How is space maintained when primary teeth are lost prematurely?

Permanent Maxillary Incisors

Beverly York, D.D.S.

Maxillary Central & Lateral Incisors

Class Traits The incisal two-thirds of the crowns appear flattened or compressed faciolingually, providing a long horizontal biting edge or margin
Distinct and rounded protuberances termed mamelons representing developmental lobes surmount the incisal margins of all newly erupted incisors The marginal ridges of all incisors are located on the mesial and distal borders of the lingual surfaces

Maxillary Central Incisor

Calcification & Eruption Schedule
Calcification begins Crown completed Eruption (emergence) .. Root completed.. 3.5 months 4.5 years 7.5 years 10 years

Maxillary Central Incisor

Facial Aspect
Cervico-Incisal length (10.5 mm) is greater than the Mesiodistal width (8.5 mm) which is greater than the Faciolingual depth (7.0 mm) Crown outline is trapezoidal with the shorter parallel side at cervix Crown width at contact area greater than at cervix
Tooth #9 Facial

Maxillary Central Incisor

Facial Aspect
A young tooth may show evidence of mamelons on the incisal edge
Tooth #9
Facial

Mesioincisal line angle is square (90 degrees); Distoincisal angle is rounded

Incisal edge is relatively straight Mesial crown outline straighter than the distal outline Cervical outline of crown is slightly concave incisally and the arc of the curvature is said to be part of a SEMICIRCLE

Maxillary Central Incisor

Facial Aspect
Facial surface may show some evidence of shallow vertical developmental depressions delineating lobe structure Facial surface is relatively flat (only slightly convex) in its incisal two thirds
Tooth #9 Facial

Mesial contact area is located in the incisal 1/3 of the crown

Distal contact area is located at the junction of incisal & middle 1/3 of the crown Root cone shaped with blunt apex slightly distal of center with no developmental depressions
M D

Maxillary Central Incisor

Facial Aspect
Facial surface may show horizontal ridges at the cervical one-third representing differing rates of enamel formation during normal growth patterns The raised portions of the ridges (positive anatomy) are termed perikymata and the horizontal grooves (negative anatomy) are termed imbrication lines

Maxillary Central Incisor

Facial Aspect
Outline of root is cone shaped with a relatively blunt apex usually located slightly distal to center line of tooth, with no developmental depressions This tooth is easy to extract in that the clinician can rotate the tooth within the alveolus, without fear of fracturing the root or any osseous tissue

Maxillary Central Incisor

Lingual Aspect
Cervical outline of crown is more concave (toward the incisal) than what is seen on facial (it is not a Tooth #9 semicircle)

Lingual

Lingual fossa in incisal of crown surface is described as a broad, shallow dish-shaped depression
Lingual fossa is bound by the incisal ridge, the mesial and distal marginal ridges and the cingulum. Lingual fossa is trapezoidal in shape. Cingulum: Well-developed in cervical of crown.

The greatest curvature lingually of the cingulum and the crest of the cervical line gingivally will be slightly distal to the mesiodistal long axis bisector of the crown.

Maxillary Central Incisor

Mesial Aspect
Tooth #9
Mesial

Crown outline is triangular with apex at incisal

Incisal edge is centered faciolingually over the root The incisal edge is lined up with the height of curvature of the cervical line and the apex of the root

Maxillary Central Incisor

Mesial Aspect
The cervical line viewed from the mesial aspect curves incisally for 1/3 of total crown length. This is the greatest height of curvature of the cervical line incisally or occlusally found on any permanent tooth
Tooth #9 Mesial

Greatest curvature of the crown outline facially and lingually will be in the cervical 1/3 of the crown at the crests of the facial and lingual cervical ridges
These facial and lingual crests are opposite one another and at the same level

Maxillary Central Incisor

Mesial Aspect
The facial outline of the crown from the crest of the facial cervical ridge to the incisal ridge is relatively flat (shows very little convexity) The lingual outline of the crown from the cingulum to the incisal ridge is slightly concave The lingual outline of the crown is said to have an S shaped contour, denoting the convexities over the cingulum and linguo-incisal ridge and a concavity over the lingual fossa
Tooth #9 Mesial

The root surface is relatively smoothly convex and has no developmental root depressions
The root is cone shaped with the blunt apex centered faciolingually

Maxillary Central Incisor

Distal Aspect
Greatest faciolingual width is in cervical 1/3 of the crown
Tooth #9 Distal

Incisal ridge and apex of the root are in line with each other along the long axis of the tooth
Note that the convexity of the outline of the cingulum begins approximately halfway between the incisal ridge and the cervical line on the lingual The curvature of the cervical line incisally is less on the distal than it is on the mesial surface by 1.0 mm The distal root surface has no developmental root depression and is relatively smoothly convex

Maxillary Central Incisor

Incisal Aspect
Mesiodistal width (8.5 mm) is greater than the faciolingual diameter (7.0 mm) Interproximal contact areas (greatest curvature mesially and distally) are centered faciolingually Incisal edge (ridge) is relatively straight and perpendicular (at a 90 angle) to the mesiodistal bisecting plane The incisal edge is positioned parallel to the faciolingual bisecting plane Note that the mesiofacial line angle is more developed than the distofacial line angle
Tooth #9 Incisal

Maxillary Central Incisor

Incisal Aspect
Crest of the cingulum (greatest curvature on the lingual) is slightly distal to the mesiodistal bisecting plane of the crown Crown outline converges lingually (gets smaller from facial to lingual) Surface outline between the mesiofacial and distofacial outlines is relatively straight There is slightly more bulk on the mesial half of the crown than on the distal half
Tooth #9
Incisal

Maxillary Lateral Incisor

Calcification & Eruption Schedule
Calcification begins Crown completed Eruption (emergence) .. Root completed.. 1 year 4.5 years 8.5 years 11 years

Maxillary Lateral Incisor

Facial Aspect
Crown length is 1.0 -1.5 mm shorter than the maxillary central incisor. Crown width is 2.0 mm less than the maxillary central incisor. This gives impression that the maxillary lateral incisor is relatively long and narrow Crown outline is trapezoidal with the shorter parallel side at the cervix Both mesial and distal incisal line angles are rounded and each is more rounded than the corresponding incisal line angle of the maxillary central incisor. The distoincisal line angle is more rounded than the mesioincisal angle The mesial proximal contact is at the level of the junction of the incisal and middle thirds of the crown The distal contact is at a level near the middle of the middle 1/3 of the crown
M Tooth #10 Facial

Maxillary Lateral Incisor

Facial Aspect
The curvature of the cervical line incisally is elliptical and not as broad as that of the maxillary central incisor The highest point of the curvature of the cervical line is likely to be slightly distal to mesiodistal bisector of the crown Facial crown surface is convex in all directions Developmental depressions are evident on the crown The root converges evenly toward the apex for the cervical two thirds of its length There is usually a characteristic curve of the root toward the distal in the apical third
M D Tooth #10 Facial

Maxillary Lateral Incisor

Lingual Aspect
The lingual fossa is relatively deep, triangular in shape and also cup-shaped
Tooth #10 Lingual

The lingual fossa occupies the incisal two thirds of the lingual surface of the crown
The anatomical features serving as boundaries for the fossa include the incisal ridge, the mesial and distal marginal ridges and the cingulum The cingulum of the maxillary lateral incisor is limited to the cervical 1/3 of the crown and the mesial and distal marginal ridges form a V as they flow into the cingulum
D M

Maxillary Lateral Incisor

Lingual Aspect
There is a very deep depression or even a pit, deep in the fossa behind the cingulum at the point of the V A developmental groove extending out of the lingual fossa between a marginal ridge and the cingulum, may be seen on the distal side of the cingulum This groove may be deep and extend across the cementoenamel junction onto the root It is termed the linguogingival groove and is unique to the maxillary lateral incisor Often times, this linguogingival groove is decayed or fissured and will need to be restored
D M Tooth #10 Lingual

Maxillary Lateral Incisor

Mesial Aspect
Greatest curvature of both the facial and lingual crown outlines is in the cervical 1/3 and each is identified as a cervical ridge Incisal ridge is in line with mid-point of the faciolingual diameter Facial crown outline is convex from facial cervical ridge crest to incisal ridge Lingual crown outline is slightly concave from lingual cervical ridge to the incisal ridge Curvature of the cervical line toward the incisal is greater on the mesial surface than on the distal surface The curvature of the cervical line extends for 1/3 of the crown length but not as great of a distance as on the maxillary central incisor since the lateral incisor has a shorter crown length Apex of the root is facial to the faciolingual long axis bisector If there is any evidence of a root depression, it will be slight
L F Tooth #10 Mesial

Maxillary Lateral Incisor

Distal Aspect
The incisal ridge and root apex will not be in line with each another, but the incisal ridge is centered faciolingually
The facial outline of root is straighter and less length than the lingual outline when measured from cervical line to apex of root The cervical line curves for a shorter distance incisally on the distal surface than on the mesial surface
F L Tooth #10 Distal

Maxillary Lateral Incisor

Incisal Aspect
Crown wider mesiodistally (6.5 mm) than it is faciolingually (6.0 mm) Incisal ridge is centered F-L
Tooth #10
Incisal

Incisal ridge crosses approximately midway between the facial and lingual outline; however, it usually shows some curvature with the convexity toward the facial
The facial outline is more continuously convex than that of the maxillary central incisor and the mesiofacial and distofacial line angles are more rounded (less prominent) Lingual crown outline converges sharply toward the lingual. The crest of the lingual outline of the cingulum will be slightly to the distal of the mesiodistal bisector (all cinguli on anterior teeth incline or point slightly toward the distal)

Maxillary Lateral Incisor

Except for 3rd molars, maxillary lateral incisors are associated with the most developmental anomalies.
Often congenitally missing (aplasia)

Maxillary Lateral Incisor

Except for 3rd molars, maxillary lateral incisors are associated with the most developmental anomalies.

Microdontia
(abnormally small teeth)

Maxillary Lateral Incisor

Except for 3rd molars, maxillary lateral incisors are associated with the most developmental anomalies.

Peg lateral (only

middle facial lobe develops)

Maxillary Lateral Incisor

Except for 3rd molars, maxillary lateral incisors are associated with the most developmental anomalies.

Dens in dente
(tooth within a tooth)

Maxillary Lateral Incisor

Except for 3rd molars, maxillary lateral incisors are associated with the most developmental anomalies.

Supernumerary teeth
(teeth in addition to normal construct)

Hutchinsons Incisor
An anomaly associated with the development

of the incisors associated with congenital syphilis. Crown of incisors resemble the shape of screwdrivers. Also associated with Mulberry Molars as the permanent 1st molars begin calcification at birth (to 3 years) and are in progress when the incisors development is affected (3 months to 5 years)

Hutchinsons Incisor

Maxillary Central & Lateral Incisors

Type Traits
Aspect
Facial

Item
Mesiodistally Mesioincisal line angle Distoincisal line angle Mesial profile Distal profile Mesial contact Facial surface Distal contact Marginal ridges and cingulum Lingual fossa Cementoenamel junction Contact area Cingulum Outline Labial surface Lobes MF and DF line angles

Central
Wide Sharp (90 degrees) Slightly rounded Straight Rounded Incisal third Relatively flat Junction of I & middle 1/3 Moderately pronounced Trapezoidal; Moderately deep Moderately curved Within incisal third Moderately convex Triangular Slightly convex Visible facially Prominent

Lateral
Narrower than central Slightly rounded Distinctly rounded Slightly rounded Highly rounded Junction of I & middle 1/3 Rounded Middle third More prominent Triangular; Deep Less curved Junction of I & middle 1/3 Convex Ovoid Highly convex Slightly visible to absent Rounded

Lingual

Mesial

Incisal

Maxillary Central & Lateral Incisors

Summary of Comparisons & Contrasts
>Central is larger than the Lateral >Central is more angular than the Lateral >Central has a straighter root, while the Lateral has a root that is often curved or pointed to the distal >Incisal third of the facial surface of the Central is fairly flat, while the incisal third of the lateral exhibits more convexity >Central exhibits minimal variation, while the Lateral is one of the most variable permanent teeth >Crests of the cingulum on both incisors are offset to the distal >Central has a trapezoidal shaped lingual fossa, while the Lateral has a triangular shape fossa >From an incisal view, both incisors display contact areas that are centered faciolingually >Both incisors, from a proximal view, display an incisal edge that is centered over the crest of curvature of the CEJ and their respective root apices >From a lingual view, the Lateral frequently displays a fissured or carious lingual pit, while the Central does not

The End

Permanent Maxillary Incisors