GROWTH AND DEVELOPMENT OF DENTITION AND OCCLUSION

Growth and Development of occlusion and Dentition 1. Mouth of the neonate 2. Primary Dentition 3. Mixed Dentition Period 4. Permanent Dentition Development of the Primary Dentition 1. Calcification 2. Eruptiom 3. Teeth and systemic disturbances 4. Size and Shape of the primary teeth 5. Anomalies 6. Primary tooth resorption 7. Ankylosis of the primary teeth Prenatal Development Arch form determined as early as the 4th month of prenatal life Determining factors: 1. developing tooth germ 2. growing basal bone

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Mouth of the Neonate - only posterior gum pads are in contact when baby bites - anterior intermaxillary space -jaw relationship not yet established due to: Immaturity of the neuromuscular system Absence of teeth Ill-defined articular eminence - infantile swallowing act -soon they will be segmented to indicate the sites of the developing teeth -maxillary arch is horseshoe in shape -mandibular arch assumes a wider U-shape -maxillary gum pads extend labially and bucally beyond that of the mandible (convex profile) 1. Calcification 2. Eruption 3. Teething and systemic disturbances Fever, vomiting, diarrhea Upper respiratory tract infection, febrile convulsion, bronchitis and other systemic problems. 4. Size and Shape of Primary Teeth Primary Teeth in boys are generally larger than those in girls Primary tooth mass and its mineral content are largely inherited 5. Anomalies Less frequent in the primary than in the permanent 6. Primary Tooth resorption Hastened by inflammation,occlusal trauma Delayed by splinting, absence of permanent successor 7. Anklylosis of Primary Teeth Primary tooth are more likely to be ankylosed than the permanent teeth Lower teeth twice as often as the upper Molars may be ankylosed and eruption may be prevented Resorption is an intermittent process and its during the rest periods that osseous and fusion between bone and cementum occurs Eruption -the movement of the tooth from within the alveolar process until it reaches its antagonist or opposing tooth. Eruption Sexual difference Male is ahead of the female Genetic influence -study conducted by Hatton 78%-effect of heredity on eruption teeth 22% - environmental

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o Calcification- the process by which organic and inorganic materials are deposited in the developing tooth germ thereby o contributing to its hardening o Calcification Sequence of initial calcification of the primary teeth Central Incisors First Molars Lateral Incisors Canines Seconde Molars - 14weeks - 151/2 weeks - 16 weeks - 17 weeks - 18 weeks o o o o

Calcification Genetic control is evident in the Following: 1. crown morphology 2. rate and sequence of growth 3. pattern of calcification 4. mineral content Sexual differences Male ahead of the female for all deciduous teeth

Eruption Eruption of Deciduous Teeth Central Incisors Lateral Incisors Canines First Molars Second Molars - 6-8months - 7-9months - 16-18months - 12-14months - 20-24months

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Primary dental arches a. Interdental spaces b. Primate spaces c. Leeway space d. Overjet and overbite Occlusal relation o Terminal plane Neuromuscular Consideration Helps in having more stable jaw relationship Primary occlusion shows less variability than the permanent and is established by the functional muscle matrix as the teeth erupt.

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Sequence of Eruption of Deciduous Teeth _ AB_DC_E A BDCE By three years of age, the roots of the deciduous teeth are already completed As the deciduous teeth erupt the following happens anterior intermaxillary space closes gradual change from infantile swallowing act to mature swallowing acy establishment of jaw relationship specially with the eruption of the first deciduous molars coupled with the maturing neuromuscular system 2 types of primary dentition: 1. spaced primary dentition(open)

Maturation of the nerves and muscles would really help in maintaining the good position of the mandible.

2.

Primary Dental Arches a. Interdental Spaces Developmental spaces found in-between the anterior deciduous teeth.

Parents would complain about these spaces (dont look good) but for us dentists, this is one of the good signs of primary dentition. It will help in the alignment of the permanent dentition. This is a normal part of the normal processes of growth and development. It may help in the normal alignment of the permanent dentition although, having interdental spaces is not a guarantee that all the permanent teeth would be normally aligned. There are cases of macrodontia (teeth are too big, cannot be accommodated well in the arch).

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Primate spaces Wider developmental spaces found on specific areas of the arch. o Upper arch- between deciduous lateral incisor and deciduous canine (B&C) o Lower arch- between deciduous canine and deciduous first molar (C&D)

Anterior Occlusion -

Occlusion interdigitation of the upper and lower teeth when the jaws are First deciduous teeth to come out are the anterior teeth. (from the central, lateral, first molar, canine, and second molar) Jaw relationship is established once the first deciduous molars have erupted. Initially, after the eruption of incisors, children would seem to bite like having a Class III or mandibular prognathism (upper within the lower) but once the deciduous molars have erupted, they will start to achieve a good occlusion. If not, there may be a problem (mandibular prognathism, etc.)

Development of occlusion starts from the anterior to the posterior

2. non-spaced primary dentition(closed)

Unlike in the permanent, they are labially angulated. In the deciduous, they are more upright.

Anterior teeth are more vertically positioned in the dental arch

Development of the primary Occlusion 1. neuromuscular consideration 2. primary dental arches -interdental spaces -primate spaces -leeway spaces -overjet and overbite 3. Occlusal relation -terminal plane

Overjet- 0-3mm Overbite- 1-2mm Ideally, upper anterior OVER the lower anteriors. Incisor Liability The collective mesiodistal dimensions of the permanent incisor tooth crowns are larger than their deciduous predecessors. The space deficiency in the maxilla it is approximately -7mm. In the mandible it is approximately -5mm. This space deficiency is called Incisor Liability. (B+A+A+B) (2+1+1+2) = Incisor Liability
If you will compare the mesiodistal (MD) width of the deciduous with the MD width of the permanent successors, you would say that the deciduous teeth are smaller than the succedaneous teeth. Take the width of the four incisors (deciduous) minus the width of the permanent successors. The answer is always a negative value. The sum of the deciduous incisors is smaller than the sum of the permanent successors making the incisor liability a negative value.

Posterior Occlusion

DEVELOPMENT OF PRIMARY OCCLUSION

1. Neuromuscular consideration
Maturation of the neuromuscular system would help at the initial stage of the occlusion of the patient. As the muscles and nerves would mature, it will help in the stabilization of the jaw relationship.

Posterior teeth occludes in such a way that the lower molar is one cusp ahead (one cusp mesial) to the upper molar. It is the lower 2nd molar that is bigger than the upper 2nd molar. Deciduous teeth (particularly anteriors) would be smaller than the permanent successors (true for all teeth except for the second deciduous molars which are bigger than the second premolars). Deciduous teeth are smaller mesiodistally as compared to their permanent successors except for the 2nd deciduous molar which is bigger than the succeeding 2nd premolar.

Class 2: the MB cusp (upper 6) occludes on the embrasure between 5 and 6. Mandible is more posterior to the maxilla. Class 3: the MB cusp (upper 6) falls on the DB groove of the lower or maybe on the embrasure of the first molar and the second molar. The mandible is more anterior to the maxilla

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Leeway space Space differential between deciduous canine and molars and permanent canine and premolars. (C+D+E) (3+4+5) = Leeway space Normal leeway space o Upper- .9mm per quadrant Entire arch: 1.8 mm o Lower- 1.7mm per quadrant Entire arch: 3.4 mm

(A), Normal occlusion; (B), Class I malocclusion; (C), Class II malocclusion; (D), Class III malocclusion. Note the position of the mesial cusp of the maxillary molar relative to the mandibular molar in each type of occlusion.

Leeway space is the difference which is a positive value. The size of the E compensates the size of the 5. In some instances, if you end up with a negative value, there will be crowding. If it is more than the normal value, maybe the permanent teeth are extra small as compared to the deciduous teeth then you will have spacing.

Face Profile
Three landmarks: glabella, lip contour and tip of the chin Typical of Class I Straight Profile Most Acceptable Profile (or a slightly convex profile)

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Terminal plane Refers to the relationship of the distal surfaces of upper and lower second deciduous molars (E).

There is a straight relationship at the distal surfaces of the upper and lower deciduous second molars (E). This is called the Terminal Plane.

Types: a. Flush Terminal Plane

If you create a straight relationship on the distal surfaces of the upper and lower E. initially, after the eruption of the deciduous teeth, a flush terminal plane is considered to be normal. The lower is occluded one cusp ahead of the upper E. as the child grows older, it should change. Class II, Convex Profile

b.

Distal Step The distal surface of upper E is mesial to the distal surface of lower E. If you will draw a line from the distal surface of the upper E, you will have a step directed to the distal. Thus, it is called Distal Step.
Distal surface of lower E is mesial to the distal surface of the upper E.

c.

Mesial Step

Class III, Concave Profile

FTP may become a distal step. (This is initially the normal relationship.) 1. When there is loss of any tooth anterior to upper E. Tendency of upper E is to drift towards the space. (mesially) 2. Presence of proximal carious lesions on any tooth anterior to upper E or upper E itself so that it drifts mesially. In an extensive Class II lesion, the contact of the tooth and its adjacent tooth is lost so there would be a space and tendency for the tooth to drift to the space. 3. Maybe because of the more forward (anterior) growth of the maxilla as compared with the mandible. The maxilla would be more anterior. FTP may become a mesial step. 1. Early loss of any tooth anterior to lower E. Tendency is for lower E would drift mesially. 2. Presence of carious lesions on the proximal surfaces of any tooth anterior to lower E. 3. When there is more forward growth of the mandible than the maxilla. Manibular hypertrophy. Importance of Terminal Plane (Clinical Significance) This would determine the future relationship of the first permanent molars. First permanent molars Key to occlusion. Determines the classification of malocclusion.

First permanent molars are non-succedaneous teeth because they dont have deciduous predecessors and they would erupt distal to the primary dentition (posterior to E). They would use the the distal surface of the roots and the distal surface of the crown of the E during eruption until it reaches occlusion. In cases wherein E was extracted early, the 1st permanent molars would not have a guide for eruption and would erupt more mesial than the normal. Terminal plane determines the first permanent molar relationship in the future. Flush Terminal Plane first perm. molars would be in a cusp-to-cusp molar relationship Distal Step first permanent molars would be in a Class 2 relationship Mesial Step - first permanent molars would be in a Class 3 relationship

Classification of Malocclusion
Class 1: the MB cusp (upper) occludes on the MB groove (lower). Normal antero-posterior relationship of maxilla and mandible. Most acceptable occlusion. Patient would exhibit a convex FTP Distal Step Mesial Step When will it lead to a Class I? with a slight mesial step