EARLY

STAGES
OF
DEVELOPMENT
5 PRINCIPAL STAGES IN
CRANIOFACIAL DEVELOPMENT
Germ layer formation and initial organization of
craniofacial structures

Neural tube formation and initial formation of the

oropharynx

Origins, migration, and interaction of cell populations

especially neural crest cells and their derivatives

Formation of organ systems, especially the pharyngeal

arches and the primary and secondary palates

Final differentiation of tissues (skeletal, muscular, and

nervous elements)
FETAL ALCOHOL SYNDROME
ANENCEPHALY
NEURAL CREST CELLS
THALIDOMIDE CHILD
NEURAL CREST CELL PROBLEMS
Treacher Collins Syndrome

Hemifacial microsomia
TREACHER COLLINS SYNDROME
CHARACTERISTICS
 Maxilla and mandible are underdeveloped

 Absent cheekbones

 Downward slanting eyes

 Micrognathia (small lower jaw)

 Underdeveloped zygoma

 Drooping part of lateral lower eyelids

malformed or absent ears
TREACHER COLLINS SYNDROME (Also
known as Mandibulofacial Dysostosis)
HEMIFACIAL MICROSOMIA
A unilateral and asymmetrical problem due to a lack
of tissue on the affected side of the face

External ear is deformed

Ramus of the mandible and associated soft tissues are

deficient or missing
HEMIFACIAL MICROSOMIA
FACIAL CLEFT PROBLEMS
The most common congenital defect
involving the face and jaws is clefting of
the lip and/or palate.
FACIAL PROCESSES
CLEFT LIP
The cleft lip is due to the failure of fusion between the
medial and lateral nasal processes and the maxillary
process, which usually occurs during the 6th week of
development.
BILATERAL CLEFT LIP AND PALATE
FETAL PERIOD OF PRENATAL
LIFE

A syndrome that arises during this period

is Crouzon’s Syndrome
CROUZON’S SYNDROME
CHARACTERISTICS OF CROUZON’S
SYNDROME
Underdevelopment of the midface

Eyes that seem to bulge from their sockets

INFANCY & EARLY CHILDHOOD:
THE PRIMARY DENTITION YEARS

The first primary tooth does not erupt until

approximately 6 months of age.

The primary dentition is usually completed

between 24-30 months of age.
 PRIMATE SPACES

In the maxillary arch, the primate space is

located between the lateral incisors and the
canines.

In the mandibular arch, the primate space

is located between the canines and the 1st
molars.
PRIMATE SPACES
GENERALIZED SPACING OF PRIMARY TEETH
 ERUPTION SEQUENCE &
TIMING

The transition from the primary to the

permanent dentition begins at about age 6
years old with the eruption of the
permanent 1st molars, followed soon
thereafter by the permanent incisors.
LABIAL POSITIONING OF MAXILLARY
CANINE
LABIAL POSITIONING OF MAXILLARY
CANINE
ERUPTION SEQUENCE & TIMING
OF THE PERMANENT DENTITION
 INCISOR LIABILITY
The maxillary arch, on average, has just
enough space to accommodate the permanent
incisors, which are larger than the primary
incisors that they replace. This is due to the
spacing seen in the primary dentition which is
normal.

However, in the mandibular arch there is on

average 1.6mm less apace available for the 4
lower incisors to erupt and be perfectly aligned
and this is referred to as “incisor liability”.
 TO OBTAIN SPACE TO ALIGN THE
LOWER INCISORS, THE EXTRA SPACE
COMES FROM 3 SOURCES:
A slight increase in the width of the dental arch
across the canines, which is known as intercanine
width.

Labial positioning of the permanent incisors

relative to the primary incisors.

Repositioning of the canines in the mandibular

arch slightly to the distal
 MAXILLARY MIDLINE
DIASTEMA

In the maxillary arch a midline diastema

may remain between the central incisors
until the permanent canines erupt.
 LEEWAY SPACE
Leeway space is defined as the difference
between the combined widths of the
deciduous cuspids, first molars, and second
molars and their permanent successors
(canines, first premolars, & second
premolars).
MAXILLARY ARCH LEEWAY
SPACE
In the maxillary arch, the primary 2nd molar
is 1.5mm larger than the 2nd premolar which
will replace it.

There is about 1.5mm of leeway space on

each side of the maxillary arch that is
available.
 MANDIBULAR ARCH
LEEWAY SPACE

In the mandibular arch, the primary 2nd

molar is even wider than the maxillary
primary 2nd molar. Therefore the leeway
space is greater in the mandibular arch than
in the maxillary arch.

There is about 2.5mm of leeway space on

each side in the mandibular arch.
SIZE DIFFERENCE BETWEEN
THE PRIMARY MOLARS AND
THE PREMOLARS
OCCLUSAL RELATIONSHIPS IN
THE MIXED DENTITION

A normal relationship of the primary 2nd

molars is referred to as a flush terminal
plane relationship.
MIXED DENTITION OCCLUSAL
RELATIONSHIPS