DEVELOPMENT OF DENTAL

OCCLUSION AND
CONCEPTS OF NORMAL
OCCLUSION N.MOTHI KRISHNA
1ST YEAR MDS
DEPARMENT OF
ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS
INDEX

 INTRODUCTION
 PERIODS OF OCCLUSAL DEVELOPMENT
 PRE-DENTAL PERIOD
 DECIDUOUS DENTITION PERIOD
 MIXED DENTITION PERIOD
 PERMANENT DENTITION PERIOD
 DEVELOPMENT OF THE CONCEPTS OF OCCLUSION
 FICTIONAL PERIOD
 HYPOTHESIS PERIOD
 FACTUAL PERIOD
• ANDREWS SIX KEYS TO OCCLUSION
• CONCLUSION
 INTRODUCTION

DORLAND’S MEDICAL DICTIONARY:

It states that occlusion is the relationship of the maxillary and the
mandibular teeth when they are in functional contact during the activity of the mandible.

In simple terms it is a relationship of upper teeth to the lower teeth when they are in functional contact.
OCCLUSION
• ANGLE defined occlusion as the normal relation of the occlusal inclined
planes of the teeth when the jaws are closed.

• SALZMAN has defined occlusion in orthodontics as the changing

interrelationship of the opposing surfaces of the maxillary and
mandibular teeth which occurs during movements of the mandible and
terminal full contact of the maxillary and mandibular dental arches.

• WHEELERS when the tooth in the mandibular arch come into contact with
the maxillary arch in any functional relation are said to be in occlusion.
STAMP CUSP AND SHEARING CUSP
• The cusp which goes into the fossa of the
opposing teeth is called stamp cusp.
• Example: lingual cusp of upper teeth

• buccal cusp of lower teeth.

• Shearing cusp is the opposite of stamp cusp
which mainly helps in cutting of the food.
• Example: buccal cusp of upper teeth

• lingual cusp of lower teeth

IDEAL OCCLUSION
• An ideal occlusion is the perfect
interdigitation of the upper and
lower teeth, which is a result of
developmental process
consisting of the three main
events, jaw growth, tooth
formation and eruption.
• Simpler terms : esthetically and
physiologically good.
NORMAL OCCLUSION
• Angle’s class 1 is considered
normal where the mesiobuccal
cusp of the maxillary 1st molar
occludes in the mesiobucall
groove of mandibular 1st
permanent molar .
• IDEAL OCCLUSION • NORMAL OCCLUSION

• A coincident midline • Some deviations from ideal

• No crowding , spacing
,rotation.
• Overjet 2-4mm

• Correct crown angulation and

inclination
• Class 1 molar and canine
relation
• A flat curve of spee
MALOCCLUSION
• Any deviation from ideal that may be considered aesthetically or
functionally unsatisfactory is called malocclusion
BALANCED OCCLUSION

CENTRIC RELATIONSHIP

TRAUMATIC OCCLUSION

THERAPEUTIC OCCLUSION
• STATIC OCCLUSION:

Is the study of contacts between the teeth when the jaw is

not moving.The contacts are points(seen as dots when articulating
paper is used).

DYNAMIC OCCLUSION:
Is the study of the contacts that teeth make when the
mandible is moving ,contacts when the jaw moves sideways , forward,
backwards or at an angle. The contacts are not points they are lines.
Pre-dental Period/ Gum Pads Stage
• It extends from birth until the eruption of first primary tooth.

• It usually lasts for six months.

• Usually, a lower central incisor erupt around 6 or 7 months of age.

GUM PADS

 Alveolar processes at time

of birth.

 Pink, firm and covered

by dense layer of fibrous
periosteum.
• The gum pad soon gets segmented by
a groove called transverse groove, &
each segment is a developing tooth site

• The pads get divided into ‘labio-

buccal’ & ‘lingual portion’, by a dental
groove.

• The groove between the canine and

the 1st molar region is called the lateral
sulcus, useful for judging the inter
arch relationship at a very early stage.
 The upper gum pad is horse shoe
shaped & shows:
• Gingival groove: separates gum
pad from the palate.
• Dental groove: starts at the incisive
papilla, extends backward to touch
the gingival groove in the canine
region & then moves laterally to
end in the molar region.
• Lateral sulcus.
 The lower gum pad is ‘U’ shaped and
rectangular, characterized by:

• Gingival groove: lingual extension of

the gum pads.

• Dental groove: joins gingival groove

in the canine region.

• Lateral sulcus.
Relationship of Gum Pads
 Mandibular lateral sulci lies posterior to maxillary lateral sulci.

 Mandibular functional movements are mainly vertical, and to a little extent

antero-posterior. Lateral movements are absent.

 When viewed from above maxilla is larger than mandible.

Status of dentition at birth
• The neonate is without teeth for about 6 months of life.

At birth:

• The gum pads are not suffciently wide to accommodate the developing incisors which are crowded in their

crypts.

During the first year of life:

• The gum pads grow rapidly permitting the incisors to erupt in good alignment.

• A precise bite‟ or jaw relationship is not yet seen.

• Therefore, neonatal jaw relationship cannot be used as a diagnostic criterion for reliable prediction of
subsequent occlusion in the primary dentition.
• Very rarely teeth are found to have erupted at the time of birth.

• NATAL TEETH NEONATAL TEETH.

•

The natal & neonatal teeth are mostly located in the mandibular incisor region.
• They show a familial tendency.

• Pre erupted teeth

Natal/neonatal teeth
• Classification
Hebling (1997) classified natal teeth into 4 clinical categories:
1. Shell-shaped crown poorly fixed to the alveolus by gingival
tissue and absence of a root;
2. Solid crown poorly fixed to the alveolus by gingival tissue
and little or no root;
3. Eruption of the incisal margin of the crown through gingival
tissue
4. Edema of gingival tissue with an unerupted but palpable
tooth.
• Gender
Predilection for females
• Kates et al (1984) reported a 66% proportion for females
against a 31% proportion for males.
Etiology
• It has been related to several factors, such as:-
 Superficial position of the germ
 Infection or malnutrition
 Eruption accelerated by febrile incidents or hormonal stimulation,
 Hereditary transmission of a dominant autosomal gene
 Osteoblastic activity inside the germ area related to the remodeling
phenomenon and hypovitaminosis
Associated syndromes
• Hallerman-Streiff

• Ellis-Van Creveld

• Craniofacial dysostosis

• Multiple steatocystoma

• Congenital pachyonychia

• Sotos Syndrome.
complications
• Interference with feeding.
• Risk of aspiration.
• Trauma to baby’s tongue and to maternal breast.
• Riga fede disease
Early eruption of teeth
causes Ulceration on the
ventral surface of the
tongue by sharp edges
of the tooth.
• Diagnosis

• A radiographic verification of the relationship between a natal and/or

neonatal tooth and adjacent structures, nearby teeth, and the presence or
absence of a germ in the primarytooth area would determine whether or
not the tooth belongs to the normal dentition ( AlmeidaCM et al 1997)
• Most natal and neonatal teeth are primary teeth of the normal dentition
and are not supernumerary teeth ( Brandt Sk et al 1983)
• Correspond to teeth of the normal primary dentition in 95% of cases,
while 5% are supernumerary (Hawkins C 1932)
Treatment
 If the erupted tooth is diagnosed as a tooth of the normal
dentition -- maintenance of these teeth in the mouth is the first
treatment option, unless this would cause injury to the baby
(Chow MH 1980, Roberts MW 1992)

 When well implanted-- these teeth should be left in the arch

and their removal should be indicated only when they interfere
with feeding or when they are highly mobile, with the risk of
aspiration (Toledo AO 1996)

 Reasons for removal -- The risk of dislocation and consequent

aspiration, traumatic injury to the baby‟s tongue and/or to the
maternal breast, (Kates GA et al 1984)
Cleaning of gum pads
• Started with the first week of birth.

• The parent can be instructed to lay the baby down with his/her head in your
lap & feet pointing away.
• Take a small gauze between thumb and forefinger & wipe vigorously over the
gum pad.
Deciduous dentition PERIOD
(6 months to 6 YEARS)
Chronology of primary dentition
Overbite
• Overbite is the amount of vertical overlap between the maxillary and
mandibular central incisors.
• This relationship can be described either in millimeters or more often as a
percentage of how much the upper central incisors overlap the crowns of the
lower incisors.
• Edge to edge or zero bite.

• The overbite in the primary dentition normally varies between 10% and 40%.
• Foster in a study of 100 British children between 2 and 3 years of age
described the overbite relationship as ideal (19%), reduced (37%), open bite
(24%), and excessive overbite (20%).

• The fact that more than 60% of the children in this population have a reduced
overbite or an open bite is attributed to the effects of the various oral habits
(finger or pacifier sucking) that are common in this age group.
Overjet
• Overjet is the horizontal relationship or the distance between the most protruded

maxillary central incisor and the opposing mandibular central incisor.

• This relationship is expressed in millimeters.

• The normal range of overjet in the primary dentition varies between 0 and 4.0 mm.

• underjet
• In the same study by Foster , the overjet was ideal in 28% of the cases and
excessive in 72% of the children.

• Again, the presence of excessive overjet was attributed to the effects of the

oral habits.
Spacing
• In the primary dentition stage a child may have generalized spaces between the
teeth, localized spaces, no spaces, or a crowded dentition.

• The presence of spacing in the primary dentition stage is a common

occurrence.

• According to Foster, generalized spacings occur in almost 2/3 of the

individuals in the primary dentition stage.

B)primate / simian / anthropodial / baume space
• Seen mesial to maxillary canines and distal to mandibular canines.

• Utilized during early mesial shift of molars from end on to class 1 relation.

• A tooth size-arch length discrepancy (TSALD) in the form of crowding is less

common and occurs in approximately 3% of the children in the primary
dentition stage.
AT AROUND 5-6 YEARS
• There are 48 teeth/parts of teeth present in the jaw. It is at this

time that there are more teeth in the jaws than at any other time.
CANINE RELATIONSHIP
• The relationship of the maxillary and mandibular deciduous canines is one of
the most stable in primary dentition.

 Class I: mandibular canine interdigitates in embrasure between the maxillary lateral and
canine.

 Class II: mandibular canine interdigitates distal embrasure.

MOLAR RELATIONSHIP
• FLUSH TERMINAL PLANE- Upper primary second molar occludes
with lower second primary molar, a tangent line drawn vertically
touches the distal surface of both upper and lower primary
molar.(37%)
• MESIAL STEP Mandibular cusp ahead of maxillary cusp in mesial
direction.(49%)
• Distal step Maxillary cusp will be ahead of mandibular cusp in
mesial direction giving distal step.(14%)
• Unfavorable relation
• Indicates developing class 2 molar relation.
Natural space maintenance
• Natural tooth is the best space

maintainer– functional , correct

size and exfoliates appropriately.

• Restoration of proximal contact

• Save tooth even if pulp treatment required.

Effects of premature loss of a tooth

• Loss of arch circumference

• Accelerated eruption

of succedaneous teeth.
MIXED DENTITION PERIOD
(6-12Years)
• The period where both deciduous and permanent teeth are present in the oral
cavity.

• Most watchful period of development of normal dentition and occlusion.

• This is important because the growth spurts of maxilla and mandible coincides
with the mixed dentition stage.

• Alveolar process is most actively adaptable during this period and thus ideal
time for most orthodontic interventions.
Divided in two stages

Early mixed dentition late mixed dentition

6-9years 9-12 years
FIRST TRANSITION PHASE(6-9years)
• Emergence of first permanent molar.

• Eruption of permanent incisors

MOLAR RELATION:-4mm forward movement of lower molar for smooth

transition to class1 molar relation , and space is provided by:-
1)Differential growth of lower jaw
2)Physiological and leeway spaces
• Early mesial shift:-eruption of first permanent molar exerts a mesial force on
deciduous dentition anterior to it.
• Primate spaces are closed

• Occurs Class1 relation from end on relation.

• LATE MESIAL SHIFT:-due to lack of primate spaces , when deciduous second

molar exfoliates permanent molar drifts mesially.
Incisor liability
• The difference in the mesiodistal dimensions of the deciduous incisors and
their succedaneous permanent incisors(Warren mayne,1969).
In maxilla:- 7.6mm
In mandible:-6mm
• Change in incisor inclination:-primary incisor are more upright than permanent
incisors.

• Decreases in angle from 150 to 123 degrees.

Safety valve mechanism
• Natural mechanism by which the maxilla and mandible maintain proper
occlusion.
• The intercanine width of maxilla acts as a safety valve.

• Mismatch in the horizontal(sagittal) growth of maxilla and mandible

postnatally.
The intertransitional phase(8-10years)
• More stable period of mixed dentition

• Deciduous canine are present in between permanent molars and incisors.

Ugly duckling stage
• Self correcting malocclusion
seen in maxilary incisor
region between 8-10years
of age.
• Seen during eruption of the
upper permanent canines.
• Children exhibit midline diastema along with
distal flaring of the incisors.
• Described by Brodbent as the ugly duckling stage as children tend to look ugly
during this phase. Erupting flared incisors tend to look like the walking of a
ducking.
• Features include:

-Maxillary midline diastema

-Distal tilting and flaring of
incisor crowns
Second transitional phase(10-12 years)
• Exchange of primary canines and premolars to permanent canine molars

• Leeway space of nance

• Term “leeway” means “more room”.

• Combined mesiodistal width of the permanent canine and premolars is lesser

than the combined width of deciduous canine, first molar and second molar.
In maxilla-1.8mm per arch or 0.9mm per quadrant
In mandible-3.4mm per arch or 1.7mm per quadrant
Importance of leeway space:
Permits the mesial movement of lower molar and shift of the flush terminal plane
mesially to establish normal occlusion
Dimisional changes of arch:-

• Decrease in arch perimeter:- due to

growth of mandible
• Decrease in arch length:- due to
uprighting of incisors and loss of
leeway space by the mesial
movement of first permanent
molar.
• Increases in intermolar width:- average increase is 2.2mm in maxillary arch width
between 8-13 years.
Permanent dentition stage
• Period begins with shedding of the last primary tooth.
• Growth of jaw bones slows and stops eventually.
Eruption sequence
o Maxillary arch
6-1-2-4-3-5-7 or
6-1-2-3-4-5-7
o Mandibular arch(knott and meredith)
6-1-2-3-4-5-7 or
6-1-2-4-3-5-7
The permanent incisors develop lingual to the deciduous incisors and move
labially as they erupt.
The premolars develop below the divergent roots of the deciduous molars.

At approximately 13 years of age all permanent teeth except third molars are
fully erupted
Vertical overbite of about one third the clinical crown height of the mandibular
central incisors.
Overjet and overbite decreases throughout the second decade of life due to
greater forward growth of the mandible
OCCLUSAL PLANE
THE DEVELOPMENT OF THE CONCEPTS OF
OCCLUSION
• The development of concept of occlusion can be traced through fictional,
hypothetical and factual approach.
• The fictional approach was a convenient arrangement of a series of
observation and thoughts more or less logically arranged.
• The hypothetical approach was based on provisional acceptance of certain
logical entities.
• Fact is a truth known by actual experience or observation. Both the fictional
and hypothetical approach are necessary for the establishment of fact.
• The fictional period, prior to 1900

• The hypothetical period from1900 to 1930.

• The factual period from1930 to present

FICTIONAL PERIOD
• Pioneers like Fuller, Clark and Imrie talked of “Antagonism”, “Meeting” or
“Gliding” of teeth.

• The creation of normal standard, a basis on which to compare departures from

normal was lacking. But this served as a working hypothesis or subsequently
became established fact after definitive research
• KINGSLEY 1880, the standard of normality of the dental arch is a curved line
expanding as it approaches the ends, and all teeth standing on that line.

• Eugene Talbot published his book “Irregularities of the teeth and their

treatment” in 1903.

• The Talbot concept of normal occlusion was that it was a historical event,
passed in the decline of the species and normality was possible only with
atavism or throwback to our primitive ancestors.

• This later became a working hypothesis and subsequently became established

fact after definitive research.

HYPOTHETICAL PERIOD
• Edward H. Angle,
• It was him, who channelised orthodontic thinking on occlusion and brought
the real concept out of fiction.
• In 1907, Angle summarised his views as ‘occlusion shall be defined as
being the normal relation of the occlusal inclined planes of the teeth when
the jaws are closed’.
• Angle cites the example of a skull of Negro male from Broomell which he
names ‘Old Glory’. In ‘Old Glory’ all the teeth are present and arranged in a
graceful curve. He emphasizes that all teeth are necessary for maintaining
occlusion. He compares ‘Old Glory’ with the profile of Appollo Belvedre a
white male.
• Angle furnished his ‘key to occlusion’ and emphasizes the first permanent
molars especially the upper first permanent molar and considers them to be
most constant in taking normal position.
• From the hypothesis of constancy of first molar and the ‘line of occlusion’ ,
Angle developed the concept that all teeth should be present if normal
occlusion is to be achieved.
Mathew Cryer and Calvin Case

• Cryer pointed out that Angle showed the straight profile of Apollo Belvedre
and choose a skull of negro male ‘Old Glory’ to exemplify ideal occlusion. He
questioned how one could mix a prognathic denture with an orthodontic
profile.
• Case accepts Angle’s hypothesis of constancy of first molar. Case related the
facial profile to each type of occlusion.
• E. LISCHER AND PAUL SIMON related teeth in occlusal contact to cranial and
facial planes.

• They considered the concept of the orbital plane as a basis for determining
anteroposterior position of teeth.

• MILO HELLMAN showed the racial variations in so called normal occlusions.

• He gives a recognition of interdependence of the teeth and the supporting craniofacial

structures.
FACTUAL PERIOD
• In 1930 Holly Broadbent and Hans Planer introduced an accurate technique of
roentogenographic cephaolmetry. Investigators were able to follow
longitudinally the orofacial developmental pattern and the intricacies of tooth
formation, eruption and adjustment.

• Planer laid emphasis on efficiency of masticating mechanism. He explained

physiological rest position and vertical dimension.

• In 1930, A third element of occlusion, the TMJ has been receiving more attention.
Now we consider atleast three components of occlusion.

1. The tooth contact position.

2. The postural rest position.

3. The temporomandibular joint.

• There is an intimate relationship between the interdigitation of the teeth, the

status of controlling, musculature and the integrity of the TMJ.
• ANDREWS 1972 gave six keys to occlusion thus providing a guidance for
exact positioning for each tooth on all 3 planes.

• ROTH 1981 in an excellent series of articles later added to the static occlusion
keys, which relate occlusal function and orthodontic mechanics. Thus made it
possible for us to attain gnathological goals orthodontically.
• He stated that evaluation of each case on articulator for optimum function
should be one of the treatment objectives. This leads to the fundamental aspect
of orthodontic correction the needs to co-ordinate tooth position and jaw
function.

• The goal of modern orthodontics according to Proffit is “the creation of best

possible occlusal relationship within the framework of acceptable facial
aesthetics and stability of result”.
• Dental occlusion varies among individuals according to tooth size and shape,
tooth position, timing and sequence of eruption, dental arch size and shape and
pattern of craniofacial growth.

• The position of the teeth within the jaws and the mode of occlusion are
determined by developmental processes that interact on the teeth and their
associated structures during the period of formation, growth and postnatal
modification
SIX KEYS TO NORMAL OCCLUSION
• LAWRENCE F.ANDREWS(1972)
Collection of 120 models of teeth with naturally excellent occlusion
• Criteria for selection
1. Had never undergone orthodontic treatment
2. Were straight & pleasing in appearance
3. Had a bite which looked generally correct
4. In his judgement, would not benefit from orthodontic treatment
• Key I – Molar relationship
• MB cusp of the max 1st molar falls
• into the mesiobuccal groove of the
• mand 1st molar and that the distal
• surface of the DB cusp of the upper
• first permanent molar should make
• contact and occlude with mesial
• surface of the MB cusp of the lower
• second molar.
• Key II Crown angulation (Tip)

• The angulation of the facial axis of

every clinical crown should be

positive
• The gingival portion of the long axis

of the all crowns must be distal than

the incisal portion.
• Key III Crown inclination
• In upper incisors, the gingival
portion of the crown‟s labial surface
is lingual to the incisal portion.
• In all other crowns, including lower
incisors, the gingival portion of the
labial or buccal surface is labial or
buccal to the incisal or occlusal
portion.
• Key IV – Rotations
• The fourth key to normal
occlusion is that the teeth should
be free of undesirable rotations.
• Key V – Tight contacts
• contact points should be tight
(no spaces).
• In absence of abnormalities
such as genuine tooth size
discrepancies, contact point
should be tight.
• Key VI – Occlusal plane or curve

of spee
 The curve of Spee should have no

more than a slight arch.

 Intercuspation of teeth is best

when the plane of occlusion is

relatively flat.
 A deep curve of spee results in a

more contained area for the upper

teeth, making normal occlusion
impossible.
 A reverse curve of spee results in excessive room for upper teeth.
• Key VII – Correct tooth size or the bolton’s ratio
• Bennett and McLaughlin in 1993 gave seventh key
to normal occlusion. i.e. the upper and lower tooth size should be correct.
• Roth (1981) added some functional keys to the previous six
• keys to normal occlusion by Andrew:
• a) Centric relationship and centric occlusion should be coincident.
• b) In protrusion, the incisors should disclude(seperate) the posterior teeth, with
the guidance provided by the lower incisal edges passing along the palatal contour
of the upper incisors.
• c) In lateral excursions of the mandible, the canine should guide the working side
whilst all other teeth on that and the other side are discluded.
• d) When the teeth are in centric occlusion, there should be even bilateral contacts
in the buccal segments.
Conclusion

Whatever may be the malocclusion we

orthodontist make poor looking girls and
boys into super models.
References

• Wheeler's Dental Anatomy, Physiology and Occlusion 9th Edition

• Text book of orthodontics by Samir E. Bishara,2nd edition.
• Handbook of orthodontics by Robert E. Moyers, 4th edition.
• Text book of craniofacial growth by Sridhar Premkumar
• Six keys to normal occlusion by Lawrence F. Andrews, AJO-DO, 1972 sep.
• Orthodontics in 3 millennia Am j orthod dentofacial orthop 2006,130:799-804.
• Dewey, M. (1931). Evolution and Development of Normal Occlusion July 23,
1930. The Journal of the American Dental Association (1922), 18(8), 1400
• Orthodontics the art and science 5th edition-S.I.BHALAJI
• Textbook of orthodontics 2nd edition – gurkeerat singh