DEVELOPMENT OF DENTITION & OCCLUSION

INTRODUCTION
The development of dentition is an important

part of craniofacial growth as the formation, eruption, exfoliation and exchange of teeth take place during this period. This is an assimilation of facts, predictions, studies, in both static and dynamic situations; the factors influencing them and their clinical implications.

PRE-NATAL DEVELOPMENTOF TEETH

The embryonic oral cavity is lined by stratified

squamous epithelium known as the oral ectoderm Around the 6th week of intra uterine life, the inferolateral border of maxillary arch and supero- lateral border of mandibular arch shows localised proliferation of oral ectoderm resulting in the formation of a horse-shoe shaped band of tissue called dental lamina Dental lamina plays a important role in the development of dentition

Early Dental Lamina

Tongue

Dental lamina Vestibular lamina

The deciduous teeth are formed by the direct

proliferation of the dental lamina The permanent molars develops from the distal proliferation of the dental lamina And permanent teeth which replace the deciduous teeth develop from the lingual extension of the dental lamina

 In certain areas the dental lamina proliferate and forms knob like

structure that grows into underlying mesenchym.

Each knob represents a future deciduous tooth and is called enamel

organ
Enamel organ passes through a number of stages ultimately

forming the teeth

Based on shape of the enamel organ develops can be divided into,

Bud stage Cap stage Bell stage

BUD STAGE
Differentiation of dental lamina leads to formation of round, ovoid swelling at 10 different points corresponding to future position of deciduous teeth. These are the primordia of enamel organ.

Enamel organ consists of peripherally located low columnar cells and centrally located polygonal cells.
.

Dental papilla : It is the area of ectomesenchymal condensation subjacent to enamel organ. Cells of dental papilla will form tooth pulp & dentine.
Dental sac: It is area of ectomesenchymal condensation surrounding the tooth bud & dental papilla. Cells of dental sac will form cementum & periodontal ligament
A: enamel organ B: dental papilla C: dental follicle

CAP STAGE :
Characterized by a shallow

invagination of deep surface of a bud.

Outer & inner enamel epithelium. Cuboidal cells cover the convexity

of the cap.
Columnar cells cover the

concavity of the cap.

Stellate Reticulum:

Polygonal cells begin to separate as more intercellular fluid is produced and forms cellular network called stellate reticulum.

 Enamel Knot: Cells in center of the enamel organ

are densely packed. This knot projects towards underlying dental papilla.Vertical extension of enamel knot forms enamel cord. Both the structures disappear before enamel formation begins.

Dental papilla & dental sac : Dental papilla is for mature organ

of dentine & shows active budding of capillaries. Dental sac are important for formations of cementum & periodontal ligament.

Cap Stage of Tooth Development

Dental (enamel) organ

Dental papilla
Dental follicle

BELL STAGE :
1.

Stage of Histodifferentiation and Morph differentiation.

2.

During histodifferentiation some cells of dental organ diffentiates into specific form and shape. This is seen in early Bell stage.
During morph differentiation Dental organ assumes characteristic shape of the tooth. This is seen in late Bell stage. The invagination of the epithelium deepens and its margins continue to grow and enamel organ assumes a bell shape.

3.

4.

1.

During histodifferentiation cells acquire their functional assignment. Odontoblasts are differentiated from mesenchymal cells with formation of dentin the cells of inner dental epithelium transform into ameloblasts and enamel matrix is lead down opposite the dentin. Presence of dentin is absolutely essential for laying down of enamel. Differentiation of epithelial cells are essential for differentiation of epithelial Odontoblasts and initiation of dentin formation. Future dentino enamel junction is outlined and the form of crown is established. Tooth germ shows the following structures

2.

3.

Dental organ :

a) Outer dental epithelium: A single rows of cuboidal cells is thrown into folds and contain blood vessels at late bell stage. b) Stellate reticulum: There is increase in intercellular fluid and layer expands. The cells assume star shape with long processes that anastomose with adjacent cells.

(a) Oral epithelium; (b) dental lamina; (c) lateral lamina; (d) successional lamina; (e) tooth bud or enamel organ (future tooth).

c) Stratum intermedium: Several layers of squamsus cells appear between stellate reticulum and inner dental epithelium and are called stratum intermedium. This layer is essential for enamel formation. It helps in calcification of enamel and is a reserve source for new ameloblasts. d) Inner dental epithelium: This consists of single layer of cells that differentiates into tall columnar cells, the ameloblasts. They have a hexagonal shape on cross section and are 4u in diameter and 40u in height. These cells influence the underlying mesenchymal cells, which differentiates into Odontoblasts.

II. Dental Papilla : It is the mesenchyme enclosed portion of the Dental organ. The peripheral cells under the influence of inner dental epithelium assume an cuboidal shape first & columnar later and are called Odon oblast, which produce dentin. The basement membrane separating the epithelial dental organ and dental papilla is called membrana performativa which forms future dentino enamel junction. III. Dental sac: Before formation of dental tissues begins, the dental sac shows a circular arrangement of its fibres and resembles a capsular structure. With the development of the root the fibers of dental sac differentiates into the periodontal fibres that become embedded in the developing cementum and alveolar bone.

 The root sheath consists of only outer and inner dental epithelium.

The inner layer of cells remains short and do not produce enamel. These cells induce the differentiation of cell of dental papilla into Odontoblasts, which lay a layer of dentin. At the same time the continuity of Hertwig's sheath is destroyed due to infiltration of connective tissue and the root sheath breaks up into small strands of epithelium called epithelial rests of Molassez.
While the coronal part of the sheath degenerates, the apical part continues to grow in length and aid in lengthening of root. The cells of dental sac differentiate into cementoblasts, which lay cementum over the outer surface of the dentin in root portion. At the same time precollagenous fibers appear between cementoblasts and become continuous with outer surface of dentin. They become collagenous and are transformed into cementoid tissue, which calcifies to form cementum.

 The sheath is folded first at future cemento enamel junction into a horizontal plane. This is called epithelial diaphragm. Differential growth of the epithelial diaphragm in multirooted teeth causes the division of the root trunk into two or three roots. During the general growth of the enamel organ the expansion of its cervical opening occurs in such a way that long tongue like extensions of the horizontal diaphragm develop. Before division of the root trunk occurs the free ends of these horizontal epithelial flaps grow toward each other and fuse. The single cervical opening of the coronal enamel organ is then divided into two or three openings. Enamel pearls: If the cells of epithelial root sheath remain adherent to the dentin surface, they may differentiates into fully functioning ameloblasts and produce enamel. Such droplets of enamel called enamel pearls.

THEORIES OF TOOTH ERUPTION

Bone remodeling Root growth Vascular pressure Periodontal ligament traction

FORMATION OF ROOT

Root start forming after dentin formation has reached future cementoenamel junction. Both dental organ and dental papilla play part in formation of root. Hertwig's epithelial root sheath :
* The outer and inner dental epithelium meets one another at future cervical area and is called cervical loop. This cervical loop forms epithelial sheath of Hertwig, which moulds the shape of the root and initiates dentin formation.

WHAT IS OCCLUSION ??
The static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogue

Occlusion is the normal relation of the occlusal inclined planes of the teeth when the jaws are closed -Angle. opposing surfaces of the maxillary and mandibular teeth, which occurs during movements of the mandible and the terminal full contact of the maxillary and mandibular dental arches Gregory. Occlusion of the teeth is not a static condition, as the mandible can assume various positions. Occlusion may be centric, habitual, mesial, distal, eccentric, labial, lingual, supra, inferior and may other forms.

Occlusion: Is the changing interrelationship of the

Different stages in development of occlusion:

1.Predental stage 2.Deciduous dentition stage 3.Mixed dentition stage 4.Permanent dentition stage

PREDENTAL PERIOD:
Extends from birth to 6 months of age. Alveolar process at birth are called as gum pads, which are horse shoe shaped.

When the upper and lower gum pads are approximated there is a uniform overjet all around. Each gum pad is separated by transverse grooves into ten segments within which the deciduous tooth sacks are present.

GINGIVAL GROOVE seperates gum pads from the palate. Transverse groove between dec.canine and molar is called as lateral sulcus. Mandibular LATERAL SULCUS is more distal to that of maxilla. Gum pads are in contact in the posterior region and are apart in the anterior region.

Teeth may be present at the time of birth which are called as NATAL TEETH. Teeth which erupt during first month are called as NEONATAL TEETH.

DECIDUOS DENTITION :
This period of dentition extends from eruption of primary teeth to the eruption of first permanent tooth around 6yrs of age . Most common sequence of teeth eruption in deciduos dentition is A-B-D-C-E A variation of six months from mean age of eruption is accepted to be normal. Dental arch remain stable from 3 to 6yrsof age.

ERUPTION SEQUENCE OF DECIDUOUS TEETH:

CHARACTERISTICS OF PRIMARY DENTITION: Overjet Overbite Spacing Molar relation

OVERJET:
Horizontal relationship or distance between the most protruded maxillary central incisors and opposing mandibular central incisors is called as overjet. Normal range of overjet in deciduous dentition is 0 to 4mm.

If the maxillary incisors are placed lingual to the mandibular incisors the condition is called UNDERJET.

OVERBITE: Amount of vertical overlap between the maxillary and mandibular central incisors is called as overbite.

Deep bite may be present in initial stages of development which is due to upright positioning of lower incisors touching the cingulum of upper incisors.

Factors contributing to the reduction of deepbite in later stages 1.Eruption of deciduous molars 2.Attrition of incisors 3.Forward growth of mandible.

In about 25% of children open bite is due to various oral habits.

SPACING:

In primary dentition stage a child may have -Generalized spacing -Localized spacing -No spacing -Crowding

GENERALIZED SPACING:

Occurs in almost 2/3rds of children.

It is otherwise called as physiological space or developmental space.

LOCALIZED SPACING: Localized space like primate space is seen mesial to the maxillary deciduous canine and mandibular deciduous first molars.

PRIMATE SPACE accomodates the canine cusp tips of opposing arches.

Priamte space is otherwise called as SIMIAN SPACE or ANTHROPOID SPACE or BAUME SPACE.
This space is used by developing larger permanent teeth.

If no space is present between deciduous teeth then it is called as HOLLYWOOD SMILE.

MOLAR RELATION: FLUSH TERMINAL PLANE: Maxillary and mandibular second primary molars are in same plane antero-posteriorly. DISTAL STEP: Distal surface of mandibular

Second molar is more distal to the maxillary second molar. MESIAL STEP: Distal surface of mandibular second molar is more mesial to the maxillary second molar.

MIXED DENTITION PERIOD:

This stage starts with the eruption of first permanent molar at the age of six years and ends with exfoliation of all the deciduous teeth by the age of 12 to 13 years. In the early stages of mixed dentition there may be open bite which is transient due to incomplete eruption of incisors or a persistent oral habit.

THREE STAGES IN MIXED DENTITION PERIOD

1.First transition period(6-8yrs.) 2.Intertransition period(8-10yrs.) 3.second transition period(10-12yrs.)

ERUPTION SEQUENCE OF PERMANENT DENTITION:

FIRST TRANSITION PERIOD: First transition period is characterized by I. Emergence of first permanent molars II. Exchange of incisors

EMERGENCE OF FIRST PERMANENT MOLARS:

These are the first permanent teeth to erupt into the oral cavity. Distal surface of deciduous second molars guides the eruption of first permanent molars .

Hence the relation between first permanent molars depends on deciduous second molar relation.

FLUSH TERMINAL PLANE:

This is normal relation in deciduous dentition. This relation may lead to Angles class-I or III.
The eruption force itself is enough to push the deciduous molars mesially thereby utilizing the primate space for establishing Angles class-I molar relation,which is called as EARLY SHIFT. Angles class-I is otherwise established by the movement of mandibular first permanent molars mesially after the shedding of deciduous molars,which is called as LATE SHIFT.

MESIAL STEP:

In mesial step permanent molars directly erupt in Angles class-I relation. If mandibular growth persists it changes to angles class III. If mandibular growth is minimal it remains in Angles class I.

DISTAL STEP:

Permanent molars may erupt in Angles class II relation. If mandibular growth is sufficient this may change to Angles class I.

EXCHANGE OF INCISORS:

Among maxillary and mandibular incisors, mandibular permanent incisors are first to erupt and are larger than deciduous incisors. The difference of the space required for eruption of incisors and the amount of space available for their eruption is called as INCISAL LIABILITY. It is around 7.6mm in maxilla and 6mm in mandible.

INCISAL LIABILITY IS OVERCOME BY THREE FACTORS:

1.Utilization of interdental space seen in primary dentition.

2.Increase in intercanine width. 3.Change in incisal inclination.

INTER TRANSITIONAL PERIOD(STABLE STAGE):

features: -Any asymmetries are made up. -Occlusal and interproximal wear occurs. -At an age of 8 a midline diastema is commonly seen in upper arch which is due to force exerted medially on the roots of central and lateral incisors by the crowns of erupting canines which causes flaring of crowns of centrals and laterals thereby leading to midline diastema. This stage lasts upto an age of 14 till the eruption of canines is completed.

This phenomenon is called as BROADBENTS PHENOMENON. And the stage of transient midline diastema is called as UGLY DUCKLING STAGE.

IDEAL DENTAL ARCH PATTERN IN MIXED DENTITION PERIOD: -Class I molar and canine relationship -Positive leeway space. -Minor or no rotation or incisor crowding. -Normal buccolingual axial inclinations -Normal mesiodistal axial inclinations. -Tight proximal contacts. -Even marginal ridges vertically. -Flat occlusal plane or mild curve of spee.

II TRANSITIONAL PERIOD: Following events occur in second transitional period

1.Exfoliation of 10 molars & canine 2.Eruption of permanent premolar & canine. 3.Eruption of permanent molars 4.Establishment of occlusion.

LEEWAY SPACE OF NANCE:

The difference between the sum of mesio-distal widths of primary canines and molars is larger than the sum of mesio-distal widths of permanent canine and premolars. In maxilla 1.5mm in mandible- 2.5mm

1.Exfoliation of mandibular canines marks the beginning of 2nd transition period. 2.Premolars and canines erupt 1 to 3 yrs after eruption of incisors. Favourable occlusion is dependent on a)favorable eruption sequence b)satisfactory tooth size available tooth ratio c)attainment of normal molar relation with minimum alteration of space available for bicuspids.

3.Before emergence, second molars are oriented in mesial and lingual direction. These teeth are guided into occlusion by CONE FUNNEL mechanism . i.e., the upper palatal cusps or cone slides into the lower occlusal fossa or funnel. During the eruption of 2nd molars crowding occurs due to mesial eruptive forces.

PERMANENT DENTITION PERIOD: First evidence of calcification is seen in first molars which extends upto 25yrs of age. Calcification in incisors is completed by 4-5 yrs of age and that of other permanent teeth by 6-8yrs of age except third molars. Permanent incisors develop lingual to the deciduous incisors and more labially as they erupt.

Permanent premolars develop below the divergent roots of deciduous molars.

Most common sequence of eruption of permanent teeth is.. 6-1-2-4-5-3-7 (or)6-1-2-4-3-5-7 in maxilla and 6-1-2-3-4-5-7(or)6-1-2-4-5-3-7 in mandible.

FEATURES OF PERMANENT DENTITION: 1.Coinciding midlines 2.ClassI molar relation 3.Overbite-1/3rd of clinical height of mandibular central incisor 4.Overjet-decreases in second decade due to forward growth of mandible 5.Curve of spee-develops during transistion and stabilizes in adulthood.