MIXED DENTITION NORM

The eruption of the first perma­nent molar will be guided by the distal surface of the second pri­mary
molar. The location and arrangement of the permanent incisors will be guided by the mesial surface
of the primary canine.
Once the permanent first molar and incisors are in the arch, (The Mixed Dentition Stage) the canine
and two premolars will then erupt into the limited space between the mesial surface of the first
permanent molar and the distal surface of the lateral incisor. This exchange takes about one and a
half years to complete.
The sum of the mesio-distal widths of the primary cuspid and first and second primary molars is
generally larger than that of the permanent cuspid and pre­molars by about lmm per quad­rant in the
maxilla and about 2mm per quadrant in the mandible. This difference is called the leeway space. The
lee­way or extra space is a fundamen­tal factor in allowing for an easy exchange of these teeth.
A normal eruption sequence of the succedaneous teeth must take place in both the mandible and
maxilla. In the mandible, the most frequent eruption sequence is the cuspid, first bicuspid, and
second bicuspid. In the maxilla, the sequence of eruption typical­ly seen is either the first bicus­pid,
second bicuspid and cuspid or first bicuspid, cuspid and sec­ond bicuspid.
When the second molars begin to erupt, the distal surface of the first permanent molar will guide
them into the arch. In most cas­es, the eruptive force of the sec­ond molar will cause a reduction in the
dental arch length using up the leeway space. In fact, the arch circumference of the perma ­nent
dentition may become shorter than that of the primary dental arch
The purpose of the Mixed Dentition Analysis is to evaluate the amount of space available in the arch
for the succeeding permanent teeth. Although many methods have been suggested, none of them
are as precise as one might like. For example, radiographs have often been used to help estimate
the size of the succedaneous teeth
dental age

to know the expected timing of these eruption stages

based on :

which teeth have erupted

amount or resorption of the roots of primary teeth

amount of developpment of the permanent teeth

dental age 6

the first stage of eruption of the permanent teeth

near- simultaneous eruption of the mandibular central incisors, the mandibular first
molars, and the maxillary first molars.
dental age 8
eruption of the maxillary lateral incisors
dental age 9

root formation on incisors and molars are nearly complete

root development of maxillary canines and second premoalres just begins

mandibular canines root developmetn are nearly completed

dental age 11
eruption of the mandibular canines, mandibular first premolars, and maxillary first premolars
at about the same time
dental age 12
eruption of the remaining succedaneous teeth
dental age 15
roots of all permanent teeth except the third molars are complete, and crown formation of third
molars often has been completed
Space Relationships in Replacement of
the Incisors

permanent incisor tooth buds lie lingual and apical to the primary incisors

mandibular permanent incisors tend to erupt lingually and slightly irregular even in children
with normal dental arch space

“primate space “ -- gaps in between primary incisors which provide potential space for
underlying , larger permanent teeth to erupt

when the central inceisor erupt , these teeth used up excessive sapace in a normal primary
dentition

mandibular anterior teeth usually lack of space for permenant teeth to erupt , which leads to
crowding in a early age after replacement
Anterior transition
-Permanent tooth buds are lingual and apical to primary teeth
-Incisor tend erupt lingual except for for upper centrals.
primate space
mandibular anterior teeth usually appear curowed in a short period after replacement
3 mechanisms which help to relieve the crowding

There is no jaw growth in the anterior area where additional space is needed.

A slight increase in the width of the dental arch across the canines.

Labial positioning of the permanent incisors relative to the primary incisors. arranges them
along the arc of a larger circle.

Repositioning of mandibular canines slight back into the primate space

Space Relationships in Replacement of Canines
and Primary Molars

the permanent canines are larger than the primary canines and the premolars are smaller
than the primary teeth they replace.

each side in the mandibular arch on average contains about 2.5 mm of what is called leeway
space

in maxillary arch, about 1.5 mm is available on average.

leeway space is normally taken up by mesial movement of teh permanetnts molars

occlusal relationships

during primary dentition

flush terminla plane : face to face relationship of counter molars

distal step relationship : = angle Class II

mesial step relantionship : = angle class 1

occlusal relationships

along the development process

At the time the primary second molars are lost, both the maxillary and mandibular molars tend
to shift mesially into the leeway space,

mandibular molar normally moves more than its maxillary counterpart. This contributes to the
normal transition from a flush terminal plane relationship in the mixed dentition to a Class I
relationship in the permanent dentition.
 posterior transtition
Permanent first molars are guided into position by
terminal plane

FTP becomes class I by differential teeth shift and

differential jaw growth

-Early mesial shift of first molars close primate space

at around age 6

-Late mesial shift of second molars to close leeway

space at around age 12

-Late mandibular growth.

Ugly duckling stage

11-12 years old diastema<2mm between upper

central incisors is normal

mesial eruption of maxillary canine should close

space.
PRIMARY INCISOR LOSS

LOCALIZED SPACE LOSS, NO BIG

DEAL
PRIMARY CANINE LOSS

LINGUAL COLLASPE OF INCISOR = LOSS OF ARCH LENGTH

PRIMARY FIRST MOLAR LOST

BAND AND LOOP..:D LOWER LINGUAL OR NANCE MAY BE USED IN THIS CASE AS WELL
PRIMARY SECOND MOLARS
SPACE CLOSURE

MOST OCCURS WITHIN THE FIRST 6

MONTHS AFTER TOOTH LOSS.

USUALLY TIPPING NOT BODILY MOVEMENT

Eruption of a neighboring tooth tends to increase

the amount of space loss.
 late lower incisor crowding

anterior crowding often gets worse in

20s-40s

due to late mandibular growth and

lower lip pressure