This document discusses the development of occlusion from prenatal development through adulthood. It covers topics like the initiation and stages of tooth development in the womb, including the bud, cap and bell stages. The development of dental arches and spacing of teeth before birth is also addressed. After birth, it examines the stages of occlusion development through primary dentition, mixed dentition, and permanent dentition. Key periods like the first and second transitional phases are outlined. Theories on the evolution of dentition in different species are also presented.
Dental tissues and their replacements/ oral surgery courses
Development of Occlusion from Birth to Permanent Dentition
1. 1
Development of Occlusion
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. 2
Contents
Introduction
Development of concepts of occlusion
Evolutionary changes
Stages of Occlusion Development
Prenatal Dental development
Mouth of Neonate
Dev of Dentition from birth to Complete deciduous Dentition
Complete deciduous dentition
The first Transitional Period
The intertransitional period
The 2nd Transitional period
Permanent Dentition
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Disorders of development of Dentition
Development of Class II/1
Development of Class II div/2
Development of class III
Development of Open bite
Development of cross bite
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Introduction to Occlusion
Oc = up Clusion = closing ; closing up
Occlusion - Relationship of dental arches
when tooth contacts are made.
Ideal occlusion in broad functional term is –
Teeth alignment is such that masticatory loads are
within physiological range and act through long axis
of as many teeth in arch as possible.
Lateral jaw movement without mechanical
interference.
When in rest position – freeway space is present
Tooth alignment is aesthetically pleasing.
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The Anatomical alignment of teeth
The Dental Arches –
Size and shape vary
follow Catenary curve
The Neutral Zone
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The curvatures of teeth and arches
Curve of Spee.
Curve of Wilson
Curve of Monson
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The anatomical occlusion of teeth
Centric occlusion
B-L relation
Centric contacts
relation b/w teeth of both jaws
Arrangement of teeth in centric occ
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Development of Concepts of
occlusion
It can be divided into
Fictional Period (prior to 1900)
Hypothetical Period (1900 to 1930)
Factual Period (1930 to present)
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Fictional Period
Fuller Clark & Imrie talked of ‘antagonism’,
‘meeting’ or ‘gliding’ of teeth.
Talbot said it’s a historical event long since passed
in the decline of species, and possible only with an
atavism ‘throwback’ to our primitive ancestors.
The creation of a normal standard of occlusion , a
basis on which to compare departure from normal
was lacking.
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Hypothetical Period
According to
Edward H. Angel
Mathew Cryer and Calvin Case
Lischer and Paul Simon
Milo Hellman
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Edward .H. Angle
In 1907 Angle put a hypothesis that:
“Occlusion is the basis of the science of orthodontia. The shapes of
the cusps, crowns and roots , and even the very structural material of the
teeth and attachments are all designed for the purpose of making occlusion
the one grand object…. we shall define occlusion as being normal relations
of the occlusal inclined planes of the teeth when the jaws are closed.”
He described the illustration “Old glory”…. which
according to him was ideal occlusion.
Angle stated Apollo Belverdo’s straight profile as ideal
The best eg. of his hypothesis was ‘key of Occlusion’
His hypothesis was suggestive of static occlusion
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Mathew Cryer and Calvin case
He opposed Angle
How could one mix prognathic denture and orthognathic
profile?
How bimaxillary protrusion considered normal and
individual variation was not considered?
Then they were proved right by Turner’s illustrations
Case’s concept of occlusion was static
Normal occlusion
( it suits Apollo’s face better)
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Lischer And Paul Simon
They tried to relate concept of occlusion by
relating teeth with rest of the face and cranium.
Lischer introduced mastication as requisite of
occlusion
Simon outlined the anthropometric approach
Milo Hellman
He showed racial variation in normal occlusion
His study was also confined to static occlusion
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Factual Period
Dividing line b/w static and dynamic occlusion.
1931 Broadbent introduced Cephalometry.
With this advanced study tech the factual period
become functional period.
By now 3 components of occlusion are set up
1. Interdigitation of teeth
2. Status of controlling musculature
3. TMJ integrity
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Evolution of Dentition
The mammalian dentition is 100, 000 million yrs old
The theories behind mammalian dentition are
Theory of Concrescence – derived by fusion of 2 or more
primitive conical teeth.
Theory of trituberculy – each tooth derived from single
reptilian tooth by secondary differentiation of tubercule
and root.
Theory of multituberculy – derived from reduction and
condensation of primitive multituberculate teeth.
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Non mammalian vertebrates – Polyphyodonty
(many dentitions)
In mammals –Diphyodonty (2 dentitions )
During growth of the animal – increase in the jaw
size is associated with tooth size
Evolution of Dentition
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Dentition of fishes ( Agnatha)
Eg - Sea lamprey & hag fishes
No true calcified teeth
Arranged circumferentially
Horny teeth are also seen on the tongue
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Chondrichthyes (carrtilagenous fishes)
Large no. of teeth are present
Homodont & polyphyodont
Teeth are covered by enameloid
lower jaw of shark
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Amphibia
Small, homodont, polyphyodont
prehension
In the frog – small teeth on the upper jaw
& no teeth on the lower jaw
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Reptiles
Homodont & polyphyodont
Tend to be tricuspid or cone shaped
Egg teeth – in embryos of lizards & snakes
- used to break the shell
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Dentition of mammals
Heterodont ( 4 types )
Restricted to 2 rows
Ability to masticate – improves digestive
efficiency for high rate of metabolism
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Other features
TMJ articulation
Salivary glands
Prismatic enamel
Diphyodonty
Secondary palate
Significant muscle development
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Dentition of protheria
Spiny ant eater – edentulous
Duck billed platypus – 3 functional
posterior teeth in each jaw quadrant
No. of additional teeth develop but do not
erupt but rapidly resorb
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Metatheria
(Marsupials)
Eg. Red Kangroo
Dental formula – 3/1, 0/0, 1/1, 4/4 .
Feed on various plant.
Anterior teeth allow the food to be firmly
grasped.
Marsupials have no. of dental features
which distinguish them from placental
animals.
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Eutheria
Eg - hedge hog
Insectivoral
Incisors form a forcep like mechanism to pick
preys.
Molars – primitive tritubercular with sharp cusps
Suitable for crushing the shells of insects
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Rodentia
Eg - rat
Heterogenous , Monophyodont
Continuously growing incisors
DF 1/1, 0/0, 0/0, 3/3
Rat & mice are widely used as experimental
animals in Dental sciences
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Carnivora
Incisors are small and arranged in line.
Enlarged canines – offensive weapons
Incisors and canine – tearing flesh
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Primates
Classified in to –
Prosimii or Lemur type
Anthropoidea
Mainly herbivorous sometimes
insectivorous
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Prosimii or Lemur type
DF – 2/2, 1/1, 3/3, 3/3
incisors & canines are procumbent and
form dental comb.
mid line diastema .
Upper canine is blade like
Upper molar tritubercular
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Anthropoidea
(monkey, apes & Man)
Eg -Macaca monkey
DF – 2/2, 1/1, 2/2, 3/3
Canines are long & prominent ( esp. in male )
Lateral diastema
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Stages of occlusal development
from clinical view ( Barnett)
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According to Vander Linden
Dev of Dentition from birth to Complete
deciduous Dentition
Complete deciduous dentition
The 1st Transitional Period
The intertransitional period Mixed Dentition
The 2nd Transitional period
Permanent Dentition
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Prenatal Dental development
Prenatal beginning of the dentition
Initiation of odontogenesis
bud stage
cap stage
bell stage
Spatial patterns
Arch shape
Spacing
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Initiation of odontogenesis
3rd week of IUL - first sign of tooth dev.
Epithelial thickening seen
6 wk IUL Dental lamina is formed.
IL border of maxilla
SL border of mandible
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Morphologic changes - 6wks IUL till 4-5 yrs.
Occurs in 3 main phases-
Initiation of entire deciduous dentition at 2nd
month IUL
Initiation of permanent teeth in successional
lamina from 5th month IUL
The dental lamina elongates distal to 2nd decid.
Molar and give rise to permanent molar tooth
germs
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Bud Stage
Seen at 7th wk IUL
Increased mitotic activity at specific sites in DL
produces 10 knob like tooth buds
Stage of proliferation with no
morphodifferentiation of cells
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Bud Stage
Early bud stage
Late bud stage
Dental lamina
Enamel organ
Mesenchymal condensation
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Cap Stage
At end of 8th wk concavity appears on deep surface of
bud – cap shape
Epithelium enlarges and proliferates in to
deeper ectomesenchyme
Its stage of morphodifferentiation
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Cap Stage
Early cap stage
Late cap stage
External dental epith.
Dental follicle
Inner enamel epith.
Dental papilla
Enamel cord
Enamel knot
Dental papilla
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Bell stage
Enlargement of tooth germ and deepening of its undersurface
Germ looses connection with oral epith.
Stage of Histodifferentiation
Determine crown shape initate dentin
and enamel formation
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Bell stage
outer enamel epith.
Stellate reticulum
Dental follicle
Stratum intermedium
Inner enamel epithelium
Dental papilla
Ameloblasts
Enamel matrix
Dentin
Predentin
Odontoblasts
Bell stage
Advanced Bell stage
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Advanced Bell stage
Inner dental epithelium – Ameloblasts – Enamel
Outer dental epith. – dental cuticle
Transition zone b/w IDE & ODE – cervical loop
Neighboring cells of IDE in dental papilla –
Dentinoblasts/odontoblasts – Dentin
.
Hertwig’s rootsheath proliferate from CL which
initiates radicular odontoblasts.
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Arch Shape
At 6 to 8 weeks it’s A-P flattened.
By bell stage or 4mth IUL – Catenary pattern.
Cleft lip and palate arrest this development.
Lateral shift of deciduous lat. incisor is seen.
4 diff arrangements of deciduous teeth in both jaws before
birth
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Frontal sec through face of 24 wk fetus showing
linear distance from midline to points on tooth germs
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Spacing
Decid. anterior teeth appear crowded.
Lateral incisor is seen out of alignment
before birth but usually erupt in good
alignment.
Summed crown size increases eight
fold but summed interdental spacing
shows little correlatin with it.
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The mouth of the Neonate
The gum pads
Neonatal jaw relationship
Status of dentition
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Gum Pads
At birth alveolar processes are covered by firm and pink
gum pads
Divided in to 10 segments by transverse
grooves.
Groove b/w canine and dm1 crypt –
lateral sulcus – assessing relation of jaws.
Maxillary arch is horse shoe shape and
extend buccally and labially
Mandibular arch is posterior to max. arch
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Neonatal jaw relationship
Anterior openbite is seen.
Contact mainly occur at dm1 region.
Infantile open bite is normal as it helps in
suckling.
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The status of dentition
Neonates are without teeth for 6mths.
Occasionally teeth seen in this period –
Natal
Neonatal
Pre-erupted
These teeth are always mandibular incisors.
Familial tendencies.
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Tooth Eruption
Two types -
Preemergent eruption
Eruption before emergence of tooth in oral cavity.
Two processes involved –
Resorption of the overlying bone (and primary tooth root).
Eruption mechanism itself then move the tooth in cleared
path.
Failure of tooth eruption –
Failure of bone resorption (Cleidocranial dysplasia)
Primary failure of eruption.
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Postemergent eruption
Eruption after emergence of tooth in oral cavity.
Postemergent spurt
Rapid eruption from a time tooth penetrates the
gingiva till tooth reaches occlusal level.
Eruption - During critical period b/w 8 PM to 1 AM.
After it attain occlusal contact ,occlusal forces
opposes further eruption
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Juvenile Occlusal equilibrium
Slow phase
Teeth erupt to fill the space created by vertical
growth of mandibular ramus.
Adult occlusal equilibrium
Compensate for occlusal and proximal wear
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Mechanism of tooth movement
Bone remodelling of crypt wall
Root formation
Vascular pressure
Periodontal ligament traction
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Development of the Dentition from
Birth to complete Deciduous
dentition
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Development of the Dentition from
Birth to complete Deciduous dentition
After birth jaws grow considerably for 6-8 mths.
Lower jaw more dorsally placed irt upper.
Ventral dev takes place during 1st yr – A-P relation
Transverse dev –
median suture in maxilla
Synchondrosis in mandible (till 6 mths.)
Eruption sequence is A B D C E
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Dev of dental arches and dev of deciduous teeth
A. At birth
B. Mand. Central
incisor- 6 to 8 mths
C. Max. central incisor
7-9 months
D. U & L lateral
incisors – 1 yr.
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E. 1st molar – 16 mth.
F. Canine – 20 mth.
G. 2nd molar – b/w 24 &
30 mths.
H. Complete deciduous
dentition with
successors within the
jaws.
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Displacement of U & L Dm1 to establish
occlusion : Cone-funnel mechanism
Palatal cusp of
max. 1st molar –
cone
Crater in mand.
1st molar –funnel
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The Complete Deciduous Dentition
Competed at 2.5 yrs of age after dm2 erupts and
lasts till 5 yr of age
Physiological spaces in primary dentition-
Primate spaces
Developmental spaces
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Spacing in Deciduous dentition
Gap toothed smile - normal
Hollywood smile with teeth in contact - not normal
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Occlusal relationship of U & L Dm2
3 types of terminal planes –
Flush terminal plane
Mesial step
distal step
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Normal situation of the Deciduous dentition
in occlusal, anterior and lateral view
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The First transition period
The emergence of 1st permanent
molar A B C D E 6
A B C D E 6
Transition of the incisors
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The emergence of 1st permanent molar
1st teeth to emerge in permanent dentition.
In mand. 6 –7 yr In maxillary arch 7- 8 yr
The A-P relation b/w two opposing permanent
molars depend upon –
Their previous position within the jaw
Sagittal relation b/w maxilla and mandible
Terminal planes of 2nd decid molars.
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Influence of terminal plane on the
position of 1st permanent molar
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Exchange of Incisors
After eruption of Pm1 , primary incisors exchange
with permanent incisors.
Incisal Liability
7 mm in maxilla
5 mm in mandible
The factors controlling the arrangement of
permanent incisors are -
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Interdental spaces in deciduous dentition
physiological & primate spaces are utilized
If closed space – crowding occur
Increase of inter-canine width
Increases 3 mm in both jaws at time of eruption
Increases1.5 mm when canine erupts
So the clasps on canine attached as space maintainer
should be cut off at this time
Increase of anterior length
Increase in length of arch in A-P dimension
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Change of tooth axis of incisor
Permanent incisor erupt labially by 2 – 3 mm, attain
overjet and over bite
Pressure by tongue , lip and perioral musculature
Interincisal angle -
150 degree in decid. Incisors.
123 degree in perm. Incisor
It increases arch circumference
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Ugly duckling stage
Child look unusual due to
Too large permanent incisor compared to primary.
Flared incisors with midline diastema.
Transitional malocclusion – called ugly duckling
stage - broadbent
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Sequence of normal transition of incisors
At 5 yr. At 6 –7 yr.
At 7 –8 yr.
At 8 – 9 yr
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Transition of incisors
Loss of decid. tooth is caused by-
Resorption of its root
By reduction of bone cervically
Several week passes b/w shedding of decid and eruption
of successor.
In the interval reconstruction of alveolar process and
healing of gingival defect occur
A perm. teeth starts eruption after ¼ of its root formed
Perm .teeth emerge in oral cavity when ¾ root is formed.
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The inter transitional period
Consist of both decid. & perm. teeth
Teeth present are 1 2 C D E 6
1 2 C D E 6
Ugly duckling stage persists in upper incisors.
Under influence of tongue mand incisor attain
proper sites from their lingual position.
The decid teeth present are worn out at this stage.
It is a stable phase with little changes in dentition.
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The Second transitional period
Transition of Lateral teeth
Eruption of Second permanent molar
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Transition of lateral teeth
Transition of C D E with 3 4 5 .
For smooth exchange following are
conditions–
Leeway space of Nance
Sum M-D width of 3, 4 & 5 < C D & E
Space available is
22.3 – 21.5 = 0.8 (U)
23.5 – 21.1 = 2.4 (L)
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Order of exchange of lateral teeth
It takes 1 ½ yrs. to complete exchange of
lateral teeth.
Sequence of eruption is –
4 5 3 in maxillary and 3 4 5 in mand.
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Eruption of second Permanent teeth
After exchange of lateral teeth 2nd permanent
molar erupts. i.e after loss of all deciduous teeth.
Sometimes it erupts before E sheds – leads to
crowding
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Transition of lateral teeth and
eruption of 2nd perm molar
At 9- 10 yrs
At 10 – 11 yrs. At 10 – 12 yrs.
At 11 – 12 yrs At 12 – 13 yrs.
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The Permanent Dentition
At around 13 yr of age all permanent teeth
(except 3rd molar) are erupted.
Situation in normal
permanent dentition
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Disorders in development of
Dentition
At time of eruption of Deciduous dentition –
Teething disorder - most of infants exhibit fever,
diarrohea, vomiting , irritability etc before tooth
eruption.
Anomolies
Its rare for primary teeth to be congenitally missing.
Primary tooth resorption
Hastened by inflammation and occlusal trauma
Delayed by splinting and absence of successor
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Ankylosis of primary teeth
In Primary molars, esp during physiologic
resorption
Disorders of primary Occlusion –
Its less compared to permanent occlusion.
Thumb sucking and other oral habits
Posterior crossbite
Open bites
Class II malocclusion
Excessive overjet
Bruxism – functional malocclusion
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Factors affecting transition of teeth
Dental caries in primary teeth
Disturbance in root resorption due to pulpal or
periodontal disturbances
A periapical lesion
Premature loss of primary molar
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Anomolies in Permanent dentition
Microdontia, macrodontia
Gemination ,Fusion, Dilaceration, Talon
cusp, Dens evaginatus
Supernumerary roots
Dentinogenesis & Amelogenesis imperfecta
Enamel Hypoplasia
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Abnormalities in dental arch
1. Arch Length Discrepancy
1. Crowding
2. Spacing
2. Deviation in no. of teeth-
1. Absence of teeth ( Agenesis)
2. Supernumerary teeth
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Absence of teeth ( Agenesis)
Sequece of agenesis is –
3rd molar > Mand. 2nd premolars > Max
Lateral Incisors > Max. 2nd Premolar
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Deviation in tooth size
Its relative in nature
All teeth combined > or < relative to size of
jaws or head.
Crowding
Spacing
Deviation in size of individual teeth
Tooth size Discrepancy
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Ankylosis
Frequent in mand deciduous molars.
In permanent 2 types
Due to abnormal position within jaw
Max perm. Canine
Due to lack of space
Mand 3rd molar
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Angle’s classification of Malocclusion
Class I
ClassII
Class II div 1
Class II div 1 subdivison
Class II div 2
Class II div 2 subdivison
Class III
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The Development of Occlusion in
Class II/ 1 malocclusion
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In Deciduous dentition
Mand dental arch
dorsally placed irt
maxillary
Limited increase in
overbite
Distal step
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In Intertransitional period
Mand dental arch dorsally
placed, large overjet
Mand 1st perm molar
occludes dorsally to max
Increased overbite
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In Permanent Dentition
Mand dental arch dorsally
placed, large overjet
Class II molar relation
Increased overbite
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The Development of Occlusion in
Class II/2 malocclusion
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Change in Incisor and Molar region in Class
II /2 , from deciduous to permanent
Mand incisor erupt
Normally Max erupting
slightly upright
Lower lip – lingual tipping
of U. Incisor
In adult, U. C. Incisor
tipped severly palatall
Lower lip – lingual
tipping of L. Incisor
Continued erution
– till vertical contact
In Decid. Dentition
Overjet less,high lip
line
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Class II /2 with more space in anterior
segment
Lingual tipping ( By L Lip)
U C P incisor - Continous
Arch with B & C
U L P incisor Erupt in
normal orientation as
sufficient space available
•Lingual tipping of U L P
incisor by L lip.
•Lingual tipping of lower
incisors.
•Rectangular arch form
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Class II /2 with less space in anterior
segment
•Lingual tipping ( By L Lip)
•U C P incisor - Continous
Arch with B & C
• Already limited space,
reduced further by palatal
tipping of centrals .
• Lateral erupts labially
• L lip placed lingual to laterals
•Max. laterals rest on the L lip.
•Max Central and Mand incisors
are perpendicular to Occ plane
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In Deciduous dentition
Mand dental arch ventrally
placed, reverse overjet
Lower ant placed ventrally to
max. less overbite
Large mesial step
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In Intertransitional period
Mand dental arch ventrally
placed, reverse overjet
Incisal surface of
U incisor contact ligual
surface of lower
Mand perm !st molar
occludes too far
mesially to max
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In Permanent dentition
Incisal surface of U incisor
contact ligual surface of
lower
Mand perm !st molar
occludes too far
mesially to max
Mand dental arch ventrally
placed, reverse overjet
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Anterior open bite
Asymmetrical open bite
due to thumb sucking
in Deciduous dentition
Open bite due to abnormal
Tongue position
(symmetrical)
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Posterior open bite
Open bite due to incomplete
eruption of teeth.Resulting
from interpositioning
of tongue
Open bite combined with
inadequate contacts.
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ClassII /1 Subdivison
• Class I on right side, class II on left
• Overjet overbite too large
• Midline shift.
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ClassIII Subdivison
• Class I on right side, class III on left
• Anterior crossbite exists
• Midline shift.
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Bilateral Crossbite
On both sides maxillary molars occlude with their
buccal cusps instead of their palatal ones
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Total exo-occlusion in ClassII/1
All maxillary teeth positioned exteriorly to mandibular
Brodie Syndrome or Telescope bite
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Total endo-occlusion in Class III
All maxillary teeth positioned interiorly to mandibular
ones
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Refrences :
Oral Anatomy - Berkovitz
Development of Dentition – Van der Linden
Transition of human Dentition – PGM Vander Linden
Handbook of orthodontics – Moyers
Contemporary orthodontics –Proffit
Orthhodontics - T. M. graber
Oral histology – Tencate
Dental Anatomy – Wheelers
Dentistry for child – Mc Donald
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