LECTURE 2 Dr- Khaled Al-Haddad.

Eruption and tooth development The term eruption describes the movement which takes a tooth from its developmental position in its crypt to its occlusal contact with opposing dentition. The formation and eruption are two processes which maybe influenced by hormonal, genetic, developmental, and environmental factors. Life cycle of the tooth: 1- Initiation (Bud stage). 2- Proliferation (Cap stage). 3- Histodifferentiation and morphodifferentiation (Bell stage). 4- Apposition. 5- Calcification. There are 2 types of dentition, the primary and the permanent dentition. The primary dentition is also called (the deciduous, milk, predecessor teeth).

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Permanent teeth: 8765432 1 8765432 1 12345678 12345678

So 6- 7- and 8 have no predecessors.

- What are the morphologic differences between primary and secondary teeth? How does each difference affect amalgam preparation? 1. Occiusal anatomy of primary teeth is generally not as defined as that of secondary teeth, and supplemental grooves are less common. The amalgam preparation therefore can be more conservative. 2. Enamel in primary teeth is thinner than in secondary teeth (usually 1 mm thick); therefore, the amalgam preparation is more shallow in primary teeth. 3. Pulp horns in primary teeth extend higher into the crown of the tooth than pulp horns in secondary teeth; therefore, the amalgam preparation must be conservative to avoid a pulp exposure. 4. Primary molar teeth have an exaggerated cervical bulge that makes matrix adaptation more difficult. 5. The generally broad interproximal contacts in primary molar teeth require wider proximal amalgam preparation than those in secondary teeth. 6. Enamel rods in the gingival third of the primary teeth extend occlusally from the dentinoenamel junction, eliminating the need in class II preparations for the gingival bevel that is required in secondary teeth. The teeth start to develop during pregnancy. At six week of intra fetus life (utero), the first step of the teeth bud formation. At six month of intra fetus life the first step of calcification. At six month of baby life, the first primary tooth

starts to erupt. At six year of child life the child life the first permanent tooth erupts. The process of movement of the tooth from alveolar bone to oral cavity until it reaches the occlusion with its antagonist is of 2 phase: 1- Intra bony phase. 2- Intra oral phase. The above 2 phases take 5 years to complete. Normal eruption process: There are developmental processes and factors related to eruption of the tooth: 1- Elongation of the root. 2- Forces exerted by vascular tissues around and beneath the root. 3- Growth of alveolar bone. 4- Growth of dentine. 5- Pulpal constraction. 6- Growth and pull of the periodontal dental membrane. 7- Pressure of the muscular action. 8- Resorption of the alveolar crest. The most important factor causing the tooth to move occlusally is the elongation of the pulp resulting from pulpal growth in a proliferation ring at its basal end. The proliferation zone is separated from the periodontal attachment tissues by an infolding of (Hertwigs epithelial sheath) revered to as the epithelial diaphragm.

The pulpal growth is normally considered to be simultaneous with and equal the elongation of (Hertwigs epithelial sheath). At the basal end of the tooth is located a (Hammock ligament) that acts to directs the growth of the tooth. In addition to these factors, hormonal, genetic, and environmental factors affect the process of eruption. The tooth emerges in the oral cavity when of the root formation has occurred. The teeth reach occlusion before the root development is completed. Epidemiological studies demonstrated that the teeth of girls erupt slightly earlier those of boys. - After the eruption of a tooth, when is root development completed? In the primary dentition, root development is complete approximately 18 months after eruption; in the permanent dentition, the period of development is approximately 3 years. -What is leeway space? Leeway space is the difference in the total of the mesiodistal widths between the primary canine, first molar, and second molar and the permanent canine, first premolar, and second premolar. In the mandible, leeway space averages 1.7 mm (unilaterally); it is usually about 0.91.1 mm (unilaterally) in the maxilla.

- Where are the primate spaces located? In the maxilla, primate spaces are located distal to the primary lateral incisors. In the mandible, primate spacing is found distal to the primary canines. Importance of time of eruption: 1- To the dentist, to put good treatment plan, it affect the type of treatment whether it is primary or permanent tooth (e.g. we can not treat primary tooth at its shedding time with root canal or pulp treatment, because the root is resorbed). 2- To dental epidemiologist, to observe the caries formation on primary or permanent teeth for preventive care means for knowledge of preventive dentistry in dental epidemiology. 3- For the physician; to compare the teeth of the child with his health (e.g. in case of underdeveloped child, the primary teeth will retain). 4- For the orthodontist; to plan the diagnosis and treatment plan according to the teeth present (e.g. between 6-11 years it is the ugly- ducking stage). 5- For the psychologist of the child; whether to wait to replace the teeth or not. 6- For the forensic odontology. 7- For anthropologist.

Sequence of eruption of primary teeth:

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Sequence of eruption of permanent teeth: 8 7 3 5 4 2 1 6 8 7 5 4 3 2 1 6 6 1 2 4 5 3 7 8 6 1 2 3 4 5 7 8

Influence of premature loss of primary molars on eruption time for their successors: 1- Extraction of primary molars at age of 4-5 years, lead to delay of eruption of permanent successors. 2- If extraction of primary molars occurs after the age of 5- years, there will be decrease in the delay of premolars eruption. 3- Extraction of primary molars at age of (8-10) years the premolars eruption results from premature loss is greatly accelerated. Variation in sequence of eruption: The mandibular canine erupts before the first and second premolars, this sequence will aid in maintaining:

1- Adequate arch length. 2- Preventing lingual tipping of the incisors. - Tipping of the incisors will lead to a loss of the arch length and will allow the development on an incisor overbite. - An abnormal lip musculature or an oral habit that cause a great forces on the lower incisor than can be compensated by the tongue will allow a collapse of the anterior segment. For these reasons, passive lingual arch appliance is often indicated when the primary canines have been lost prematurely or when the sequence of eruption is undesirable. - The eruption of maxillary canine is often delayed because of an abnormal position of previous path of eruption. - Loss of primary molars in maxilla allows the first permanent molars to drift mesially and block the maxillary canine labially. - If the maxillary second permanent molar erupts before the first and second premolars, this result in loss of arch length.