Orthodontic Department

Development of Normal
Occlusion
Professor Name : Prof. Dr. Mona Salah fayed
BDS, MSc, PhD (Cairo), DrMedDent (Bern)
Professor of Orthodontics (Cairo University)
Professor title at MSA: Head of Department MSA University
LECTURE OUTLINE

• Mixed Dentition Stage

➢The Permanent Incisors
➢The Upper Permanent First Molar
➢Eruption of the Permanent Canines and Premolars

• Early Permanent Dentition Stage

• Adult Occlusion
• Dimensional Changes in the
Dental Arches
LECTURE ILOs

• Identify the normal occlusion at different age and its deviations that lead to
malocclusion.
• Differentiate between the normal occlusion at different stages and the
malocclusion
• Describe the needed measures for the prevention of malocclusion in the
primary and mixed dentition stage.
Development of Normal
Occlusion
Mixed Dentition Stage
 Mixed Dentition Stage
This covers the period from the eruption
of the first permanent tooth till the
shedding of the last deciduous tooth (from
6 – 12 years).
 Mixed Dentition Stage

permanent dentition starts

calcification after birth with the
exception of cusps of the first
permanent molars. so, postnatal
environmental disorders and diseases
might affect the calcification.
It was found that the permanent teeth do not begin eruptive
movements until their crowns are completed.

They pass or pierce through the crest of the alveolar process

when approximately two thirds of the roots are formed and pierce
the gingival margin and emerge to the oral cavity when nearly ¾
of the roots are completed.
The germs of all the permanent teeth are
formed on the lingual side of their
deciduous predecessors.
Permanent incisors remain lingual to the deciduous
throughout their development and if a deciduous
incisor fails to shed the permanent one will normally
erupt in a lingual position.
 The Permanent Incisors

The tooth will tend to move to the

line of the dental arch causing the
deciduous to shed out or it may be
locked out of occlusion.
The incisor teeth are often rotated
before eruption to occupy less space, but
at the time of their eruption they improve
their position as lateral growth of the
dental arches takes place.
In a potentially crowded mouth this
rotation may persist after eruption.
• The premolars migrate at an early stage from their lingual
position so as to lie between the roots of the deciduous molars
before they start calcification
 The Upper Permanent First Molar

The upper first molar develops in the tuberosity of the maxilla with its
occlusal surface facing somewhat distally.

It moves downwards and forwards as growth takes place by bone apposition

on the tuberosity until it erupts,

Its former position being occupied by the second molar and finally the third
molar.
Lengthening of the Maxilla by Apposition of
Bone to the Maxillary Tuberosities
 Similarly the lower permanent first molar develops in the ascending
ramus of the mandible with its occlusal surface tilted mesially.
This tooth moves forward as growth takes place by bone remodeling
of the mandible.
The second and then the third molar replace it in the ascending ramus.
 Eruption of the Permanent Incisors

Deciduous incisors are much smaller than their permanent

successors (Incisor liability). THE FOLLOWING mechanisms
may accommodate the greater size of the permanent incisors
in the dental arches
1. The normal space present between deciduous incisors, which
might increase slightly but may remain unchanged until they are
shed.
2. Increase in the intercanine width. In average terms,
there is 1 – 2 mm increase in intercanine width during
the time the deciduous incisors are in the mouth.
• During the eruption of the permanent incisors and especially the permanent
canine, there is about 3 – 5 mm increase in the upper arch and much less in
the lower.
The increase in mandibular intercanine width stops earlier than that of the
maxilla.
3.The fact that the permanent incisors are more proclined than
their predecessors giving rise to a wider arch and more
space is available to accommodate larger permanent
incisors.
• If the deciduous incisors are in contact and not spaced, this
should be regarded as essentially a crowded condition.
Eruption of the Permanent Canines and Premolars
In an average individual the combined mesiodistal width of the mandibular
deciduous canine, first molar and second molar are in average 1.7 mm
greater than that of the mandibular permanent canine, first premolar and
second premolars.
This difference in size is called the LEEWAY SPACE.
However, this Leeway space is lesser in the maxillary arch as the
combined mesio-distal width of the maxillary deciduous canine and
molars is on average greater 0.9 mm. than that of the maxillary
permanent canine and premolars.
 Thus, there is a Leeway space of 3.4 mm in the
mandible bilaterally while it is only 1.8 mm in the
maxilla bilaterally in the transition from mixed
dentition to the full permanent dentition.
 Late Mesial Shift

Molar moves into

FTP this space... Class I
• Some of this Leeway space is taken by the distal movement of
the larger permanent canine falling into the primate space,
while other part is utilized by the late mesial shift of the
mandibular molars in order to establish a normal molar
relationship.
The Ugly Duckling Stage
• The maxillary permanent canine
develops distant from the dental
arch and close to the floor of the
orbit.
• At 9 to 10 years as it moves
downward and forward towards
occlusion, it comes to lie against
the apices of the erupted permanent
lateral and central incisors causing
mesial pressure on their roots.
The centrals clinically respond to that pressure by
central diastema and distal crown flaring while the
laterals show labial tipping.
 • Broadbent called this clinical picture
"UGLY DUCKLING STAGE".
• This temporarily clinical picture improves as the
permanent maxillary canine continues to erupt
and exert mesial wedging action on the crowns
of the lateral and central incisors.
Ugly Duckling Stage
• Since the maxillary canine erupts after its
neighbors it is particularly liable to be
the victim of crowding.
Early Permanent Dentition Stage
 Early Permanent Dentition
Stage

After the eruption of the permanent premolars, canines

and second molars at about 12 to 13 years, now all teeth
are in good intercuspation, normal molar relationship.
As the mandible continues to grow forward more than the maxilla,
the mandibular incisors are locked lingually to the upper, they tip
lingually and the mandibular arch perimeter decreases more. This
may lead to the so-called "LATE TEEN CROWDING" of the
lower incisors especially seen in boys.
Adult Occlusion
After the eruption of the third molars
very little changes take place in the
dental arch size and relations.
Dimensional Changes in the
Dental Arches
 Arch Width

The width is a term which may be given

to the transverse linear measurements
between the right and left canines and
called the intercanine width or between
molars and called intermolar width .
• The maxillary intercanine width increases from 3 to 14
years by about 5 mm, less increase in width is
observed in the intermolar width for both arches.
 Arch length

• Arch length is usually defined as the length of a perpendicular line

drawn from the mesial contact point of the upper central incisors to a
line joining the distal contact points of the second deciduous molars or
second premolars.
 Arch Perimeter

• The arch perimeter is measured

from the mesial surface of the first
permanent molar around the arch
over the contact points between
premolars or deciduous molars and
over the incisal edges of the
incisors to the mesial surface of the
first permanent molar of the
opposite side.
• In the maxilla there is a slight increase in the arch length
and the arch perimeter between 6 and 10 years as the
permanent incisors erupt while the deciduous molars are
still present.
• This is followed by a decrease as the latter teeth are
replaced by the smaller permanent premolars.
 In the mandible there is no increase in the arch length or perimeter but a noticeable
decrease after 10 years. This decrease in mandibular arch perimeter may be attributed to:

1) Late mesial shift of the mandibular molar as the Leeway space is utilized.
2) The inter-proximal wear of the teeth.
3) The mesial drift tendency of the teeth throughout the life.
4) The lingual tipping of the mandibular incisors as the mandible grows forward.
References:

Mitchell, Laura, Simon J. Littlewood, Zararna Nelson-Moon, and Fiona Dyer. An Introduction to Orthodontics.
2013