DENT 114 | Occlusion 2nd Semester (AY ’19-’20) 2nd Exam | 3

Development of the Permanent Dentition UPCD Batch 2023

Josievitz Tan-Zafra, DMD, MSD May 15, 2020

OUTLINE

B. Eruption of Permanent Teeth

I. Dentitional and Occlusal Adjustments before the Middle Teens
A. Calcification of Permanent Teeth - ERUPTION – process that moves a tooth from its crypt position
B. Eruption of Permanent Teeth through the alveolar process into the oral cavity and to occlusion with its
C. Pattern of Eruption in the Mandible antagonist (Moyers, p. 112)
1. Canine - primary tooth resorbs, root of the permanent teeth lengthens,
2. First Premolar alveolar process increases in height, and the permanent tooth moves
3. Second Premolar through the bone (Moyers, p. 112)
4. Second Molar
D. Problems in the Eruption Pattern of the Mandible
1. Canine
2. First Premolar
3. Second Premolar
4. Second Molar
E. Pattern of Eruption in the Maxilla
1. First Premolar
2. Second Premolar
3. Canine
4. Second Molar
F. Problems in the Eruption Pattern of the Maxilla
1. First Premolar
2. Second Premolar
3. Canine
4. Second Molar
II. Dentitional and Occlusal Adjustments in the Young Adult
A. Eruption of the Third Molar Figure 1. Developmental Processes during eruption of permanent teeth. (Moyers, p. 113)
B. Problems in the Eruption of Third Molar
- permanent teeth do not begin eruptive movements until after the
1. Congenitally Missing
crown is completed (Moyers, p. 112)
2. Crowding
3. Impaction - they pass through the crest of alveolar process at varying stages of
C. Dimensional Changes root development (Moyers, p. 112)
1. Mandibular Arch Perimeter
2. Maxillary Arch Perimeter
3. Mandibular and Maxillary Arch Width
4. Mandibular and Maxillary Arch Length
5. Mandibular Intercanine Diameter
D. Changes in the Overbite and Overjet
1. Overbite
2. Overjet
E. Resorption of Permanent Teeth
III. Aging and Dentition
Figure 2. Crude approximations of Mandibular root lengths during its emergence
through the alveolar crest. (Moyers, p. 113)
I. DENTITIONAL AND OCCLUSAL ADJUSTMENTS BEFORE THE MIDDLE
TEENS - it takes 2 to 5 years for the posterior teeth to reach the alveolar
crest after the crowns have been completed (Moyers, p. 112)
A. Calcification of Permanent Teeth - and it takes 12 to 20 months to reach occlusion after the alveolar
margin has been reached (Moyers, p. 112)
- girls are more advanced in calcification of permanent teeth than - the roots will then be completed a few months after occlusion is
boys (Moyers, p. 111) attained (Moyers, p. 112)
- racial differences and socioeconomic status’ effect on calcification - “TIME OF ERUPTION” – moment of emergence of the permanent
and eruption of the teeth can also exist (Moyers. p. 111) tooth into the oral cavity (Moyers, p.112)

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- if the primary tooth is extracted after the permanent successor has > the anterior component of force can be countered by the
begun its active eruptive movements, the permanent tooth will erupt approximal contacts of the teeth and by the musculature of the lips and
earlier (Moyers, p.114) cheeks (Moyers, 119)
- if the primary tooth is extracted prior to the onset of permanent
eruptive movements (prior to root formation), the permanent tooth is
likely to be delayed in its eruption (Moyers, p. 114)
- girls erupt their permanent teeth with an average of approximately 5
months earlier than boys. except for third molars (Moyers, p. 117)
- during the intra-alveolar eruption, the tooth’s position is also
affected by:
> the presence or absence of adjacent teeth
> rate of resorption of the primary teeth
> early loss of primary teeth
> localized pathologic conditions
> other factors that alter the growth or conformation of the
alveolar process (Moyers, p. 118)
- MESIAL DRIFTING TENDENCY – tendency of the teeth to drift mesially
even before they are in occlusion. (Moyers, p. 119)
> they can be moved by the lip, cheek, tongue, or by extraneous
objects brought into the mouth, and the teeth drift into spaces created
by caries or extractions (Moyers, p. 118) Figure 4. The position of the incisors relative to the lip and tongue posture. (Moyers, p.
- ANTERIOR COMPONENT OF FORCE – tendency for the teeth to move 119)
forward as a result of mastication and swallowing
C. Pattern of Eruption in the Mandible

- eruption sequence: 6-1-2-3-4-5-6-7 or 6-1-2-4-3-5-7

Figure 5. Favorable eruption sequence in the Mandible. (Moyers, p. 118)

1. CANINE (9-10 years old)

- follicles of the developing canines are in a position lingual to the
deciduous roots (Wheeler’s, p. 30)

Figure 3. Anterior component of force. (Moyers, p. 119)

> it is also the result of muscle forces acting through the

intercuspation of the occlusal surfaces
> it varies greatly according to the angulations of the teeth with
each other
> and it is also affected by the steepness of the occlusal plane
(Moyers, p. 118) Figure 6. Developing anterior permanent teeth are placed lingually to the deciduous
roots. (Wheeler's, p. 29)

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- the canines erupt first because it tends to maintain the arch 4. SECOND MOLAR (11-13 years old)
perimeter and prevents the lingual tipping of incisors which may - as the second molar erupts, it makes the mandibular first molar to
overerupt (Moyers, p. 135) be upright (because the crowns of the mandibular first molars are tipped
somewhat lingually when it erupted) (Moyers, p. 123)
2. FIRST PREMOLAR (10-12 years old) - because they usually erupt at 12 years of age, they are also called
- developing premolars are within the bifurcation of primary molar 12-year molars. (Wheeler’s, p. 31)
roots (Wheeler’s, p. 30)

Figure 9. Mandibular second molar is in the process of erupting. (Wheeler's, p. 235)

D. Problems in the Eruption Pattern of the Mandible

- canines, premolars, maxillary first permanent molar and the

Figure 7. Developing premolars at the bifurcation of primary molar roots. (Wheeler's p. maxillary lateral incisors are usually found in ECTOPY (teeth developing
30) away from their normal position) (Moyers, p. 118)

- periapical lesions, pulpitis, and pulpotomy of a primary molar will 1. CANINE

hasten its eruption (Moyers, p. 114) - transposition of canines is a very rare ectopy. it typically involves
3. SECOND PREMOLAR (11-12 years old) exchanged positions between canines and first premolars or canines
- developing premolars are within the bifurcation of primary molar and lateral incisors (Moyers, p. 118)
roots (Wheeler’s, p. 30) 2. SECOND PREMOLAR
- it is one of the most frequently congenitally absent tooth [fun - congenitally absent (Moyers, p 121)
fact: females are more likely to have congenitally missing teeth than - rotated due to imbalanced resorption of the roots of primary
males] (Moyers, p. 121) molars (Moyers, p.)
- LEEWAY SPACE – because the mandibular primary molar teeth
has a larger mesiodistal dimension than the permanent premolars, there
will be a space that would be gained by the difference in their
mesiodistal dimensions.
> in effect, this space will provide for the mesial movement of
the permanent molars (Wheeler’s, p. 281)
> in mandible, the leeway space is approximately 2.5-mm per
quadrant. (Cobourne)

Figure 8. Leeway space. Difference in mesiodistal dimensions between primary teeth

(A) and permanent teeth (B). Arrows indicate the movement of the permanent molars
after loss of primary molars and eruption of the second permanent premolar.
(Wheeler's, p. 281)
Figure 10. Rotated second premolar.
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- most vulnerable for potential crowding (Cobourne, p. 102)

Figure 11. Crowding of mandibular second premolar. (Cobourne, p. 102)

4. SECOND MOLAR
- the appearance of second molar ahead of the canines or
premolars has a strong tendency to shorten the arch perimeter and may
also create space difficulties which leads to crowding (Moyers, p.117)
- can also be impacted (Cobourne, p.103) Figure 14. Note the crowns of permanent maxillary premolars located between the
roots of the first and second primary molars, with their roots still intact. (Wheeler's, p.
48)

- periapical lesions, pulpitis, and pulpotomy of a primary molar will

hasten its eruption (Moyers, p. 114)

2. SECOND PREMOLAR
- developing premolars are within the bifurcation of primary molar
roots (Wheeler’s, p. 30)
- LEEWAY SPACE – maxilla has approximately 1.5 mm per quadrant

3. CANINE
- placed further distally in the arch
- it erupts pointing mesially and labially
- their eruption is also an important factor in widening and
Figure 12. Impaction of second molars. (Cobourne, p.103) changing the shape of the maxillary dental arch
E. Pattern of Eruption in the Maxilla

- eruption sequence: 6-1-2-4-5-3-7 or 6-1-2-4-3-5-7

Figure 13. Favorable eruption sequence in the Maxilla. (Moyers, p. 118)

1. FIRST PREMOLAR
- developing premolars are within the bifurcation of primary molar
roots (Wheeler’s, p. 30)

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- one-half of all tooth germs in ectopy are maxillary canines and

two-thirds of all upper ectopic canines are found in girls (Moyers, p. 118)
- transposition of canines, a very rare ectopy, typically involves
exchanged positions between canines and first premolars or canines
and lateral incisors (Moyers, p. 118)

Figure 15. Note the placement of the permanent maxillary canine and second Figure 17. Transposed maxillary canine and maxillary first premolar, (Moyers, p. 387)
premolar, and the position and stage of development of the maxillary second
permanent molar. (Wheeler's, p. 30) - most vulnerable for potential crowding (Cobourne, p. 102)

4. SECOND MOLAR
- only erupts when all of the teeth anterior to it has already erupted

Figure 18. Crowding of maxillary canine. (Cobourne, p. 102)

4. SECOND MOLAR
- the appearance of second molar ahead of the canines or
premolars has a strong tendency to shorten the arch perimeter and may
also create space difficulties (Moyers, p.117)

II. DENTITIONAL AND OCCLUSAL ADJUSTMENTS IN THE YOUNG ADULT

A. Eruption of the Third Molar

- the role of erupting third molars in mesial drift of anterior teeth

appeared to be small (Moyers, p.119)
Figure 16. The maxillary second molar crown is well developed. (Wheeler's, p. 48) - posterior jaw growth is required after the age of 12 to allow room for
the third molars (Wheeler’s p. 31)
F. Problems in the Eruption Pattern of the Maxilla

- canines and the premolars, together with maxillary first permanent

molar and the maxillary lateral incisors are usually found in ECTOPY
(teeth developing away from their normal position) (Moyers, p. 118)

1. SECOND PREMOLAR
- one of the most frequently congenitally absent tooth (Moyers, p
121)

2. CANINE
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- teeth cannot erupt because of impingement or collision (Moyers,

p. 118)
- become impacted when the mandible fails to grow sufficiently for
resorption of the anterior border of the ramus to permit their eruption.

Figure 21. Impacted third molar. (Wheeler's, p. 203)

Figure 19. Development of the maxillary and mandibular third molars. (Wheeler's, p. 32)

B. Problems in the Eruption of the Third Molar

1. CONGENITALLY MISSING
- also called anisomerism
- means a reduction of the number of teeth by loss or fusion
(Moyers, p. 121)
- reported congenitally absent as much as 25% of the time in North
American whites

2. CROWDING
- the claim that the “third molars are the primary cause of incisal
crowding” does not have enough evidence to support it (Moyers, p. 124) Figure 22. Impacted third molar adjacent to second mandibular molar. (Wheeler's,
p.235)

4. AGENESIS
- agenesis means lack or failure of development. agenesis of third
molars is related to:
> agenesis of other teeth
> delayed calcification of other posterior teeth
> different developmental sequences (Moyers, p. 121)

Figure 20. Typical crowding in the mandibular arch. (Moyers, p. 369)

3. IMPACTION
- most frequently impacted teeth are the mandibular third molars
(Moyers, p. 118)

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Figure 23. Agenesis. (Moyers, p. 121)

C. Dimensional Changes

1. MANDIBULAR ARCH PERIMETER

- during transitional and early adolescent dentition, the mandibular
arch perimeter diminishes because of the following:
> the late mesial shift of the first permanent molars as the
“leeway space” is preempted
> the mesial drifting tendency of the posterior teeth
throughout of life Figure 24. Comparison of the angulation of the permanent and primary incisors.
> slight amounts of interproximal wear of the teeth (Moyers, p. 125)
> the lingual positioning of the incisors as a result of the
differential mandibulomaxillary growth > greater increases in mesiodistal width of the tooth (Moyers,
> the original tipped positions of the incisors and molars. p. 124)
(Moyers, pp. 123-124)
- diminution can be also caused by: 3. MANDIBULAR ARCH WIDTH
> differences in skeletal pattern - increases (they are parallel)
> sex (female’s arches shorten more than male’s) - increases in the premolar region because the crowns of the
> caries experience (Moyers, p. 124) premolars are placed further buccally than the centers of the crowns of
the wider primary molars (Moyers, p. 123)
2. MAXILLARY ARCH PERIMETER
- increases slightly. 4. MAXILLARY ARCH WIDTH
- these account for the tendency to preserve the circumference - widens with vertical growth
even though the permanent molars are drifting mesially: > because the alveolar processes diverge (Moyers, p. 123)
> difference in the angulation of the maxillary permanent
incisors against the maxillary primary incisors in which permanent 5. MANDIBULAR AND MAXILLARY ARCH LENGTH
incisors has greater angulation than primary incisors - any changes in arch length are coarse reflections of the changes
in perimeter
- sometimes, one-half the circumference is referred to as “arch
length” (Moyers, p. 123)

6. MANDIBULAR INTERCANINE DIAMETER

- increases only slightly
> it results from the distal tipping of the primary canines into
the primate space, since the mandibular incisors are not normally moved
labially through time (Moyers, p. 122)

D. Changes in the Overbite and Overjet

- during growth of severe Class II and Class III malocclusions, the

overbite and overjet must adapt to the abnormal skeletal relationships
and thus behave differently from the mean changes (Moyers, p. 126)

1. OVERBITE
- vertical overlap of the incisors (Moyers, p. 125)
- from the early mixed dentition to the completion of the
permanent occlusion, it increases slightly then decreases
- overbite is also correlated with a number of vertical facial
dimensions such as ramus height (Moyers, p. 126)
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- impinging overbite is the excessive vertical overlap of the

anterior teeth that may result in tissue impingement
> orthodontics is generally required, and sometimes
orthognathic surgery is recommended.
> gingivitis and periodontitis may also occur from continued
impinging overbite. (Wheeler’s, p. 284)

Figure 26. Overjet vs. overbite. (Wheeler’s, p. 283)

E. Resorption of the Permanent Tooth

Figure 25. Impinging overbite. (Wheeler's, p. 284, 303)

Figure 27. Root resorption of maxillary lateral incisor (C) and root resorption of
2. OVERJET maxillary first premolar due to orthodontic treatment. (Wheeler’s, p. 234)
- horizontal overlap (Moyers, p. 125)
- because the maxilla tends to be larger than that of the mandible,
the maxillary teeth “overhang” the mandibular teeth (Wheeler’s, p. 283)
- the overlapping of the maxillary teeth over the mandibular teeth
has a protective feature: during the opening and closing movements of
the jaws, the cheeks, lips, and tongue are less likely to be caught. hence,
there is less cheek-biting. (Wheeler’s, p. 284)
- correlated with the anteroposterior skeletal relationship
- also sensitive to abnormal lip and tongue function

Figure 28. Severe root resorption during orthodontic treatment. (Cobourne, p. 19)

- anterior maxillary region has the greatest amount and severity of

root resorption, especially the maxillary lateral incisors (Cobourne, p. 18)
- there is a genetic tendency and ethnic susceptibility, with Asian
patients having a lower incidence (Cobourne, p. 18)
- other risk factors of root resorption include:

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> unusually shaped roots, including blunted, pipette-shaped and

short roots
> history of dentoalveolar trauma
> excessive orthodontic force
> movement of teeth without occlusal contact
> intrusive forces
> reduction of large overjets by distal movement of anterior teeth
> pushing apices of teeth into cortical bone

III. AGING AND DENTITION

- as age increases, gradual and progressive loss in arch length also
persists. particularly in the mandibular arch of females
- thus, creating an increase in mandibular incisor crowding with age
- changes found in orthodontically untreated individuals are very
similar in nature to those found in patients following orthodontic
treatment (Cobourne, p.105)

REFERENCES:

Cobourne, M.T. & DiBiase, A.T. (2010). Handbook of Orthodontics.

Elsevier Limited: United Kingdom.

Moyers, R.E. (1988). Handbook of Orthodontics. 4th edition. Year Book

Medical Publishers, Inc.: USA.

Nelson, S.J. & Ash, Jr., M.M. (2010). Wheeler’s Dental Anatomy,
Physiology, and Occlusion. 9th edition. Saunders, Elsevier Inc.: Missouri.

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