DEVELOPMENT OF OCCLUSION

 Presented By: Department of

Pedodontics & Preventive
Name:Isha
Dentistry
PG student
GNDDC ,SUNAM
MDS 1st year
 Introduction

Early diagnosis and successful treatment of developing

malocclusions can have benefits achieving goal of
occlusal harmony,function,and dental facial aesthetics.
The various stages of occlusal development are:
 Predentate jaw relationship
 The deciduous dentition period
 The mixed(transitional)dentition period
 The permanent dentition period
 Predentate Period
 The neonate has no teeth at this stage

 GUM PADS
 The alveolar process at the time of birth is called the gum pads.
 They are horseshoe shaped pads that are pink,firm, and covered with a
layer of dense periosteum .
 They are divided into two parts by
Dental groove

 Lateral sulcus-Transverse groove

Between canine and first molar .
 Maxillary gum pad is wider & longer.
Infantile open Bite: The only contact
that occurs is around the molar region
while space exists in anterior region normally
helpful in suckling.
NEONATAL TEETH vs NATAL TEETH
ETIOLOGY: Superficial position of tooth germs,increased rate of eruption due to febrile
Incidents,hormonal stimulation and heredity. Eruption depends on osteoclastic activity
Within area of tooth germ.
SYNDROMES ASSOCIATED: Chondro ectodermal dysplasia,
Riga Fede disease,etc.

NEONATAL TEETH:Those premature teeth that erupt

during the neonatal teeth ,from birth to 30 days are
designated neonatal teeth. NEONATAL TEETH

NATAL TEETH:Those precociously erupted that are

Present at the time of birth.
These are more frequent than neonatal teeth.

NATAL TEETH
DECIDUOUS DENTITION PERIOD
 The initiation of primary teeth occurs during first 6 weeks of IUL the
first tooth erupts at the age of 6 months.It takes around 2.5to3.5 years
for all the primary teeth to establish their occlusion.

 CLINICAL FEATURES OF DECIDUOUS DENTITION:

1. GENERAL CHARACTERISTICS
i. Both the dental arches are half round in shape or ovoid
ii. Almost no curve of spee is present
iii. Shallow cuspal interdigitation
iv. Slight overjet and overbite
v. Vertical inclination of the incisors
vi. Little or no crowding.
2.SPACING
 SPACED DENTITION:
Spaced dentition is supposed
to be good as spaces in
between the teeth can be
utilized for adjustment of
permanent successors which
are always larger in size
compared to deciduous
teeth.
These are of two types:
1.Primate spacing
2.Physiologic spacing
 NON-SPACED
DENTITION:
This dentition is highlighted
by lack of space between
primary teeth either due to
small size of jaw or larger
teeth.This type of dentition
usually indicates to crowding
in permanent dentition.
Primate Spaces:
These spaces are very prominent,present between the
maxillary lateral
Incisors and the canines (present medial to maxillary
deciduous canines)
And mandibular canines and first deciduous molars (present
distal to mandibular deciduous canines).These spaces are also
called
Anthropoid or simian spaces as they were initially found in our
ancestral simian species .
Fig. Primate spaces
Physiologic /Developmental spaces:
Present in between all the primary teeth and play an important
role
In normal development of permanent dentition.The total space
present may vary from 0 to 8 mm with an average 4mm in
maxillary arch and 1-7 mm with an average of 3mm in the
mandibular arch.
3.OCCLUSAL RELATIONSHIP
Primary dentition develops quite independently of
other morphologic
process i.e there is little relationship between
primary tooth development
and skeletal maturation.This dentition is complete
after the eruption of
the second primary molars,indicating that location
for permanent teeth
In future has already been determined at this stage.
Terminal Planes:
The relationship of the distal surface of the maxillary and
mandibular
2nd deciduous molars is one of the key factors of that dentition
This is of three types:

 FLUSH TERMINAL PLANE:

a. The distal surfaces of the deciduous second maxillary and

mandibular molars are in a straight line and therefore
situated on the same vertical plane.
It is the most favorable relationship to guide the permanent
molars into class 1.
It is seen in 74%
Flush terminal plane
 MESIAL STEP TERMINAL PLANE:

a. The distal surfaces of the deciduous second mandibular

molar is
more mesial to that of the deciduous second maxillary molar.
Invariably,this guides the permanent molars into
relationship.

b. However,a few can proceed into half cusp class III during
molar
transition and further into full class III relation with
continued
mandibular growth.

c. Seen in 14%.
Mesial step terminal plane Distal step terminal plane
 DISTAL STEP TERMINAL PLANE :

a. The distal surface of the deciduous second mandibular molar is

more distal to that of the deciduous second maxillary molar.This
relationship is unfavorable as it guides the permanent molars into
distal occlusion.

b. Seen in 10%
 ANTERIOR TEETH RELATIONSHIP
 OVERBITE: The distance that incisal edge of the maxillary
incisors overlaps vertically past the incisal edge of the
mandibular incisors .The primary incisors erupt in a deep
overbite which is corrected by eruption of posterior teeth around
5 years of age .The average overbite in the primary dentition is
2mm.
 Edge-to-Edge bite: When incisal edges of the two incisors are
in same plane,this is also called zero overbite.This is most
common due to attrition,lengthening of ramus, and downward-
forward growth of mandible.
 Overjet: Horizontal distance between lingual aspect of
maxillary incisors and labial aspect of mandibular incisors when
teeth are in centric occlusion .Average in primary dentition is 1-2
mm.
CANINE RELATIONSHIP
 Class I: The mandibular canine interdigitates in embrasure
between the maxillary lateral incisor and canine.

 Class II: The mandibular canine interdigitates distal to

embrasure between maxillary lateral incisor and canine.

 Class III: The mandibular canine interdigitates in any other

relation.
Class 1 canine relation Class 2 canine relation

Class 3 canine relation

 ARCH DIMENSIONS
 Arch Size: Size of the primary dental arch is the arch width
between primary canine and second molars.
 Arch length: From the most labial surface of primary
central incisor to canine and to second primary molars.
• Arch circumference: It is determined by measuring the
length of
curved line passing over the incisal edges and buccal cusps
of
teeth from the distal surfaces of primary second molar
around the
arch to the distal surface of second primary molar on the
other side.

• Arch width: Bicanine or bimolar width is called the arch

width.
MIXED DENTITION PERIOD(6 - 12 yrs)
The period during which both the primary and permanent
teeth are present in the mouth together is known as mixed
dentition.
The permanent teeth erupting in place of previous
deciduous teeth called successional teeth.
Whereas those erupting posteriorly to the primary teeth are
called the accessional teeth.
FIRST TRANSITIONAL PERIOD
 This is characterized by emergence of 1st permanent molars
and exchange of deciduous incisors with permanent
incisors.
Emergence of 1st permanent molars:

• The mandibular molars are the first to erupt at around 6

years of age.Their position and relation depends on the
relation of second deciduous molars as they are guided into
dental arch by the distal surfaces of these teeth.

• Early mesial shift:The eruptive forces of first permanent

molars
are strong enough to push the deciduous molars forward in
the arch ,utilizing primate spaces and establishing class I
relationship.
Early mesial shift

Late mesial shift

Late mesial shift: Lacking primate spaces and have non spaced
dentition
thus erupting permanent are not able to establish Class I
relation even
as they erupt.In these cases,the molars establish Class I relation
by
drifting mesially and utilizing the Leeway space after exfoliation
of
deciduous molars and this is called late mesial shift.
Mesial terminal plane Class 1 relation

Distal terminal plane Class 2 relation

Exchange of incisors: The deciduous incisors are
replaced by permanent incisors during this phase.

• Period of transition is from 6.5 to 8.5 years.

• The permanent incisors are larger as compared to their
primary counterparts and thus require more space for
their alignment .
This difference between space available and space required
is called incisal liability.

• MAXILLARY ARCH- 7mm MANDIBULAR ARCH-5mm

Exchange of incisors Change in incisor angulation
Factors that help in alignment of incisors by gaining space are:
• Utilization of interdental spacing of primary incisors-
Avg. 4mm in maxillary arch and 3mm in mandibular arch.

• Increase in intercanine arch width: In males6mm in

maxilla
4mm in mandible.
In females4.5 in maxilla and 4mm in mandible.

• Increase in intercanine arch length:This is due growth of

jaws.

• Change in interincisal angulations: The angle between

maxillary and mandibular incisors is about 150 degree in
primary dentition and 123 degree in permanent
dentition,thus allowing more proclination and gaining space
for incisor alignment.This is called incisor liability.
Second Transitional Period:
In this phase deciduous molars and canines are replaced
by premolars and permanent cuspids and the eruption of
maxillary lateral incisors and canines.This takes 9-11 years
of age and is very critical for the alignment of the erupting
permanent teeth
Replacement of Deciduous Molars and
Canine
• The combined mesiodistal width of
permanent canine
and premolars is less than that of deciduous
canine and
molars. This extra space is called Leeway
space of Nance
and is utilized by mandibular molars
to establish Class I relationship through late
mesial shift.
• It is 1.8 mm (0.9 mm on each side) in
maxillary arch and
3.4 mm (1.7 mm on each side) in mandibular
arch.
• The dimensions of deciduous 2nd molars is
more than
that of 2nd premolars, this excess space is
called as
E-space
Leeway space of Nance
 Eruption of Maxillary Canine
• The other event of significance in second transition period
is eruption of maxillary lateral incisors and canines.
• As the permanent maxillary canines erupt they displace
the roots of maxillary lateral incisors mesially. This force is
transmitted to the central incisors and their roots are also
displaced mesially. Thus, the resultant force causes the
distal divergence of the crown in an opposite direction,
leading to midline spacing . This is called
Ugly Duckling Stage or Broadbent phenomenon. The term
ugly duckling stage indicates the unesthetic appearance
of child during this stage .
• This condition corrects itself after the canines have
erupted. The canines after eruption apply pressure on the
crowns of incisors thereby causing them to shift back to
original positions.
• No orthodontic treatment should be attempted at this
stage as there is a danger of deflecting the canine from its
normal path of eruption.
Broadbent phenomenon
PERMANENT DENTITION
 The entire permanent dentition formed within jaws after
birth
except for the cusps of first molar ,which are formed before
birth.
o Changes seen in permanent dentition are:
 Vertical overbite decreases up to age of 18 years by 0.8 mm
 Horizontal overbite decreases
 Dental arches become shorter
 Overjet decreases by 0.7 mm between 12 and 20 years of
age.
Andrew’s six of keys of occlusion:

 Molar interarch relationship

 Mesiodistal crown angulation
 Labiolingual crown inclination
 Absence of rotation
 Tight contacts
 Curve of spee
 Bolton’s discrepancy
Molar Interarch Relationship
• The distal surface of the distobuccal cusp
of the upper 1st
permanent molar made contact and
occluded with the
mesial surface of the mesiobuccal cusp of
the lower 2nd
molar.
• The mesiodistal cusp of the upper 1st
permanent molar
fell within the groove between the mesial
and middle
cusps of the lower 1st permanent molar.
• The canines and premolars enjoyed a cusp-
embrasure
relationship buccally, and a cusp fossa
relationship
lingually.
 Mesiodistal Crown Angulation
• Crown angulation refers to angulation (or
tip) of the long
axis of the crown, not to angulation of the
long axis of the
entire tooth.
• The gingival part of the long axis of the
crown must be
distal to the occlusal part of the axis. The
long axis of the
crown for all teeth, except molars, is judged
to be the middevelopmental
ridge, which is the most prominent and
centermost vertical portion of the labial or
buccal surface
of the crown. The long axis of the molar
crown is identified
by the dominant vertical groove on the
buccal surface of the crown.
Crown Inclination
• Crown inclination refers to the labiolingual
or buccolingual
inclination of the long axis of the crown, not
to the
inclination of the long axis of the entire
tooth
• Crown inclination is determined by the
resulting angle
between a line 90 degrees to the occlusal
plane and a line
tangent to the middle of the labial or buccal
clinical crown.
• Cervical area of crown is lingually placed
then it is called
as positive crown inclination and if it is
more bucally then
it is called as negative crown inclination.
• Maxillary incisors-positive, mandibular
incisors-negative,
posteriors-negative crown inclination.
Absence of Rotation
• Rotated teeth will occupy more space
hence normal
occlusion should be free from rotation.
• Rotated molars and premolars occupy
more space in the
dental arch than normal, rotated incisors
may occupy less
space than those correctly aligned and
rotated canines
adversely affect esthetics and may lead to
occlusal interferences.
Tights Contacts
• Permanent dentition should have close contact to
optimize space.
• Persons, who have genuine tooth-size discrepancies pose
special problems but in the absence of such abnormalities
tight contact should exist.
 Curve of Spee :
• Occlusal plane should be flat with curve of
Spee not
exceeding 1.5 mm.
• There is a natural tendency for the curve of
Spee to deepen
with time, for the lower jaw’s growth
downward and
forward sometimes is faster and continues
longer than
that of the upper jaw, and this causes the
lower anterior
teeth, which are confined by the upper
anterior teeth and
lips, to be forced back and up, resulting in
crowded lower
anterior teeth and/or a deeper overbite and
deeper curve
of Spee .
(A) A deep curve of Spee
results in a more confined area
for the upper teeth, creating
spillage of the upper teeth
progressively
mesially and distally; (B) A flat
plane of occlusion is most
receptive to
normal occlusion; (C) A reverse
curve of Spee results in
excessive room
for the upper teeth
Self correcting Anomalies:
Anomalies, which arise in the child’s,
developing dentition
during the period of transition from
predentate period to
permanent dentition period and get
corrected on their own
without any dental treatment .
REFERENCES
 Textbook of Pediatric dentistry , Nikhil Marwah , 4th
edition.

 Textbook of Pedodontics , Shobha Tandon , 2nd edition

 Dental Anatomy , Histology and Development , S.I

Balahji, 3rd edition.

 McDonald and Avery’s Dentistry for the child and

Adolescent, Jeffrey A.Dean ,11th edition.