Developing Dentition And Its Disturbances

Development of Occlusion

Pre-dentate period Deciduous dentition Mixed dentition Permanent dentition

Pre-dentate period
Period from birth to eruption of first deciduous teeth Alveolar arches of infant called gum pads The gum pads: the alveolar processes at birth pink, firm and covered with fibrous periosteum Divided into 10 segments by transverse/ lateral grooves Lateral Sulci: prominent lateral grooves between deciduous canine and deciduous first molar Develop in 2 parts: Labial portion (Differentiates first) Lingual portion (Differentiates later) These 2 portions separated by dental groove- site of origin of dental lamina

Maxillary gum pads

Horse shoe shaped Consists of: Gingival groove Dental groove Lateral sulcus (canine and deciduous molar segments)

Papilla Lateral grooves Lateral sulcus

Dental groove
Gingival groove

Maxillary Gum Pad

Mandibular gumpads

U shaped with labially everted anterior portion Also consists of: Gingival groove Dental groove Lateral sulcus

Molar Segment

Lateral sulcus Canine Segment Gingival groove

Mandibular Gum Pad

Relationship of Gumpads

At rest, gumpads separated by tongue over lower gum pad Variable overjet with contact only at molar segment Lateral sulcus of lower is distal to upper At function: Mainly vertical No lateral movement Very little in antero-posterior plane In early foetal development, mandibular protrusion present which is gradually reversed At birth, lower jaw situated posteriorly

Relationship of Gumpads

Growth of Gum Pads

At birth, width is inadequate to accommodate all incisors Growth of gum pads is rapid in first year More in transverse and in labio-lingual direction Each segment becomes prominent & prepare for eruption Eruption commences at 6 months of age

Deciduous or Primary Dentition

General features Both dental arches are half round/ovoid No curve of spee Shallow cuspal digitation Slight overjet/overbite Vertical incisors Spacing is normal/ No crowding

The Occlusion of Primary Dentition

1. The incisors are more vertically positioned in the alveolus & are

often spaced.
2. The overbite is usually greater. 3. Significant primate spaces (the spaces distal to the lower canine and mesial to the upper canine) 4. The distal edges of the upper and lower primary molars may be flush, mesial or distal step.

Spacing in Primary Dentition

Spaced dentition: Considered good as the spaces can be utilized for adjustment of permanent teeth 2 types: Primate space/Simian/Anthropoid space Physiologic space/Development space

Primate Spaces

between upper lateral and canine between lower canine and first deciduous molar

Developmental/ Physiologic spaces

Total space varies from 0-8 mm, average 4mm in maxillary arch Total space varies from 1-7 mm, average 3mm in mandibular arch

Primary Molar relation

Relationship of the Distal surface of maxillary and mandibular second primary molars

Flush Terminal Plane relation Mesial step Distal step

Primary Anterior teeth relation

Overbite: Vertical overlap, minimal to about 2 mm Overjet: Horizontal overlap, range 2-6 mm, average 1-2 mm at 2yrs 4mm decreases with age upto 5 yrs Canine relation: most stable class I class II Arch dimensions Arch circumference Arch length Bicanine diameter Arch width Bimolar diameter Arch height

The six/four rule

for primary tooth emergence (4 teeth emerge for each 6 months of age)
1. 6 months: 4 teeth (lower centrals & upper centrals)
2. 12 months: 8 teeth ( 1. + upper laterals & lower laterals) 3. 18 months: 12 teeth (2. + upper first molars & lower first molars) 4. 24 months: 16 teeth (3. + upper canines & lower canines) 5. 30 months: 20 teeth (4. + lower second molars & upper second molars)

Summary for primary teeth development

By 4th week in utero, dental lamina; 6th week tooth germs By 5 months in utero, all crowns start calcification. By 1 year (11-12 months), all crowns complete formation. By 2.5 years, all primary teeth have emerged. By 4 years , all primary teeth complete root formation.

Abnormal Behaviour of Primary Teeth

1. Retained primary teeth

2. Submerged primary teeth 3. Remnants of Primary Teeth

4. Natal and Neonatal Teeth

Retained Primary Teeth

Submerged Teeth

Ankylosed Teeth

Natal teeth

Natal Teeth

Natal teeth already present at the time of birth; neonatal teeth erupt during the first 30 days after birth Generally develop on the lower arch where the central incisors will be. Have little root structure and are attached to the margin of the gingiva by soft tissue Because of their placement, they may cause irritation and trauma to the infant's tongue May cause pain/irritation to mother while feeding If the tooth is loose,the child runs a risk of aspiration

Self correcting anomalies

Pre-dentate: retrognathic mandible anterior open bite infantile swallow pattern Primary dentition: anterior deep bite FTP Spacing

Mixed dentition: anterior deep bite lower anterior crowding ugly duckling stage end-on relation Permanent dentition: overjet and overbite

Infantile Swallow