Development of DentitionUG Class

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DEVELOPMENT OF DENTITION
DEVELOPMENT OF THE
DENTITION
Gowri sankar
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Dr. S. GOWRI SANKAR M.D.S
professor
Department. of Orthodontics
Narayana Dental College
NELLORE.—A.P.
S. Gowri sankar 2
Powerscope OF DENTITION
DEVELOPMENT
• Introduction
• Prenatal development of human dentition
• Eruptive tooth movement
• Phases of occlusion development
Pre-dental period
Deciduous dentition period
Mixed dentition period
Permanent dentition period
• Dimensional changes in dental arches
• Transient malocclusions
• Clinical significance
• References
DEVELOPMENT
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DEVELOPMENT
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Phases of occlusal development

DEVELOPMENT
• Pre-dental period( from birth to 6 months of age)
• The deciduous dentition period (from 6 months to 6 yrs.)
• The mixed dentition period( from 6-12 yrs.)
• The permanent dentition period( 12 yrs onwards.)

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Predental period
DEVELOPMENT
Gum pads
• At time of birth, alveolar arches are firm and pink termed as ‘gum
pads’.
• Divided into labiobuccal and lingual portion by the ‘dental groove’
• Lingual portion limited by gingival groove at junction of gum pad

with the palate- Less conspicuous in the lower jaw.
• Transverse grooves divide it into ten segments each of which

consists of developing deciduous tooth germ.
• Lateral sulcus -between canine and 1st deciduous molar- determine

relation of upper to lower jaw.
DEVELOPMENT
• At rest upper and lower gum pads separated by the tongue which
lies over the lower gum pads and behind the lower lips.
• Upon occlusion the gum pads contact only in molar region –

Transient open bite /infantile open bite - helps in suckling.
• Upper gum pad is wider and longer than mandibular gum pad.
• Uniform overjet all around is present when the gum pads are
approximated.
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DEVELOPMENT
Jaw relationships
– Mandibular arch lingual to maxillary arch in both incisor and
molar region – 70%
– Mandibular arch slightly lingual in incisor area and distal to
maxilla an the molar region – 27%
– Mandibular arch definitely distal in both incisor as well as in the
molar region – 3%
DEVELOPMENT
Precociously erupted teeth
 Natal teeth mandibular

Neonatal teeth incisors
 may be supernumerary or normal teeth.

 normal or small conical shaped, yellowish brown, opaque,
hypoplastic teeth
 erupt precociously due to
1. superficially placed tooth germ in the arches.
2. Endocrine disturbances
3. familial tendencies
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Deciduous dentition period

DEVELOPMENT
• Deciduous dentition period lasts from 6 months to 6 years of post

natal life
• At 2 ½ years 70% of children have full set of deciduous dentition
• 90% of children have the whole complement of deciduous dentition

by 2-3 years
DEVELOPMENT
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DEVELOPMENT
Eruption :
 Sequence
8 14 18 24
AB D C E
A B D C E
6 7 12 16 20
•
DEVELOPMENT
 Teething has been often complained as a cause for various

systemic disturbances. Symptoms
• Vomiting
• Fever
• Diarrhoea
• Irritability
Teething
• Rhinorrhea
 Teething as a diagnostic label should be avoided by physician
DEVELOPMENT
Spacing
• Normally exists-called physiologic or developmental spaces.
• Spaces present mesial to maxillary canines and distal to mandibular

canines-anthropoid or simian or primate spaces. (to accommodate
larger permanent maxillary incisors and permanent canines in
mandibular arch).
• It is possible to use spacing between lower deciduous teeth for

predicting degree of crowding
DEVELOPMENT
DEVELOPMENT
Occlusal relationship
• Gum pad stage – no specific occlusal relation or centric.

• With eruption of primary first molars ,the first 3-dimensional
occlusal relationship is established.
• The primary teeth are not centered over each other to aid in good
inter digitation. Large palatal cusps of maxillary first deciduous
molar with its cone shaped cusp is placed within the crater on the
occlusal surface of mandibular primary molar (CONE FUNNEL
mechanism)
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DEVELOPMENT
• The mandibular cusp articulates just ahead of corresponding

maxillary cusp.
• The mesiolingual cusp of maxillary molars occlude in central fossa
of mandibular molars
• Incisors are straight with minimal overjet and overbite.
DEVELOPMENT
Second primary molars are in flush-terminal plane

People with coarse diet
The occlusal surface of primary teeth wear to a greater extent
Removal of cuspal interferences
forward positioning of mandible edge to edge incisal

relationship and mesial step terminally
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DEVELOPMENT
Deep bite
 When deciduous incisors erupt, the overbite of upper incisors is

equivalent to height of crown of lower incisor. This overbite is
reduced by
– eruption of deciduous molars
– attrition of incisors
– Skeletal maturation
DEVELOPMENT
Features of normal primary dentition
• Spaced anteriors
• Primate spaces
• Shallow overbite and overjet
• Straight terminal plane
• Class I molar and cuspid relation
• Almost vertical inclination of anterior teeth
• Ovoid arch form
• Flat occlusal plane.
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Mixed dentition period

DEVELOPMENT
• Begins at 6 yrs –
– eruption of 1st permanent molar till last deci. tooth is shed
(maxillary canine at 12-13 yrs)
• Deciduous teeth are present along with some permanent teeth.
• Most malocclusions make appearance in this stage
• Alveolar process is most actively adaptable (areas of bone growth)
during this period and thus ideal time for most orthodontic
interventions.
DEVELOPMENT
• STAGES
• Early mixed dentition – 6-9 yrs
• Late mixed dentition – 9-12 yrs
Divided also as
1. 1st transitional phase – 6-8 yrs
2. 2nd transitional period – lasts 14 months
3. Intertransitional period – occurs between above
two
DEVELOPMENT
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DEVELOPMENT
First transition period

• Characterised by
1. eruption of 1st permamnant molars and
2. exchange of incisors.
DEVELOPMENT
Eruption of 1st permanent molar
• Called ‘key to normal occlusion’ by Angle as they play important

role in establishment and function of occlusion
• Preceding continuous increase in size of jaws posterior to deciduous

molars provides space for the molars.
• A-P relation between two opposing permanent molars after

emergence depends on
• Positions occupied in jaws posteriorly
• Sagittal relation between jaw bases
• Terminal plane relation in deciduous dentition
DEVELOPMENT
DEVELOPMENT
• flush terminal plane

ClassIII
ClassI(with late mesial shift)
End-end
Mesial step
ClassIII(normally)
ClassI(desirable)
Distal step
ClassII
DEVELOPMENT
Influence of terminal plane relation of Primary molar

on the A – P relation of Secondary molar
• In most children flush terminal plane observed at end of primary

dentition.
• Secondary molars guided by distal surfaces of second primary

molars into end on relation upon eruption which is normal for that
age.
DEVELOPMENT
• About 3.5mm forward movement of lower molar relative to

upper molar required for smooth transition to class I molar
relation in permanent dentition. Space for this provided by
1. By physiologic and Leeway spaces
2. by differential growth of lower jaw
DEVELOPMENT
• This shift occurs in two ways

1. Early mesial shift
2. Late mesial shift
• Early shift
• In early mixed dentition period.
• Eruptive forces of 1st perm molar pushes the deciduous 1st and
2nd molars forward utilizing primate spaces.
• Late shift
• Occurs in late mixed dentition period.
• Utilizes leeway space.
DEVELOPMENT
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DEVELOPMENT
DEVELOPMENT
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DEVELOPMENT
Exchange of incisors
• Permanent incisors larger than primary incisors.

• The difference between the amount of space needed for
accommodation of the incisors and the space available is called incisor
liability.
• Maxillary arch-7 mm
• Mandibular arch - 5 mm.
• Overcome by
1. Utilization of physiologic spaces.
2. Change in incisor inclination.
3. More labial positioning of incisors.
4. Forward growth of maxilla and mandible.
DEVELOPMENT
Incisor liability:
Mayne has coined the term incisor liability
Permanent incisors are larger than primary incisors,this
difference
in size is termed incisal liability.
Eruption of permanent incisors make the
permanent arch circumference wider,normally the interincisal
angle is 150 degree in primary dentition and 120 degree in
permanent dentition
The period of transition determine the successful alignment of
the permanent teeth toward an ideal arch form
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DEVELOPMENT
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DEVELOPMENT
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DEVELOPMENT
Inter-transitional period
• Teeth present are
6EDC21 12CDE6
6EDC21 12CDE6
• Relatively stable period.
• No changes occur.
DEVELOPMENT
Second transitional period
• Changes seen in this stage are

1. Transition of posterior teeth and
2. emergence of second permanent molar
• Sequence of transition
1. Mandibular canines
2. Maxillary and mandibular first deciduous molars
3. Maxillary and mandibular second deciduous molars
4. Maxillary canines
DEVELOPMENT
DEVELOPMENT
• 1st and 2nd deci. molars larger than width of 1st and 2nd premolars
mesiodistally.
Permanent canine
Primary canine
Leeway space
1st premolar
Deciduous 1st molar
2nd premolar
Deciduous 2nd molar
DEVELOPMENT
DEVELOPMENT
• The excess space is called leeway space ( Nance )

• This discrepancy greater in lower jaw
• Maxillary – 0.9/side – 1.8mm on whole
• Mandibular - 1.7mm/side – 3.4mm on whole
• Utilized in late mesial shift for establishment of class I molar

relationship in permanent dentition.
DEVELOPMENT
Broadbent’s phenomenon (Ugly duckling stage)
• Seen in late mixed dentition ( 8-11 years).

• Features include
– Maxillary midline diastema.
– Distal tilting and flaring of incisor crowns.
• Crowns of cuspids impinge on developing roots of lateral incisors
causing the crowns to flare laterally. This force is transmitted to the
roots of central incisors causing distal divergence of crowns and
midline diastema .
• With eruption of canines the point of influence of canine on laterals
shift incisally causing closure of midline diastema
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'Ugly duckling stage.:
-' On occasion, the permanent incisors 'spread out' due to
spacing. In the older literature, is called by the 'ugly

duckling stage.' With the eruption of the permanent canines,
the spaces often will close.
This is the norm between ages 7 through 12 years of age, and

usually is not connected with a permanent space between the
teeth. This stage of development needs special comment because
its often mistaken as an orthodontic problem.
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DEVELOPMENT
• Dynamics of ugly duckling stage

– Normal path of eruption of maxillary cuspids- slide along
distal surfaces of permanent lateral incisors without creating
any appreciable amount of incisor spacing.
– When path of cuspid eruption is slightly exaggerated mesially

impingement of lateral incisor roots flaring
of incisors.
– If path of eruption of cuspids exceed normal range

impingement of incisor roots resorption of roots
insufficient growth and inter-cuspid arch width.
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Eruption of second permanent molar
• They follow all teeth anterior to it
• Eruption of maxillary second molar

before mandibular molar is
symptomatic of developing Class II
malocclusion.
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Permanent dentition period

DEVELOPMENT
• Development
– Calcification begins at birth by calcification of cusps of first
permanent molars.
• Sequence of eruption
– Maxillary 6124357 or 6124537
– Mandible 6123457 or 6124357
DEVELOPMENT
Features of permanent dentition

• Coinciding midline
• Angles Class I molar relation
• Absence of spacing, crowding and rotations
• Vertical overbite 1/3rd of clinical crown height of mandibular central
incisor
• Overjet of 2 mm
• Curve of Spee
– Concave in mandible
– Convex in maxilla
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Dimensional changes in dental

arches
DEVELOPMENT
• Arch dimensions measured are

– Widths of canine, primary molars (pre-molars) and first
permanent molars
– Length( or depth)
– Circumference
DEVELOPMENT
Arch width
• Dental arch width increases correlate with vertical alveolar

process growth, whose direction is different in upper arch
(more diverging pattern) than in lower arch (more parallel
pattern.)
• Hence maxillary arch width increase much greater than that of

mandibular arch width.
• Intercanine diameter increases in two spurts

1. During replacement of incisors
2. Transition of canines.( perm. canines more buccally placed than
their predecessors.)
DEVELOPMENT
• Increase in intercanine width is more in maxilla than in mandible.
• The increases in ach width dimensions are larger in ventral region

than in the dorsal region, and larger in maxilla than in mandible.
DEVELOPMENT
Arch length (depth)
• Is measured at the midline from a point midway between the

incisors to a tangent touching the distal surfaces of second primary
molars or premolars.
• Not clinically significant.
DEVELOPMENT
Arch circumference or perimeter

• Measures from mesial of first permanent molar around the arch
over the contact points and incisal edges in a smooth curve to the
mesial of first permanent molar on other side.
• Mandibular arch circumference decreases during transitional

period because of
1. Late mesial shift of first perm.molars as leeway space is
preempted.
2. Mesial drifting tendency of posterior teeth throughout life.
3. Interproximal wear of teeth.
DEVELOPMENT
• Maxillary arch perimeter increases slightly probably because

1. Greater increases in width in maxilla
2. More proclined perm. incisors as compared to primary incisors.
DEVELOPMENT
• Clinically…. it is easy to increase the arch width and

length in maxilla than it is in mandible.
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Transient malocclusions/self
correcting malocclusions
DEVELOPMENT
Gum pad stage
1. Anterior open bite.

eruption of incisors
2. Scissor bite.
Differential growth of jaws
3. Infantile swallow
maturation process
eruption of teeth
4. Distal relation of mandible to maxilla

Differential growth of jaws
DEVELOPMENT
Primary dentition.
• Deep bite
eruption of deciduous molars
attrition of incisors
Forward downward growth of mandible
• Flush terminal plane

early and late mesial shift
• Spacing
eruption of permanent teeth
DEVELOPMENT
Transitional phase
• Anterior deep bite
eruption of permanent posteriors
• Ugly duckling stage.

eruption of canines
• End on molar relation

late mesial shift
• Mandibular anterior crowding

jaw growth and expansion
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Clinical significance
DEVELOPMENT
• Dental age is determined from three characteristics :

– Erupted teeth
– Amount of resorption of roots of primary teeth
– Amount of development of permanent teeth
DEVELOPMENT
Developmental disturbances affecting teeth
• Disturbances during initiation of tooth germs

– Ectodermal dysplasia
– Anodontia
– Supernumerary and supplemental teeth
– Natal and neo-natal teeth
– Pre-deciduous dentition
– Post-permanent dentition
DEVELOPMENT
• Disturbances during morpho-differentiation

– Hutchinson's incisors
– Mulberry molars
– Peg laterals
– Macrodontia
– Microdontia
– Dens in dente
– Dens evaginatus
– Gemination
– Fusion
– Dilaceration
– Taurodontism
DEVELOPMENT
• Disturbances during apposition of hard tissues

– Enamel hypoplasia
– Amelogenesis imperfecta
– Dentinogenesis imperfecta
– Dentin dysplasia (rootless teeth)
– Shell teeth
– Odontodysplasia
– Pigmentation of enamel and dentin
– Cemental hypoplasia
– Enamel pearls
DEVELOPMENT
• Disturbances during calcification

– Enamel hypocalcification
– Inter globular dentin
DEVELOPMENT
References
• Hand book of orthodontics – MOYERS

• Dental anatomy ,physiology and occlusion – WHEELERS
• Development of dentition –VAN DER LINDEN
• Text book of orthodontics – SAMIR E BISHARA
• Text book of orthodontics - SALZMAN
• Contemporary orthodontics – WILLIAM R PROFFIT
• Oral histology – A R TEN CATE
• ORBAN’s oral histology and embryology
• Text book of Pedodontics – SHOBHA TANDON
• Text book of Orthodontics – GOWRI SANKAR
• Text book of Pedodontics – Mc DONALD

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Dr. S. GOWRI SANKAR M.D.S

Phases of occlusal development

• Pre-dental period( from birth to 6 months of age)

• The deciduous dentition period (from 6 months to 6 yrs.)

• The mixed dentition period( from 6-12 yrs.)

• The permanent dentition period( 12 yrs onwards.)

• Divided into labiobuccal and lingual portion by the ‘dental groove’

• Lingual portion limited by gingival groove at junction of gum pad

• Transverse grooves divide it into ten segments each of which

• Lateral sulcus -between canine and 1st deciduous molar- determine

• Upon occlusion the gum pads contact only in molar region –

 Natal teeth mandibular

 may be supernumerary or normal teeth.

Deciduous dentition period

• Deciduous dentition period lasts from 6 months to 6 years of post

• At 2 ½ years 70% of children have full set of deciduous dentition

• 90% of children have the whole complement of deciduous dentition

 Teething has been often complained as a cause for various

• Normally exists-called physiologic or developmental spaces.

• Spaces present mesial to maxillary canines and distal to mandibular

• It is possible to use spacing between lower deciduous teeth for

• Gum pad stage – no specific occlusal relation or centric.

• The mandibular cusp articulates just ahead of corresponding

Second primary molars are in flush-terminal plane

The occlusal surface of primary teeth wear to a greater extent

Removal of cuspal interferences

forward positioning of mandible edge to edge incisal

 When deciduous incisors erupt, the overbite of upper incisors is

Features of normal primary dentition

Mixed dentition period

First transition period

• Called ‘key to normal occlusion’ by Angle as they play important

• Preceding continuous increase in size of jaws posterior to deciduous

• A-P relation between two opposing permanent molars after

• flush terminal plane

Influence of terminal plane relation of Primary molar

• In most children flush terminal plane observed at end of primary

• Secondary molars guided by distal surfaces of second primary

• About 3.5mm forward movement of lower molar relative to

• This shift occurs in two ways

• Permanent incisors larger than primary incisors.

Second transitional period

• Changes seen in this stage are

• The excess space is called leeway space ( Nance )

• Utilized in late mesial shift for establishment of class I molar

Broadbent’s phenomenon (Ugly duckling stage)

• Seen in late mixed dentition ( 8-11 years).

spacing. In the older literature, is called by the 'ugly

This is the norm between ages 7 through 12 years of age, and

• Dynamics of ugly duckling stage

– When path of cuspid eruption is slightly exaggerated mesially

– If path of eruption of cuspids exceed normal range

• They follow all teeth anterior to it

• Eruption of maxillary second molar

Permanent dentition period

Features of permanent dentition

Dimensional changes in dental

• Arch dimensions measured are

• Dental arch width increases correlate with vertical alveolar

• Hence maxillary arch width increase much greater than that of

• Intercanine diameter increases in two spurts

• Increase in intercanine width is more in maxilla than in mandible.