Isfahan Dental School Pediatric Dentistry Departement Dr. S.E.Jabbarifar PRIMARY DENTITON RELATIONSHIPS GENERAL OBJECTIVES: To present the establishment of the occlusion in the primary dentition.
Download ReportTranscript Isfahan Dental School Pediatric Dentistry Departement Dr. S.E.Jabbarifar PRIMARY DENTITON RELATIONSHIPS GENERAL OBJECTIVES: To present the establishment of the occlusion in the primary dentition.
Slide 1
Isfahan Dental School
Pediatric Dentistry
Departement
Dr. S.E.Jabbarifar
2009
Slide 2
PRIMARY DENTITON RELATIONSHIPS
GENERAL OBJECTIVES:
To present the establishment of the
occlusion in the primary dentition.
Slide 3
SPECIFIC OBJECTIVES:
1. Follow the development of occlusion from
birth – 3 years.
2. Define and illustrate all of the terminal plane
relationships for primary molars.
3. Explain canine relationships in the primary
dentition.
4. Follow the occlusion from 3-6 years.
5. Know normal anterior relationships in the
primary dentition: Overjet, Overbite.
6. Explain spacing in the primary dentition.
Slide 4
I
Neutrocclusion is a maximum
intercuspidation of maxillary and mandibular
teeth with minimal overbite and overjet.
The development of occlusion is the most
dynamic phenomenon in the mouth. This is a
permanent changing process from birth to
death. It can be divided into four periods.
1.
2.
3.
4.
Primary Dentition: birth to 3 years
Mixed Dentition: 6-12 years
Young Permanent Dentition: adolescence
Adult Dentition.
Slide 5
Slide 6
Slide 7
DECIDUOUS DENTITION
5 months in
utero
2 yrs
(± 6 mos.)
7 months in
utero
3 yrs
PRENATAL
(± 6 mos.)
Birth
6 mos.
(± 2 mos.)
9 mos.
(± 2 mos.)
1 year
(± 3 mos.)
4 years
(± 9 mos.)
5 yrs
(± 9 mos.)
6 years
(± 9 mos.)
18 months
(± 3 mos.)
INFANCY
EARLY CHILDHOOD
(Pre-school age)
Slide 8
Slide 9
Slide 10
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
Slide 19
THE THREE TYPES OF TERMINAL PLANES
FLUSH PLANE
MESIAL STEP
TYPE
TYPE
DISTAL STEP
TYPE
Slide 20
ESSENTIAL FACTORS FOR A SMOOTH
TRANSITION FROM PRIMARY TO
PERMANENT DENTITION
1. Primate space.
2. General spacing.
3. Preservation of “leeway space”.
4. Sequences of eruption.
5. Tooth size and jaw in harmony.
Slide 21
PERMANENT DENTITION ESTABLISHMENT & RELATIONSHIPS
GENERAL OBJECTIVES:
Explain the establishment of the
occlusion of the permanent dentition.
Slide 22
SPECIFIC OBJECTIVES:
1. Describe the eruption sequence and
timing of permanent teeth.
2. Describe the desirable eruption pattern
and identify variations of normality.
3. Explain how the inter-canine distance
changes when incisors erupt.
4. Explain temporary minor mandibular
crowding.
5. Explain the ugly ducking stage.
Slide 23
SPECIFIC OBJECTIVES (con’t)
6. Explain space relationships in replacement
of canines and primary molars.
7. Describe normal closure of a maxillary
midline diastema.
8. Project from molar relationships in the
primary dentition, the type of Angle
classification that will result.
9. Describe and illustrate Angle’s classification
of occlusion: class I, class II with divisions
and subdivisions, class III.
10.Recognize acceptable overbite and overjet
relationships in the permanent dentition.
Slide 24
STEPS OF TOOTH ERUPTION
1. Pre-emergent eruption - Pre-eruptive phase
a) resorption of the bone and primary tooth
roots
b) the eruption mechanism
2. Post-emergent eruption - Eruptive phase
a) post-emergent spurt - Eruptive phase
(Pre-functional)
Slide 25
Steps of Tooth Eruption (con’t)
2.
b) juvenile occlusal equilibrium
Eruptive phase (Functional)
c) adult occlusal equilibrium
Slide 26
Primary tooth
Bone trabeculae
at fundus
Enamel
Apex
Permanent tooth
Bone
trabeculae at
alveolar crest
Apex
Enamel
Bone
trabeculae at
fundus
Slide 27
Slide 28
Slide 29
Slide 30
LOCAL, SYSTEMIC AND CONGENITAL FACTORS
THAT CAN INFLUENCE THE ERUPTION OF THE
TEETH.
Local
•
•
•
•
Systemic
• Primary failure of eruption
• Hypothyroidism
Congenital
• Down’s Syndrome
• Achondroplastic Dwarfism
• Cleidocranial Dysplasia
Two rows of teeth
Ectopic eruption
Infected primary teeth
Ankylosis
Slide 31
Slide 32
Slide 33
Slide 34
ECTOPIC ERUPTION/IMPACTIONS
Primary dentition
• Extremely rare in primary dentition
Permanent dentition
• Permanent molars
– 1st > 2nd; maxillary > mandibular
– Incidence of 1st molar: - 2-3%
• Suggested etiologies include
– Small maxilla
– Posterioly positioned maxilla
relative to cranial base
Slide 35
• Etiologies (continued):
– Molar path of eruption
– Mesiodistal dimension
– Asynchronization between tuberosity
growth and molar eruption
– Retarded calcification and eruption
– Genetic
Slide 36
• Treatment
– Mild: observation (Pulver: 2/3 of
ecotypically erupting 1st molars will
self-correct)
– Moderate: brass ligature; spring;
distalize 1st permanent molar
–Severe: extract primary molar and
distalize 1st permanent molar.
Slide 37
• Permanent mandibular incisor(s)
– Common: typically erupt lingual to overretained primary incisors
– Rationale for treatment: allow teeth
to move into area of attached gingival
– Treatment: extract primary incisors;
tongue pressure will typically push
incisors into place
Slide 38
• Permanent maxillary canines
– Prevalence 1-2%
– Reported incisor root resorption - 50%
(Ericson and Kurol)
– Diagnosis
• Palpation
• Radiographic
Slide 39
• Radiographic (continued)
– poor prognosis indicators
– permanent canine crown mesial of
midline of lateral incisor root
– palatal displacement of permanent
canine as viewed on cephalometric
film
Slide 40
Slide 41
Slide 42
ANKYLOSIS
Primary dentition
• First molars most common
• Typically require no treatment and exfoliate
normally
• Involved second molar maybe indication of
agenesis of succedaneous tooth
• Treatment:
– Prevent space loss
»Build-up occlusion surface of
involved tooth
»Extract tooth and place space
maintainer
Slide 43
Permanent dentition
• Difficult to treat ankylosed permanent teeth
– Create adequate space
– Attempt to break area of ankylosis with
luxation
– Immediately apply orthodontic traction
force (>50 G) or
– Surgically reposition tooth and hold in
position orthodontically (pulp
endodontic therapy necessary)
– Ankylosed permanent teeth tend to reankylose.
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Primary tooth
Bone trabeculae
at fundus
Enamel
Apex
Permanent tooth
Bone
trabeculae at
alveolar crest
Apex
Enamel
Bone
trabeculae at
fundus
Slide 53
Chronology of Tooth Development
Permanent Dentition
C a lc ifica tio n
b e g in s
C ro w n
c o m p le te d
E ru p tio n
R o o t c o m p le te d
T o o th
M a x.
M an d .
M a x.
M an d .
M a x.
M an d .
M a x.
M an d .
C e n tra l
3 m o.
3 m o.
4 ½ yr.
3 ½ yr.
7 ¼ yr.
6 ¼ yr.
1 0 ½ yr.
9 ½ yr.
L a te ra l
11 m o.
3 m o.
5 ½ yr.
4 yr.
8 ¼ yr.
7 ½ yr.
1 1 yr.
1 0 yr.
C a n in e
4 m o.
4 m o.
6 yr.
5 ¾ yr.
1 1 ½ yr.
1 0 ½ yr.
1 3 ½ yr.
1 2 ¾ yr.
st
20 m o.
22 m o.
7 yr.
6 ¾ yr.
1 0 ¼ yr.
1 0 ½ yr.
1 3 ½ yr.
1 3 ½ yr.
nd
27 m o.
28 m o.
7 ¾ yr.
7 ½ yr.
1 1 yr.
1 1 ¼ yr.
1 4 ½ yr.
1 5 yr.
M o la r
32 w k.
in u te ro
32 w k.
in u te ro
4 ¼ yr.
3 ¾ yr.
6 ¼ yr.
6 yr.
1 0 ½ yr.
1 0 ¾ yr.
1 P re
M o la r
2 P re
M o la r
1
st
2
nd
M o la r
27 m o.
27 m o.
7 ¾ yr.
7 ½ yr.
1 2 ½ yr.
1 2 yr.
1 5 ¾ yr.
1 6 yr.
3
rd
M o la r
8 yr.
9 yr.
1 4 yr.
1 4 yr.
2 0 yr.
2 0 yr.
2 2 yr.
2 2 yr.
Slide 54
ERUPTION SEQUENCE AND
TIMING
Age 6:
Age 8:
Age 11:
Age 12:
16,26,36,46,41,31
42,32,11,12,21,22
33,34,43,44,14,24,
13,23,35,45,15,25
Slide 55
Slide 56
Slide 57
At dental age 9, the maxillary lateral
incisors have been in place for 1
year, and root formation on other
incisors and first molars is nearly
complete.
Root development of the maxillary canines and all second premolars is
just beginning, while about one third of the root of the mandibular
canines and all of the first premolars have been completed.
Slide 58
Dental age 11 is characterized by the
more or less simultaneous eruption of
the mandibular canines, mandibular
first premolars, and maxillary first
premolars
Slide 59
Dental age 12 is characterized by
eruption of the remaining
succedaneous teeth (the maxillary
canine and the maxillary and
mandibular second premolars)
and, typically a few months alter, the maxillary and mandibular
second molars.
Slide 60
By dental age 15, the roots of all
permanent teeth except the third molars
are complete, and crown formation of
third molars often has been completed.
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Slide 66
7 years old
9 years old
14 years old
Changes in the axial inclination due to the eruption of the maxillary anterior
teeth (Broadbent, 1957).
Slide 67
ERUPTION OF PERMANENT MOLARS
MESIAL STEP
DISTAL STEP
BECAUSE OF MESIAL STEP
ERUPT IN CUSP-GROOVE
RELATIONSHIP
BECAUSE OF DISTAL STEP
ERUPT IN DISTAL
RELATIONSHIP
6/6
6/6
6/6
6/6
Slide 68
Primary
Permanent
Distal Step
Class II
Flush Terminal
Plane
End-End
Mesial Step
Minimal Growth Differential
Forward Growth of Mandible
Shift of Teeth
Class I
Class III
Slide 69
Slide 70
Slide 71
Slide 72
Slide 73
Slide 74
Slide 75
Slide 76
Slide 77
Slide 78
Slide 79
Slide 80
Slide 81
Slide 82
Slide 83
Slide 84
Slide 85
Slide 86
Slide 87
Slide 88
Isfahan Dental School
Pediatric Dentistry
Departement
Dr. S.E.Jabbarifar
2009
Slide 2
PRIMARY DENTITON RELATIONSHIPS
GENERAL OBJECTIVES:
To present the establishment of the
occlusion in the primary dentition.
Slide 3
SPECIFIC OBJECTIVES:
1. Follow the development of occlusion from
birth – 3 years.
2. Define and illustrate all of the terminal plane
relationships for primary molars.
3. Explain canine relationships in the primary
dentition.
4. Follow the occlusion from 3-6 years.
5. Know normal anterior relationships in the
primary dentition: Overjet, Overbite.
6. Explain spacing in the primary dentition.
Slide 4
I
Neutrocclusion is a maximum
intercuspidation of maxillary and mandibular
teeth with minimal overbite and overjet.
The development of occlusion is the most
dynamic phenomenon in the mouth. This is a
permanent changing process from birth to
death. It can be divided into four periods.
1.
2.
3.
4.
Primary Dentition: birth to 3 years
Mixed Dentition: 6-12 years
Young Permanent Dentition: adolescence
Adult Dentition.
Slide 5
Slide 6
Slide 7
DECIDUOUS DENTITION
5 months in
utero
2 yrs
(± 6 mos.)
7 months in
utero
3 yrs
PRENATAL
(± 6 mos.)
Birth
6 mos.
(± 2 mos.)
9 mos.
(± 2 mos.)
1 year
(± 3 mos.)
4 years
(± 9 mos.)
5 yrs
(± 9 mos.)
6 years
(± 9 mos.)
18 months
(± 3 mos.)
INFANCY
EARLY CHILDHOOD
(Pre-school age)
Slide 8
Slide 9
Slide 10
Slide 11
Slide 12
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
Slide 19
THE THREE TYPES OF TERMINAL PLANES
FLUSH PLANE
MESIAL STEP
TYPE
TYPE
DISTAL STEP
TYPE
Slide 20
ESSENTIAL FACTORS FOR A SMOOTH
TRANSITION FROM PRIMARY TO
PERMANENT DENTITION
1. Primate space.
2. General spacing.
3. Preservation of “leeway space”.
4. Sequences of eruption.
5. Tooth size and jaw in harmony.
Slide 21
PERMANENT DENTITION ESTABLISHMENT & RELATIONSHIPS
GENERAL OBJECTIVES:
Explain the establishment of the
occlusion of the permanent dentition.
Slide 22
SPECIFIC OBJECTIVES:
1. Describe the eruption sequence and
timing of permanent teeth.
2. Describe the desirable eruption pattern
and identify variations of normality.
3. Explain how the inter-canine distance
changes when incisors erupt.
4. Explain temporary minor mandibular
crowding.
5. Explain the ugly ducking stage.
Slide 23
SPECIFIC OBJECTIVES (con’t)
6. Explain space relationships in replacement
of canines and primary molars.
7. Describe normal closure of a maxillary
midline diastema.
8. Project from molar relationships in the
primary dentition, the type of Angle
classification that will result.
9. Describe and illustrate Angle’s classification
of occlusion: class I, class II with divisions
and subdivisions, class III.
10.Recognize acceptable overbite and overjet
relationships in the permanent dentition.
Slide 24
STEPS OF TOOTH ERUPTION
1. Pre-emergent eruption - Pre-eruptive phase
a) resorption of the bone and primary tooth
roots
b) the eruption mechanism
2. Post-emergent eruption - Eruptive phase
a) post-emergent spurt - Eruptive phase
(Pre-functional)
Slide 25
Steps of Tooth Eruption (con’t)
2.
b) juvenile occlusal equilibrium
Eruptive phase (Functional)
c) adult occlusal equilibrium
Slide 26
Primary tooth
Bone trabeculae
at fundus
Enamel
Apex
Permanent tooth
Bone
trabeculae at
alveolar crest
Apex
Enamel
Bone
trabeculae at
fundus
Slide 27
Slide 28
Slide 29
Slide 30
LOCAL, SYSTEMIC AND CONGENITAL FACTORS
THAT CAN INFLUENCE THE ERUPTION OF THE
TEETH.
Local
•
•
•
•
Systemic
• Primary failure of eruption
• Hypothyroidism
Congenital
• Down’s Syndrome
• Achondroplastic Dwarfism
• Cleidocranial Dysplasia
Two rows of teeth
Ectopic eruption
Infected primary teeth
Ankylosis
Slide 31
Slide 32
Slide 33
Slide 34
ECTOPIC ERUPTION/IMPACTIONS
Primary dentition
• Extremely rare in primary dentition
Permanent dentition
• Permanent molars
– 1st > 2nd; maxillary > mandibular
– Incidence of 1st molar: - 2-3%
• Suggested etiologies include
– Small maxilla
– Posterioly positioned maxilla
relative to cranial base
Slide 35
• Etiologies (continued):
– Molar path of eruption
– Mesiodistal dimension
– Asynchronization between tuberosity
growth and molar eruption
– Retarded calcification and eruption
– Genetic
Slide 36
• Treatment
– Mild: observation (Pulver: 2/3 of
ecotypically erupting 1st molars will
self-correct)
– Moderate: brass ligature; spring;
distalize 1st permanent molar
–Severe: extract primary molar and
distalize 1st permanent molar.
Slide 37
• Permanent mandibular incisor(s)
– Common: typically erupt lingual to overretained primary incisors
– Rationale for treatment: allow teeth
to move into area of attached gingival
– Treatment: extract primary incisors;
tongue pressure will typically push
incisors into place
Slide 38
• Permanent maxillary canines
– Prevalence 1-2%
– Reported incisor root resorption - 50%
(Ericson and Kurol)
– Diagnosis
• Palpation
• Radiographic
Slide 39
• Radiographic (continued)
– poor prognosis indicators
– permanent canine crown mesial of
midline of lateral incisor root
– palatal displacement of permanent
canine as viewed on cephalometric
film
Slide 40
Slide 41
Slide 42
ANKYLOSIS
Primary dentition
• First molars most common
• Typically require no treatment and exfoliate
normally
• Involved second molar maybe indication of
agenesis of succedaneous tooth
• Treatment:
– Prevent space loss
»Build-up occlusion surface of
involved tooth
»Extract tooth and place space
maintainer
Slide 43
Permanent dentition
• Difficult to treat ankylosed permanent teeth
– Create adequate space
– Attempt to break area of ankylosis with
luxation
– Immediately apply orthodontic traction
force (>50 G) or
– Surgically reposition tooth and hold in
position orthodontically (pulp
endodontic therapy necessary)
– Ankylosed permanent teeth tend to reankylose.
Slide 44
Slide 45
Slide 46
Slide 47
Slide 48
Slide 49
Slide 50
Slide 51
Slide 52
Primary tooth
Bone trabeculae
at fundus
Enamel
Apex
Permanent tooth
Bone
trabeculae at
alveolar crest
Apex
Enamel
Bone
trabeculae at
fundus
Slide 53
Chronology of Tooth Development
Permanent Dentition
C a lc ifica tio n
b e g in s
C ro w n
c o m p le te d
E ru p tio n
R o o t c o m p le te d
T o o th
M a x.
M an d .
M a x.
M an d .
M a x.
M an d .
M a x.
M an d .
C e n tra l
3 m o.
3 m o.
4 ½ yr.
3 ½ yr.
7 ¼ yr.
6 ¼ yr.
1 0 ½ yr.
9 ½ yr.
L a te ra l
11 m o.
3 m o.
5 ½ yr.
4 yr.
8 ¼ yr.
7 ½ yr.
1 1 yr.
1 0 yr.
C a n in e
4 m o.
4 m o.
6 yr.
5 ¾ yr.
1 1 ½ yr.
1 0 ½ yr.
1 3 ½ yr.
1 2 ¾ yr.
st
20 m o.
22 m o.
7 yr.
6 ¾ yr.
1 0 ¼ yr.
1 0 ½ yr.
1 3 ½ yr.
1 3 ½ yr.
nd
27 m o.
28 m o.
7 ¾ yr.
7 ½ yr.
1 1 yr.
1 1 ¼ yr.
1 4 ½ yr.
1 5 yr.
M o la r
32 w k.
in u te ro
32 w k.
in u te ro
4 ¼ yr.
3 ¾ yr.
6 ¼ yr.
6 yr.
1 0 ½ yr.
1 0 ¾ yr.
1 P re
M o la r
2 P re
M o la r
1
st
2
nd
M o la r
27 m o.
27 m o.
7 ¾ yr.
7 ½ yr.
1 2 ½ yr.
1 2 yr.
1 5 ¾ yr.
1 6 yr.
3
rd
M o la r
8 yr.
9 yr.
1 4 yr.
1 4 yr.
2 0 yr.
2 0 yr.
2 2 yr.
2 2 yr.
Slide 54
ERUPTION SEQUENCE AND
TIMING
Age 6:
Age 8:
Age 11:
Age 12:
16,26,36,46,41,31
42,32,11,12,21,22
33,34,43,44,14,24,
13,23,35,45,15,25
Slide 55
Slide 56
Slide 57
At dental age 9, the maxillary lateral
incisors have been in place for 1
year, and root formation on other
incisors and first molars is nearly
complete.
Root development of the maxillary canines and all second premolars is
just beginning, while about one third of the root of the mandibular
canines and all of the first premolars have been completed.
Slide 58
Dental age 11 is characterized by the
more or less simultaneous eruption of
the mandibular canines, mandibular
first premolars, and maxillary first
premolars
Slide 59
Dental age 12 is characterized by
eruption of the remaining
succedaneous teeth (the maxillary
canine and the maxillary and
mandibular second premolars)
and, typically a few months alter, the maxillary and mandibular
second molars.
Slide 60
By dental age 15, the roots of all
permanent teeth except the third molars
are complete, and crown formation of
third molars often has been completed.
Slide 61
Slide 62
Slide 63
Slide 64
Slide 65
Slide 66
7 years old
9 years old
14 years old
Changes in the axial inclination due to the eruption of the maxillary anterior
teeth (Broadbent, 1957).
Slide 67
ERUPTION OF PERMANENT MOLARS
MESIAL STEP
DISTAL STEP
BECAUSE OF MESIAL STEP
ERUPT IN CUSP-GROOVE
RELATIONSHIP
BECAUSE OF DISTAL STEP
ERUPT IN DISTAL
RELATIONSHIP
6/6
6/6
6/6
6/6
Slide 68
Primary
Permanent
Distal Step
Class II
Flush Terminal
Plane
End-End
Mesial Step
Minimal Growth Differential
Forward Growth of Mandible
Shift of Teeth
Class I
Class III
Slide 69
Slide 70
Slide 71
Slide 72
Slide 73
Slide 74
Slide 75
Slide 76
Slide 77
Slide 78
Slide 79
Slide 80
Slide 81
Slide 82
Slide 83
Slide 84
Slide 85
Slide 86
Slide 87
Slide 88