DEVELOPMENT OF OCCLUSION

Development of occlusion and the dental arches

The human dentition is in a dynamic state, constantly changing throughout life A knowledge of these changes assists the clinician in determining whether or not a specific occlusion will be: sustained, worsen or self corrected overtime.

Terminology

Intercanine
width
Measure from the cusp tips of the canines

Terminology

Intermolar width
measured from the mesiobuccal cusp tips of first permanent molars or the mesiolingual cusp tips of the first permanent molars -or the central fossa of first permanent molars

Terminology Arch depth is

measured at the midline from a point midway between the central incisors to a tangent touching the distal surfaces of the second primary molars or second premolars

Terminology Arch length -distance between lateral incisors to the distal of the E (or mesial of the 6

The development of occlusion occurs over three distinct stages. 1. The deciduous dentition begins soon after birth and is complete with the eruption of all deciduous teeth. 2. The eruption of the first permanent molar ushers in the mixed dentition and 3. Loss of the last deciduous tooth denotes the transition to the permanent dentition.

Characteristics Deciduous arches are generally ovoid in shape with spacing a normal occurrence in the anterior part of the primary dentition. Primary spaces refer to distinct spaces in two locations

The maxillary primate space lies between the lateral incisors and canines The mandibular primate space between the canines and first molars. Developmental spaces between the incisors, may become larger as the alveolar processes expand. Generalised spacing of the primary teeth is required for proper alignment of the permanent incisors

The dimensions of the deciduous arches remain relatively constant from: the completion of the deciduous dentition ( 2 years of age) up until the eruption of the first permanent molars ( 6 years of age)

Occlusal relationships Deciduous incisors are placed more vertical than their permanent successors demonstrating minimal overjet and overbite. Occlusal attrition commonly seen in the deciduous dentition may help to reduce a deep overbite in the years preceding exfoliation of the incisors.

Overbite Vertical Overlap Overjet Horizontal overlap

The lower second deciduous molar is somewhat wider mesiodistally than the upper E, typically providing a flush terminal plane at the posterior limit of the primary dentition.

end to end molar relationship of the deciduous The lower second deciduous molar is somewhat wider mesiodistally than the upper E, typically providing a flush terminal plane at the posterior limit of the primary dentition.

Flush terminal plane, acts as a guide for the permanent molars to erupt into an end end relationship Variations to this are mesial step and distal step relationships.

Occlusal relationships Deciduous incisors are placed more vertical than their permanent successors demonstrating minimal overjet and overbite. Occlusal attrition commonly seen in the deciduous dentition may help to reduce a deep overbite in the years preceding exfoliation of the incisors.

Occlusal relationships Deciduous incisors are placed more vertical than their permanent successors demonstrating minimal overjet and overbite. Occlusal attrition commonly seen in the deciduous dentition may help to reduce a deep overbite in the years preceding exfoliation of the incisors.

MIXED DENTITION the period in which both the primary and permanent teeth are present in the mouth together. It typically begins with the eruption of the first permanent molars at approximately 6 years of age

Incisor Liability The combined width of the permanent incisors is greater when compared to those they replace. Incisor liability is the term given to this size difference and varies greatly from person to person. This disparity in the maxillary arch is accommodated by the interdental spaces between primary incisors, and the more labial positioning of the permanent incisors which culminates in an increase in arch depth

distal flaring of upper anteriors (ugly duckling face prominent from 8 12)

Ugly duckling stage

A

stage characterised by the distal flaring of the lateral incisors coupled with a midline diastema in the maxillary arch Central incisors in the maxilla often erupt with a diastema between them that may partially closewith the subsequent eruption of the lateralincisors. However a diastema is unlikely to spontaneously close if greater than 2mm in dimension

As the maxillary canines erupt, they may encroach on the roots of lateral incisors Ugly duckling stage applying distal pressure A stage characterised by the distal flaring of the which resultslateral incisors coupled with a midline diastema in a slight distal inclination of the in the maxillary arch lateral incisors. Central incisors in the maxilla often erupt with a This stage is transient and with the subsequent eruption of the lateral usually resolves after canine incisors. eruption is complete. From here, the canines may However a diastema is unlikely to spontaneously erupt uneventfully through close if greater than 2mm in dimension the alveolar process distal to the lateral incisors.

diastema between them that may partially close

Leeway Space The first and second deciduous molars are Wider mesiodistally than their permanent premolar successors. This difference is referred to as leeway space or E space as most of the difference is provided by the differencebetween the Es and second premolars. maxillary leeway space is 1.1mm mandibular leeway space and 2.4mm

Pseudo Class III Pseudo class III malocclusion is characterised by the presence of an anterior crossbite caused by a mandibular displacement It is recommended that pseudo class III malocclusion should be treated early to eliminate functional shift of the mandible whilst improving the alignment of incisors If correction of the displacement is undertaken before the eruption of the permanent canines and premolars, this allows the development of a proper class I anterior relationship in the correct mandibular relationship

Permanent Dentitional Period (15 years to old age) # General characteristics 1. normal surface contact example: overbite and overjet

2. normal cusp to fossa relationship example: mesio-lingual cusp of upper molars to central fossa of lower molars

3. normal triangular ridge to embrasure or groove contact example: triangular ridge of upper canine to embrasure between lower first premolar and canine

example: mesio-buccal cusp of upper first molar to mesiobuccal groove of lower first molar

# Tooth Contacts (A B C) Stamp cusp Shear cusp

li

bu

Shear cusp

Stamp cusp

# Tooth Contact A points on the shear cusps of maxillary teeth contacting points of the stamp cusps of mandibular teeth

B shear cusps of mandibular teeth contacting stamp cusps of maxillary teeth; key contact point

C stamp cusps of maxillary teeth occluding with the shear cusps of mandibular teeth

# Significance of ABC contacts - For every occluding tooth, three contact points are seen (concept of TRIPODIZATION). For every tooth contact on an inclined surface, there is a counter contact on another and opposite inclined surface, and a reciprocating force to equalize occlusal forces. The horizontal forces of occlusion are in equilibrium and the resultant forces of occlusion are vertically along the long axis of the tooth.

a. prevent horizontal or lateral drift of the teeth buccolingually because of the reciprocating effect on the occlusal forces

b. prevent mesial and distal drifting of teeth because stamp cusps occlude with the respective mesial or distal marginal ridges on the opposing teeth adjacent to its occluding fossa

Stamp Cusps occlude in fossa of opposing teeth well within the perimeter of the crowns of teeth not exceeding 4 sq.mm. amount of tooth contact crush and cut food as they are directed past the opposing shear cusps and cutting ridges toward an occlusal fossa are responsible for maintaining the vertical dimension of occlusion

Shear cusp act as centric stops during contact with the opposing stamp cusps and they minimize tissue impingement shear the food to reduce it to smaller particles and act as grabbing cusps to grab and hold food on the occlusal table give stability to mandible by providing a tight and definite occlusal relationship when teeth occlude (maximum intercuspation)

Alignment and Occlusion of the Dentition

Factors and forces that determine tooth position 1. during eruption - by the muscular pressure exerted by opposing forces that stabilize the tooth in the neutral position or space, provided there is adequate space in the arch

2. After eruption a. by muscular patterns b. by oral habits c. by proximal contact between adjacent teeth d. by occlusal contact

 Intraarch tooth alignment * Plane of occlusion Maxillary

Mandibular

Angles Classification of occlusion

Class I: Neutrocclusion Here the molar relationship of the occlusion is normal or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.

Class II: Distocclusion (retrognathism, overjet) In this situation, the upper molars are placed not in the mesiobuccal groove but anteriorly to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes: Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded. Class II Division 2: The molar relationships are class II but the central are retroclined and the lateral teeth are seen overlapping the centrals .

Class III: Mesiocclusion (prognathism,negati ve overjet) is when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

Significance: 1. guide the mandible through the various lateral movements (anterior guidance) 2. incise food 3. speech, esthetics and lip support 4. anterior discluders of posterior teeth during lateral and protrusive excursive sliding movements

Significance: 1. guide the mandible through the various lateral movements (anterior guidance) 2. incise food 3. speech, esthetics and lip support 4. anterior discluders of posterior teeth during lateral and protrusive excursive sliding movements