood and adolescence, the growth of the lower jaw is inhibited and that of the upper jaw is promoted. If orthodontic therapy is not sufficient to correct the undershot bite, orthodontic surgery can be performed in adulthood.

Crowding / lack of space (Angle class III)

If the teeth do not have enough space in the jaw, there is crowding. With primary, hereditary crowding, there is not enough space from the start, while with secondary, acquired crowding, the necessary space has been lost due to tooth migration.

Possible consequences if no correction is made:

  • Difficult dental care
  • Increased risk of tooth decay and periodontal disease

Treatment:

In children and adolescents, jaw growth is stimulated, e.g. B. A jaw that is too narrow is widened so that the teeth have enough space. After enlarging the jaw, the teeth are arranged in the dental arch. Fixed braces are usually used for this.

In adults, the influence on jaw growth is no longer possible. If the crowding is not too pronounced, the teeth are shifted using fixed braces or a transparent dental splint (aligner).

If there is a slight lack of space, it can make sense to carefully grind the teeth from the side. The enamel is then polished and fluoridated and recovers by itself after a few months. This can save a few millimeters of space.

If there is a very pronounced lack of space, it may be necessary to remove the teeth. In most cases the first small molars (4 teeth) are removed. The remaining teeth are then placed in the dental arch with fixed braces.

Displaced / Retained Teeth (Angle Class III)

Teeth that do not erupt at a certain time are referred to as retained (= restrained). If there is also a change in the location of the tooth germ in the bone, one speaks of retention and displacement. Without help, these teeth do not break through at all or only with a long delay and in a different location. If a tooth only partially erupts, it is a question of half retention.

Possible consequences if no correction is made:

  • When teeth are shifted towards the palate (palatal), swelling (tissue swelling) can occur on the palate. In the case of a (vestibular) displacement towards the cheek, swellings in the folds of the envelope are very likely.
  • There is a risk that the displaced teeth will damage the roots of the neighboring teeth if they attempt to erupt in the wrong place.

Treatment:

Shifted teeth that do not endanger other teeth can erupt in the wrong place and then be maneuvered to the right place in the row of teeth as part of an orthodontic treatment with fixed braces.

Crossbite (Angle Class III)

In the case of a crossbite, the cusps of the lower posterior teeth bite laterally past the cusps of the upper posterior teeth. The chewing surfaces of the teeth do not meet correctly when biting because the posterior teeth in the upper jaw are too far inward (palatal = towards the roof of the mouth) or the posterior teeth in the lower jaw are too far out (buccal = towards the cheek).

There are three types of cross bite:

  • Head bite: When clenching, the cusps and dimples of the opposing molars usually mesh, much like gears. The lower incisors are largely covered by the upper incisors. With a head bite, on the other hand, the cusps of the molars in the upper and lower jaw and the edges of the front teeth in the upper and lower jaw meet.
  • Unilateral cross bite: The teeth of the upper and lower jaw bite correctly on one side. On the other hand, the teeth of the lower jaw are too far outside in relation to the upper jaw or the teeth in the upper jaw are too far inside in relation to the lower jaw teeth.
  • Double cross bite: The teeth in the upper and lower jaw clench incorrectly on both sides. The teeth of the lower jaw are too far out in relation to the upper jaw or the teeth in the upper jaw are too far in in relation to the lower jaw teeth.

Possible consequences if no correction is made:

  • Inhibited upper jaw growth
  • The lower jaw can grow unilaterally to the side of the cross bite and cause a "crooked" face.
  • impaired language development e.g. B. Lisp
  • Temporomandibular joint pain and premature wear and tear
  • Impaired chewing function

Treatment:

With a slightly pronounced crossbite, removable or fixed braces can achieve good results.

If the crossbite is very pronounced, braces therapy alone is problematic, as the jaw is incorrectly formed in most cases. Braces cannot then adjust the jaw, but only remedy the consequences of incorrect jaw growth. In these cases, surgery to treat crossbite is usually the better alternative.

Open bite (Angle Class II)

With an open bite, there is a gap that cannot be closed between the upper and lower incisors. The gap between the incisors remains even if the canines and molars are tightly on top of each other.

A frontal open bite denotes the incisors that are not on top of each other, which often leads to lisp and problems pronouncing certain letters. The most common cause is the pacifier, which is used up to daycare and kindergarten age. The continuous sucking and the spacing of the upper and lower jaws can encourage malformation of the jaw.

On the other hand, there is the laterally open bite, which is caused by a genetic predisposition.

Possible consequences if no correction is made:

  • Difficult food intake
  • Speech disorders
  • Mouth breathing, resulting in snoring and the formation of polyps
  • Headache, tiredness from nocturnal restlessness

Treatment:

In childhood, an open bite can usually be corrected well with functional orthodontic devices. If it is clearly beyond the age of growth, an orthodontic correction is usually the only solution to remedy the problem.

Tooth gaps

The term tooth gap (also diastema, ancient Greek for "space") describes too much space between the central incisors in the upper jaw, and more rarely in the lower jaw. A distinction is made between real diastema and fake diastema. The real diastema is mostly hereditary. For example, a lip frenulum that is too deep can prevent the two incisors from growing closer together. It is also possible that the two teeth are simply not wide enough to fill the gap.

In the fake diastema, the two incisors erupt at different times. In some cases, the cause is also a failure or stunting of one or both lateral incisors.

Tooth accidents and periodontal disease also leave tooth gaps. Often neighboring teeth then move into the free gap and leave their original position in the row of teeth, so that further gaps arise.

Possible consequences if no correction is made:

  • The position of other teeth is at risk.
  • The tooth gap provides a nesting place for bacteria.
  • Impaired speech
  • wrong bite
  • crunch
  • Tension in the jaw muscles, which can extend over the neck and into the entire body.
  • Jawbone retreats

Treatment:

Fixed braces move the root of the tooth itself and the gap between the teeth gradually disappears.

Many adult patients prefer invisible braces. In the Invisalign system, transparent splints, similar to a grinding splint, are used. These bring the teeth into the desired position so that the gap gradually closes.

Fixed appliances that are attached to the inside of the teeth are also barely visible and can close gaps between the teeth. This method is known as the lingual technique.

Missing teeth (failure to create teeth)

If teeth are not created (aplasia), permanent teeth are not present from birth, so that after the milk teeth there are no permanent teeth. The milk teeth then stay in the dentition longer than usual. However, since milk teeth do not last as long as permanent teeth, it is to be expected that those affected will have to be provided with dentures at a later point in time.

Aplasia often occurs as a hereditary genetic defect. The failure of teeth can also be the result of a developmental disorder and is one of the most common anomalies.

In most cases the wisdom teeth are missing, which usually does not have any negative effects on the teeth.

Possible consequences if no correction is made:

  • Disorder of the bite (occlusion disorder)
  • the neighboring teeth or the opposite tooth grow into the gap
  • insufficient lip closure
  • disturbed nasal breathing with unfavorable tongue positioning

Treatment:

If teeth are missing, dental implants are often used to fill the gap. Orthodontic gap closure can also be a good alternative. With the help of braces, the teeth are moved in such a way that the gap is closed with your own teeth.

This method of orthodontic therapy is also possible in adults.

Too many teeth (hyperdontia)

Hyperdontia is an excess of teeth. These appear as multiple or double structures, as twin teeth, as amalgamations or as adhesions. Fusion or adhesions can then look like one large tooth.

Possible consequences if no correction is made:

  • Cysts
  • Breakdown of the tooth root from adjacent teeth
  • Different proportions of the lower or upper jaw size
  • Local crowding of teeth
  • Formation of an unusually enlarged jaw segment
  • difficult biting and chewing
  • Asymmetries such as B. Crossbite
  • easily flammable dirt niches
  • Faults in eruption of permanent teeth

Treatment:

Excess teeth should be extracted as early as possible so that a gap can be closed.Plastic splints, removable braces or so-called lingual retainers are used for a complete row of teeth and a stable bite.

Causes of misaligned teeth

Inheritance of misaligned teeth

Tooth misalignments are genetically determined in many cases, as the shape of the dentition is not infrequently hereditary.

A typical congenital jaw misalignment is, for example, a lower jaw that is too large (progeny), which is generally referred to as the "Habsburg lip or chin". The incisors in the lower part of the jaw bite in front of the teeth in the upper part.

Other congenital misalignments are the distal bite, an overbite of the lower jaw and the cover bite. The cleft lip and palate or too many or too few teeth also belong to this category.

Overproduction of growth hormones

In rare cases, misalignments of the jaw and teeth can be caused by hormones. Overproduction of a growth hormone can cause acromegaly. This disease leads to incorrect development of the teeth, the jaw and / or the chewing system.

Unrestored tooth gaps

If a tooth gap is not provided with a dental prosthesis after previous tooth extraction, neighboring teeth can migrate and change the bite over time. Partially retained wisdom teeth also cause displacements and misaligned teeth. Sometimes the lower tooth front is then nested.

Other causes of misaligned teeth or jaw misalignment

Infectious diseases and chronic vitamin deficiencies impair bone structure and thus also the position of the jaw and teeth.

Malfunctions of the tongue motor skills or swallowing muscles as well as sucking the toddler's fingers or baby pacifiers can also lead to malpositions.

Prevent tooth misalignment

Dental care from the first milk tooth

Tooth decay quickly leads to greater damage and pain in small children, as the milk teeth have a very sensitive structure. For this reason, it is all the more important to start dental care as early as the first milk tooth and to attend regular check-up appointments with the dentist. This tracks the development of teeth and jaws and examines whether they are healthy.

Further tips for children's dental care:

  • Clean children's teeth every day from the first tooth. Initially, a soft cloth or a cotton swab is sufficient. A children's toothbrush is recommended later.
  • Use a fluoridated children's toothpaste for the milk teeth. This contains a child-friendly amount of fluoride, which protects the tooth enamel.
  • Let your child brush their teeth from primary school age. Check the dental care and brush if necessary.
  • Get your child used to drinking water or unsweetened teas. Sugar and acidic drinks such as lemonade, fruit juice or sweetened teas should only be drunk rarely. These can damage the sensitive enamel and lead to "peat caries". Constant sucking on the drinking bottle is also harmful to teeth and jaws.

Misaligned teeth: which doctor can help?

The treatment of misaligned teeth and jaws is carried out by dentists and orthodontists. Orthodontics is a branch of dentistry. If a major imbalance in the jaw cannot be treated with orthodontic braces alone, the treatment must be carried out by the oral surgeon.

In these cases, sections of the jaw or the entire jaw can be surgically adjusted. The procedure is carried out in close cooperation between an oral and maxillofacial surgeon and an orthodontist. Oral and maxillofacial surgeons are specialists who have degrees in both medicine and dentistry.

Tooth misalignment: how high are the correction costs?

The exact cost of fixed or loose braces is difficult to quantify, as it always depends on the individual diagnosis and the opinion of the attending physician. The amount is made up of the type of dental regulation, the duration of treatment and the material used. Smaller corrections start at around 500 euros, fixed braces start at 1,500 euros, and a TMJ defect that requires long-term treatment costs 6,000 euros or even more.

What does the GKV pay?

Whether the statutory health insurance pays for a correction in the case of a misaligned tooth or jaw depends on the classification in the orthodontic indication groups (KIG). Since January 2002, the orthodontist has had to assess the misalignment before starting treatment with "grades" of 1-5. The GKV only pays from classification 3. In the case of KIG 1-2, the costs must be borne by yourself, although the therapy may also be medically necessary in these cases. The classification of the malformation of the dentition is based on precisely measurable criteria, is registered by the health insurance companies and checked by the expert.

In the case of KIG 3-5, 80% of the treatment costs for the first child and 90% of the treatment costs for further children are immediately covered by the statutory health insurance. The missing 10% or 20% will only be reimbursed upon successful completion of the treatment. Non-contractual services for optimized orthodontic treatment must be self-financed. This also applies to additional services that shorten the treatment or make it more pleasant.

In the case of the treatment of adult legally insured persons, there is basically no entitlement to reimbursement of costs. The therapy is only financially supported in exceptional cases. Exceptions include severe jaw anomalies such as: B. with congenital malformations, malocclusion caused by bones and jaw misalignments caused by injuries. Here, the statutory health insurance pays a standard treatment after approval by means of a cost estimate.

What does the DFV pay for?

The six-time Stiftung Warentest test winner DFV-ZahnSchutz Exklusiv 100 pays 100% of the costs for all dental and orthodontic treatments - regardless of age and classification level. The insurance cover is valid worldwide, there are no waiting times or health issues. In addition, you can freely choose among the resident, licensed dentists and orthodontists.

Beautiful and straight teeth - with the test winner!

The five-time Stiftung Warentest test winner DFV-ZahnSchutz reimburses up to 100% of the costs for your orthodontic treatment!

  • Up to 100% reimbursement for orthodontic treatments
  • KIG 1 - KIG 5 for children and adults
  • Free choice of orthodontist
  • Without a health issue
  • Without waiting
Ensure the best protection for your smile

FAQs about misaligned teeth

How many millimeters of misaligned teeth does the health insurance company pay for braces?

The statutory health insurance provides benefits when classified in the orthodontic indication groups (KIG) 3-5.

KIG 3:

  • Open bite with a distance of 2 to max. 4 mm
  • Deep bite with overlapping of the upper incisors by more than 3 mm, the lower incisors injure the gums
  • Cross bite on both sides of the jaw
  • Crowding from 3 to max. 5 mm
  • Lack of space with space requirements of over 3 mm

KIG 4:

  • Tooth not created
  • Breakthrough disorder
  • Upper incisors protrude more than 6 to a maximum of 9 mm
  • Undershot: The lower incisors are up to 3 mm in front of the upper incisors
  • Open bite with a distance of more than 4 mm
  • The upper posterior teeth stand on the outside in front of the lower posterior teeth
  • Cross bite on one side of the jaw
  • Crowd of more than 5 mm
  • Lack of space in the jaw with space requirements of over 4 mm

KIG 5:

  • Cleft lip and palate and other developmental disorders in the head area
  • Dislocation of teeth
  • Upper incisors protrude more than 9 mm
  • Undershot: The lower incisors are more than 3 mm in front of the upper ones
  • Open bite with a distance of over 4 mm

What are slight misaligned teeth?

In orthodontics, orthodontic indication groups (KIG) 1 and 2 are considered to be slight misalignments. According to the service catalog of the statutory health insurances, these do not require treatment, so that those affected have to pay for the costs of a correction themselves.

KIG 1:

  • Upper incisors protrude by a maximum of 3 mm
  • Open bite with a distance of the incisor edges up to 1 mm
  • Deep bite with an overlap of the upper incisors of 1 to max. 3 mm
  • Crowding less than 1 mm

KIG 2:

  • Upper incisors protrude more than 3 to a maximum of 6 mm
  • Open bite with a distance of 1 to max. 2 mm
  • Deep bite with overlap of the upper incisors of more than 3 mm, teeth touching the gums.
  • Head bite
  • Crowding from 1 to max. 3 mm
  • Lack of space with space requirements of up to 3 mm

All statements without guarantee.