DEVELOPMENT

OF
DENTITION
Presented by,
Dr.M.SWATHI
Department of Orthodontics and Dentofacial Orthopedics

MIDS
 CONTENTS
 INTRODUCTION
 PRE-NATAL DEVELOPMENT
 MOUTH OF NEONATE
 POST-NATAL DEVELOPMENT
 DEVELOPMENT OF PRIMARY DENTITION
 MIXED DENTITION STAGE
 DEVELOPMENT OF PERMANENT DENTITION
 CONCLUSION
 INTRODUCTION

 Malocclusion is a developmental condition.

 Development of malocclusion is a reflection of
disturbances in the normal processes of development
of dentition and craniofacial structures.
 Unlike more complex skeletal problems, problems
involving dental development often need orthodontic
treatment as soon as they are discovered..
 Therefore some knowledge of development of
dentition is needed.
 Teeth are derived from ectoderm, mesoderm and neural
crest contribution.
 Enamel – oral ectoderm
 Dentine,pulp,cementum—neural crest cells
 Periodontium-both NCC and mesoderm.
 neural inductive influence
 Genetic influence-signalling molecules
 PAX 9,MSX1,NGF,SHH,FGF,BMP,DLX,Wnt families
regulate early stages of tooth morphogenesis.
Textbook of sperbers
 Pre-natal development
 Every dentition should pass through four stages
of tooth development,,
 Stage 1-initiation of odontogenesis
 Stage 2-bud stage
 Stage 3-cap stage
 Stage 4-bell stage
 Initiation of odontogenesis:-
 First sign of tooth development- 3rd week IUL
 Thickening of epithelial lining

of oral cavity from connective

tissue beneath.
 Thickenings form,
maxilla –lateroinferior borders
mandible- laterosuperior borders join to form

a
lateral margins of s
stomodeum
By 6th week IUL,
 Maxilla –two odontogenic zones anteriorly from frontal
nasal prominence coalese with lateroinferior thickenings and
form DENTAL LAMINA of maxilla.
 Mandible – two odontogenic zones fuse at midline coalese
with laterosuperior border and form DENTAL LAMINA of
mandible.
 C-shaped /horse-shoe shaped epithelial arches.
 Vestibular lamina buccally it from cheeks and lips and lingually
it forms teeth and alveolar bone
 Attached vestibular lamina forms labial frenula.
 Morphologic changes in dental lamina occurs from
6th week IUL to 5th or 6th year of age
 During 2nd month IUL –initiation of entire
deciduous dentition
 During 5th month IUL-initiation of permanent
dentition(successional lamina)
 Distal end of lamina grows in to mesenchyme called
successional lamina (lingual to dental lamina
 Distal end of dental lamina gives rise to
permanent molars tooth germs
 1st molar-4 months
 2nd molar-1year
 3rd molar-4 to 5 years.
 Tooth formation begins by invagination of dental
lamina In to mesenchyme.
Local proliferations of dental lamina
are induced in to subjacent
mesenchyme at locations
corresponding to develping dental
papilla.
 The positioning of teeth depends on
discrete locations of competent
mesenchyme responding to
continuous inductively active
epithelium.
 Ectodermal projections form
primordia of enamel organ.
Ten tooth germs develop in each jaw.
 Concomitant with morphologic
alterations,histodifferentiation occurs in tooth germ
through 3 stages
 Bud stage
 Cap stage
 Bell stage
 BUD STAGE:
 first buds at mandibular anteriors-7th week IUL
 Max ant. And posteriors-8th week IUL
Morpho differentiation:-
 Extensive proliferation of dental
lamina cells in to underlying mesenchyme
forms
 knob like structures called tooth buds.
 Mesenchyme also proliferates.
 Histodifferentiation:-
 Enamel organ consists of peripherally of cuboidal cells.
 Centrally polygonal cells
 CAP STAGE:-
 Morpho differentiation:-
 Unequal proliferation leads
to formation of cap like

structure of enamel organ.

 Mesenchyme condenses around enamel organ to form
dental papilla and dental follicle
 Tooth germ-enamel organ-ectoderm-enamel

dental papilla-NCC-dentin,pulp

dental follicle-Mesoderm-periodontium
 BELL STAGE:-
 Increase in overall
size of tooth germ,deepening
of its undersurface.
 Histodifferentiation
 Stellate reticulum-
 influx of water due to release of acid
mucopolysaccharides enlarge central polygonal cells.
 Zone of stretched but interconnected cells.
 Mucoid fluid,rich in albumin,acts like cushion
 Inner enamel epithelium
 Indented inner layer lining
dental papilla which
differentiates in to transient
secretory ameloblasts.
 Outer enamel epithelium:
 Leading edge of
germ-dental cuticle.
 Stellate intermedium:
 Squamous cellular
condensation between
IEE and Stratum reticulum.
 Inner and outer enamel epithelium form cervical loop
elongating in to hertwigs epithelial root sheath.
 Crown-IEE – odontoblasts – preameloblasts –enamel-
dentine
 Root- IEE-odontoblasts-dentine
 Lack of stratum intermedium fails to differentiate itself
in to enamel forming ameloblasts,accounting for
absence of enamel in the roots
 Disintegration of OEE by apoptosis –epithelial cell
rests of malassez-periodontal cysts.
 Cementum forms on dentine after disintegration.
 Fibres pre-existing in cementum form principal fibres
of PDL
 Foldings of Bilaminar membrane –enamel knot
 Ameloblasts –amelogenin and enamelin-enamel
 Oontoblasts- collagen matrix Predentine-dentine
 Dental papilla-dental pulp,odontoblasts,fibroblasts
 Dentine formation is a continuous process throughout
life
 Enamel formation restricted to pre-eruptive phase.
Ends with deposition of enamel cuticle.
 Reduced enamel epithelium
 Meanwhile ,
 bony crypts
 PDL
 Spatial patterns:-
Arch shape:-
 By the bell stage of tooth germs,anterior segments of dental
arch has elongated and approaches Catenary by the beginning
of 4th month.
 Lingual drifting of lateral incisors.
 Spacing:-
 Sum of mesiodistal widths increases until 23weeks,
interdentalspace is relatively constant in this period
 anterior segments keep pace with growth of jaws but posterior
segments do not.!
 Fields:-
 Tooth germ together with space mesial and distal to it.
 Interdental fields are shared by neighbouring tooth
 The greatest level of occupancy of a tooth field is by
first deciduous molar and lateral incisors(80%)
 By 16 weeks ,lateral incisor occupies 100%
 But there is often concomitant rotation and lingual
displacement to keep lateral incisor in 80%occupancy.
 Often lateral incisor appears crowded prenatally,but
erupts in good alignment.
 Mouth of neonate:-
 Gum pads:-
 firm and segmented indicating
sites of developing tooth.
 Acc to leighton,Size of gum pads
at birth depends on,,
 state of maturity of infant at birth
 Child Birth weight
 Dental groove & transverse
groove
 Sulcus
Neonatal jaw relationships:
 This cant be used as
diagnostic criterion for reliable
prediction of subsequent
occlusion in primary dentition.
 Anterior openbite is normal
for suckling and normal
incisor relationship.
 Maxillary gumpad overlaps
mandibular gumpad both
horizontally vertically.
 Precociously erupted primary teeth:
 Natal –at birth
 Neonatal-erupted during first month
 Pre-erupted- during 2nd or 3rd month.
 Show enamel hypoplasia
 Mostly mandibular incisors
 Extract only if it troubles
Development of primary dentition:-
 Starts at 6months and ends about 29 months.
 Sequence of eruption:

Timing of eruption is under genetic influence.

 Acc to falkner,development and eruption of primary
dentition is independent of development of child as a whole.
 Highly associated with height than weight
 6months acceleration or delay is normal.(preterm infants)
Teething :-
 1/3rd infants has no symptoms.
 60%-diarrhoea,irritability and rhinorrhea
 Primary tooth size and mineral mass is inherited.
 Ankylosed teeth –primary molars-late primary or
mixed dentition period-intermittent resorption-
posterior open bite-submerged tooth
 Arch form:-
 Ant part of maxilla from birth to 12months
 Posterior diameter increases
 Palatal vault width


 Interdental spacing and diastema increases at end of

dev.due to increased rapid development of jaws and
approaching permanent teeth lingually during 4 to 5years.
 By 9months,arch form and width for both primary and
permanent dentition is established,later only
anterioposterior arch length changes.
 Normal signs of deciduous dentition:

 Spaced anteriors
 Primate spaces
 Shallow overbite and overjet
 Straight terminal plane
 Vertical inclination of anterior teeth
 Ovoid arch form
 Spaced anteriors
 Interdental spacing in primary dentition will avoid
crowding in permanent dentition.
 One of indicators of sufficiency or insufficiency of
space.
 Adult appearing or
hollywood smile is
a sign of crowding
in permanent dentition
 Primate spaces
 Subhumans primates have these spaces throughout
life,hence the name.
 Maxilla-b/w lateral incisors and canines
 Mandible-b/w canines and molars.
 Overjet and overbite
Acc to foster ,on study of 1oo british children of 2 to 3
years,
 Over bite -10%-40% normal
 Overjet- 0- 4mm is normal.
 Over jet diminishes in 6 months due to
anterioposterior skeletal growth.
 Decreased vertical overbite is a reflection of skeletal
maturity.
 Primary molar relationships
 Mesiolingual cusp of maxillary molar occludes with central fossae of
mandibular molar.

 Mesiodistal width of mandibular

molar is more than max.molar.result
in flush terminal plane

 Skeletal growth pattern ,interproximal caries,sucking habits produce

‘step’.
 Mesial step
 Flush terminal plane
 Distal step
 Development of permanent dentition

 Both sequence and timing of eruption is genetically determined.

 Nutritional, endocrine disturbances has less significant effect.
 Periapical lesion,pulpitis,pulpotomy of primary molar will hasten
eruption successor premolar.
 Trauma, intrusion of primary incisor cause disturbances in
mineralization process of permanent tooth.
 Primary tooth extraction should be co-related with stage of

development of permanent tooth.

Nolla tooth development stages
 Sequence of Eruption:

No relationship between sequence of calcification and sequence of

emergence in to mouth.

In Maxilla :- 6-1-2-4-(3-5)-7

(or)
6-1-2-4-(5-3)-7

In mandible:- 6-1-2-3-4-5-7

(or)

6-1-2-4-3-5-7
Stages of eruption
 Pre-Eruptive
 Intra-Alveolar
 Intra-Oral
 Occlusal
Pre-Eruptive
 When crown of teeth is formed very slow
labial drift of tooth follicle within bone
occurs.
 At onset, position of determined by
hereditary traits
 Intra-Alveolar
Soon after crown formation completed and root formation begins eruption

process starts.

Two processes occurs in preemergent eruption process.

1. Resorption of primary tooth roots and bone.

2. Propulsive mechanism that move tooth in the path cleared.

Failure – cleidocranial dysplasia.

Different mechanisms controlled rate of bone resorption

and rate of eruption.

 Primary failure of eruption
 Do not erupt even though bone eruption and primary
tooth resorption occurs to clear path.
 No mechanical obstruction.
 Defect in propulsive mechanism.
 Mutation in parathyroid hormone receptor
gene1(PTHR1).
 Involve tooth do not respond to orthodontics force which
show evidence that there is abnormality in PDL.
 Extraction is only treatment option.
 Other possible preemergent propulsive
mechanisms are –
1. Variations in blood flow.
2. Contraction of fibroblast.
3. Extracellular PDL.
Intraoral or Preocclusion-
 Lips,cheek,tongue,muscles,extraneous objects.
Occlusal stage –
 Circadian rhythm 8PM to 1AM- Growth hormone
release
 Anterior component of force
 Axial inclination of permanent teeth.
 Steepness of occlusal plane.
 Masticatory forces.
 Counteracted by approximate contacts of teeth
and musculature of lips and cheeks.
 Juvenile occlusal equilibrium.
 Adult occlusal equilibrium.
Mixed Dentition period
 Succesional period.
 Accessional period.
 Ideal time for major orthodontic
treatments-
1.Utilization of arch perimeter.
2.Adaptive changes in occlusion.
Leeway space of nance
 Anterior-negative-
A+B<1+2
 Posterior-positive-
C+D+E>3+4+5
 Mandible(1.8) >
Maxilla(0.9).
 First transitional period :-
 Emergence of first permanent molars.
 Exchange of deciduous incisors with permanent
incisors.
 Establishment of occlusion
 1st molar eruption
 Mandible:-
 Guided into its occlusal position by distal surface of
2nd primary molar
 Mesial and lingual path of eruption
 Maxilla :-
 Crown placed dorsally before eruption.
 Due to maxillary tuberosity growth, Space created
posteriorly to accomadate crown.
 Distal and buccal path of eruption
Incisors eruption:
 Mandible
 Permanent incisors erupt
lingually to primary incisors.
 Move labially after exfoliation.
 Lateral incisors push pri.canines distally and close
primate spaces.
 Lip ,facial musculature and tongue decides ideal
position.
 Mixed dentition analysis
 Large permanent incisors-resorption or exfoliation of
primary cuspids.
 If premature shedding of primary cuspid occurs????
 Lingual tipping
 Hypermentalis activity
 Eruption of permanent canine in labioversion
 Class II div 1 ,thumbsucking
 Sensitive time & sensitive region-1st symptoms of
malocclusion
 Maxilla
 Functional stop by mand.incisors.
 More labial and distal inclination
 Midline diastema closed by lat.incisors and cuspid.
 Lat.incisor erupts labially due to more labial and
distal position of cuspid crowns.
 Minor rotations corrected after eruption of cuspids.

Incisal liability
Space relationships in replacement of incisors:-

 Permanent incisors erupt lingual to primary incisors.

 Canines erupt in line with primary teeth.
 Transient crowding at age 8 or 9 years will resolve,where did
space come from??
 No jaw growth
 Moorrees and chaddah study,3 possibilities,
1. outward eruption of tooth-arch width inc(2mm)
2.labial position of per.incisors
3.Repositioning of canine (incisal liability adjustment)
Inter-transitional stage
 Stable phase
 Contains both sets of dentition
 Permanent 1st molars and incisors
 Deciduous canines and deciduous 1st
and 2nd molars
Second transitional stage:
 Emergence of bicuspids,cuspids,2nd
molars
 Establishment of occlusion.
 Cuspid & bicuspid eruption:-
 Mandible:
 Favourable sequence- cuspid-1st premolar-2nd
premolar.
 If cuspid lost early-labioversion
 1st premolar-
 uneven resorption of first molar-bicuspid rotations
 Exfoliate primary 1st molar
 2nd premolar
 Loss of 2nd primary
molar-mesial shift –
space maintainer
 Mixed dentition analysis
to control mesial shift
 2nd bicuspid show
variability in calcification
& development.
 Maxilla:
 Favourable sequence
 1st bicuspid-canine-second bicuspid
 Tooth size of 1st bicuspid is same as
predecessor,hence do not disturb cuspid or
primary molar.
 Greater mesiodistal width of primary 2nd molar
accomodates 2nd bicuspid.
 This extra space is used by large cuspid and
avoid mesial shift.
 Tortuous pathway & tendency for mesial shift
makes tight situation In maxilla
 At 3 yrs of age,high in maxilla,with crown directed
mesially & lingually
 Moves occlusally by gradual uprighting untill it touches
distal aspect of lateral incisor.
 In oral cavity,it erupts high in alveolar process with
mesial inclination.
 Cuspid eruption closes interdental spacing.
 Labioversion or blocked out canine is seen ?????
 if permanent second molar erupts earlier than cuspid.
 Shortened arch perimeter
Space relationships in replacement of canines and
primary molars
 Per.canines larger than primary,use primate
spaces.
 Bicuspids are smaller than primary molars.
Ugly duckling stage:-
 Second molars:-
 Mandibular and maxillary 2nd molars should erupt
after all teeth
 If it erupts before cause mesial shift,loss of arch
perimeter.
 In maxilla –blocked out / labioversion cuspid
 In mandible –ectopic eruption of second premolar
 Tendency for class II- if maxillary 2nd molar erupts
prior to mandibular 2nd molar
 Third molars:
 more variability in calcification and eruption.
 Not related to somatic growth,sexual maturation
 No sex differences
 High constancy in eruption
 If 1 or more 3rd molars missing,
 Strong tendency for agenesis of other teeth
 Delayed formation of other posterior teeth
 Reduction in size of other tooth
Dental age

 Depends on,
 First -which teeth erupted
 Second-amount of resorption of primary
tooth
 Third-amount of development of
permanent tooth.
At 6,
 Near simultaneous eruption of
permanent mandibular central incisors,
maxillary 1st molars and mandibular 1st
molars
At 7
 Eruption of maxillary central incisors
followed by mandibular lateral incisors.
 Root formation of maxillary lateral
incisor advanced.
 Premolars and canines in stage of
crown completion.
At 8
 Eruption of maxillary lateral incisors
 Delay of 2-3 years before any more
permanent teeth erupt.
At 9
  Primary canines,1st and 2nd deciduous
molars present
 Root development of maxillary canines
and all second premolars is just
beginning
 One third of the root of the mandibular
canines and all of the first premolars
have been completed.
At 10
 Completion of one half of the root development of
mandibular canine, mandibular 1st premolar and
maxillary 1st premolar
 Significant root formation of maxillary canine and
second premolars.
 Completion of roots of mandibular incisor teeth
 Near completion of roots of maxillary laterals
At 11
  Near simultaneous eruption of
mandibular canine , mandibular 1st
premolar and maxillary 1st premolar.
At 12
  Eruption of maxillary canine, maxillary
and mandibular 2nd premolar.
 Second permanent molars in both the
arches are nearing eruption.
At 13,14,15
 Progressive completion of roots of
permanent teeth.
 If 3rd molar is present crown formation
is complete.
References:
 Robert Moyers. Handbook of orthodontics
 Samir E. Bishara . Textbook of Orthodontics
 Sperbers: craniofacial development
 William R. Profitt .Contemporary orthodontics: fourth edition
 Wheelers dental anatomy
 Samir E. Bishara .Changes in molar relationship between deciduous and
permanent dentition – a longitudinal study. Am J Orthod. 1988; 93:19-28.
 The sequence of eruption of the permanent dentition . Am J Orthod 1953
39 : 460- 467
 Nolla CM.The development of the permanent teeth. J Dent Child 1960; 27 :
254-266
 Van der linden FPGM et al .Tooth size and position before birth . J Dent
Res 1972;51:71-74 126
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