1. DEVELOPING OCCLUSION-clinical implications and variations.

2. PREDENTATE PERIOD

3. Gum pads They are pink, firm and fibrous Maxillary- horse shoe shaped
Grooves and Sulci seen
Mandibular
Contact posteriorly
Anterior open bite

4. Clinical implications or variations
NATAL TEETH AND NEONATAL TEETH

5. PRIMARY DENTITION: from 6 months to 6 years of age.
As a general rule, the mandibular dentition precedes the maxillary dentition, except for the maxillary lateral incisors.

6. Chronology of eruption of primary teeth
Lower central incisors
Upper central incisors
Upper lateral incisors
Lower lateral incisors
First molars
Canines
Second molars

7. Clinical implications or variations

8. Clinical implications or variations
Neonatal teeth
Eruption Cyst

9. Characteristics of Primary Dentition
OVERJET
OVERBITE
SPACES IN DENTITION
RELATIONSHIP OF SECOND DECIDUOS MOLARS

10. Sagittal relationship in Primary Dentition
What is ‘OVERJET’?

11. Sagittal relationship in Primary Dentition
The incisors usually are in normal overjet relation of 1mm or in an edge to edge relationship.

12. Vertical relationship in Primary Dentition
What is ‘OVERBITE?

13. Vertical relationship in Primary Dentition
Overbite reduces throughout the primary dentition until the incisors are edge to edge, which can contribute to marked attrition.

14. Clinical implications or variations
Influence of habits like thumb and digit sucking may lead to :
-Increased overjet
-Anterior open bite
Cross bite

15. Spaces in primary teeth
Generalized spacing
Primate spaces

16. Clinical implications or variations
No spacing
Crowding in
primary teeth
This leads to increased probability of crowding in permanent dentition as dental arch length anterior to second primary molars does not increase after their eruption

17. Determining the terminal plane relationships in the
Terminal plane relationship between the distal surfaces of the maxillary and mandibular second primary molars.
Usually because of larger mandibular second molars, the distal surfaces of the occluding second molars are flush, whereby the term "flush terminal plane" or straight terminal plane.
Determining the terminal plane relationships in the
primary dentition stage is of great importance as it guides the erupting first permanent molars into occlusion

18. Clinical implications or variations
A, Flush terminal planes B, Mesial step with the C, Distal step with the
mandibular plane mesial mandibular plane to
the maxillary plane distal to maxillary plane.

19. MIXED DENTITION: from 6 years to 12 years of age.
First transitional period
Characterised by:
Eruption of Permanent First Molars
Eruption of Incisors

20. Chronology of eruption of permanent teeth

21. Clinical implications or variations

22. Eruption of Permanent First Molars
CLASS l MOLAR RELATION
CLASS ll MOLAR RELATION
CLASS lll MOLAR RELATION

23. Eruption of Permanent First Molars
Factors that change molar relationship pattern in primary molars to that in permanent molars:
The FIRST PERMANENT MOLARS when erupt , they utilise the
spaces present in the primary teeth to drift mesially. This is called
EARLY SHIFT OF PERMANENT MOLARS
FORWARD GROWTH OF MANDIBLE

24. Clinical implications or variations
The first Permanent Molars may erupt into one of the following occlusal relationships

25. Eruption of Permanent Incisors
The maxillary arch, on the average, has just enough space to accommodate the permanent lateral incisors when they erupt. In the mandibular arch, however, when the lateral incisors erupt, there is on the average 1.6 mm less space available for the four mandibular incisors than would be required to perfectly align them.
This difference between the amount of space needed for the incisors and the amount available for them is called the "incisor liability." ‘INCISOR LIABILITY’
Repositioning of the canines in the mandibular arch. As the permanent incisors erupt, the canine teeth not only widen out slightly but move slightly back into the primate space. This contributes to the slight width increase already noted because the arch is wider posteriorly, and it also provides an extra millimeter of space. since the primate space in the maxillary arch is mesial to the canine, there is little opportunity for a similar change in the anteroposterior position of the maxillary canine.

26. Because of the incisor liability, a
normal child will go through a transitory stage of mandibular incisor crowding at age 8 to 9 even if there will eventually
be enough room to accommodate all the permanent teeth in good alignment

27. Where did the extra space come from to align these mildly crowded lower incisors?
Most jaw growth is in the posterior, and there is no mechanism by which the mandible can easily become longer in its anterior region.
Rather than from jaw growth per se, the extra space comes from three sources:
Proclination of incisors
Eruption of incisors in a wider arc
Utilization of spaces of primary dentition
Increase in inter canine width

28. Eruption of Permanent Maxillary Incisors
7 years old
9 years old
14 years old
UGLY DUCKLING STAGE

29. Clinical implications or variations
UGLY DUCKLING STAGE

30. Clinical implications or variations
(1)
(2)
Diastema may be caused by an erupted or unerupted
Supernumery tooth in midline(1) or a low frenum(2)

31. Thumb sucking and digit habits may lead to
Clinical implications or variations
Thumb sucking and digit habits may lead to
anterior openbite

32. Clinical implications or variations
Sometimes the deciduous incisor may be retained leading to palatal
Eruption of Maxillary Incisor

33. Permanent Maxillary Incisors may develop palatally
Clinical implications or variations
Permanent Maxillary Incisors may develop palatally
Leading to CROSSBITE

34. Intertransitional period
This stage is characterized by continued
eruption of already
erupted permanent teeth. No significant changes occur.

35. 1.8mm in maxilla 3.4 mm in mandible
Second transitional period
This period, characterized by shedding of the primary canines and molars, emergence of the permanent canines, premolars, and permanent second molars
Leeway space;
1.8mm in maxilla mm in mandible

36. This leeway space is utilized by permanent molars as they drift mesially. This is called late mesial shift.
So that a flush terminal relationship is converted into a class I molar relationship
Mandibular molar normally moves mesially more than its maxillary counterpart.

37. Improper utilization of LEEWAY SPACE may lead to
Clinical implications or variations
Improper utilization of LEEWAY SPACE may lead to
CROWDING
WHY??

38. BECAUSE:
Even if incisor crowding is present, the leeway space is normally taken up by mesial movement of the permanent molars.
SOLUTION:
An opportunity for orthodontic treatment is created at this time.

39. PERMANENT DENTITION: from 12 years of age to eruption of third molars

40. PERMANENT DENTITION
The overbite often ranges between 10% and 50%, and the overjet ranges between 1.0 and 3.0 mm.
Intercanine width : canine to canine.
- ↑ 1-2 mm during primary dentition.
- ↑ 3 mm in mixed dentition.
Growth is completed around 9 years.

41. Development of the dental arches
Mandible
Maxilla
Changes in Dental Arches from 6 TO 13 yrs

42. Tooth – jaw size discrepancy may lead to (1)CROWDING or
Clinical implications or variations
(1)
(2)
Tooth – jaw size discrepancy may lead to (1)CROWDING or
(2) DENTAL PROTRUSION

43. TEETHING

44. The process of teething is sometimes referred to
Teething is the process by which an infant's teeth sequentially appear by breaking through the gums
The process of teething is sometimes referred to
as "cutting teeth".

45. TEETHING SIGNS: General irritability Disturbed sleep Loss of appetite
Chewing of objects
Bruises/swelling in gums:Some blood and bruising during teething is common in most infants and babies:Not all babies bleed from the mouth when teething, but in some cases, a pocket of blood in the gum just above the tooth ruptures. eruption isn't any more painful than usual. It just looks scary to parents!
Excess salivation

46. Running nose
Teething has not been shown to cause fever or diarrhea. A slight rise of temperature may occur when the teeth come through the gum, but this does not make a baby ill.

47. Historical management of teething
. Remedies that have been prescribed for teething through the ages have included blistering, bleeding, placing leeches on the gums, and applying cautery to the back of the head!
Lancing
Systemic medicaments
Opiates and poisons such as lead acetate, mercurials and bromide. many of these compounds are actually causative of the symptoms associated with teething!
The teething relief method under constant debate is the age-old remedy of rubbing rum or whiskey on the baby's gums.

48. Current methods of the management of teething
Non-pharmacological management
Teething rings
Hard, non-sweetened rusks made from flour and
wheatgerm with no sugar or sweetener
Reassurance
Pharmacological management
Topical agents
Systemic analgesics

49. ‘Alternative' holistic medicine
acupressure,
aromatherapy,
and homeopathy

50. DIFFERENCES BETWEEN PRIMARY AND PERMANENT TEETH

51. THANK YOU