Longitudinal study of

occlusion in the primary dentition

in 3- to 7-year-old children

J. J. RAVN

Department of Pedodontics, Royal Dental College, Copmkagm^. Denmark

RavrijJ. J,: Longitudinal study of occlusion in the primary dentition in 3- to 7-year-old children. Scand. J.
Dent. Res. 1980: 88: 165^170.

Abstract - Tiie material for the study comprises plaster models of 269 Copenhagen children, the
impressions for which were taken during the month each child attained the ages of 3 and 7 years. A
comparison was made of occlusion in the single child in the period. The study illusiirates clearly that the
same given percentage in two age groups is by no means a guarantee that there have been no changes. The
canine relatiomsJaips in particular are utistable during the period of study. The only stable occlusion is
distal occlusion in the primary dentition. This occlusion'isinvariablyraaintaiBedand is always transferred
unchanged to the permanent dentition.

Key words: occlusion; teeth, primary.

J. J. Ravn, Department of Pedodontics, Royal Dental College, 160 Jagtvej, DK-2100 Copenhagen 0,
Denmark.
Accepted for publication 20 January 1980.

It is. generally agreed that occlusion and spacing
of the primary dentition are important to
occlusion in the corresponding permanent denti-
tion (7). Numerous studies have pointed to the
link between extractions in the primary denti-
tion and developnient of the permanent denti-
tion (4, 5, 14). In contrast;, reports on develop-
ment of occlusion in the perm.anent dentition
without early loss of primary teeth are less
common (8, 9, 11). Observers do not agree on
the development of occlusion in the primary
dentition and its influence upon occlusion in the
permanent dentition. BAUME (1) arid SILLMAN
(15) take the view that the primary dentition
remains unchanged from eruption of the full
dentition to the stage at which the secondary
dentition begins or the 6-year teeth erupts while
other researchers claim that the incidence of
children with distal occlusion in the primary
dentition increases from 3 to 6 years of age (6,
10); still others have ascertained an unchanged
number with distal occlusion but a greater
number with mesial occlusion (11). One of the
contributory factors in the matter of occlusion is
the child's sucking habits, a point documented
by several observers (2, 13).
The aim of the present project has been to
attempt to illustrate development of occlusion in
primary dentition on a longitudinal basis and, if
applicable, to study the relationship between
occlusion in primary dentition and the sub-
sequent adjustment of 6-year teeth,, -
166 RAVN
Material and methods
The study was based on a group of 310 children in
Copenliagen, all of whom were examined at the age of
3 years at the city^'s "Royal Dental GoUege (12, i 3). The
• children were re-examined by the Pedodontics
Department ofthe College or by iocal authority dental
practitioners during the month in which they attained
the age of 7 years, and impressions were taken for
models. By the date of re-examimationj the material
had been reduced to 269 children on accoiant of
removal to another area, failure to report for
examination, etc. Information was obtained with
regard to extraction of primari,' teetii and sucking
habits, although in many cases the information
relating to the period 3-7 years of age was recorded at
the age of 7. Oeelusion was determined on the primary
canines and the primary second! molars in aecordance
with the criteria dictated by FOSTER & HAMILTON (3).
The relationship ofthe canines was considered Class 1
or normal if the tip ofthe primary maxillary canine was
in the same vertica! plane as the distal surface of the
mandibular canine in central occlusion. If the tip ofthe
primary' maxillary canine was anterior to the distal
surface of the priinar)'" mandibular canine in central
occlusion it was considered Class 2 or distal occlusion,
and if the tip of the primary m:axillary canine was in
posterior relationship to the distal surface of the
primar>^ mandibolar canine it was considered Class 3
or mesial occlusion. On the basis of tlie termination
pattern of the dental, arehes in centric occlusion, the
relatioBship of the primary second molars was
recorded as straight when tlie distal surfaces of primary
maxillary and mandibular second molars were in the
Table 1
Canine relationship in 269 children aged 3 and 7years
Canine relationship
Right side Left si^
Class 1 Class 1
Class 2 Class 2
Class I Class 2
Class. 2 Class,!
Other combinations
same vertical plane, and as distal when the distal
surface ofthe primary maodibular second molar was in
posterior relationship to that ofthe primar)' maxillary
second molar. If th:e distal surface of the primary
naandibular molar was in anterior relationship to tliat
of the primary maxillary s^econd molar it was
considered normal. Due to loss of primary incisors and
non-er up tion of permanent incisors it was not possible
to assess either the horizontal or the vertical incisor
relations at the age of 7 years. In cases where the
permaneEUt 6-year loolars had erupted and occluded,
their position was related to the distal termination of
the primar^^ second molars. A comparison was made of
occlusion ofthe primary canines and the second molars
at the age of 3 and 7 years, respectively, and any
diifFerences observed were considered in relation to
premature extraction, sucking Iiahits and unknown
factors.
Results
PRIMARY CANINES
Canine relations hips at the age of 7 years are
shown in Table 1, whicb also provides a
co:m.parative indicatiO'O of the same material at
the age of 3 years. It will be noted that the
number of children udth normal canioe relation-
ships, on both sides is the same in the two age
groups (47%). Distal canine relationships al-
tered from 31.6% at 3 years to 24.9% at 7 years.
The number of children with difierent relation-
ships but eitber distal or normal is uniform in tbe
3-year-olds 7-year-olds
128 (47.6%) 127(47.1%)
85 (31..6%) 67 (24.9%)
12 (4.5%) 27 (10.0%)
38(14.1%) 36 (13.4%)
6 (2,5%) 12 (4.5%.)
269 269
 OCCLUSION IN PRIMARY DENTITION 167

Table 2 instances, and in seven instances there could

The cmtine relationship among 128 chitdrm aged 7years and
have been a variety of causes such as sucking,
with Class 1 relations in both sides at the age of 3years abrasion, caries or combinations of these. In the
case of unilateral changes, the explanation was
Canine relationskip' premature los:s of primary teeth in half (12) of the
cases, prolonged sucking habits in six, and no
Right side Left side n immediately apparent explanation in the re-
maining five.
Class 1 Class 1 88 Of the new cases of normal eanine relation-
Class 2 Class 2 12 ships, 20 had originally been distal on both sides;
Class 1 Class 2 12 the cause of the change was quite clearly
Class 2 Class 1 11 termination of the sucking habit in 16 cases,
Other combinations 5 probably abrasion in one case, and no apparent
explanation in three. In 14 cases the change was
from originally distal on the right and normal oo
128
the left, to normal on both sides. The cause in 11
cases was obviously termination of the sucking
habit; the remaining three had different causes
case of distal reladonships on the right side, while (in two cases the treatment of crossbite had
the number with normal relationships on the changed the relationship to normal on both
right side increased from 4.5% to 10.0% from sides).
age 3 to 7 years. Other combinations also altered With regard to cases of distal relationships of
from 2.3% to 4.5%. canines at the age of 3, 41 of the original 85 were
On considering the cases with normal re- still distal at the age of 7, 20 were bilaterally
lationships at the age of 3 years, we fmd 88 out of normal, while 24 were still unilaterally distal and
128 still normal at the age of 7, while 40 had normal on the other side. In six of the latter 24
altered, as indicated in Table 2. In the case of the cases the cause of the change was premature loss
12 altered to distal relationships, migration had of primary teeth; termination of the sucking
occurred as a result of premature extraction of habit was the cause in nine cases, while in the
the primary first molar of the mandible in five remaining nine there were no apparent causes.

Table 3
The primary molar occlusion in 269 children aged 3 and 7yean

Molar o c elusion 3 years 7 years

Right side Left side

Normal Normal 81 (30.1%) 107 (39.8%)

Normal Straight 18 (6.7%) 21 (7.8%)
Straight Normal 34 (12.6%) 22 (8.2%)
Straight Straight 52 (19.3%) 18 (6.7%)
Distal Distal 37 (13.8%) 40 (14.9%)
Other combinations 47 (17.5%) 61 (22.7%)

269 269
168 RA.VN

Of the 26 new cases of distal relationships at the unchanged while nine were changed (three
age of 7 years, 12 had been normal at the age of normal on both sides, four normal on one side,
3; of these, premature extraction was the cause in and two indeterminable occlusion at the age of 7
four cases. Eleven were originally distal on the years). The 12 new with distal occlusion
right and normal on the left (extraction was comprised six with unilateral distal and straight
cause in three cases); two^ had originally been on the other side,, five normal or straight, and one
normal OD the right and distal on the left (one of normal/distal.
these had resulted from extraction at the age of Of the 52 patients with straight termination
3). on both sides, only 10 were unchanged at the age
of 7, while 42 were changed, including 30 to
PRIMARY MOLARS normal on both sides or on one side, and eight to
Molar occlusion in 7-year-olds is shown in Table 3, distal on both sides or on one side. It will be noted
which indicates an increase in the number of that it is primarily a change to normal. There are
normal relationships and a reduction in the only eight new cases of straight/straight from
number with straight terminal occlusion, while what were formerly unilateral cases, with
the remainder are largely unchanged. Of the straight/normal in six cases, and straight/distal
original 81 bilaterally normal, 59 were still in two cases.
normal, while 22 had changed.
In nine cases the cause was clearly premature PERMANENT MOLARS
loss of primary molars. Of the 48 new with The position of the permanent first molars could
normal relationships, 17 had come from straight be assessed in 221 patients (Table 4), whereas
on both sides, 22 from cases with straight on one this was not possible in 48 cases due to lack of
side and normal on the other (i.e. 39 cases of eruption. Normal relationships were to be found
straight changing to normal), three from distal in a total of 103 patients, with termination distal
on both sides, and the remainder from a variety from the primary second molars as shown in
of combinations with no cause immediately Table 5. There was distal occlusion of the
apparent. permanent first molars in 36 patients, of whom
Of the 37 originally distal bilaterally,, 28 were 35 had distal termination on both sides of the

Table 5
Table 4 The relationship of the permanent Jlrst molar occlusion sad the
The relationship of the permanentJirsl molar in 221 children 7 terminal step in the primary dentition in 103 patients with
years old normal occlusion of permanent first molar

Right side Left side Right side Left side

Normal Normal 103 (46.6%) Normal Normal 86

Di.«al Distal 36 (15.8%) Straight Normal 4
Straight Straight 13 (5.9%) Normal Distal 3
Normal Straight 36(16.3%) Normal Straight 3
Straight Normal Straight Straight 1
Other combinations 33 (1,5.4%) Other coinbinations 6

221 103
 OCCLUSION IN PRLMARY DENTITION
primary dentition, the 36th having distal on one
side and straight on the other. Cusp-to-ctisp
arrangement of the permanent iirst molars was
to be found among 13 patients, all with straight
termination in primary dentition. Unilateral
straight and normal was found in 36 cases, all in
accordance with completion of primary denti-
tion. Finally, a number of combinations were
recorded in 33 cases without any clear relation-
ship to the primary dentition but frequently,
however, with the same termination in the
primary dentition.
Discussion
In view of the fact that numerous factors can
influence the occlusal development of the
primary dentition, it is difficult to arrive at any
general conclusion, and the explanation for the
change can be as complex as the cause. Cross-
sectional studies of occlusion at different ages can
thus readily result in misinterpretation. That a
given percentage is the same in two age groups is
by no means a guarantee that there have been no
changes, and the present study illustrates this
clearly. Considering that canine relationships,
for example, at ages 3 and 7 years were normal in
47% of both age groups, it is worth reflecting
that of those originally normal at the age of 3
years only 69% (88 out of 188) were still normal
at the age of 7 years, the remainder being
changes.
Much of the increase in the proportion of
normal at the age of 7 years resulted from cases
which had had straight terminal occlusion at the
age of 3 years. This may be due to difEctilty in
assessing correct termination of the distal
surfaces at the age of 3 years (12) btit in addition
in some cases there was a closing of spacing,
particularly between primary molars, but also
the primate spacing in the mandible, a pheno-
menon previously recorded by other researchers
(9).
It would appear that the most stable occlusion
is distal occlusion of the molars in primary
dentition; this occlusion. is invariably main-
tained and is always transferred unchanged to
169
the permanent dentition. This observation could
well imply certain consequences, in the treatment
of primary dentition, particularly as there is no
especially close relationship between distal
molar occlusion in primary dentition and
sucking habits before the age of 3 years (13).
In an attempt to obtain a ftjller understanding
of the problem, a comparison was made of the
width factors of the canine region in the
maxillarj' and mandibular arches. It was found
that patients with distal relationships on the
whole possess a narrower maxilla, which could
be interpreted as indicating compulsion of the
mandible in a distal direction, thus presenting
the possibility of a change in occltision by an
expansion prior to eruption of permanent
dentition. This possibility is being investigated in
another group of patients.
References
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170 RAVN

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