Mixed Dentition Occlusion and

Analysis

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Dr S.E.Jabbarifar
Associate Professor
Department of Pediatric
Dentistry /Isfahan 2009
 Dental Efficiency
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 Definition of a Mixed Dentition
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6edc21 12cde6
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 Mixed Dentition
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 Mixed Dentition
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 Mixed Dentition
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 Mixed Dentition
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Deep overbite

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 Adequate Spacing
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 Adequate Spacing
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 Average Tooth Measurements
Anterior to First Permanent Molar
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Primary Mixed Permanent

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Maxilla 68.2 75.8 74.0
Mandible 61.8 67.8 64.4
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Most tooth mass
during mixed dentition!!

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 Occlusal Changes in the
Mixed Dentition
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• Flush terminal plane may lead to:

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– Class I (with late mesial shift)

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– Class II

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– End to end
• Mesial step may lead to:
– Class I (normally)
– Class III
• Distal step leads to Class II
 Flush Terminal Plane
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Class II

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Class I
(desirable)
FTP
ETE
 Mesial Step
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Class III

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Class I
(desirable)
Mesial
Step
 Disto Step
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Always

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Class II

Disto
Step
 Class II division 1, transverse
dimension
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• Changes in arch length and width follow

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same general pattern as normals
• Class II, div 1 have relative constriction
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of the maxillary arch
• Constriction present at three stages of
dental development, and does not self
correct.
Bishara, et al, “Longitudinal comparisons of dental arch changes in normal and
untreated Class II, division 1 subjects and their clinical implications” AJO,
November 1996.
 Leeway Space
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• Sum of (c-d-e) > (3-4-5)
• This allows more space for 3-4-5
• This "leeway space" averages 1.7 mm. in the
mandibular buccal segment; 0.9 in the maxillary buccal
segment
 Serial Disking
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 Serial Disking
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 Late Mesial Shift
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• Refers to mandibular permanent molar

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moving mesially

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• Good news - if permanent molars are

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ETE, late mesial shift allows mandibular
molar to move into a Class I occlusion
• Bad news - the above reduces arch
length
 Late Mesial Shift (cont.)
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FTP
Molar moves into
this space...

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Class I
 Late Mesial Shift (cont.)
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 Incisor Liability
• Permanent incisors are
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larger than primary

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incisors

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• This difference in size

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is termed "incisor
liability"
• How does the body
create enough room for
the larger, permanent
incisors?
 Overcoming Incisor Liability
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• Interdental spacing of primary incisors

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• Intercanine arch width growth

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• Labial positioning of the permanent

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incisors
• Favorable size ratio between the
primary and permanent incisors
 Overcoming Incisor Liability
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• Interdental spacing of primary incisors

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Good interdental spacing of primary

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incisors allows for better alignment of
the larger permanent incisors.
 Primary Spacing
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 Primary Spacing
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 Overcoming Incisor Liability
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• Intercanine arch width growth

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– width growth creates more room for the

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permanent incisors

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– mandibular intercanine growth occurs
mostly during permanent incisor eruption
– maxillary intercanine growth occurs during
incisor eruption, and continues
– unpredictable
 Intercanine growth
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 Overcoming Incisor Liability
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• Labial positioning of the permanent

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incisors

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– permanent incisors erupt to a more labial

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position
– permanent incisors are angled more
labially
– the above creates more arch length
 Labial Positioning
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 Overcoming Incisor Liability
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• Favorable size ratio between the

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primary and permanent incisors
– size ratio between the primary and

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permanent incisors may be favorable or
unfavorable
– favorable: large primary, small permanent
– unfavorable: small primary, large
permanent
 Mixed Dentition Analysis
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• Why: predict amount of crowding after

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permanent teeth come in
• When: during mixed dentition
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• What: boley guage, models, prediction
table
• Where: your office
• Who: YOU!!!
 MDA Methodology
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• Measure mesial-distal diameter of the

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mandibular incisors and sum

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• Measure space available for mandibular

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incisors
• Subtract #1 from #2; negative number
indicates crowding in the incisor region
 MDA Methodology (cont.)
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• Measure space available for 3-4-5 on

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each side of the arch

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• Calculate from prediction table the size

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of 3-4-5
• Subtract #2 from #1 on each side
 MDA Methodology (cont.)
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• At this point, you should have three
numbers:

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– number for incisor crowding or excess space

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– number for right buccal segment crowding or

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excess space
– number for left buccal segment crowding or
excess space
• Add the three numbers; negative =
crowding, positive = space
 MDA Methodology (maxillary
arch)
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• Use mandibular incisors to predict the

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size of the maxillary 3-4-5
• Do everything else the same as
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described for mandibular teeth

REMEMBER!
 MDA Example
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Left Incisors Right

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Space 19.8 mm

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Available

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Tooth Size 23.0 mm

Difference

Measure 21-12, measure space

available for 21-12
 MDA Example
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Left Incisors Right

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Space 19.8 mm.

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Available

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Tooth Size 23.0 mm.

Difference -3.2 mm.

Subtract tooth size from

space available
 MDA Example
0 0 1 1 0 0 1 0 1 0 1 0 1 1 0 1 0 0 0 1 0 Left
100 1011 Incisors Right

Space 20.1 mm. 19.8 mm. 19.5 mm.

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Available

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Tooth Size 23.0 mm.

Difference -3.2 mm.

Measure space available for

3-4-5 on each side
 Moyer's Prediction Chart
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19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0

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Max 75% 20.6 20.9 21.2 21.5 21.8 22.0 22.3 22.6 22.9 23.1

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Man 75% 20.1 20.4 20.7 21.0 21.3 21.6 21.9 22.2 22.5 22.8
 MDA Example
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Left Incisors Right

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Space 20.1 mm. 19.8 mm. 19.5 mm.

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Available

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Tooth Size 22.2 mm. 23.0 mm. 22.2 mm.

Difference -3.2 mm.

Calculate size of 3-4-5 from

prediction table
 MDA Example
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Left Incisors Right

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Space 20.1 mm. 19.8 mm. 19.5 mm.

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Available

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Tooth Size 22.2 mm. 23.0 mm. 22.2 mm.

Difference -2.1 mm -3.2 mm. -2.7 mm.

Subtract tooth size from

space available on left and right
 MDA Example
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Left Incisors Right

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Space 20.1 mm. 19.8 mm. 19.5 mm.

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Available

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Tooth Size 22.2 mm. 23.0 mm. 22.2 mm.

Difference -2.1 mm -3.2 mm. -2.7 mm.

Total difference is -8.0 mm.

 Allowance for Late Mesial Shift
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• If permanent molars are end to end,

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mandibular molar should move mesially

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to obtain Class I interdigitation.

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• This will decrease the arch length
available for 3-4-5.
• Figure 1.7 mm. per side with ETE
relationship.
 Other Factors Influencing
Amount of Predicted Crowding
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• Anterior-posterior position of incisors

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• Position of molars
• Curve of Spee
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