DEVELOPMENT OF DENTITION

DEVELOPMENT OF
OCCLUSION WITH SPECIAL
REFERENCE TO ANDREWS 6
KEYS TO OCCLUSION
BY:-
DEPARTMENT OF DR. PARIJAT CHAKRABORTY
ORTHODONTICS PG 1ST YEAR,
 DEVELOPMENT OF DENTITION

DEVELOPMENT OF OCCLUSION

ANDREWS 6 KEYS TO NORMAL OCCLUSION

 CONTENTS
 INTRODUCTION
 EVOLUTION
 DEVELOPMENT OF TOOTH
 DEVELOPMENT OF OCCLUSION
 ERUPTION OF DECIDUOUS TEETH
 DECIDUOUS DENTITION
 MIXED DENTITION
 PERMANENT DENTITION
 ANDREWS 6KEYS TO NORMAL OCCLUSION
 INTRODUCTION
 The term Dentition is used to describe the natural
teeth in the jaw bones. It may be defined as the
type, number and arrangement of the teeth or it
refers to all the upper and lower teeth collectively.

 Humans have 2 sets of teeth during their lifetime---

Primary and Permanent.
 EVOLUTION
 During evolution several significant changes took
place in the jaws and teeth. When the reptilian
evolve to mammalian , the dentition went from

 polyphydont diphydont
 homodont heterodent
 acrodont thecodont
 DENTAL FORMULA EVOLUTION

PRESENT DENTAL
ORIGINAL FORMULA OF
FORMULA- TEETH NUMBER
MAMMALS
REDUCED

• Permanent dentition • Permanent dentition

Incisor3/3, Canine1/1, Incisor2/2, Canine1/1,
Premolar4/4, Premolar2/2, Molar3/3=32
Molar3/3=44teeth teeth

• Decidous dentition • Deciduous dentition Incisor2/2,

Incisor2/2, Canine1/1, Canine1/1, Molar2/2 =20
Molar2/2=20teeth teeth
DEVELOPMENT OF TOOTH
PRENATAL DENTAL DEVELOPMENT
MORPHOLOGICAL PHYSIOLOGICAL

1. Dental lamina Initiation

2. Bud stage
3. Cap stage Proliferation

4. Early bell stage Histodifferentiation

5. Advanced bell stage Morphodifferentiation

6. Formation of enamel and dentin matrix Apposition

7. Hertwig’s epithelial root sheath and root formation
8. Formation of enamel and dentin matrix.
NOLLA’S STAGES OF TOOTH
DEVELOPMENT(1960)
 DEVELOPMENT OF OCCLUSION

 Term occlusion is derived from the Latin word,

“occlusio”; defined as the relationship between all
the components of the masticatory system in normal
function, dysfunction and parafunction.

 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
 PERIODS OF OCCLUSAL DEVELOPMENT

 Occlusal development can be divided into the

following development periods:-

 Neo-natal period.
 Primary dentition period.
 Mixed dentition period.
 Permanent dentition period
 NEONATAL PERIOD
(From the time of birth to 6th month)

The gum pads

 Neonatal jaw relationship
 Status of dentition
 GUM PADS
 This is the period after birth during which the
neonate does not have any teeth.It usually lasts for
6 months after birth
 The alveolar processes at the time of birth are
known as gum pads.
 They are pink, firm & are covered by a dense layer
of fibrous periosteum.
 They are horse shoe shaped and develop into 2
parts:
 Labio buccal portion
 Lingual portion
 These are seperated from each other by a groove
called dental groove.
 The gum pads are divided into 10 segments by
certain grooves called transverse grooves.
 Each of these consists of 1 developing decidious
tooth sac.
 The gingival groove seperates the gum pads from the
palate and the floor of the mouth.
 The transverse groove between the canine & 1st
decidious molar segment is called the lateral sulcus.
 Neonatal jaw relationship
 Anterior open bite is seen at rest with contact only at the molar region.
 Complete overjet.
 Class II pattern with maxillary gum pad being more prominent.

 Mandible is distal to the maxilla of 2.7mm- male and 2.5- female

Sillman JH 1938

 The range of variation of this distal relationship is from 0 to 7 mm

Sillman JH 1938

 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.
 Status of dentition
 Teeth that are present at birth are natal teeth and
teeth that emerge through the gingiva during first
month of life are neonatal teeth.
masler and savara (1950)

 Pre-erupted teeth erupt during the 2nd or 3rd

month. These teeth are almost always mandibular
incisors
 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)
 THEORIES OF ERUPTION

 Bone remodeling theory

 Root growth theory
 Vascular pressure theory
 Ligament traction theory
 CLASSIFICATION OF TOOTH
ERUPTION STAGES
PRE EMERGENT ERUPTION
• FOLLICULAR PHASE: Labial or buccal drift of the tooth
follicle within the bone. Eruptive movements begin soon after
root begins to form. Thus in the “PRE EMERGENT SPURT
PHASE” eruption begins.

POST EMERGENT
: ERUPTION
• EMERGES 3/4th of its root development is complete.
• EMERGES erupts rapidly approaches the occlusal level
and is subjected to masticatory forces. At this point eruption
slows.
 PRIMARY DENTITION PERIOD
(From around the 6th month to 6 years)

 The mandibular central incisors are the first to

develop in deciduous dentition followed by other
incisors. This takes place at the period of 6 months
after birth.
 After 3-4 months around 10 months the mandibular
and maxillary first molars erupt.
 Within 24-30 months the max & mandibular second
molars also erupt..at this stage primary dentition is
complete.
 Normal signs of a primary dentition:
Spaced incisors
Primate spaces
Flush terminal plane
Overbite
 SPACING
 Spaced dentition is supposed to be good as spaces
in between the teeth can be utilized for adjustement
of permanent successors which are always larger in
size compared to deciduous teeth.
 Generalised spacing occurs in almost 2/3rd of the
children refered to as physiological spaces or
developmental spaces
 PRIMATE SPACES
 Also called simian space or anthropoid space
 Seen in about 87% cases.
 In the maxillary arch it is present between lateral
and canine.
 In the mandibular arch seen between canine and 1st
decidious molar.
 This space is used up by the developing larger
permanent teeth.
 FLUSH TERMINAL PLANE: Both maxillary &
mandibular planes are at the same level anterio-
posteriorly.
 Mesial step terminal plane: Maxillary terminal
plane is relatively more posterior than the
mandibular terminal plane forming a mesial step.
 Distal step terminal plane: The maxillary terminal
plane is relatively more anterior than the mandibular
terminal plane.
 Overbite
 It is the amount of vertical over lap between
maxillary and mandibular central incisors.
 Deep bite may be seen in the initial stages of
development.
 It is accentuated by the fact that decidious incisors
are more upright with the lower incisor edges almost
contacting the upper cingulum.
 ERUPTION OF DECIDUOUS TEETH
PRIMARY (UPPER) FIRST EVIDENCE OF CROWN ERUPTION( ROOT COMPLETED
CALCIFICATION COMPLETED MONTHS) (YEARS)
(Wks IUL) (MONTHS)

CENTRALS 14(13-16) 11/2 10 11/2

LATERALS 16 21/2 11 2

CANINES 17 9 19 31/4

1ST MOLARS 151/2 6 16 21/2

2ND MOLARS 19 11 29 3

Wheelers
PRIMARY (LOWER) FIRST EVIDENCE OF CROWN ERUPTION( ROOT COMPLETED
CALCIFICATION COMPLETED MONTHS) (YEARS)
(Wks IUL) (MONTHS)

CENTRALS 14(13-16) 21/2 8(6-10) 11/2

LATERALS 16 3 13(10-16) 11/2

CANINES 17 9 20(17-23) 31/4

1ST MOLARS 151/2 51/2 16(14-18) 21/4

2ND MOLARS 18 10 27 3

Wheelers
 Status of dentition
 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
 MIXED DENTITION PERIOD
(Around 6 years- 12 years)

FIRST TRANSITION INTER TRANSITION SECOND TRANSITION

PERIOD PERIOD PERIOD

• Emergence of 1st • Both sets of teeth • Emergence of

permanent molar present bicuspids, cuspids,&
• Incisors transition • 4 permanent incisors second permanent
• Establishment of & 1st permanent molar.
occlusion molars present • Establishment of
• Decidious canines and occlusion
1st & 2nd molars
 First transitional period
1. Emergence of 1st permanent molar:
 Erupts by around 6th year of life. Its location &

relationship depends upon the distal surface

relationship between upper and lower second
decidious molars.
 The distal surface of these decidious 2nd molars

guide the erupting permanent molar into 3 relations:

 Early mesial shift
 If the deciduous dentition is spaced with a flush
terminal relation of the 2nd deciduous molar, then
the eruptive force of the 1st permanent molar
causes the closing of any existing spaces.
 That is closure of the PRIMATE SPACES. Mesial to
the deciduous canine in the maxillary arch and
distal to the deciduous canine in the mandiular arch.
 Late mesial shift
 The combined mesiodistal width of the permanent
canines and premolars is usually less than that of
the decidious canines & molars.
 This surplus space is called as Leeway Space Of
Nance.
 LEEWAY SPACE:- MAXILLARY 1.8 mm(0.9 mm
in each arch)
MANDIBULAR 3.4 mm(1.7
mm in each arch)

By NANCE in 1947
 Incisors transition
 The deciduous incisors are replaced by permanent
incisors. The mandibular incisors are the first to erupt.
 The permanent incisors are considerably larger than the
deciduous they replace. This difference between the
amount of space needed for the accomodation of
incisors and the amount of space available for this is
called “Incisal Liability”.
 Maxillary:- 7.6mm
 Mandibular:- 6mm (Wayne)
 Change in inclination of permanent incisors:
 Primary teeth are upright
but permanent teeth incline
to the labial surface, thus
decreasing the inter-incisal
angle from about 151º in the
deciduous dentition to 124º
in the permanent dentition.
This increases the arch parameter.
 INTER TRANSITION PERIOD
 This is a latent period with no exchange of teeth
taking place.
 Permanent incisors and 1st molar are present.
 Decidious canine, 1st & 2nd molars are present
 This phase during mixed dentition period is
relatively stable and no change occurs.
 SECOND TRANSITION PERIOD
UGLY DUCKLING STAGE

 Around the age of 8 - 9 years, a midline diastema is

commonly seen in the upper arch, which is usually
misinterpreted by the parents as a malocclusion.
 As the developing permanent canines erupt, they displace
the roots of the lateral incisors mesially and inturn on to the
central incisors.
 This causes the flaring up of the incisor crowns. Thus causing
a midline diastema
 Described by Broadbent
 With the eruption of the canines, the impingement from the
roots shift incisally thus driving the incisor crowns medially,
resulting in closure of the diastema as well as the correction
of the flared lateral incisors.
 ERUPTION OF PERMANENT SECOND MOLARS

 Teeth- formed palatally, guided into occlusion by

Cone Funnel mechanism , upper palatal cusps (cone)
slides into the lower occlusal fossa (funnel)
 Arch length is reduced by mesial eruptive forces
 Thereby, crowding if present is accentuated
 PERMANENT DENTITION STAGE
 This stage begins with the exfoliation of last primary Teeth
and eruption of all Permanent teeth except 3rd molar.
 The permanent incisors develop lingual to the deciduous
incisors and move labially as they erupt.
 The premolars develop below the diverging roots of the
deciduous molars
 At approximately 13 years of age all permanent teeth
except third molars are fully erupted.
 The important characterstics of normal occlusion in
permanent dentition were:
Described by Andrew’s in 1972 as 6 keys of occlusion.
 ERUPTION OF PERMANENT TEETH
PERMANENT FIRST EVIDENCE OF CROWN ERUPTION ROOT COMPLETED
(UPPER) CALCIFICATION COMPLETED (YEARS) (YEARS)
(MONTHS IN IUL) (YEARS)

CENTRALS 3-4 4-5 7-8 10

LATERALS 10-12 4-5 8-9 11

CANINES 4-5 6-7 11-12 13-15

1ST PREMOLARS 11/2-13/4 YR 5-6 10-11 12-14

2ND PREMOLARS 2-21/4 YR 6-7 10-12 9-10

1ST MOLARS At Birth 21/3-3 6-7 12-14

2ND MOLARS 21/3-3 YR 7-8 12-13 14-16

3RD MOLARS 7-9 YR 12-16 17-21 18-25

Wheelers
 PERMANENT FIRST EVIDENCE OF CROWN ERUPTION ROOT COMPLETED
(LOWER) CALCIFICATION COMPLETED (YEARS) (YEARS)
(MONTHS IN IUL) (YEARS)

CENTRALS 3-4 4-5 6-7 9

LATERALS 3-4 4-5 7-8 10

CANINES 4-5 6-7 9-10 12-14

1ST PREMOLARS 13/4-2 YR 5-6 10-12 12-13

2ND PREMOLARS 21/4-21/2 YR 6-7 11-12 13-14

1ST MOLARS AT BIRTH 21/2-3 6-7 9-10

2ND MOLARS 21/2-3 YR 7-8 11-13 14-15

3RD MOLARS 8-10 12-16 17-21 18-25

Wheelers
SELF CORRECTING ANOMALIES
 ANDREWS 6 KEYS TO NORMAL
OCCLUSION
 LAWRENCE F.ANDREWS(1972)
collection of 120 models of teeth with naturally excellent
occlusion

Criteria for selection

 Had never undergone ortho treatment

 Were straight & pleasing in appearance

 Had a bite which looked generally correct

 In his judgement, would not benefit fromortho treatment

Andrews LF (1972). The six keys to normal occlusion. Am J Orthod Dentofacial Orthop, 62(3): 296-309
1. MOLAR RELATIONSHIP
2. CROWN ANGULATION
3. CROWN INCLINATION
4. ROTATIONS
5. TIGHT CONTACTS
6. OCCLUSAL PLANE
 KEY 1
MOLAR INTERARCH RELATIONSHIP
 The mesiobuccal cusp of the upper 1st molar should
occlude in the groove between the mesial and
medial buccal cusp of the lower 1st molar.

According to angle
(1899)
CLASS I
CLASS II DIV 1
CLASS II DIV 2
CLASS III
TRUE
PSEUDO
 KEY 2
MESIO DISTAL CROWN ANGULATION
 A line that passes along the long axis of the crown
through the most prominent part of the center of the
labial or the buccal surface is called the long axis
of the clinical crown.
 The gingival part of the long axis must be distal to
the occlusal part of the axis.
 KEY 3
LABIO LINGUAL CROWN INCLINATION
 If the gingival area of the crown is more lingually
placed than the occlusal area:-positive crown
inclination.
 If the gingival area is more labially or buccally
placed:- negative crown inclination.
 Maxillary incisors:- +ve inclination.
 Mandibular incisors:- -ve inclination.
 Posteriors:- -ve inclination
 KEY 4
ABSENCE OF ANY ROTATION
 Normal occlusion is characterized by absence of
any rotation.
 Rotated posterior teeth occupy more space while
rotated incisors occupy less space.
 KEY 5
TIGHT CONTACTS
 To consider an occlusion normal there should be
tight contacts between adjacent teeth
 KEY 6
CURVE OF SPEE
 A normal occlusion plane according to Andrews
should be flat with the curve of Spee not exceeding
1.5mm
 An excessive curve of spee restrict the amount of
space available for the upper teeth results in
crowding.
 A reverse curve of spee creates excessive space in
upper jaw.
 COMPENSATORY CURVES
 Curve of spee: anterio posterior curve passing
through the buccal cusps of premolars and molars
on to the anterior border of ramus to end on the
center of condyle.
 Curve of wilson: it is a medio lateral curve
passing through buccal to palatal and then palatal
to buccal of the other side.
 Curve of monson: it is a combination of both
medio lateral and anterioposterior curve to form a
8 inch sphere with center on glabella.
 KEY 7
CORRECT TOOTH SIZE
 Bennett and McLaughlin in 1993 gave seventh
key to normal occlusion. i.e. the upper and lower
tooth size should be correct.
 CONCLUSION
 Occlusion ,good or bad is the result of an intricate
and complicated synthesis of genetic and
environmental relationship at work through out the
early developmental stages of childhood and
young adulthood.
 So, understanding the concept can have a far
reaching implications in diagnosis, treatment
planning and prognosis of malocclusion
 REFERENCE
 William R. Profitt – ‘Contemporary orthodontics’ 4th
edition.
 Graber T.M. – Orthodontic principles and practice’
 Moyers and Robert – ‘Hand book of Orthodontics’
 Dental Anatomy, Physiology & Occlusion: Wheeler.
 Textbook of Pedodontics: Shoba Tandon
 Andrew L.F. – ‘The six keys to normal occlusion’.
American Journal of Orthodontics. Vol 62, 1972, Pg.
296-302.