1. MANAGEMENT OF THE DEVELOPING DENTITION

2. OUT LINE NORMAL DENTAL DEVELOPMENT
ABNORMALITIES OF ERUPTION AND EXFOLIATION
MIXED DENTITION PROBLEMS
PLANNED EXTRACTION OF DECIDUOUS TEETH
WHAT TO REFER AND WHEN

3. 1. NORMAL DENTAL DEVELOPMENT
CALCIFICATION AND ERUPTION TIMES
THE TRANSITION FROM PRIMARY TO MIXED DENTITION
DEVELOPMENT OF DENTAL ARCHES

4. 1. NORMAL DENTAL DEVELOPMENT
CALCIFICATION AND ERUPTION TIMES
ASSICAITION BETWEEN DENTAL AGE AND CHRONOLOGICAL AGE

5. 1. NORMAL DENTAL DEVELOPMENT
THE TRANSITION FROM PRIMARY TO MIXED DENTITION
6TH MONTH APPEARANCE OF 1ST MILK TOOTH
BY 3 YEARS COMPLETETION OF DECIDUOUS DENTION
LACK OF SPACE IN MILK TEETH WILL STRONGLY RECOMMEND THE NEED OF ORTHO TREATMENT
SPACING IS NORMAL
SIGN OF MIXED DENTITION EITHER 6S OR LOWER INCISORS ERUPTION
UPPER AND LOWER INCISOR DEVELOPED LINGUALY TO THERE
UGLY DUCKLING STAGE
BY AGE OF 8 Y PALBATE THE UPPER CANINE
LEWAY SPACE MAXILLA MM
MANDIBLE MM

6. 2. ABNORMALITIES OF ERUPTION AND EXFOLIATION
SCREENING
NATAL TOOTH
ERUPTION CYST
FAILURE OF/DELAYED ERUPTION
DISRUPTION OF NORMAL ERUPTION
ASYMETRY OF ERUPTION OF CONTRALATERAL BY MORE THAN 6 MONTHS X RAYS IS RECOMENEDED

7. 3. MIXED DENTITION PROBLEMS
PREMATURE LOSS OF DECIDUOUS TEETH
RETAINED DECIDUOUS TEEH
INFRA-OCCLUDED (SUBMERGED) PRIMARY MOLARS
IMPACTED FIRST PERMANENT MOLARS
DILACERATION
SUPERNUMERARY TEETH
HABITS
FIRST PERMANENT MOLARS OF POOR LONG TERM PROGNOSIS
MEDIAN DIASTEMA
Premature loss of : incisors, canines and 1st primary molar and 2nd primary molars
(Balancing and compensating extraction), space maintanance (the best is the tooth is self to matatin the bone around it
2.Retained decisuous if the contralateral tooth is not erupted in period of 6 months we should be suspicous and x rays should be taken
3. Infra occluded primary molars: 1-9 %, resorption is not continous process and period of repair, ankylosis happen if only repair happen
Its assocaited with ectopic eruption, palatal displacement of upper canines,conginitaly missing premolars
Extraction of submerged teeth in two case: 1- the danger of the tooth disappering below gingival level 2- root formation of permanent tooth is near completon
4. impacted 1st permmanent molar 2-6 %
Ectopic eruption
Brass separation wire in mild cases for 2 months
5. dilaceration: distortion or bend of root of upper central or lateral incisors
Causes: developmental ( female ,centrral , upward and labial crown tilting)or truma (erupt palatly and enamel and dentin deformaties)
6-supernumery teeth
2 % permenet and 1 % deciduoud
Morphology: supplemental, conical. Tuberculate, odontome
Position: mesiodense, distomolar=bparamolar
Management and effect: failure of eruption, displacement, crowding, no effect
7- habits
Intensitity frequancy and types
8- 1st permanent molars of poor long term
factor to be considered: - check the presence of all permenanet teeth – if dentition is uncrowded extraction should be avoided – maxila has greater tendency for mesial drift –lower 2nd molar has been developed in the biforcation – angle between the long axis is 15/30 –extraction of lower 6 alone will resorlve post crowding not anterior –extraction of lower should be avoided if upper extraction is done –impaction of lower 3rd molar is less likely after extraction of 1st molar
9- median diastima
98% of 6 years old
49% of 11 y
7% of ys
Causes: -physilogical –small teeth in larg jaws –missing teeth –midline supernumery tooth –proc;ination of upper front –promenant frenum
when assocaited with high frenum: - blinching of incisive paplia –radigraphicaly there is notch in the crest –ant teeth are crowded
Management:
If less 3 mm, no intervention if more than 3 mm and lateral is erupted then fixed appl and becarful of the root not to cause resorption

8. Premature loss of of deciduous teeth: incisors, canines and 1st primary molar and 2nd primary molars
(Balancing and compensating extraction), space maintenance (the best is the tooth it self to maintain the bone around it)
2.Retained deciduous: if the contralateral tooth is not erupted in period of 6 months we should be suspicious and x rays should be taken

9. 3. Infra occluded primary molars: 1-9 %, resorption is not continuous process and period of repair, ankylosis happen if only repair happen
Its associated with ectopic eruption, palatal displacement of upper canines, congenitally missing premolars.
Extraction of submerged teeth in two case:
1- The danger of the tooth dis-appearing below gingival level
2- Root formation of permanent tooth is near completion

10. 4. impacted 1st permmanent molar: 2-6 % Ectopic eruption Brass separation wire in mild cases for 2 months 5. dilacerations: distortion or bend of root of upper central or lateral incisors Causes: Developmental ( female ,central) or Trauma (erupt palatal , enamel and dentin deformities)

11. 6-supernumery teeth 2 % permanent and 1 % deciduous
Morphology: supplemental, conical. Tuberculate, odontome
Position: mesiodense,
distomolar = paramolar
Management and effect:
failure of eruption, displacement, crowding, no effect
7- habits
Intensity frequency and types

12. 8- 1st permanent molars of poor long term
factor to be considered: - check the presence of all permanent teeth – if dentition is un-crowded extraction should be avoided –
–lower 2nd molar has been developed in the bifurcation –
extraction of lower 6 alone will resolve post crowding not anterior –
–impaction of lower 3rd molar is less likely after extraction of 1st molar

13. 9- median diastema 98% of 6 years old 49% of 11 y 7% of 12-18 ys
Causes: -physiological –small teeth in large jaws –missing teeth –midline supernumery tooth –proclination of upper front –prominent frenum
when associated with high frenum: - blinching of incisive papilla –radigraphicaly there is notch in the crest –ant. teeth are crowded
Management:
If less 3 mm, no intervention if more than 3 mm and lateral is erupted then fixed appl and be carful of the root not to cause resorption

14. 4. PLANNED EXTRACTION OF DECIDUOUS TEETH
SERIAL EXTRACTION
-Solve sever crowding in class I occlusion, all teeth present
-Extraction of Cs then Ds then 1st premolar
-Shifting the crowding from anterior to posterior segment
1-serial extraction
In 1946 by kjellgren swedish orthodontist
Solve sever crowding in class I occlusion, all teeth present
Extraction of Cs then Es then 1st premolar
Shifting the crowding from anterior to posterir segment
2-indications for ex of deciduoud canines
In several cases which ex avoid complication:
Crowding upper arch, lat erupt palatly and in class I this will result in crossbite – crowding lower ant arch with buccal eruption of permenant incisor , ex is indicated
In class III lower extraction –to improve the displacement of permenant canines

15. INDICATIONS FOR EXTRACTION OF DECIDUOUS CANINES
-Crowding upper arch, lat erupt palatal and in class I ,this will result in crossbite
– crowding lower ant arch with buccal eruption of permanent incisor , ex is indicated
-In class III lower extraction –to improve the displacement of permanent canines

16. -Delay eruption of permanent incisors
5. WHAT TO REFER AND WHEN
DECIDUOUS DENTITION:
- CLEFT LIP AND PALAT
- CARINOFACIAL ANOMILIES
MIXED DENTITION
-Delay eruption of permanent incisors
–ectopic canine
-impaction of failure to erupt 6s
Decisuous: cleft lip and other cranifacual anomilies
Mixed: sever class III –delay eruption of permanent incisors –impaction of faliure to erupt 6s -6s with poor prognosis –ant cross bite with perio problem –hypodontia –ectopic canine – medicaly compromise patient – pathology like cyct – sever calss II

17. - ant cross bite with perio problem – sever class II
– medically compromise patient
- 6s with poor prognosis
–pathology like cyst
- ant cross bite with perio problem – sever class II
–hypo-dontia

18. Eruption of the Primary Teeth
Natal tooth

19. Primate space

20. Physical Development in Late Childhood Late childhood: from age 5 or 6 to the onset of puberty.
By age 7,
completed neural growth. The brain and the brain case are as large as they will ever be.
Lymphoid tissue throughout the body has proliferated beyond the usual adult levels, and large tonsils and adenoids are common..
Growth of the sex organs has hardly begun
general body growth is only modestly advanced

21. Eruption of the Permanent Teeth
Preemergent Eruption
Postemergent eruption

22. Preemergent eruption
Eruptive movement begins soon after the root begins to form.
Two processes are necessary for preemergent eruption.
There must be resorption of bone and primary tooth roots overlying the crown of the erupting tooth.
the eruption mechanism itself then must move the tooth in the direction where the path has been cleared

23. Bone resorbtion and primary root resorption.
It has been demonstrated experimentally in animals that the rate of bone resorption and the rate of tooth eruption are not controlled physiologically by the same mechanism.

24. Eruption mechanism Controlling factors: collagen maturation
blood pressure or flow
forces derived from contraction of fibroblasts,
alterations in the extracellular ground substances periodontal ligament

25. Postemergent eruption
It is divided into 2 stages:
Once a tooth emerges into the mouth. it erupts rapidly until it approaches the occlusal level and is subjected to the forces of mastication ( post emergent spurt)
At that point. Its eruption slows and then as it reaches the occlusal level of other teeth and is in complete function ( juvenile occlusal equilibrium)

27. Controlling factors:
The rate of eruption controlled by the forces opposing eruption, not those promoting it .
Chewing
Soft tissue pressure from lips,
cheeks, or tongue contacting the teeth.

28. Adult Occlusal Equilibrium:
During adult life, teeth continue to erupt at an extremely slow rate. If its antagonist is lost at any age a tooth can again erupt more rapidly demonstrating that the eruption mechanism remains active and capable of producing significant tooth movement even late in life.

29. Eruption Sequence and Timing
Dental age is determined from three characteristics:
Which tooth have erupted
Amount of resorption of the root of the primary teeth
Amount of development of the permanent teeth.

30. Dental age 6

31. Dental age 7
The maxillary central incisors and the mandibular lateral incisors erupt.
root formation of the maxillary lateral incisor is well advanced, but it is still about 1 year from eruption.
the canines and premolars are still in the stage of crown completion or just at the beginning of root formation.

32. Dental age 8

33. Dental age 9

34. Dental age 10
Approximately one half of the roots of mandibuler canine and mandibular first premolar have been completed; and nearly half the root of the upper first premolar is complete
there is significant root development
of the mandibular second premolar. maxillary canine, and maxillary second premolar
completion of the roots of the mandibular incisor teeth and near completion of the roots of the maxillary laterals.

35. Dental age 11

36. Dental age 12

37. Dental age 13,14 & 15

38. Several reasonable normal variation in eruption sequence have clinical significant and should be recognized:
Eruption of the second molar ahead to the second premolar in the mandibular arch,
Eruption of the canines ahead to the first premolar in the maxillary arch
Asymmetries in the eruption between the right and left sides.

39. SPACE RELATIONSHIP IN REPLACEMENT OF THE INCISORS

41. Incisor liability: the difference between the the amount of the space needed for the incisors and the amount available for them

43. THE SPACE RELATIONSHIP IN REPLACEMENT OF CANINES AND PREMOLARS.
1.5
2.5
Leeway space

44. Controlling factors:
At the time the primary second molars are lost. Both the maxillary and mandibular molars tend to shift mesially into the leeway space. but the mandibular molar normally moves mesially more than its maxillary counterpart.
a characteristic of the growth pattern at this age is more growth of the mandible than the maxilla, so that a relative deficient mandibule gradually catches up.

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