DEVELOPMENT OF DENTITION

AND OCCLUSION

Presented by
Astha Pandey ( Roll no : 05)
Astha Rani Toppo (Roll no : 06)
Guided By :Dr Abhay Jain Sir
 Bud stage
Cap stage
Bell stage
Root formation
Periods of occlusal development
Pre-dental period
Gum pads

CONTENT The deciduous dentition period

Eruption age and sequence of deciduous
dentition
Spacing in deciduous dentition
Flush terminal plane
Deep bite
The mixed dentition period
First transitional period
Inter-transitional period
The second transitional period
1. The permanent dentition period
INTRODUCTION
 The embryonic oral cavity is lined by stratified
squamous epithelium known as the oral ectoderm
 . Around the 6th week of intra-uterine life, the
infero-lateral border of the maxillary arch and the
supero-lateral border of the mandibular arch show
localized proliferation of the oral ectoderm
resulting in the formation of a horse shoe shaped
band of tissue called the dental lamina
 This dental lamina plays an important role in the
development of the dentition. The deciduous teeth
develop by lingual extension of the dental lamina.

 The ectoderm in certain areas of the dental lamina
proliferates and forms knob-like structures that grow into
the underlying mesenchyma.
 Each of these knobs represents a future deciduous tooth
and is called the enamel organ.
 The enamel organ passes through a number of stages
ultimately forming the teeth.
 Based on the shape of the enamel organ, the development
of teeth can be divided into three stages.
 They are the bud, cap and the bell stage.
BUD STAGE
 This is the initial stage of tooth formation where the enamel
organ resembles a small bud
 During the bud stage, the enamel organ consists of peripherally
located low columnar cells and centrally located polygonal cells.
 The surrounding mesenchymal cells proliferate, which result in
their condensation in two areas.
 The area of condensation immediately below the enamel organ is
the dental papilla
 The ectomesenchymal condensation that
surrounds the tooth bud and the dental
papilla is the dental sac.
 The dental papilla as well as the dental sac
are not well defined during the bud stage .
 They become more defined during the
subsequent cap and bell stages.
 The cells of the dental papilla form the
dentin and pulp while the dental sac forms
cementum and periodontal ligament.
 CAP STAGE
 The tooth bud continues to proliferate resulting in a cap
shaped enamel organ .
 This is characterized by a shallow invagination on the under
surface of the bud.
 The outer cells of the cap covering the convexity are cuboidal
and are called the outer enamel epithelium.

The cells lining the concavity of the cap become tall columnar
and are referred to as the inner enamel epithelium.
The central area of the enamel organ between the outer and
inner enamel epithelium, which initially consisted of polygonal
cell , acquire intercellular fluid and form a cellular network called
as stellate reticulum.
 Stellate reticulum revel a branched network of cells.
 BELL STAGE
 Due continued uneven growth of the enamel organ it
acquires a bell shape .
 The cells of the inner enamel epithelium differentiate
prior to amelogenesis into tall columnar cells called
ameloblast , which lay down enamel.
 The cells of the inner enamel epithelium exert a
strong influence on the underlying mesenchymal cells
of the dental papilla
 A few layers of flat squamous cells are seen between
the inner enamel epithelium and the stellate
reticulum This layer is called the stratum
intermedium.
 It is believed to be essential for enamel formation .
 The stellate reticulum expands further due to continued
accumulation of intra cellular fluid.
 The cells of this area are star shaped having large processes
that anastamose with those of adjacent cells.
 As the enamel formation starts, the stratum reticulum
collapses to a narrow zone thereby reducing the distance
between the outer enamel epithelium.
 The cells of the outer enamel epithelium flatten to form low
cuboidal cells.
 The outer enamel epithelium is thrown into folds, which are
rich in capillary network.
 This provides a source of nutrition for the enamel organ.
 Before the inner enamel epithelium begins to produce enamel, the peripheral cells of
the dental papilla differentiate into odontoblasts.
 These are cuboidal cells that later assume a columnar form and produce dentin.
 The dental sac exhibits a circular arrangement of its fibres and resembles a capsule
around the enamel organ The fibres of the dental sac form the periodontal fibres that
span between the root and bone.
 The junction between the inner enamel epithelium and odontoblasts outlines the
future dentino-enamel junction.
 ROOT FORMATION
 Root formation began after the
dentin and enamel formation
reaches the future cementoenamel
junction
 Outer and inner enamel epithelium
join and form a sheath that help in
moulding the shape of root
 The sheath is known as Hertwig’s
epithelial root sheath
 PERIOD OF OCCLUSAL DEVELOPMENT

Occlusal development can be divided into the following developmental periods:

Pre-dental period.
The deciduous dentition period.
The mixed dentition period.
 The permanent dentition period.
 PRE DENTAL PERIOD

 This is the period after birth during which the neonate does not have any teeth. It
usually lasts for 6 months after birth.
 GUM PAD
 The alveolar processes at the time of birth are known as gum pads.
 The gum pads are pink, firm and are covered by a dense layer of fibrous periosteum.
 They are horse-shoe shaped and develop in two parts .
 They are the labio-buccal portion and the lingual portion. The two portions of the
gum pads are separated from each other by a groove called dental groove.
 The gum pads are divided into ten segments by certain grooves called transverse
grooves
 Each of these segments consists of one developing deciduous tooth sac.
 The gingival groove separates the gum pad from the palate and floor of the
mouth. The transverse groove between the canine and first deciduous molar
segment is called the lateral sulcus. T
 The lateral sulci are useful in judging the inter-arch relationship at a very early
stage. The lateral sulcus of the mandibular arch is normally more distal to that of
the maxillary arch.
 The upper and lower gum pads are almost similar to
each other.
 The upper gum pad is both wider as well as longer
than the mandibular gum pad.
 Thus when the upper and lower gum pads are
approximated, there is a complete overjet all around.
Contact occurs between the upper and lower gum
pads in the first molar region .
 This infantile open bite is considered normal and it
helps in suckling .
 During the first year of life rapid growth of the gum pads are seen. This occurs in
the posterior
 Region to accommodate the deciduous molars. They also show marked
transverse growth.
 The increased overjet seen when the gum pads come together usually reduces in
the first six months due to facial growth and forward movement of mandible.

 THE STATUS OF DENTITION

 The neonate is without teeth for about 6 months of life.

 At birth the gum pads are not sufficiently wide to accommodate the developing
incisors, which are crowded in their crypts.
 During the first year of life the gum pads grow rapidly permitting the incisors to erupt
in good alignment

 Very rarely teeth are found to have erupted at the time of birth. Such teeth that are
present at the time of birth are called natal teeth .
 Sometimes teeth erupt at an early age. Teeth that erupt during the first month of age
are called neonatal teeth.
 The natal and neonatal teeth are mostly located in the mandibular incisor region and
show a familial tendency.
 THE DECIDOUS DENTITION

 The initiation of primary tooth buds occurs during the first six
weeks of intra-uterine life. The primary teeth begin to erupt at
the age of about 6 months.
 The eruption of all primary teeth is completed when second
deciduous molar come into occlusion
  The mandibular central incisors are the first teeth to erupt into
the oral cavity.
 They erupt around 6-7 months of age.
ERUPTION  The average age of eruption of the deciduous dentition is given
in .
AGE AND  The timing of tooth eruption is highly variable. A variation of 3
SEQUENCE months from the mean age has been accepted as normal.
OF  The sequence of eruption of the deciduous dentition is: A –B-D-
C-F
DECIDUOUS  The primary dentition is usually established by 3 years of age
DENTITION on eruption of the second deciduous molars.
 Between 3-6 years of age, the dental arch is relatively stable
and very few changes occur.
SPACING IN DECIDOUS DENTITION

 Spacing usually exists between the deciduous teeth. These

spaces are called physiological spaces or developmental
spaces .
 The presence of spaces in the primary dentition is important
for the normal development of the permanent dentition.
 Absence of spaces in the primary dentition is an indication
that crowding of teeth may occur when the larger permanent
teeth erupt.
 Deciduous anteriors which are in good alignment but with no
spaces between them have a 70% chance of crowding in
permanent DENTITION.
 Ideally about 6 mm of space in primary dentition is required
to avoid crowding in permanent dentition.
 Deciduous dentition which exhibit interdental spaces are
sometimes referred to as open dentition while those with
no spaces present are called closed dentition.

 Spacing invariably is seen mesial to the maxillary canines
and distal to the mandibular canines . These physiological
spaces are called primate spaces or simian spaces or
anthropoid spaces as they are seen commonly in primates.
 These spaces help in placement of the canine cusps of the
opposing arch.
FLUSH TERMINAL RELATIONSHIP

 The mesio-distal relation between the distal surfaces of the

upper and lower second deciduous molars is called the
terminal plane.
 A normal feature of deciduous dentition is a flush terminal
plane where the distal surfaces of the upper and lower second
deciduous molars are in the same vertical plane.
 DEEP BITE

 A deep bite may occur in the initial stages

of development.
 The deep bite is accentuated by the fact
that the deciduous incisors are more
upright than their successors.
 The lower incisal edges often contact the
cingulum area of the maxillary incisors.
 A. Eruption of deciduous dentition
 B. Attrition of incisors.
 C. Forward movement of the mandible due to growth.
 D.Forward movement of the mandible due to growth
 THE MIXED DENTITION PERIOD
 The mixed dentition period begins at approximately 6 years of age with the eruption
of the first permanent molars.
 During the mixed dentition period, the deciduous teeth along with some permanent
teeth are present in the oral cavity.
 The mixed dentition period can be classified into three phases.
 1. First transitional period
 2. Inter-transitional period
 3. Second transitional period
 FIRST TRANSITION PERIOD

 The first transitional period is characterized by the emergence

of the first permanent molars and the exchange of the
deciduous incisors with the permanent incisors.
Emergence of the first permanent molar
 The mandibular first molar is the first permanent tooth to erupt at around 6 years of
age.
 The location and relationship of the first permanent molar depends much upon the
distal surface relationship between the upper and lower second deciduous molars.
The first permanent molars are guided into the dental arch by the distal surface of
the second deciduous molars.
 The mesio-distal relation between the distal surfaces of the upper and lower second
deciduous molars can be of three types.
 FLUSH TERMINAL RELATIONSHIP

 The distal surface of the upper and lower second deciduous

molars are in one vertical plane .
 This type of relationship is called flush or vertical terminal
plane. This is a normal feature of the deciduous dentition.
 Thus the erupting first permanent molars may also be in a flush
or end on relationship.
 For the transition of such an end on molar relation to a Class I
molar relation, the lower molar has to move forward by about
3-5 mm relative to upper molar
About 3-5 mm relative to the upper molar. This occurs by utilization of the
physiologic spaces and leeway space in the lower arch and by differential forward
growth of the mandible.

The shift in lower molar from a flush terminal plane to a Class I relation can occur
in two ways. They are designated as the early and the late shift (fig8).

 Early shift occurs during the early mixed

 The eruptive force of the first permanent molar is sufficient to
push the deciduous first and second molars forward in the arch to
close the primate space and thereby establish a Class I molar
relationship. Since this occurs early in the mixed dentition period
it is called early shift
 Many children lack the primate space and thus the erupting permanent molars are
unable to move forward to establish Class 1 relationship. In these cases, when the
deciduous second molars exfoliate the permanent first molars drift mesially
utilizing the leeway space. This occurs in the late mixed dentition period and is thus
called late shift.
 MESIAL STEP TERMINAL PLANE
 Mesial step terminal plane: In this type of relationship the
distal surface of the lower second deciduous molar is more
mesial than that of the upper .
 Thus the permanent molars erupt directly into Angle’s Class I
occlusion. This type of mesial step terminal plane most
commonly occurs due to early forward growth of the
mandible .
 If the differential growth of the mandible in a forward direction
persists, it can lead to an Angle’s Class III molar relation. If the
forward mandibular growth is minimal, it can establish a Class I
molar relationship.
 DISTAL STEP TERMINAL PLANE

 Distal step terminal plane: This is characterized by the distal

surface of the lower second deciduous molar being more distal
to that of the upper
 Thus the erupting permanent molars maybe in Angle’s Class II
occlusion.
 EXCHANGE OF INCISOR

 During the first transitional period the deciduous incisors are

replaced by the permanent incisors. The mandibular central
incisors are usually the first to erupt. The permanent incisors
are considerably longer then the deciduous teeth they
replace .
 The difference between amount of space needed for
accomodation of incisor and amount of space available is
known as incisor labiality
 Maxilla – 7mm
 Mandible- 5 mm
UTILIZING THE INTERDENTAL SPACE

A. Utilization of interdental spaces seen in primary dentition:

 The physiologic or the developmental spaces that exist in the
primary dentition are utilized to partly account for the incisal
liability. The permanent incisors are much more easily
accommodated in normal alignment in cases exhibiting
adequate inter- dental spaces than in an arch that has no space.
 INCREASE IN INTERCANINE WIDTH

 Increase in inter – canine width:

 During the transition from the primary incisors to the
permanent incisors an increase in inter-canine width of both
the maxillary as well as the mandibular arches has been
observed.
 This is an important factor that allows the much larger
permanent incisors to be accommodated in the arch previously
occupied by the deciduous incisors.
 CHANGE IN INCISOR INCLINATION

 C. Change in incisor inclination: One of the differences

between deciduous and permanent incisors is their inclination.
The primary incisors are more upright than the permanent
incisors. Since the permanent incisors erupt more labially
inclined they tend to increase the dental arch perimeter.
 This is another factor help in accomodating the large
permanent incisors
 INTERTRANSITION PERIOD

 In this period the maxillary and mandibular arches consist of sets of deciduous
and permanent teeth. Between the permanent incisors and the first
permanent molars are the deciduous molars and canines. This phase during
the mixed dentition period is relatively stable and no change occurs
 SECOND TRANSACTION PERIOD
 The second transitional period is characterized by the
replacement of the deciduous molars and canines by the
premolars and permanent cuspids respectively T.
 The combined mesio distal width of the permanent canines
and premolars is usually less than that of the deciduous
canines and molars. The surplus space is called leeway space
of Nance .
 The amount of leeway space is greater in the mandibular
arch than in the maxillary arch. It is about 1.8mm (0.9 mm on
each side of the arch) in the maxillary arch and about 3.4mm
(1.7mm on each side of the arch)
 The mandibular arch. This excess space available after the
exchange of the deciduous molars and canines is utilized for
mesial drift of the mandibular molars to establish Class I molar
relation.
 UGLY DUCKLING STAGE
 Sometimes a transient or self correcting malocclusion is seen in
the maxillary incisor region between 8 – 9 years of age. T
 This is a particular situation seen during the eruption of the
permanent canines.
 As the developing permanent canines erupt, they displace the
roots of the lateral incisors mesially.
 This results is transmitting of the force on to the roots of the
central incisors, causes midline spacing.
 This situation is known as Broadbent as the ugly duckling stage as
children tend to look ugly during this phase of development.
 Parents are often apprehensive during this stage and consult the
dentist.
 This condition usually corrects by itself when the canines erupt and
the pressure is transferred from the roots to the coronal area of the
incisors.

 PERMANENT DENTITION

 The permanent dentition forms within the jaws soon after birth, except for the cusps
of the first Permanent molars, which form before birth.
 The permanent incisors develop lingual or palatal to the deciduous incisors and move
labially as they erupt. The premolars develop below the diverging roots of deciduous
molars.
 The mean eruption dates of the permanent dentition .
 The second permanent molars erupt by 12 years of age. The
third molars erupt between 17 and 22 years of age and is the
last step in establishing the permanent dentition.
 Many of these teeth remain unerupted (impacted) or fail to
develop.
Dentition may exhibit variation. The frequently seen sequences in the maxillary
arch are:
6-1-2-4-3-5-7 ог
6-1-2-3-4-5-7.
In case of the mandibular arch the sequence is
6-1-2-3-4-5-7 ог
 6-1-2-4-3-5-7.
DECIDUOUS DENTITION
 REFERENCE

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