Malocclusion results from the interaction between genetic and environmental factors, making it essential for orthodontists to understand this interplay for effective diagnosis and treatment. Awareness of genetic influences helps differentiate inherited malocclusions from those caused by environmental factors, facilitating personalized care. Most malocclusions are polygenic/multifactorial, though some specific cases may be strongly influenced by single genes. Heritability estimates vary, with craniofacial traits generally showing higher heritability than dentoalveolar traits. While fluctuating asymmetry reflects environmental stress, genetic factors influence an individual's resilience. Contrary to the belief that genetically caused malocclusions are harder to treat, environmental changes can positively affect polygenic traits. Future research into how environmental factors affect gene expression will enhance treatment strategies, promoting more effective and personalized orthodontic care.