DEVELOPING

OCCLUSION-clinical
implications and variations.
PREDENTATE PERIOD
 Gum pads
They are pink, firm and fibrous

Maxillary- horse shoe

shaped

Grooves and Sulci seen

Mandibular

Contact posteriorly
Anterior open bite
Clinical implications or variations

NATAL TEETH AND NEONATAL TEETH

PRIMARY DENTITION: from 6
months to 6 years of age.

As a general rule, the mandibular dentition precedes

the maxillary dentition, except for the maxillary
lateral incisors.
Chronology of eruption of
primary teeth
Lower central incisors
Upper central incisors
Upper lateral incisors
Lower lateral incisors
First molars
Canines
Second molars
Clinical implications or variations
Clinical implications or variations

Neonatal teeth

Eruption Cyst
Characteristics of Primary Dentition

• OVERJET
• OVERBITE
• SPACES IN DENTITION
• RELATIONSHIP OF SECOND
DECIDUOS MOLARS
Sagittal relationship in Primary Dentition

What is ‘OVERJET’?
 Sagittal relationship in Primary Dentition

The incisors usually are in normal overjet relation of 1mm or

in an edge to edge relationship.
Vertical relationship in Primary Dentition

What is ‘OVERBITE?
 Vertical relationship in Primary Dentition

Overbite reduces throughout the primary dentition until the incisors

are edge to edge, which can contribute to marked attrition.
 Clinical implications or variations
•Influence of habits like thumb and digit sucking may lead to :
-Increased overjet
-Anterior open bite

Cross bite
 Spaces in primary teeth

Generalized spacing

Primate spaces
 Clinical implications or variations

• No spacing
• Crowding in
primary teeth

This leads to increased probability of crowding in

permanent dentition as dental arch length
anterior to second primary molars does not
increase after their eruption
 Terminal plane relationship between the distal
surfaces of the maxillary and mandibular second
primary
molars.

Usually because of larger mandibular second molars,

the distal surfaces of the occluding second molars are
flush, whereby the term "flush terminal plane" or straight
terminal plane.

Determining the terminal plane relationships in the

primary dentition stage is of great importance as it
guides the erupting first permanent molars into
occlusion
 Clinical implications or variations

A, Flush terminal planes. B, Mesial step with the C, Distal step with the
mandibular plane mesial mandibular plane to
the maxillary plane. distal to maxillary plane.
MIXED DENTITION: from 6 years
to 12 years of age.
First transitional period

Characterised by:
Eruption of Permanent First Molars
Eruption of Incisors
Chronology of eruption of
permanent teeth
Clinical implications or variations
 Eruption of Permanent First Molars

CLASS l MOLAR RELATION

CLASS ll MOLAR RELATION

CLASS lll MOLAR RELATION

 Eruption of Permanent First Molars

Factors that change molar relationship pattern in

primary molars to that in permanent molars:

• The FIRST PERMANENT MOLARS when erupt , they utilise the

spaces present in the primary teeth to drift mesially. This is called
EARLY SHIFT OF PERMANENT MOLARS

• FORWARD GROWTH OF MANDIBLE

 Clinical implications or variations
The first Permanent Molars may erupt into one of the following occlusal
relationships
 Eruption of Permanent Incisors

The maxillary arch, on the average, has just enough space to

accommodate the permanent lateral incisors when they erupt. In
the mandibular arch, however, when the lateral incisors erupt,
there is on the average 1.6 mm less space available for the four
mandibular incisors than would be required to perfectly align
them.
This difference between the amount of space needed for the
incisors and the amount available for them is called the "incisor
liability." ‘INCISOR LIABILITY’
 Because of the incisor liability, a
normal child will go through a transitory stage of
mandibular incisor crowding at age 8 to 9 even if
there will eventually
be enough room to accommodate all the
permanent teeth in good alignment
Where did the extra space come from to align these
mildly crowded lower incisors?

Most jaw growth is in the posterior, and there is no

mechanism by which the mandible can easily become
longer in its anterior region.

Rather than from jaw growth per se, the extra space
comes from three sources:

• Proclination of incisors
• Eruption of incisors in a wider arc
• Utilization of spaces of primary dentition
• Increase in inter canine width
 Eruption of Permanent Maxillary Incisors

7 years old 9 years old 14 years old

UGLY DUCKLING STAGE

Clinical implications or variations

UGLY DUCKLING STAGE

 Clinical implications or variations
(1)

(2)

Diastema may be caused by an erupted or unerupted

Supernumery tooth in midline(1) or a low frenum(2)
Clinical implications or variations

Thumb sucking and digit habits may lead to

anterior openbite
 Clinical implications or variations

Sometimes the deciduous incisor may be retained leading to palatal

Eruption of Maxillary Incisor
Clinical implications or variations

Permanent Maxillary Incisors may develop palatally

Leading to CROSSBITE
 Intertransitional period
This stage is characterized by continued
eruption of already
erupted permanent teeth. No significant changes occur.
 Second transitional period
This period, characterized by shedding of the primary canines
and molars, emergence of the permanent canines, premolars,
and permanent second molars

Leeway space;
1.8mm in maxilla 3.4 mm in mandible
 This leeway space is utilized by permanent molars as they
drift mesially. This is called late mesial shift.

So that a flush terminal relationship is converted into a

class I molar relationship

Mandibular molar normally moves mesially more than its

maxillary counterpart.
Clinical implications or variations

Improper utilization of LEEWAY SPACE may lead to

CROWDING
WHY??
BECAUSE:

Even if incisor crowding is present, the leeway

space is normally taken up by mesial movement
of the permanent molars.

SOLUTION:
An opportunity for orthodontic treatment is
created at this time.
PERMANENT DENTITION: from
12 years of age to eruption of third
molars
 PERMANENT DENTITION

The overbite often ranges between 10%

and 50%, and the overjet ranges
between 1.0 and 3.0 mm.

Intercanine width : canine to canine.

- ↑ 1-2 mm during primary dentition.

- ↑ 3 mm in mixed dentition.
Growth is completed around 9 years.
Development of the dental arches

Mandible
Maxilla

Changes in Dental Arches from 6 TO 13 yrs

 Clinical implications or variations
(1)

(2)

Tooth – jaw size discrepancy may lead to (1)CROWDING or

(2) DENTAL PROTRUSION
TEETHING
 TEETHING
Teething is the process by which an infant's teeth
sequentially appear by breaking through the gums

The process of teething is sometimes referred to

as "cutting teeth".
 TEETHING
SIGNS:
• General irritability
• Disturbed sleep
• Loss of appetite
• Chewing of objects
• Bruises/swelling in gums:Some blood and bruising during
teething is common in most infants and babies:Not all babies
bleed from the mouth when teething, but in some cases, a
pocket of blood in the gum just above the tooth ruptures.
eruption isn't any more painful than usual. It just looks scary
to parents!
• Excess salivation
•Running nose
•Teething has not been shown to cause fever or diarrhea. A
slight rise of temperature may occur when the teeth come
through the gum, but this does not make a baby ill.
 Historical management of teething

•. Remedies that have been prescribed for teething through the

ages have included blistering, bleeding, placing leeches on the
gums, and applying cautery to the back of the head!

•Lancing

•Systemic medicaments
Opiates and poisons such as lead acetate, mercurials and
bromide. many of these compounds are actually causative of
the symptoms associated with teething!

•The teething relief method under constant debate is the age-old

remedy of rubbing rum or whiskey on the baby's gums.
 Current methods of the
management of teething
Non-pharmacological management
• Teething rings
• Hard, non-sweetened rusks made from flour and
wheatgerm with no sugar or sweetener
• Reassurance

Pharmacological management
• Topical agents
• Systemic analgesics
‘Alternative' holistic medicine
• acupressure,
• aromatherapy,
• and homeopathy
 DIFFERENCES
BETWEEN PRIMARY
AND PERMANENT
TEETH