Early Stages Of Developlement

Late fetal Development and Birth

- During last 3 months of intrauterine life ->
rapid growth -> tripling body mass to
about 3000 gm
- Dental development begins in the third
month -> proceeds rapidly in last 3
months ->development of all primary
teeth and the permanent first molars
starts before birth
- total body mass represented by the head
decreases from the fourth month on
intrauterine life
- the brain case (calvaria) can increase in
length and decrease in width, assuming
the desired tubular form and easing
passaged through the birth canal
- neonatal line across the surface of primary teeth, location varies; under normal circumstances,
the line is so slight that it can be seen only in magnification, but if the neonatal period was
stormy, a prominent area of stained, distorted or poorly calcified enamel can be the result
- postnatally, the normal mandible grows more than the other facial structures, gradually
catches up, producing eventual balanced adult proportions
- small decrease in weight during first 7-10 days of life -> growth disturbance lasting 1-2 weeks
will leave visible record in the enamel of teeth forming at this time -> permanent as well as
primary teeth can be affected by illnesses during infancy and early childhood

A partir del tercer mes de vida el feto puede sobrevivir al parto prematuro.

- Empieza el desarrollo dental

Los tres últimos meses el crecimiento es mucho mas rápido y se triplica la masa corporal. A partir de allí
el desarrollo dental avanza con rapidez.

Cualquier alteración del crecimiento que se produzca tras el nacimiento se refleja en el esmalte.

Línea neonatal  línea leve en la superficie de la dentición primaria, que solo puede apreciarse si se
amplia la superficie dental, pero si el periodo neonatal ha sido accidentado se puede producir una zona
prominente de esmalte teñido, distorsionado o poco calcificado.

INFANCY and EARLY CHILDHOOD: The primary dentition years

PHYSICAL DEVELOPMENT in the PRESCHOOL YEARS

- rapid growth continues with relatively steady increase in height and weight
 INFLUENCES ON PHYSICAL DEVELOPMENT
1. Premature Birth – LOW Birth Weight – Parto prematuro/ bajo peso al nacer
- weight less than 2500gm at birth – greater risk of problems in the immediate postnatal perios
- ELBW ( extremely low birth weight) – less than 1000 gm
- 80% of death in ELBW occur in first 3 days
- Child will gradually overcome initial handicap; can be expected to be small throughout the first
and second years of life
- not an indicator of problems with childhood or adolescent ortho treatment
- Peso < 2500gr al nacer  propensos a sufrir problemas en el periodo posnatal inmediato
- Cuando un niño de bajo peso al nacer supera los 4 días de vida, sus probabilidades de
supervivencia aumentan, a partir de allí dependen de la gravedad de su enfermedad.
- Si sobrevive al periodo neonatal  crecimiento sigue patrón normal
o Serán mas pequeños de tamaño los primeros años de vida
2. Chronic illness – Trastornos crónicos
- 90% of the available energy is taken to meet the requirements for survival and activity, 10% is
left for growth; if the illness occurs then there is less energy left for growth
- Chronically ill children fall behind their healthier peers in height and weight -> if the illness
persists -> growth deficit is cumulative
- El crecimiento esquelético solo avanza cuando las demás necesidades del individuo se han
cubierto.
- Se necesita una cantidad determinada para mantener la vida, otra adicional para la actividad e
incremento de crecimiento
o Sólo 10% para crecimiento
o 90% supervivencia y actividad
- Trastornos crónicos  dejan menos energía del total disponible para mantener el crecimiento.
o Atrasados en altura y peso
o Episodio agudo: interrupción pasajera que si es breve no produce efectos a largo plazo.
o Cuanto mas dura el trastorno mayor será el impacto acumulativo.

3. Nutritional Status – Estado nutricional

- must be a nutritional supply in excess of the amount necessary for mere survival
- inadequate nutrition has similar effect to chronic illness
- additional nutritional intake is not stimulus to more rapid growth
- Para el crecimiento es necesario el aporte de nutrientes que supera la cantidad necesaria solo
para supervivencia
- Nutrición insuficiente: interrumpe el crecimiento
- Nutrición excesiva no supone un estimulo para que el crecimiento sea mas rápido.

4. Secular change in growth and development – Variación secular en el crecimiento y desarrollo

- Lowering In the age of sexual maturation ->recently children have grown faster and matured
earlier
- nutrition, exposure to chemicals with estrogenic effects
- skull proportions changed – head and face taller and narrower
- Los signos de maduración sexual aparecen ahora en muchas niñas mucho antes de las fechas
aceptadas anteriormente
o Por mejor nutrición  permite ganar peso mas rápido  maduración más precoz.
- Nutrición con chemicalias con effecto estrogenico

MATURATION OF ORAL FUNCTION

- Respiration, swallowing, mastication and speech
- Respiratory needs are primary determinant of posture of the mandible and tongue
- To open the airway the mandible must be positioned downward and the tongue moved
downward and forward away from the posterior pharyngeal wall
- Newborn infants are obligatory nasal breathers
- swallowing occurs during last months of fetal life
 - 2 maneuvers of transfer the milk – suckling and swallowing. Suckling – small nibbling
movements of the lips, swallowing with tip of tongue “glued” to lower lip
- Infant’s role is to stimulate the smooth muscle to contract and squirt milk into his mouth -> by
suckling and groove the tongue and allow milk to flow posteriorly into the pharynx and
esophagus
- Infantile swallow -> active contractions of the musculature of
the lips, tongue tip brought forward into contact with the
lower lip and little activity of the posterior tongue or
pharyngeal musculature.
- Tongue-to-lower-lip apposition is so common that it is
adopted at rest
- suckling reflex and infantile swallow disappear during first
year of life
- as the infant matures – increasing activation of the elevator
muscles of mandible as child swallows
- when adding semi-solid and solid food the tongue is forced to
produce more complex way – gather up a bolus, position it
along the middle of the tongue and transport it posteriorly
- youngs’ children chewing – mandible laterally as it opens,
then back toward the midline, closing and bringing teeth into
contact with the food – by the time primary molars erupt, the
juvenile chewing pattern is established
- maturation has the gradient from anterior to posterior -> at birth lips are relatively mature and
capable of vigorous suckling, more posterior structures are quite immature -> as time passes,
greater activity by the posterior parts of the tongue and more complex motions of the
pharyngeal structures are acquired
- front to back maturation is well illustrated by the acquisition of speech
- the first speech sounds are the labial sounds - /m/ /p/ /b/; then tongue tip consonants /t/ /d/;
then sibilant /s/ /z/(tongue tip close to but not against palate); the last speech sound /r/ is not
acquired until age 4 or 5
- habitual non-nutritive sucking – a thumb, finger or similarly shaped objects -> from 6 months to
2 years
- after primary molars erupt during the second year of life -> drinking from the cup
- the adult way of swallowing – cessation of lip activity (i.e. lips relaxed with the tongue tip
placed against the alveolar process behind the upper incisors, and the posterior teeth brought
into occlusion during swallowing
- at age 8 about 60% have achieved adult type of swallowing, the rest are still in transition; a
complete transition may require some months
- Chewing pattern of adult -> opens straight down, moves jaw laterally and brings teeth into
contact. Child moves jaw laterally on opening. Transition from the juvenile to adult -> in
conjunction with eruption of permanent canines at about 12 y.o.

Principales funciones de la cavidad oral:

- Respiración (determinante esencial para la posición de la mandíbula y la lengua)

o Para abrir la vía respiratoria al nacer hay que deprimir la mandíbula y desplazar la lengua
hacia abajo y adelante, alejándola de la pared faríngea posterior  Permite el paso del
aire por la nariz y faringe hacia los pulmones.
- Deglución
o Empiezan durante los últimos meses de vida fetal
o El liquido amniótico es importante estimulo para la activación del sistema inmunitario
o Deglución del lactante / Amamantar: estimula la musculatura lisa para que se contraiga e
inyecte la leche en su boca, después tiene que acanalar la lengua y dejar que fluya hacia la
faringe y esófago. Con la lengua situada anteriormente, en contacto con el labio inferior.
o Succión digital, si persiste no se produce la transición completa a la deglución adulta
- Masticación
 o Desplazamiento lateral de la mandíbula al abrirse, retroceso hacia la línea media y cierre
posterior para poner los dientes en contacto con los alimentos.
 Los adultos abren la boca hacia abajo y después desplaza lateralmente la mandíbula
y pone los dientes en contacto.
 El desarrollo se produce a la vez que la erupción de los caninos, a los 12 años.
o Proceso de maduración de delante hacia atrás. Al principio los labios permiten mamar con
fuerza, mientras que las estructuras posteriores son bastante inmaduras. Con el paso del
tiempo, se requieren mayor actividad de la parte posterior de la lengua y movimientos mas
complejos de las estructuras faríngeas.
- Fonación
o Los primeros sonidos son bilabiales
o Mas tarde consonantes que se pronuncian con la punta de la lengua
o Posteriormente sonidos sibilantes (lengua cerca del paladar)
o Finalmente, r (hasta las 4-5 años)

ERUPTION OF THE PRIMARY TEETH – Erupción de la dentición primaria

- Occasionally a “natal tooth” is present; normally do not erupt until 6 months of age
- Dates of eruption are relatively variable, up to 6 months of acceleration or delay is
within the normal range
- Primary dentition is usually complete at 24-30 months
- Spaces between the teeth are normal throughout the anterior part of the primary
dentition but most noticeable in two locations -> primate spaces -> in maxilla between
lateral and canine, in mandible between canines and first molars

La secuencia se mantiene bastante constante, puede haber diferencias de 6 meses.

- Salen primero los IC inferiores, seguidos del resto de incisivos

- Tras 3-4 meses Erupcionan 1ºM sup e inf
- Después de 3-4 meses mas C sup e inf
- Suele completarse a los 24-30 meses con la erupción de los 2ºM sup y después inf.
- Espacios de primate  espacios en toda la parte anterior. En superior entre IL y C, en inferior entre
C y 1ºM.

LATE CHILDHOOD: THE MIXED DENTITION YEARS – Segunda infancia: los años de
la dentición mixta

Physical Development in Late Childhood - Desarrollo físico en la segunda infancia

- From age 5-6 to the onset of puberty -> important social and behavioral changes -> the maximum
disparity in the development of different tissue systems occurs in late childhood
- By age 7 -> completed neural growth – the brain and brain case are as large as they will ever be;
lymphoid tissue has proliferated beyond the usual adult levels -> large tonsils and adenoids are
common; sex organs has hardly begun and general body growth is only modestly advanced

5-6 años hasta pubertad - Importantes cambios sociales y de conducta, Prolongación del patrón de
crecimiento. Mayor disparidad en el desarrollo de los órganos y tejidos.

- 7 años desarrollo neural completado. Tejido linfoide ha proliferado, amígdalas y adenoides de

gran tamaño. No se ha iniciado el desarrollo de los órganos sexuales

Assessment of Skeletal and Other Developmental Ages - Valoración de la edad ósea y de

otras edades de desarrollo
- Planning orthodontic treatment – can be important to know how much skeletal growth remains ->
evaluation of skeletal age is frequently needed -> timing of treatment for class II patients is
considered -> most effective when done during the adolescent growth spurt -> reliable assessment
of skeletal age must be base on the maturational status
 - Ossification of the boned of the hand and the wrist was for many years the standard for skeletal
development -> 30 small bones, all of which have a predictable sequence of ossification, compared
with standard radiographic images in atlas of the development of the hand and wrist -> correlate
reasonably well with the adolescent spurt in growth of the mandible
- Cervical vertebrae, as seen in cephalometric
radiograph -> CVM method -> are obtained
routinely for ortho patients
- Improvement in assessing growth status relative
to peak growth at adolescence from using hand-
wrist radiographs is not worth extra radiation
except in special circumstances; CVM is better
predictor for timing of the adolescence growth
spurt than chronologic age
- Behavioral age can be important in dental
treatment -> induce to behave appropriately and
cooperate
- Correlation between developmental ages of all types and chronologic ages is quite good, as
biologic correlations go -> correlation of dental age with chronologic is not that good

Se tiene que basar en el grado de maduración de una serie de indicaciones del esqueleto.

- Referencia: osificación de los huesos de la mano y la muñeca

- Radiografía cefalométrica (no requiere radiación adicional)
Paciente de clase II  tto ortodóntico es más eficaz cuando coincide con el estirón puberal.

ERUPTION OF PERMANENT TEETH

- Can be divided in several stages. The nature of eruption and its control before the emergence of
the tooth into the mouth are somewhat different after emergence

PREEMERGENT ERUPTION – ERUPCIÓN Preemergente

- When the crown of tooth is being formed, very slow labial or buccal drift of the tooth follicle within
the bone -> follicular drift is not attributed to the eruption mechanism itself
- Eruptive movement begins soon after the root begins to form -> metabolic activity within the
periodontal ligament is necessary for eruption
- 2 processes are necessary for preemergent eruption -> resorption of bone and primary tooth
roots, and propulsive mechanism then must move the tooth in the direction where the path has
been cleared
- Lack of bone resorption -> incisors cannot erupt, they never appear in mouth -> incisor absent in
mice
- Syndrome of cleidocranial dysplasia -> resorption of primary teeth and bone deficient, fibrous
gingiva and multiple supernumerary teeth also impede normal eruption -> mechanically block the
succedaneous teeth -> if interference is removed, the teeth often erupt and can be brought into
occlusion
- Rate of bone resorption and the rate of tooth eruption are not controlled physiologically by the
same mechanism
- The overlying bone and primary teeth resorb and propulsive mechanism then moves tooth into the
space created by the resorption
- Signal for resorption -> completion of the crown, removes inhibition of the genes necessary for
root formation as well as inhibition of the layer of osteoclasts that forms just above the top of the
crown and creates eruption path
 - Rate of eruption -> apical area remains at the same place while the crown moves occlusally -> if
eruption is mechanically blocked, the proliferating apical area will move in the opposite direction -
> including resorption where it usually does not occur -> dilaceration
- PFE – primary failure of eruption – teeth are not mechanically prevented from eruption because
when they are surgically exposed, no signs or ankylosis -> propulsive mechanism is defective –
mutation in the parathyroid hormone receptor gene (PTHR1) leads to this condition + other genes
involved -> involved teeth DO NOT respond to ortho force and cannot be moved into position ->
abnormality in the periodontal ligament
- Preemergent propulsive mechanism – collagen maturation + Localized variations in blood pressure
or flow, forces derived from contraction of fibroblasts and alterations in extracellular ground
substances of periodontal ligament similar to those occur in thixotropic gels

El movimiento eruptivo comienza poco después de empezar a formarse la raíz.

Requiere dos procesos, que actúan coordinadamente:

- Reabsorción del hueso y las raíces de los dientes primarios por encima de la corona del diente
emergente
o Factor que limita la velocidad en la erupción
- Mecanismo de propulsión debe desplazar el diente en la dirección del camino abierto

POSTEMERGENT ERUPTION
- Once a tooth has emerged into mouth, it erupts rapidly until the occlusal level -> eruption slows as
it reaches occlusal level of other teeth and is in complete function, eruption halts
- Relatively rapid eruption from time the tooth penetrates gingiva until it reaches occlusal level –
postemergent spurt, juvenile occlusal equilibrium – following phase of very slow eruption
- Short-term movements during postemergent spurt -> between 8PM and 1AM -> circadian rhythm -
> growth hormone release
- Application of pressure against erupting teeth -> eruption stopped by force for only 1-3 minutes
- Blood flow in the apical area is contributing factor
- Collagen cross-linking in the periodontal ligament is more prominent after a tooth has come into
occlusal function -> shortening collagen fibers and control mechanism certainly is different
- During juvenile equilibrium -> teeth in function erupt at rate parallel the rate of vertical growth of
mandibular ramus -> as mandible continues to grow -> moves away from the maxilla, creating
space into which teeth erupt
- Ankylosed tooth appears to submerge over period as the other teeth continue to
erupt, while it remains at the same vertical level -> total eruption path of first
permanent molar is 2,5cm -> half is traversed after the tooth has reached
occlusal level and is in function -> if first molar is ankylosed at early age, it can
submerge that will be covered with gingiva as other teeth erupt and bring
alveolar bone along with them
- Rate of eruption parallels the rate of jaw growth -> pubertal spurt in eruption of
teeth accompanies the pubertal spurt in jaw growth -> after tooth is in occlusion,
the rate of eruption is controlled by the forces opposing eruption, not those
promoting it -> from chewing and soft tissue pressures from lips, cheeks or
tongue
- Light pressures of long duration are more important in producing ortho tooth movement -> light
but prolonged pressures might affect eruption
- Adult occlusal equilibrium – when pubertal growth spurt ends -> during adult life teeth continue
to erupt at extremely slow rate, if antagonist is lost a tooth can again erupt more rapidly
- If extremely severe wear occurs -> eruptions may not compensate for the loss of tooth structure ->
vertical dimension of the face decreases
Una vez emerge, el diente erupciona rápidamente hasta aproximarse al nivel oclusal y verse sometido a
fuerzas de masticación. A partir de allí, la erupción disminuye de velocidad y continua hasta alcanzar el
nivel oclusal de los otros dientes.

- Acelerón postemergente: desde el momento en que perfora inicialmente la encía hasta que
alcanza el nivel oclusal
o Solo erupcionan entre las 20:00 y la 1:00, durante las primeras horas del día deja de
erupciona.
- Equilibrio oclusal juvenil: fase posterior de erupción, muy lenta.

ERUPTION SEQUENCE AND TIMING: DENTAL AGE – Sequencia y cronologia de la

erupcion: edad dental
- Transition from primary to permanent dentition begins at age 6 with the eruption of first
permanent molars -> then incisors -> permanent teeth tend to erupt in groups
- Calculation of dental age -> important during mixed dentition years -> determined from 3
characteristics – which teeth have erupted, the amount of resorption of the roots of primary teeth
and amount of development of the permanent teeth
- Comienza a los 6 años, con la erupción de los 1ºM permanentes.
- La edad dental se determina basándose en tres parámetros:
- Dientes que han erupcionado
- Grado de reabsorción de las raíces de los dientes primarios
- Grado de desarrollo de los permanentes.
- AGE 6 -> mandibular central incisor -> permanent mandibular first molar -> permanent maxillary
first molar
- 6 años: IC inferiores, seguida de los 1ºM inferiores y mas adelante 1ºM superiores

- \
- AGE 7 – maxillary central incisors -> mandibular lateral incisors -> root of max. lateral Is advanced
but still 1 year from erupting, canines and premolars are still in the stage of crown completion
- 7 años: IC superiores y IL inferiores
- AGE 8 – maxillary lateral incisors -> 2/3 years of break
- 8 años: IL superiores
o Pasan 2-3 años antes de que emerjan mas dientes permanentes
-

- AGE 9 & 10 – extent of resorption of the primary canines and premolars and the extent of root
development of their permanent successors
- 2-3 years for roots to be completed after the tooth has erupted into occlusion
- 9-10 años: no erupcionan dientes
o Grado de reabsorción de los C y PM primarios
o Grado de desarrollo de las raíces de sus sucesores permanentes
 Los dientes emergen una vez se han completado tres cuartas partes de sus raíces.
 Las raíces necesitan 2-3 años para completar su desarrollo una vez que el diente ha
llegado al contacto oclusal.
- AGE 11 – roots of all incisors and permanent 4 should be well completed; eruption of mandibular
canines, mandibular 4, maxillary 4
- 11 años: erupción de C inferiores, 1ºPM inferiores y 1ºPM superiores
o Arcada inferior  C antes que PM
o Arcada superior  PM mucho antes que C

-
- AGE 12 – remaining succedaneous teeth erupt, second molars are nearing eruption, early
beginnings of 3 molar (mineralization of the crown)
- 12 años: erupción de 2ºM permanentes superiores e inferiores
- By dental age 15 – if 3molar is going to form it should be apparent on the radiographs, and roots
of all other teeth should be completed
- Teeth erupt with considerable degree of variability from chronologic standards
- Change is the sequence is more reliable sign of disturbance than generalized delay or acceleration
- Normal variations – 2molars before lower premos, canines before premos in upper
- 13, 14 y 15 años: culminación del desarrollo de las raíces de los dientes permanentes.
- Change in sequence of eruption is much more reliable sign of disturbance in normal development
than generalized delay or acceleration
- Several reasonably normal variations in eruption sequence have clinical significance -> eruption of
second molars ahead of premolars in the mandibular arch, eruption of canines ahead of premolars
in the maxillary arch and unusually large asymmetries in eruption between the right and left sides
- Early eruption of mandibular second molar -> decrease the space for second premolar and may
lead to its being partially blocked out of arch
- Maxillary canine erupts at about the same time as the maxillary first premolar -> canine probably
forced labially

Space relationships in replacement of the incisors Relaciones espaciales en la sustitución de los

incisivos
- Fase del patito feo: abanicamiento y separación de los incisivos .
- Un diastema central de 2mm o menos es probable que se cierre, mientras que no suele ser
probable que suceda lo mismo con uno que supere inicialmente los 2mm.
- Spacing between the primary incisors is critically important – permanent incisors and canine are
each 2-3mm wider than the primary
- Ugly duckling stage of development – flared and spaced upper incisors, spaces tend to close when
canine erupt – 2mm diastema will probably close spontaneously, larger is unlikely

Space Relationships in replacement of canines and primary molars – Relaciones espaciales

en la sustitucion de los C y M primarios
- E space – space created from the primary molars bigger than permanent
premolars
- Leeway space – 2.5mm on each side of the arch in mandible and 1.5mm in
maxilla
- Flush terminal plane
- Los C permanentes son mas
grandes que los C primarios
y los PM permanentes son
mas pequeños que los
dientes primarios a los que
reemplazan
- Espacio E  espacio
adicional para los dientes
permanentes.
- Espacio de deriva 
2,5mm a cada lado de la
mandíbula, 1,5mm en
arcada superior.
-