Development of occlusion

Shrirang Anand Sevekar

www.dentistpro.org

Contents
Evolution of tooth
Form Type Number

Evolution of dentition Development of concept of occlusion

Fictional era Hypothetical era Factual era

Prenatal Dental Development

Initiation of odontogenesis Spatial pattern

The mouth of neonate

Gum pads Jaw relation Precocious eruption

Contents
The Primary teeth and occlusion
Development of teeth Development of occlusion

The mixed Dentition period

First transitional period Inter-transitional period Second transitional period

Permanent teeth and occlusion Dentitional and occlusal development in Young Adult Clinical Implications Adaptive mechanisms Conclusion References

Evolution of Tooth : Form

Evolution from reptilian dentition
Reptiles
Single cusp tooth triangular in shape (homodonty) development from single lobe

Evolution of tooth : Form

Rise of Triconodonty (Concrescence theory- Rose)
Multicusp teeth- Fusion of Adjacent single lobe teeth Accessory small cusp - On these expanded portion of crown
Maxillary molar -Lingual expansion Mandibular molars - Buccal extension

Evolution of tooth : Form

Cingulum theory (Tim)
Cingulum
Extra cusp

Kinetogenetic theory (Ryder)

TMJ movement
Formation of ridge and groove on occlusal surface

Evolution of tooth : Form

Tritubercular theory (Cope and Osborn)
Three tubercle
Paracone Protocone Metacone

Multitubercular theory (Forsyth Major)

Multitubercular since origin

Diamer theory (Bolk)

One origin for all mammalian teeth Supports the concrescence, Kinatogenetic and Cingulum theory Against Tritubercular theory

Evolution of tooth : Form

Differentiation theory
Additional cusp
By budding or outgrowth from the crown of a tooth rather than clustering of multiple teeth.

Evolution of tooth : Form

Tooth crown development from lobes Lobes grow and develop with in their bony crypts until they fuse. Coalescence Developmental groves.

Evolution of tooth : Type

Butlers Field theory
Developmental fields Conc. Of morphogensHeterodonty

Clayton theory
Vestigial organ

Evolution of tooth : Number

Change in hunting patterns
Reduction in tooth number

5-1-4-7 ----------- in mammal like reptiles 4-1-4-7 3-1-3-4 ----------- as generalized mammalian pattern 3-1-3-4 2-1-2-3 ----------- as generalized pattern for primates 2-1-2-3

Recent human dentition evolution

Reduction in size - facial reduction. Economical advantage as fewer resources will be utilized in making smaller teeth. Reduced Culinary skills -teeth ceased to have survival value. Food preparation - minimized the importance of teeth for survival.

Development of dentition
Reptilian -Many sets of teeth (polyphyodont) Humans - Two sets of teeth (diphyodont)

Development of concept of occlusion

Oc- Up Clusion - Closing

Fictional period
Just growed, Antagonism, Meeting, Gliding of teeth

Development of concept of occlusion

Hypothetical period
Angles thinking
Shape of cusp, crown, roots, structure of teeth and attachment key to occlusion Cornerstone of occlusion Occlusion-Normal relations of occlusal inclined planes of the teeth when the jaws are closed

Lischer and Simon

Relation of teeth to rest of face and cranium outside denture proper

Development of concept of occlusion

Factual period
Relation with muscle physiology and TMJ Harmonious correlation between musculature, TMJ, teeth

Development of concept of occlusion: Factual Era

Normal occlusion ingredientsspacing, crowding, axial inclination, overjet, overbite

Development of concept of occlusion Current concept

Occlusal position or tooth contact
Size and shape of teeth, masticatory pattern, inclination, functional premature contact, environmental factors

Postural resting position

Musculature

Integrity of stomatognathic system

Interrelation between TMJ, Tongue, Oral cavity, Musculature

Development of concept of occlusion: Current concept

Nervous regulation

Prenatal Dental Development

Prenatal Dental Development

Initiation of Odontogenesis3rd Embryonic week Epithelial thickening 6th week- c shaped epithelial arches (Enamel organ)

Prenatal Dental Development

Bud Stage
Enamel organ
Peripheral columnar cells Central Polygonal cells

Dental sac and Dental papilla 7th week- first mand. Tooth bud formation

Prenatal Dental Development

Cap Stage
Proliferation of tooth bud into cap form Outer enamel epithelium Inner enamel epithelium Stellate reticulum

Prenatal Dental Development

Bell Stage
Inner enamel epithelium Ameloblast Stratum intermedium Dental papillaOdontoblast formation PDL formation
Dental papilla

Stratum reticulum

Prenatal Dental Development

Sequence pattern of development
CI-LI-C-M1-M2 25% - Postnatal variations
Mand. Incisor eruption before max. incisor
Molar tooth germ development at same maturation

Sexual dimorphism
Deciduous dentition
Malefaster growth

Permanent dentition
Female Faster growth

Prenatal Dental Development

Spatial pattern
Arch shape
6-8 week- Flat anteroposterior 4th monthElongation of Ant. Segment - Catenary curve

Prenatal Dental Development

Spacing JDR: 1971:73
Laterals in more crowded position Age advancement Increased mesiodistal width of tooth germs - Decreased spacing

Prenatal Dental Development : Spatial pattern

Fields
Tooth germ together with the space mesial and distal to it within the dental arch Interdental space sharing

Prenatal Dental Development : Spatial pattern: Fields

Maximum occupancy of tooth field80%-1st Dec. Molar, Lateral incisors More occupancy
Rotation - DI-2 lingual displacement

Mouth of the neonate Predentate Period

Mouth of the neonate: Predentate Period

Gum pads
Alveolar process at birth Pink, firm, covered by dense fibrous periosteum, Form
State of maturity of infant at birth Size at birth as expressed by birth weight Size of developing primary teeth Genetic factor

Predentate Period: Gum pads

ArchHorse shoe shaped

Complete overjet Contact area

Molar region

Infantile anterior open bite

Predentate Period: Gum pads

Dental groove
Labio buccal portion Lingual portion

Transverse groove
Ten segments Lateral sulcus
Interarch width

Predentate Period
Neonatal Jaw relationship
No precise Bite or J.R. Ant. open bite incidence Sensory guidance system for neuromuscular functions
Suckling, swallowing respiration

Predentate Period
Dental arch width (AJO: 1997:401-9)
Preeruptive
Significant increase between 6 week to 1 year

Predentate Period
Precociously erupted primary teeth
Natal teeth Neonatal teeth Pre-erupted teeth Predeciduous teeth

Predentate Period : Self correcting anomalies

Retrognathic mandible
Differential and forward growth of mandible

Anterior open bite

Eruption of primary incisors

Predentate Period: Self correcting anomalies

Infantile swallowing pattern
Introduction of solid food in diet

Deciduous dentition

Deciduous dentition
Development of Primary teeth
Calcification
Central incisor- 14 week 1st molar- 15 week Lateral incisor- 16 week Canine- 17 week 2nd molar- 18 week

Genetic control
Morphology, rate and sequence of growth, pattern of calcification, mineral content

Deciduous dentition: Development of Primary teeth

Eruption
Movement of tooth towards occlusion Sexual differences
Male- early eruption till 15 month Female- Surpass after 15 months

Hatton study
Heredity- 78% Environmental factors- 22%

Height and weight

(Clin.Pediatr.J:2005)

Deciduous dentition: Development of Primary teeth

Size and shape of primary teeth
Male- More larger No marked sexual dimorphism Heredity Anomalies
Less frequent 1% congenital absence

Deciduous dentition: Development of Primary teeth

Ankylosis
Molars
Mand: Max -2:1

Physiologic resorption
PDL resorption
Osseous bridging and fusion between bone and dentin

Submerged tooth
Failure of vertical development

Deciduous dentition
Development of primary occlusion
Neuromuscular consideration
Sequential interdentation Guidance of teeth in occlusal position by muscular functional matrix. Role of low cusp ht. and attrition

Deciduous dentition: Development of occlusion

Primary dental arches
Ovoid in shape Role of tongue

In maxilla
Increased intercanine width by 6 mm between 3-13 yrs Increased Intermolar width of 2 mm between 3-5 yr

Deciduous dentition: Development of occlusion

In mandible
Increased intercanine width by 3.7 mm between 313 yrs Increased Intermolar width of 1.5 mm between 3-5 yr

Loss of arch length in mixed and permanent dentition

Uprighting of incisors, loss of leeway space

Deciduous dentition: Primary dental arches

Arch length and circumference
Small amt. of decrease
Mesial migration of 2nd primary molar during eruption Proximal caries

Not many changes during 3-6 yrs

Deciduous dentition: Primary dental arches

Arch width
No substantial increase Increase to accommodate permanent molars

Arch height
Increase in height of alveolar bone No substantial increase Theoretical value

Deciduous dentition: Development of occlusion

Occlusal relation
Flush terminal plane
Distal surface of U/L Favourable to guide permanent molars 59.1%

Deciduous dentition: Development of occlusion

Mesial step
Distal surface of lower more mesial to upper
Eating habit, Attrition and growing mandible Favourable

19.1%

Deciduous dentition: Development of occlusion

Distal step
Distal surface of lower more distal to upper Sucking habits Prognostically unfavourable 4.8%

Deciduous dentition
Normal characteristics Over bite
Vertical Incisor overlap Average- 1- 2mm 10-40% variation Foster study
Ideal- 19% Reduced- 37% Openbite-24% Excessive overbite- 20%

Deciduous dentition: Normal characteristics

Overjet
Horizontal relationship Normal
1-2mm

Effects
Habits Mandibular forward growth Excess wear

Deciduous dentition: Development of occlusion

Canine relationship
Most stable Cl-I

Interincisal angulations
150 in primary 123 in permanent
Dental arch circumference wider

Deciduous dentition: Normal characteristics

Spacing
According to Baume
Closed dentition Spaced dentition
Localized Primate spaces (anthropoid/ simion spaces) GeneralizedPhysiologic Pressure from the tongue (Barber)

Total spaceMaxi-0 to 8mm Mandible-0 to 7mm

Deciduous dentition: Normal characteristics

Normal signs of Deciduous dentition

Spaced anteriors Primate space Shallow overbite and overjet Straight terminal plane Cl-I molar and cuspid relationship Almost vertical inclination of anterior teeth Ovoid arch form

Self correcting anomalies of Deciduous dentition

Anterior deep bite
Cause- Incisors more upright Correction
Attrition of incisal edges Eruption of permanent molars Forward and downward growth of mandible

Self correcting anomalies of Deciduous dentition

Physiologic spaces
Permanent incisor accommodation
Maxilla-7mm Mandible-5mm

Self correcting anomalies of Deciduous dentition

Primate space
Early mesial shift

Flush terminal plane

Early mesial shift Late mesial shift (Leeway space)

Deciduous dentition
Prevalence
Crossbite, Cl-II molar relationship, Excessive overjet, Openbite

Mixed dentition

Mixed dentition
Period of both primary and permanent dentition Clinical importance
Utilization of arch perimeter Adaptive changes in occlusion Orthodontic intervention

Mixed dentition
Three phases
First transitional period. Inter transition period. Second transitional period

Mixed dentition
First transitional period :Emergence of first permanent molars. Exchange of deciduous incisors with permanent incisors. Establishment of occlusion

Mixed dentition
Intertransitional period
Both sets of dentition
Permanent incisors, 1st molars Deciduous canines, 1st ,2nd molars

Mixed dentition
Second transitional period
Emergence of Bicuspids, cuspids, 2nd molar. Establishment of occlusion

Mixed dentition
1st molar eruption
Mandible
Guidance by distal surface of 2nd primary molar Mesial and lingual path of eruption

Maxilla
Distal and buccal path of eruption Forward movement of maxillary growth
Space created posteriorly

Mixed dentition
Molar adjustment
Closure of primate space
Early mesial shift Controversial
5 Yr 7 Yr

Late mesial shiftMesial migration of first permanent molar after loss of second deciduous molar using leeway space.

Mixed dentition
Difference of space
Leeway space
Mandible- Per quadrant 1.7mm Maxilla- 0.9mm

Mixed dentition : Leeway space

Controversy
Anterior segment Maxilla3.2- 3.5 mm larger in one segment

Mandible
2.4-2.5 mm larger

Balancing of posterior Leeway space

Mixed dentition : Leeway space

Morrees view
Measurement of deciduous and permanent teeth in same mouth No leeway space available Maxilla
1-6 mm More space required

Mandible
At least 1 mm space required

Mixed dentition
Occlusal changes
Flush terminal plane of primary dentition
Cl I molar relations achieved by.
Late mesial shift Greater forward growth of mandible Combination of both

Mixed dentition
A

Class I

Mixed dentition
Incisor eruption
Mandible
Develop lingually to primary roots
Exfoliation of dec.lat.incisor activation of eruption and labial movement

Lateral eruptionCrowding

Mixed dentition
Moves Primary cuspids distally and laterally closing the primate space Premature loss of cuspids- Incisors tip lingually Lingual tipping of incisorsLabioversion of cuspids

Mixed dentition: Incisor eruption

Maxilla
Safety valve mechanism
Prevention of collapse by mandibular incisors

More labially eruption than primary Labial inclination Lateral incisors

Developing crowns of cuspids lie labially and distally to its roots
Eruption more labially than centrals

No Orthodontic correction
Root resorption

Mixed dentition
Incisor liability (Alignment of incisors)
Deciduous Permanent incisor difference= 6-7 mm Mechanisms of incisor liability adjustment
Intercanine arch growth-3 to 4 mm

Mixed dentition: Incisor liability

Interdental (Developmental spacing)- 2 to 3 mm

More anterior position of permanent incisors as they erupt-1 to 2 mm

Mixed dentition: Cuspid and Bicuspid eruption

Mandible
Favourable eruption sequence
6-1-2-3-4-5-7
Eruption of 3
Maintenance of arch perimeter Increased intercanine width Prevention of lingual tipping of incisors Hastened by extraction of primary cuspids

Mixed dentition: Cuspid and Bicuspid eruption

Eruption of 1st Bicuspid
Rarely any difficulty Sometimes rotation due to uneven resorption of primary molar

Mixed dentition: Cuspid and Bicuspid eruption: Mandible

Eruption of 2nd bicuspid
Last succedaneous tooth to erupt Eruption complication
Mesial migration of 1st molar Tooth size- Space available ratio poor Premature exfoliation of 2nd primary molar

Extreme variation in calcification and development schedule

Mixed dentition: Cuspid and Bicuspid eruption

Maxilla
Sequence of eruption
6-1-2-4-5-3-7 or 6-12-4-3-5-7

Displaced labially
Habits
Affect eruptive pattern of cuspid and bicuspid

Mixed dentition: Cuspid and Bicuspid eruption

Maxilla
1st bicuspid
Minimal difficulty in eruption Same size as primary predecessor

2nd bicuspid
Easy eruption Larger mesiodistal width of primary predecessor

Cuspid

Mixed dentition: Cuspid and Bicuspid eruption: Maxilla

Use of Leeway space to accommodate More tortuous path of eruption Favourable sequence
Cuspid before 2nd molar

Labioversion with mesial inclination

Ugly duckling stage (Broadbent Phenomenon)

Mixed dentition
2nd molar eruption
Last to erupt before 3rd molar Mandible
If precede 2nd bicuspid tips the 1st molar mesially

Maxilla
Eruption before mandibular 2nd molar Symptom of developing ClI relation

Max. molar eruption before mand. molarsymptomic C lI

Mixed dentition
Molar eruption
Incisor eruption

Leeway space

Mixed dentition
Self correcting anomalies
Anterior deep bite
Proprioceptive condition response of patient with slight supraeruption of permanent molars and premature contact of pads of tissue

Mixed dentition: Self correcting anomalies

Mandibular anterior crowding
Increased intercanine width Tongue pressure
Labial movement and inclination of incisors

Mixed dentition: Self correcting anomalies

Ugly Duckling Midline diastema
Eruption of canine
7 Year

8 Year

11 Year

Mixed dentition: Self correcting anomalies

End on molar relation
Late mesial shift
Leeway space

Permanent dentition

Development of permanent teeth

Calcification
Sexual dimorphism Nollas stages

Development of permanent teeth : Eruption

Ectopic development
Teeth developing away from normal position Most common- Maxi1st molar, canine, mand. Cuspid, maxi 2nd premolar, maxi lateral
Large primary and permanent teeth Diminished maxi. Length Posterior position of maxilla Atypical angle of eruption

Sexual dimorphism

Development of permanent teeth : Eruption

Factors determining

the tooths position

Inheritable trait Presence or absence of adjacent teeth Mesial drifting tendency

Factors determining the tooths position

Anterior component of force
Muscular forces (lip, cheek, tongue)

Habits Rate of resorption of primary teeth Localized pathosis

Permanent dentition
Dimensional changes in the dental arches
Combined width of teeth Dimensions of dental arches in which the teeth are arrayed Dimension of basal bone

Permanent dentition: Dental arches

Width
Width increase dependant on alveolar process growth Maxillary
Path of eruption of canine
outward forward and downward

Premolar , Molar More divergence Clinical significance

Permanent dentition: Dental arches

Mandible
Mandibular process more parallel path of eruption Less width

Canine
Distal tipping of primary cuspids into primate spaces during incisor eruption

PremolarBuccal crown placement

MolarsMesial shiftConvergence

Permanent dentition: Dental arches

Circumference or perimeter
Reduction
Late mesial shift Mesial drifting tendency Lingual positioning of incisors due to differential mandibulomaxillary growth Original tipped position of incisors and molars Localized factors 3rd molar eruption

Maxillary arch perimeter

Angulation of incisorsPreservation

Permanent dentition
Overjet and overbite
Primary dentitionAlmost zero Mixed dentitionOverbiteIncreases followed by decrease No. of facial variation

Overjet
Anteroposterior skeletal relationship Sensitivity to abnormal lip and tongue function

Dentitional and occlusal changes in young adults

3rd molar development
Most variable in calcification and eruption Role of 3rd molar in crowding Simultaneous events
Arch perimeter shortening Increased incisor crowding More Forward Mandibular growth than maxilla

Dentitional and occlusal changes in young adults

Intra arch tooth alignment :Relationship of teeth with in the dental arch. Teeth in varying degree of inclination. Maxillary arch
Anterior teeth
mesially inclined

Posterior teeth
Distally inclined.

Mandible
Obliquely backward

Dentitional and occlusal changes in young adults

Inter arch tooth alignment :Relationship of teeth in one arch to those in other arch. Mandibular arch length and width is slightly less than maxillary arch. Occlusal contacts occur mainly through two types
Cusp to fosse relationship Cusp to embrasure relationship

Dentitional and occlusal changes in young adults

Curve of spee
Anteroposterior direction the occlusal plane Inclination of teeth in lateral view The average value 2.5 3 mm

Dentitional and occlusal changes in young adults

Curve of Wilson:A mediolateral curvature to occlusal plane
In frontal view Posterior teeth
Maxillary arch Slight buccal inclination Mandibular arch Lingual inclination

Andrews six keys of occlusion

These are a set of six characteristics that were consistently present in collection of 120 casts of naturally optimal occlusion, identified by Dr. Lawrence F Andrews.

Andrews six keys of occlusion

Inter- arch relationship
Molar
Maxillary 1st
Mesiobuccal cusp Mesiolingual cusp Distal marginal ridge

Andrews six keys of occlusion

Interarch relationship
Premolar
Cusp-Embrasure

Canine
Cusp-Embrasure

Incisor
Maxillary overlap

Andrews six keys of occlusion

Mesio-distal crown Angulation
The gingival portion of the long axis of crown is more distal than the incisal portion

Andrews six keys of occlusion

Labio-lingual crown inclination
Maxillary incisors
Positive inclination

Mandibular incisors
Slightly negative inclination.

Andrews six keys of occlusion: Labio-lingual crown inclination

The Canines and premolars
negative and similar.

Maxillary first and second molars

More negative than canines and premolars.

Andrews six keys of occlusion

Absence of rotation

Andrews six keys of occlusion

Tight contact

Andrews six keys of occlusion

Curve of spee
The depth of the curve of Spee ranges from a flat plane to slightly concave surface.

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. Understanding the concept can have a far reaching implications in diagnosis, treatment planning and prognosis of malocclusion

References
Handbook of orthodontics Robert Meyers. Dental anatomy Julian Woelfel, Rickne Scheid Oral anatomy,histology, embryology B.K.B. Berkovitz,G.R. holland,B.J. moxham Development,function and evolution of teeth Mark Teaford, Smith, W.J. Ferguson. Shobha Tandon Graber Profit Bhalaji Barber Andrews six keys to normal occlusion AJO 1972;62:296-309 Genetics of human tooth agenesis AJO 2000;117:650-6 Occlusion DCNA April 1995. AJO1997:111:401-9 Ped.Dent:2001:118-122

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