ro o 1Ppr4( SVsT'

r&cr( -too c

The Development of the Permanent Teeth(

CARMEN M. NOLLA, B.S., D.D.S., M.S.*

I T. is important to every dentist treat-

ing children to have a good under -
standing of the development of the den-
in the mouth of different children, the
majority of the children exhibit some
pattern in the sequence of eruption
tition. In order to widen one's think- (Klein and Cody) 9 (Lo and Moyers). 1-3
ing about the impingement of develop- However, a consideration of eruption
ment on dental problems and perhaps alone makes one cognizant of only one
improve one's clinical judgment, a com- phase of the development of the denti-
prehensive study of the development of tion. A measure of calcification (matura-
the teeth should be most helpful. tion) at different age-levels will provide
In the study of child growth and de- a more precise index for determining
velopment, it has been pointed out by dental age and will contribute to the
various investigators that the develop- concept of the organism as a whole.
ment of the dentition has a close cor- In 1939, Pinney 2' completed a study
relation to some other measures of of the development of the mandibular
growth. In the Laboratory School of the teeth, in which he utilized a technic for
University of Michigan, the nature of a serial study of radiographs of the same
growth and development has been in- individual. It became apparent that a
vestigated by serial examination of the similar study should be conducted in
same children at yearly intervals, utiliz- order to obtain information about all of
ing a set of objective measurements the teeth. Therefore, an investigation
of various physical and mental attri- was star ted,isirigPinney's technic, with
butes. It has been found by Olson and some modifications. It seemed logkal to
Hughes'6' 17, 18, 19 that there is an in- conduct such a radiographic study of the
timate relationship in the functioning of development of the dentition, since ra-
all the aspects of normal growth, as has diographs are used extensively in dental
been shown by the plotting of a number diagnosis and clinical practice. Further-
of measurements in the same graph. more, by means of serial radiographs
When this relationship is appreciated, one can obtain continuous data on the
one thinks of the development of the changes exhibited by the individual be-
teeth, not as an isolated process, but as ing studied.
one which relates to other developmen- Many investigators have studied the
tal processes. development of the dentition by employ-
So far, the only available measure of ing different methods of observation.
dental age has been secured by noting These investigators should be recognized
the eruption of teeth (Cattell). 5 Al- for their contributions because they have
though the eruption of the teeth may facilitated further research. However,
differ greatly in the time of appearance one still finds principles in the litera-
ture that have not been explained sat-
Formerly Assistant Professor of Dentistry,
isfactorily and some misinterpretation of
School of Dentistry, University of Michigan, Ann
Arbor. Present address: 1408 Magdalena Ave., information. A review of the literature on
Candado, Santurce, Puerto Rico. the development of the dentition shows
254

/ 76
 FOURTH QUARTER, 1960 255

that the technics and methods used 3. . To prepare tables of development

by Legros and Magitot,'l' 12 Black," 2 of permanent teeth which will permit
Pierce, 20 Colyer, 7 B roomell and Fichclis, 4 the interpretation of individual differ-
Brady,3 Schour and Massler,22' 23, 24, 25 ences in dental growth, by the age-unit
Logan and Kronfc-ld,'' 14 and Mc- method;
Call'4' 23 are inconclusive from, the point. 4. To gain information relative to the
of view, of serial growth and develop- amount and kind of variation displayed
ment of the individual as a whole. The by the growth 'of the permanent teeth;
method most frequently used by these 5. To contribute to the understanding
investigators has been the anatomic, his- of differences in dental development of
tologic or radiographic study of autop boys and girls;
sled material.. These methods of study 6. To reconstruct previous evidence,
have a number of limitations. For in- with its errors in sampling and the omis-
stance, with anatomic or microscopic sec- sions, into a theoretical set of develop-
tions it is impossible to study the con- mental norms for permanent teeth from
tinuity of growth in the same individual. beginning to completion;
According to Todd '26 "A dead. child is a 7. To make recommendations for fur-
defective ` - .child in whom there has oc- ther study in terms of 'progress made by
curred an interruption or prohibition of the current study.
developmental growth sometime before It would appear that the information
death, unless death is due to an acute derived would aid the dentist to assess
disease or an accident, such as injury or and pace the development of a young
burns. The interpretive study of actual person's dentition. Hence, .a meaningful
skulls must be tempered by recognition concept, of normality, involving an in-
of this fact. If we are to investigate dividual' growing child, might be se-
healthy skulls, we must. do it on the liv- cured.
ing." The,lmitation of the radiographic MATERIALS
study is that the, developmental changes
which occur prior to calcification are not The materials used for this :study con-
sisted of "serial oral radiographs of twen-
observed radiographically. On the other
hand, a study of serial radiographs of
the same individual provides, a good
ty-five bo'ys' and twenty-five girls obtained
from the files of the Child Development
5 fv c
Laboratories of the University of Mich-
method for the longitudinal study of
,igan School.. Each set of radiograph in-
growth. . cluded:
This investigation, now to be report- 1. Extra-oral right and left lateral
ed, was formulated in accord with, the jaws,
following objectives: '2. Intra-oral maxillary and mandib-
1. To organize a technic for the de- ular occiusals,
tailed appraisal of the development, of 3. 'Intra-oral right and left maxillary
the permanent dentition as revealed by periapicals of posterior teeth.
radiographs; These radiographs were' exposed and
2. To construct norms (tables and processed by the technicians in' the De-
graphs) which will display the average partment of Radiography of the School
development of individual teeth, both of Dentistry, University of Michigan.
for boys and girls; Usually, a set of radiographs was secured
256 JOURNAL OF DENTISTRY FOR CHILDREN

for each year of the record at a time Not all of the long series were used. were
approximating the individual's birthday. The radiographs were placed on a spe- that t]
The total number of radiographs for the cial view table which permitted accurate ly the
girls was 1746 and for the boys 1656. reading of details. The observation took is in a
The range in age of the group studied cognizance only of the degree of develop- in his
is shown in Table I. ment, as outlined in Figure I, which is can b
a set of drawings illustrating the ten are re
TABLE I stages of development of the teeth as ob- the te
RANGE IN AGE served radiographically. The first column dil)Ie.
(right) appraises the growth-stage of the the ol
Beginning Terminal
Age in Age in central and lateral incisor, the second peatin
Sex Months Average Months Average the cuspid, the third the bicuspids, and In
Girls 25- 80 55.3 141-279 198.2 the fourth the molars. The drawings il- the d4
Boys 41-121 68.3 163-277 201.8 lustrate for each of the ten stages (1 to the r2
10 inclusive) the appearance of the stage as pos
METHOD of dental development observed radio- For e
The radiographic records were select- graphically. were
ed from the files on the basis of length. Although both right and left sides given
root '
grade
10. APICAL ENVOY ROOT COMPLETED iiig la'
was in
ample
. S 9. ROOT ALMOST COMPLETED OPEN APEX
ilj were
of the
. TWO-THIRDS OF ROOT COMPLETED ... VLIUC
showe
7. ONE-THIRD OF ROOT COMPLETED er tha
m uch
the fl(
. CROWN COMPLETED
e am1
of the
5. CROWN ALMOST COMPLETED l,ecorr,
one-th
4. TWO-THIRDS OF CROWN COMPLETED grade
1.1 tent

3. ONE-THIRD OF CROWN COMPLETED i.iitlica

examl
appro.
() 0 0 0 Q Q Q Q 2. INITIAL CALCIFICATION
would
root i
0 0 0 0 0000 1. PRESENCE OF CRYPT
would
Tlim
0. ABSENCE OF CRYPT
difhcu
FIGURE 1. Stages of development of mandibular and maxillary teeth. LIC, as
 FOURTH QUARTER, 1960 257

re used. were observed and studied, it was found the growth-level, half-way between the
)fl a spe- that the rate of growth was approximate- growth-stage, and close to the next level.
accurate ly the same in both sides. This finding Attempts to appraise radiographs more
;ion took is in agreement with Pinney's experience accurately than this grading do not
develop- in his earlier investigation. As a rule, it seem feasible.
which is can be said that the values for one side A detailed description of the changes
the ten are representative of the development of in developing teeth as observed radio-
th as ob- the teeth of the maxilla and the man- graphically now will be described. In de-
t column dible. In all of the radiographs studied termining the amount of maturation of
ge of the the observations were controlled by re- developing teeth, the marginal appear -
e second peating the observation a second time. ance becomes the important considera-
pids, and In order to obtain an appraisal of tion. The first radiographic sign of de-
twings ii- the development of a particular tooth, velopment is the appearance of an al-
ges (1 to the radiograph was matched as closely most circular radiolucent structure in
the stage as possible with the comparative figure. the bone which has been designated as
d radio- For example, if one-third of the crown the crypt. The radiolucent tooth-germ is
were completed the observation was enclosed within this crypt. Important
left sides given the value 3.0, if one-third of the cellular changes may have taken place
root were completed the observation was prior to this stage, such as initiation,
graded 7.0. When the radiographic read- proliferation, histodifferentiation, mor-
ing lay between two grades this appraisal phodifferentiation and apposition.
was indicated as the value of 0.5. For ex- The next change to be observed is the
ample, if the reading of the radiograph appearance of small radiopaque trian-
were between one-third and two-thirds gular points close to the inner coronal
of the root completed it was given the border of the crypt. In the succeeding
value of 7.5. When the radiograph annual radiographs, the quantiative in-
showed a reading that was slightly great- crease in calcification easily is de_te__r_-
er than the illustrated grade, but not as mined. The outline of the radiolucent
much as half way between that stage and pulp can be followed readily through
the next, the value 0.2 was added. For the different stages of development. The
example, if slightly more than two-thirds completion of the apical end of the root
of the crown were completed if would
become 4.2, or if somewhat more than
one-third of the root were completed the
grade would become 7.2. If the develop-
r)ent were slightly less than the grade
indicated the value 0.7 was added. For
example, if two-thirds of the crown were
approximately completed the grade
would become 3.7, or if two-thirds of the
loot were almost completed the grade
would become 7.7.
Thus, it is possible, without much
FxGui.r 2. Radiograph showing the man-
difficulty, to assign the observational val- dibular first permanent molar at stage 6 or the
ue as seen on the growth level above crown completed.
258 JOURNAL OF DENTISTRY FOR CHILDREN

the stage of growth is represented by the

drawings and on the horizontal axis the
chronological age in months is represent-
ed. The readings, as plotted, and the
0 ME
curves obtained show the development
wi.....
for each individual tooth. Figure 7 shows
the graphs of the mandibular and maxil-
NEWS
lary teeth of one of the girls studied.
NNIFZM
NMWAM
MENEM
.1! MOEN
--
FIGURE 3. Radiograph showing the mandibular
first permanent molar at stage 7 (one-third of
the root completed), the second permanent FIGURE 7. Graph
molar and second bicuspid at stage 3.5 (more G67.
than one-third of crown completed), and the
DE:
first bicuspid at stage 4.5 (more than two-thirds
of the crown completed). The observatic
graphically in ter:
is the final stage to be observed radio- ment in the ordi
graphically in the process of matura- age in the absci:
tion. FIGURE 5. Radiograph showing the mandibular
Figures 2 to 6 are radiographs which first permanent molar at stage 10 (root com-
serve as examples of the different stages pleted), the second permanent molar and sec-
of growth. ond bicuspid at stage 8 (two-thirds---oLroot
completed) and the third molar at stage 4 (two-
In recording the degree of develop-
ment of the individual teeth, special
graphs were designed for the mandibular
thirds of the crown completed).
Mal
and maxillary teeth. On the vertical axis Boys
QQQe
QQO
0000
)0o0
0000
a

GIRLS Ooea
Oboe
GQ6
FIGURE 4. Radiograph showing the mandib- FIGURE 6. Radiographs showing the maxillary
ular first permanent molar at stage 7 (one-third permanent cuspid at stage 7 (one-third of the o 000
0000
of the root completed), the second bicuspid at root completed), the permanent lateral incisor
stage 2 (beginning maturation), and the second at stage 8 (two-thirds of root completed) and
permanent molar at stage 2.5 (less than one- the central incisor at stage 9 (apical end still
third of crown completed). wide).
 FOURTH QUARTER, 1960 259

MAXILLARY MAND I BULAR

DEVEL OPMENTAL LEVELS

CEVELOPMENTAL LEVELS

3 --;-------f-H --4 -_

------
------------H 0000___ __________

00(0

0000
000c
4 33 4* *0 72 44 14 01 00 .32 144 04 44 00 (91 204 20

07 24 34 41 20 72 44 14 011700114444 04 *01,
C3200QAAI A.

FIGURE 7. Graph showing developmental curves for the maxillary and mandibular teeth of case
G67.
DENTAL AGE connected by lines providing a dental
The observation-points were recorded developmental curve. In order to tab-
graphically in terms of degree of develop- ulate the data for the developmental
ment in the ordinate and chronological norms of dental age, the developmental
age in the abscissa. These points were curves were read back at the year-points

MAXILLARY MANDIBULAR

0000
BOYS 00011

0 0902 0000

0000

0000 0000

0000 0000

0000 0000
(4

DEVELOPMENTAL LEVELS

Y^ q If
QV go

GIRLS (.9ooO 0002

720110
0900 011
0000 0.0011
0000 0000
0000 0000
aL

FIGURE 8. Norm-developmental curves for boys and girls.

 260 JOURNAL OF DENTISTRY FOR CHILDREN

in chronological age so that the develop- the boys and of the girls. The interpreta-
mental value, given for tabulation, is the tion of these curves reveals that the gen-
intercept of the curve with successive eral type of growth displayed by each
abscissa at the year-points. It is obvious tooth was the same and that the equa-
that the tabulated values permit the tion which expresses the general type of
assumption that the progress in the de- change in rate is an algebraic quadratic
velopment of the tooth is a linear func- (y = ax2 + bx + c). Few developmental
tion from the two actual points of ob- differences were shown between right
servation and technically may be termed and left teeth of the same kind. No sig-
interpolation, with occasional short nificant differences in sex were observed
periods of extrapolation. These values in the time required for development,
were averaged at the year points of boys however, the girls started dental develop-
and girls, both for maxillary and man-
ment at an earlier age and finished de-
dibular teeth. These averages, as de-
velopment earlier. With few exceptions,
scribed, provide a general average of all
differences for the sexes in the general
teeth, a dental age as a whole.
sequence of the completion of develop-
RESULTS AND DISCUSSION ment of each tooth were not apparent.
Norm-developmental curves for each The roots of the mandibular teeth were
tooth and dental-age values, both for completed in the following order:
boys and girls, were obtained. Figure 8 1. Central incisor
shows the norm-developmental curves 2. Lateral incisor and first permanent
for maxillary and mandibular teeth of molar

TABLE II
NORMS FOR THE MATURATION OF PERMANENT TEETH FOR BOYS
Age Mandibular Teeth (Growth S :age) Maxillary Teeth (Growth S ge)
(Yrs.) lii 212 515 616 8j8 lii 21 2 313 414 515 6 16
3 5.2 4.5 3.2 2.6 1.1 5.0 4.3 3.4 3.0 2.0 1.0 4.2 1.0
4 6.5 5.7 4.2 3.5 2.2 6.2 2.0 5.4 4.5 3.9 3.0 2.0 5.3 2.0
5 7.5 6.8 5.1 4.4 3.3 7.0 3.0 6.4 5.5 4.8 4.0 3.0 6.4 3.0
6 8.2 7.7 5.9 5.2 4.3 7.7 4.0 7.3 6.4 5.6 4.9 4.0 7.4 4.0
7 8.8 8.5 6.7 6.0 5.3 8.4 5.0 .8 8.2 7.2 6.3 5.7 4.9 8.2 5.0
8 9.3 9.1 7.4 6.8 6.2 9.0 5.9 1.4 8.8 8.0 7.0 6.5 5.8 8.9 5.8 1.0
9 9.7 9.5 8.0 7.5 7.0 9.5 6.? 1.8 9.4 8.7 7.7 7.2 6.6 9.4 6.5 1.8
10 10.0 9.8 8.6 8.2 7.7 9.8 7.4 2.0 91 9.3 8.4 7.9 7.3 9.7 7.2
11 9.1 8.8 8.3 9.9 7.9 2.7 9.95 9.7 8.8 8.6 8.0 9.8 7.8 3.0
I 12 9.6 9.4 8.9 8.4 33 9.95 9.2 9.2 8.7 8.3 4.
13 9.8 9.7 9.4 8.9 4.5 9.6 9.6 9.3 8.8 4.9
14 10.0 9.7 9.3 5.3 9.8 9.8 9.6 9.3 15.9
15 10.0 9.7 6.2 9.9 9.9 9.9 9.6 16.6
l6.. 10.0 7.3 10.0 17.7
(tt 17 7.6 8.0
 FOURTH QUARTER, 1960 261

TABLE HI
NORMS FOR THE MATURATION OF PERMANENT TEETH FOR GIRLS

Age Mandibular Teeth (Growth Stage) Maxillary Teeth (Growth Stage)

(Yrs.)12l233 4 5 6 77 8 1R 2 3 4 5 6k3 717 88
3.4 2.9 1.7 5.0 1.6 4.3 3.7 3.3 2.6 2.0 4.5 1.8
4 6.6 6.0 4.4 3.9 2.8 6.2 2.8 5.4 4.8 4.3 3.6 3.0 5.7 2.8
5 7.6 7.2 5.4 4.9 3.8 7.3 3.9 6.5 5.8 5.3 4.6 4.0 6.9 3.8
6 8.5 8.1 6.3 5.8 4.8 8.1 5.0 7.4 6.7 6.2 5.6 4.9 7.9 4.7
7 9.3 8.9 7.2 6.7 5:7 8.7 5.9 1.8 8.3 7.6 7.0 6.5 5.8 8.7 5.6
8 9.8 9.5 8.0 7.5 6.6 9.3 6.7 2.1 9.0 8.4 7.8 7.3 6.6 9.3 6.5 2.1
9 10.0 9.9 8.7 8.3 7.4 9.7 7.4 2.3 9.6 9.1 8.5 8.1 7.4 9.7 7.2 2.4
10 10.0 9.2 8.9 8.1 10.0 8.1 3.2 10.0 9.6 9.1 8.7 8.1 10.0 7.9 3.2
11 9.7 9.4 8.6 8.6 3.7 10.0 9.5 9.3 8.7 8.5 4.3
12 10.0 9.7 9.1 9.1 4.7 9.8 9.7 9.3 9.0 5.4
13 10.0 9.4 9.5 5.8 10.0 10.0 9.7 9.5 r
14 9.7 9.7 6.5 10.0 9.7 68
15 10.0 9.8 6.9 9.87.3
16 10.0 7.5 10.0 8.0
17 8.0 8.7

3. Cuspid The norm-developmental values at the

(S 4. First bicuspid year-points, both for boys and girls are
5. Second bicuspid reported in Tables II and III, respective-
age)
6. Second permanent molar ly. In order to obtain a dental age for
7. Third molar all of the teeth as a group, the values
The roots of the maxillary teeth were for the maxillary and mandibular teeth
completed in the following order: were added at the year points and
1. Central and first permanent molar Tables IV and V 1 resulted. Tables IV
2. Lateral incisor and V' show the age-norm for maxillary
3. First bicuspid and cuspid and mandibular teeth combined. The
4. Second bicuspid statistical summary has permitted the
5.8 1 1.0
5. Second permanent molar preparation of dental-age scales which
6.5 1.8 6. Third molar facilitate the clinical application of the
7.2i The importance of obtaining norm- results.

:iI -0
7.8 ! developmental curves is that one can In order to obtain a dental age in
show actual and average development, terms of tooth development it is neces-
8.8 4.9 This procedure enables the dentist to sary to know how much each tooth has.
see the extent to which the variability developed at a series of levels. This in-
9.3 5.9
of the individual adheres or departs formation is secured by examining the
9.6 6.6 from the average. Thus, individual dif- radiographs, utilizing the technic which
10.0 7.7 ferences of clinical significance are re- has been described previously. (See Fig.
8.0 vealed. .. 1.) The developmental value obtained.
262 JOURNAL OF DENTISTRY FOR CHILDREN

TABLE IV
AGE NORMS FOR MAXILLARY AND MANDIBULAR TEETH OF GIRLS AGE NORMS FOR
(EXCLUDING THIRD MOLARS)

Sum of Stages for

Sum of Stages for Sum of Stages for 14 Maxillary and Suir
Age in Years 7 Mandibular Teeth 7 Maxillary Teeth Mandibular Teeth Age in Years 7 Ma

.3 24.6 22.2 46.8 3

4 32.7 29.6 62.3 4
5 40.1 37.9 78.0 5
6 46.6 43.4 90.0 6
.7 52.4 49.5 101.9 7
8 57.4 54.9 112.3 8
9 58.4 59.6 118.0 9
10 64.3 63.4 127.7 10
11 66.3 64.0 130.3 11
12 67.9 67.8 135:7 12
13 68.9 69.2 138.1 13
14 69.4 69.7 139.1 14
15 69.8 69.8 139.6 15
16 70.0 70.0 140.0 16
17 70.0 70.0 140.0 17

for each tooth (maxillary and mandib- lents for the growth of maxillary and The difference between
ular) is added. This sum is matched with mandibular teeth, this table indicates a the average shows the
the table for the translation of the de- dental age of 96 months (8 years). Sup- ability which is display
velopmental value into the dental age. pose she were 7 1/2 years old chronolog- which is called the i
(See Table IV-V1 ). For example, a girl ically, then she will be plus six months growth in tooth develo
has a value of 112.0 for the sum of the in tooth development. Hence, the extent reason one should avoid
maxi14ry and the mandibular teeth, ex- to which the individual displays greater dental age-equivalent as
c1udirg the third molars. Referring to than average, average and lower than standard. However, thi
Table IV, which shows the age-equiva- average development can be determined. one in understanding

TABLE IV'
AGE NORMS FOR MAXILLARY AND MANDIBULAR TEETH OF GIRLS AGE NORMS FOF
(INCLUDING THIRD MOLARS)

Sum of Stages for Sum of Stages for Sum of 16 Maxillary S.

Age in Years 8 Mandibular Teeth 8 Maxillary Teeth and Mandibular Teeth Age in Years 811

7 54.2 49.5 103.7 7

8 59.5 57.0 116.5 8
9 66.7 62.0 122.7 9
10 67.5 66.6 134.1 10
11 70.0 68.3 138.3 11
12 . 72.6 73.2 145.7 12
13 74.7 75.4 . 150.1 13
14 75.9 76.5 152.4 14
15 76:7 77.1 153.8 15
16 77.5 78.0 155.5 16
17 78.0 78.7 156.7 17
 FOURTH QUARTER, 1960 263

TABLE V
AGE NORMS FOR MAXILLARY AND MANDIBULAR TEETH OF BOYS
(EXCLUDING THIRD MOLARS)

Sum of Stages for

Sum of Stages for Sum of Stages for 14 Maxillary and
Age in Years 7 Mandibular Teeth 7 Maxillary Teeth Mandibular Teeth

3 22.3 18.9 41.2

4 30.3 26.1 56.4
5 37.1 33.1 70.2
6 43.0 39.6 82.6
7 48.7 45.5 94.2
8 53.7 50.8 104.5
9 57.9 55.5 113.3
10 61.5 59.5 121.0
11 64.0 62.6 126.6
12 66.8 65.3 131.6
13 67.8 67.3 135.1
14 69.0 68.5 137.5
15 69:7 69.3 139.0
16 70.0 70.0 140.0
17 70.0 70.0 140.0

The difference between the actual and child is making a greater than average,
the average shows the amount of van- average, and less than average in tooth
ability which is displayed, a variability development. In a graphical form, Fig-
which is called the individuality of ure 9 shows the dental-age curves for
growth in tooth development. For this both maxillary and mandibular teeth
reason one should avoid thinking of the combined, excluding the third molar:---
dental age-equivalent as a rigid norm or The broken line shows the dental-age
standard. However, this method assists curve of the girls and the solid line rep-
one in understanding why any given resents the dental-age curve for the boys.

TABLE V1
AGE NORMS FOR MAXILLARY AND MANDIBULAR TEETH OF BOYS
(INCLUDING THIRD MOLARS)

Sum of Stages for Sum of Stages for Sum of 16 Maxillary

Age in Years S Mandibular Teeth 8 Maxillary Teeth and Mandibular Teeth

7 49.5 45.5 95.0

8 55.1 51.8 106.9
9 59.7 57.3 117.0
10 63.5 61.8 125.3
11 66.7 65.6 132.3
12 69.8 69.3 139.1
13 72.3 72.2 144.5
14 74.3 74.4 148.7
15 75.9 75.9 151.8
16 77.3 77.7 155.0
17 77.6 78.0 155.6
264 JOURNAL OF DENTISTRY FOR CHILDREN

The lower extension of the curves has ment of teeth is important, not only for
been predicted only. Again, one can see reasons of diagnosis and treatment, but AGES
from this curve that no significant dif- also for more detailed purposes of re-
ferences for sex in the time required for search. Calcification of teeth may, in this
development are apparent, since the way, be used as a criterion of dental age Teeth
curves are of the same nature. and of the physiologic age of a patient. Mand.
The technic which has been described It provides an index of physiologic
provides a new understanding of the in- maturity of the permanent dentition.
11 3
dividuality of change with time and of Knowledge about general acceleration
22 4
individual differences among children at or retardation of calcification of the 33 6
a given time. The graph designed for the teeth of an individual is important to 44 7
compilation of the developmental curves the orthodontist who wishes to deter- 55 7
for each tooth shows, at a glance, the mine time of treatment on the basis of 66 4
77 8
stage of development of the dentition as the physiologic age of the patient.
a unit, as well as the growth of individ- Finally, it has been possible to pre- Max.
ual teeth. pare a table of the average ages for the 11 41/
The information about the develop- completion of each tooth for boys and 22 51/
33 61/
GROWTH NORMS FOR MAXILLARY AND MANDIBULAR TEETH 44 7
(EXCLUDING THIRD MOLARS) 55 8
60 66 41/
77 8
150
BOYS
140 girls. Table
130 at which ea
has become
20
that the pro
Ito investigated,
U)
stages of cal
100
z which erupti
90

Serial anni
-
(total radiog
girls (total ra
from the files
50 -
Er
igan Child
cD 40 -- - - were studied
curate proce
30
praisal of th
20 manent denti
10 graphs. The
I
-Predicted Norm-
1_1 I I FFFFET
0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 192 204
was appraise'
graphs whicl
DENTAL AGE from 0 to 10,
FIGURE 9. Growth Norms for maxillary and mandibular teeth. appraisals wa

-----
 FOURTH QIJARTER, 1960 265

TABLE VI

AGES FOR COMPLETION OF CALCIFICATION OF PERMANENT TEETH

- Crown Completed Root Completed

Logan and Kronfeld1
Teeth (Modified by Schour
Mdnd. (No11a10) (Nolla16 )
and Massler22 )

Root Completed
Boys Girls Boys Girls

11 3 yrs. 8 ma. 3 yrs. 6 mo. 10 yrs. 8 yrs. 6 mo. 9 yrs.

.2 2 4 yrs. 4 mo. 4 yrs. 10 yrs. 6 mo. 9 yrs. 8 mo. 10 yrs.
33 6 yrs. 5 yrs. 8 mo. 13 yrs. 6 mo. 12 yrs. 12-14 yrs.
44 7 yrs. 6 yrs. 6 mo. 14 yrs. 12 yrs. 6 mo. 12-13 yrs.
55 7 yrs. 8 ma. 7 yrs. 2 mo. 15 yrs. 14 yrs. 6 mo. 13-14 yrs.
66 4 yrs. 3 yrs. 10 mo. 11 yrs. 6 ma. 10 yrs. 9-10 yrs.
77 8 yrs. 2 mo. 7 yrs. 16 yrs. 6 mo. 15 yrs. 6 mo. 14-15 yrs.

Max.
11 4 yrs. 4V2 yrs. 11 yrs. 10 yrs. 10 yrs.
22 5/j yrs. 5 yrs. 2 ma. 12 yrs. 11 yrs. 11 yrs.
33 6i/ yrs. 5 yrs. 10 ma. 15 yrs. 12 to 13 yrs. 13-15 yrs.
44 7 yrs. 4 mo. 6 yrs. 4 ma. 14 4 yrs. 12 yrs. 9 mo. 12-13 yrs.
55 8 yrs. 5 mo. 7 yrs. 3 ma. 15,4 yrs. 14 yrs. 13-14 yrs.
66 4V2 yrs. 4 yrs. 2 ma. 11,4 yrs. 91,4 yrs. 9-10 yrs.
7 7 8 yrs. 2 mo. 7 yrs. 6 mo. 16 4 yrs. 15 yrs. 6 mo. 14-16 yrs.

girls. Table VI shows the average age both graphically and numerically, and
at which each tooth is completed. It provided material to show the dental de-
has become apparent from this study velopment of each person and numerical
that the process of eruption should be values for the tabulation of diittage--
investigated, in order to determine the scales.
stages of calcification in the teeth at Few developmental differences were
which eruption begins. found between right and left teeth of
the same kind. No significant differences
SUMMARY
in the rate of development were ob-
Serial annual radiographs of 25 boys served in males and females, however,
(total radiographs = 1656) and of 25 the girls started dental development
girls (total radiographs = 1746) obtained earlier and finished earlier. The general
from the files of the University of Mich- type of growth displayed by each tooth
igan Child Development Laboratories was the same. The statistical summary of
were studied in order to develop an ac- individual tooth development has per-
curate procedure for the detailed ap- mitted the preparation of detailed
praisal of the development of the per- growth-age scales which facilitate clin-
manent dentition, as revealed by radio- ical application of the results.
graphs. The development of each tooth
CONCLUSIONS
was appraised by studying the radio-
graphs which were graded on a scale 1. The type of growth displayed by
from 0 to 10. Each set of observational each tooth is the same.
appraisals was summarized individually, 2. No significant differences in the
266 JOURNAL OF DENTISTRY FOR CHILDREN

rates of development were observed in 12. The origin and formation of the dental
-------:

follicle. (Trans. by M. S. Dean). Chicago, Jan-

males and females. sen, McClurg and Co., 1880. 216 p.
3. On the average, differences in the 13. Lo, R. T., and MOYERS, R. E.: The sequence of
eruption of the permanent teeth. Am. J.
general sequence of development were Orthodont., 39:460-7, June 1953.
not apparent between the sexes. 14. LOGAN, W. H. G., and KEONFELD, RUDOLF: De-
velopment of the human jaws and surrounding
4. Few development differences were structures from birth to age fifteen. Am. Den:.
shown between right and left teeth of A. J., 20:379-424, Mar. 1935.
15. MCCALL, J. 0., and WALD, S. S.: Clinical dental
the same kind. roentgenology. 2nd ed. Philadelphia, Saunders,
1947. XVI + 349 p. (p. 100).
BIBLIOGRAPHY
16. NOLLA, CARMEN M.: The development of perma-
1. BLACK, C. V.: Chart showing lines of contempo- nent teeth. Ann Arbor, University of Michigan,
raneous calcification of teeth. Ill. S. Dent. Soc. 1952. 60 p. thesis.
Tr., 1893. 238 p. (Frontispiece.) 17. OLSON, W. C.: Child development. Boston, D. C.
2. -: Operative dentistry. Chicago Medico- Heath and Co., 1949. XIII + 417 p. (p. 163-91)
Dental Publishing Co., 1908. XI + 319 p. Vol. 18. OLsON, W. C., and HUGHES, B. 0.: Growth of the
1 facing p. 258. child as a whole. p. 199-208. (In Barker, R. C.,
3. BRADY, W. J.: A chart of the average time of Kounin, J. S., and Wright, H. F. Child be-
development, eruption and absorption of teeth. havior and development. New York, McGraw
Kansas City, W. J. Brady, 1924. 15 p. Hill, 1943. 652 p.)
4. Ba00MELL, I. N., and FI5CHELI5, PHILIP?: Anat- 19. -: Manual for the description of growth in
omy and histology of the mouth and teeth. 6th age units. Ann Arbor, University of Michigan,
ed., Philadelphia, Blakiston, 1923. XIII + 461 1950. 27 p.
p. (p. 102-83). 20. PIERCE, C. N.: Calcification and development of
5. CATTELL, PSYCHE: The eruption and growth of mandibular teeth. Dent. Cosmos, 26:449-55, Aug.
the permanent teeth. J. Dent. Res., 8:279-97, 1884.
Apr. 1928. 21. PINNEY, L. C.: Calcification and development of
6. -: Dentition as a measure of maturity. mandibular teeth. Ann Arbor, University of
Cambridge, Harvard University Press, 1928.
Michigan, 1939. 59 p. Thesis.
91 p.
22. SEHOUR, ISAAC, and MASSLER, MAURY: The de-
7. Coxsa, J. F.: Dental surgery and pathology. 4th
velopment of the human dentition. Am. Dent.
ed. London, Longmans, Green and Co., 1919.
A. J., 28:1153-60, July 1941. (p. 1154).
XIV + 899 P. (p. 11)
23. -: Development and growth of teeth. p. 33-52
8. DIAMOND, Mosss: The patterns of growth and
(In Orban, Balint, ed. Oral histology and em-
development of human teeth and jaws. J. Dent.
bryology. St. Louis, Mo15y-l94-342 p.)
Res., 23:273-303, Aug. 1944.
9. KLEIN, HENRY, and CODY, J. F.: Graphic charts 24. ScHOUR, ISAAC, and MCCALL, J. 0.: Chronology
which depict the variations in number of erupt- of the human dentition. p. 240. (In Orban,
ed permanent teeth in grade school children. Balint, ed. Oral histology and embryology. St.
Am. Dent. A. .1., 26:609-11, Apr. 1939. Louis, Mosby, 1944. 342 p.)
10. KEONFELD, RUDOLF: Development and calcification 25. MASSLEE, MAURY, SCHOUR, ISAAC, and PONCHER,
of the human deciduous and permanent denti- H. G.: Developmental pattern of the child as
tion. Bur, 35:18-25, Mar. 1935. reflected in the calcification pattern of the
11. LEGROS, CHARLES, and MA0X70T, EanLE: Chronol- teeth. Am. J. Dis. Child., 62:33-67, July 1941,
ogy of the dental follicle in man. p. 394. (In p. 46.
Noyes, F. B. Dental histology and embryology. 26. TODD, T. W.: The orthodontic value of research
4th ed. Philadelphia, Lea and Febiger, 1929. and observations in development of the face.
X + 527 p.) Angle Orthodont., 1:67-9, Apr. 1931.