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Chronology is the study of the timing of tooth development from initiation to completion of root formation and eruption. Tooth development times are well documented for primary and permanent teeth. [PRIMARY AND PERMANENT] teeth follow distinct patterns of crown completion, eruption, and root completion. There are several theories for the mechanism of tooth eruption including bone remodeling, root growth, vascular pressure, and periodontal ligament traction. Tooth eruption results from a complex interplay between these factors.
Chronology is the study of the timing of tooth development from initiation to completion of root formation and eruption. Tooth development times are well documented for primary and permanent teeth. [PRIMARY AND PERMANENT] teeth follow distinct patterns of crown completion, eruption, and root completion. There are several theories for the mechanism of tooth eruption including bone remodeling, root growth, vascular pressure, and periodontal ligament traction. Tooth eruption results from a complex interplay between these factors.
Chronology is the study of the timing of tooth development from initiation to completion of root formation and eruption. Tooth development times are well documented for primary and permanent teeth. [PRIMARY AND PERMANENT] teeth follow distinct patterns of crown completion, eruption, and root completion. There are several theories for the mechanism of tooth eruption including bone remodeling, root growth, vascular pressure, and periodontal ligament traction. Tooth eruption results from a complex interplay between these factors.
& PREVENTIVE DENTISTRY BDS IV PROF. ROLL NO. 43 CHRONOLOGY DEFINITION: Chronos - Time Logos Study It is defined as the study which deals with the timing of various stages of tooth development, starting with initiation of the first dental tissue laid down to the emergence of the tooth into the oral cavity & its completion of calcification.
Originally it was based on the data of Logon & Kronfeld (1933). Modified by: Massler & Shour (1941), Moorrees, fanning & hunt (1963), Kraus & jordan (1965), Nystrom (1977). TIMING OF CROWN & ROOT DEVELOPMENT PRIMARY TEETH PERMANENT TEETH Crown completion
Eruption
Root completion Crown completion
Eruption
Root completion Incisors Canine & molars 4-6 months 6-12 months 1 year 3-4 years 3 years NOLLA STAGES OF TOOTH DEVELOPMENT (1952) Stage 0 : absence of crypt Stage 0 : absence of crypt
Stage 1 : presence of crypt
Stage 2 : initial calcification
Stage 3 : 1/3 rd of crown completed
Stage 4 : 2/3 rd of crown completed
Stage 5 : crown almost completed
Stage 6 : crown completed
Stage 7 : 1/3 rd of root completed
Stage 8 : 2/3 rd of root completed
Stage 9 : root completed , apex open
Stage 10 : apical foraman closed A
B
C
D
E
F
G
H DECIDUOUS DENTITION Initiation of hard tissue development for all deciduous teeth occurs between 3.5 & 4.5 intrauterine months.
Crown get mineralized halfway by birth and become fully formed during first 12 month.
Roots are completed b/w the age of 1.5 & 3 years.
TOOTH FIRST EVIDENCE OF CALCIFICATION (weeks in utero) CROWN COMPLETED (months) ERUPTION (months) ROOT COMPLETED (years) UPPER A 14 1 10 (8-12) 1 B 16 2 11 (9-13) 2 C 17 9 19 (16-22) 3 D 15 6 16 (13-19) 2 E 19 11 29 (25-33) 3 LOWER A 14 2 8 (6-10) 1 B 16 3 13 (10-16) 1 C 17 9 20 (17-23) 3 D 15 5 16 (14-18) 2 E 18 10 27 (23-31) 3 CHRONOLOGY OF PRIMARY DENTITION SEQUENCE OF ERUPTION OF PRIMARY TEETH
AB D C E A B D CE PERMANENT DENTITION Mineralization of 1 st permanent molar commences at birth & is followed by the other teeth during first 3.5 years of postnatal life.
Crown completion takes place at an age of 7 years.
Mineralization ceases at an av. Age of 15-16 years with completion of roots of 2 nd molars. Mineralization stages of 3 rd molar: Initiation 9 years Crown completion 13 years Root formation 20 years
Development of central incisors is more rapid.
Development of canine & 2 nd molars the slowest.
Root development alone takes on an av. From 6-7 years. Tooth First evidence of calcification Crown completed (years) Eruption (years) Root completed UPPER 1 3-4 mo 4-5 7-8 10 2 10-12 mo 4-5 8-9 11 3 4-5 mo 6-7 11-12 13-15 4 1-1 yr 5-6 10-11 12-13 5 2-2 yr 6-7 10-12 12-14 6 At birth 2-3 6-7 9-10 7 2-3 yr 7-8 12-13 14-16 8 7-9 yr 12-16 17-21 18-25 LOWER 1 3-4 mo 4-5 6-7 9 2 3-4 mo 4-5 7-8 10 3 4-5 mo 6-7 9-10 12-14 4 1-2 yr 5-6 10-12 12-13 5 2-2 yr 6-7 11-12 13-14 6 At birth 2-3 6-7 9-10 7 2-3 yr 7-8 11-13 14-16 8 8-10 yr 12-16 17-21 18-25 TOOTH ERUPTION Derived from erumpere, meaning to break out. Axial or occlusal movement of tooth from its developmental position within jaw to its functional position in the occlusal plane.
Eruption is only a part of physiological tooth movement.
TYPES OF ERUPTION 3 types: Continuously growing Continuously extruding Continuously invested teeth. TYPES OF ERUPTION
Continuously growing: formation & eruption occurs throughout the life. formed from proliferative base. Crown & roots are similar morphologically. Extensive wear. Eruption velocity increases whenever velocity of wear increases. E.g. incisors of rodent.
TYPES OF ERUPTION
Continuously extruding: Teeth stop forming once root formation is complete. Moderate occlusal wear. Height is maintained by apical migration of surrounding epithelial attachment, without simultaneous deposition of alveolar bone. Tooth eventually loosen & exfoliate completely. E.g. cheek teeth of cattle & sheep.
TYPES OF ERUPTION Continuously invested teeth: Similar to continuously extruding, but the alveolar bone remodels in response to eruption. With normal attrition, the clinical crown shortens & tooth erupts to maintain vertical height & occlusal function & bring the alveolar bone with it. E.g. human teeth. PHYSIOLOGICAL TOOTH MOVEMENT Consist of : a. Preeruptive tooth movement b. Eruptive tooth movement c. Posteruptive tooth movement
PREERUPTIVE TOOTH MOVEMENT It is a movement positioning the tooth & its crypt within growing jaws preparatory to tooth eruption. Change in the position of tooth germ is a result of Body movement of tooth germ Growth of tooth germ Relative change in position of associated deciduous and permanent tooth germs The permanent molars , which have no deciduous predecessors, also exhibit movement. All these movement occurs in association with growth of jaw . ERUPTIVE TOOTH MOVEMENT During this phase, tooth moves from its position within the bone of the jaw to its functional position in occlusion.
Principal direction of movement is occlusal or axial.
PREFUNCTIONAL TOOTH MOVEMENT movement of tooth after its appearance in the oral cavity till it attains the functional position.
Tooth erupts about 4 mm in 14 weeks. POST ERUPTIVE TOOTH MOVEMENT These are the movement that-
1. Maintain the position of an erupted tooth while jaws continues to grow and
2. Compensate for occlusal and proximal wear.
Forces opposing the eruption mechanism control post emergent eruption. MECHANISM OF TOOTH MOVEMENT The mechanism that brings about tooth movement is still debatable & is likely to be a combination of a number of factors. Main factors include Bone remodeling Root growth Vascular pressure Ligament traction THEORIES OF ERUPTION Bone growth theory Root growth theory Vascular pressure theory Periodontal ligament traction theory Constriction of pulp Pulp growth BONE REMODELING THEORY Selective deposition & resorption of bone brings about eruption. It is important to permit tooth movement. Experiment establishes absolute requirement for dental follicle to achieve bony remodeling & tooth eruption. It is the follicle that provide s the source of new bone forming cell & conduit for osteoclasts.
ROOT FORMATION THEORY Proliferating root impinges on fixed case, thus converting an apically directed force into occlusal movement. Root formation follows crown formation and involves cellular proliferation & formation of new tissue that must be accommodated by either movement of crown of the tooth or the resorption of bone at the base of socket. Translation of the root growth into occlusal movement requires fixed base . Advocates of this theory postulated the existence of cushion hammock ligament , that provide fixed base CONTRADICTIONS Cushion hammock ligament cannot act as fixed base. Some teeth move a distance greater than the root length & eruptive movement also occur after completion of root formation. Experimental resection preventing further root formation does not stop eruptive tooth movement. VASCULAR PRESSURE THEORY A local increase in the tissue fluid pressure in periapical region is sufficient to move the tooth. Teeth move in synchrony with arterial pulse, so local volume changes can produce limited tooth movement. Factors in favour of this theory are- Increase in hydrostatic pressure induced by hypotensive drugs increases the rate of eruption while stimulation of sympathetic nerves decreases rate of eruption. No. of capillaries increases with the eruption rate & their distribution varies; more no. of capillaries are seen near the base of crypt than the alveolar crest. PERIODONTAL LIGAMENT TRACTION THEORY Cells & fibers of ligament pull the tooth into occlusal. There is is good deal of evidences that the eruptive force resides in dental follicle- periodontal ligament complex. Abnormalities of dental follicle as shown in certain diseases are associated with delayed tooth eruption. Drugs that interrupt proper formation of collagen in ligament also interfere with eruption. PDL fibroblast have a ability to contract & transmit contractile forces to extracellular environment. Thus acc. to this theory, eruption of teeth could be brought about by a combination of events involving: Contractile forces by fibroblast Transmitted to ECC & collagen Tooth movement Via fibronexuses At appropriate inclination So , eruptive tooth movement is multifactorial, like vascular pressure at apex along with contractile forces generated by dental follicle playing an important part & bone formation & resorption facilitating the process. MECHANISM OF POSTERUPTIVE TOOTH MOVEMENT Mechanism of axial movement is similar to that of eruptive tooth movement. Mesial drift involves a combination of 2 separate forces resulting from occlusal contact of teeth & contraction of transseptal ligaments b/w teeth. When jaws are clenched, bringing teeth into contact, force is generated in a mesial direction because of summation of cuspal planes & because many teeth have a mesial inclination. Clinical consideration Assessment of dental age Natal & neonatal teeth Delayed eruption Ankylosis Impaction Supraeruption
SHEDDING OF DECIDUOUS TEETH Physiological process resulting in elimination of deciduous dentition is called shedding or exfoliation. Shedding is a result of progressive resorption of roots of teeth & their supporting tissue , periodontal ligament . Pressure generated by the growing & erupting permanent tooth dictates the pattern of deciduous tooth resorption. First sign of root resorption is seen in deciduous CI & first molar by the age of 4-5 year. In CI resorption starts on lingual side. In molars from inner surfaces of root. Resorption of deciduous incisors takes place more rapidly (1.5-2 yr) than that of canine & molars(2.5-5.7 yr.) . Mechanism of shedding Pressure from the erupting successional tooth plays a key role because the odontoclasts appear at predicted sites of pressure. Unlike osteoblast, cementoblasts are not responsive to hormone & cytokines. Therefore prior to resorption cementoblastic layer has to be damaged probably by inflammatory process . Reduced enamel ep. of erupting tooth release some substances to initiate this process. Predentin resist resorption more than any other hard tissue. Odontoclast Attaches to hard tissue surfaces through clear zone Sealed space lined by ruffled border Microenvironment Ruffled border act as proton pump Acidify EC environment Dissolution of mineral Secretion of lysosomal enzyme into same environment Degrade organic matrix FACTORS AFFECTING SHEDDING When a successional tooth germ is missing , shedding of the deciduous tooth is delayed .
Forces of mastication.
Clinical considerations Remnants of deciduous teeth Retained deciduous teeth Submerged deciduous teeth TOOTH NUMBERING SYSTEM VARIOUS NUMBERING SYSTEMS ARE: Universal system Symbolic system FDI system UNIVERSAL SYSTEM Recommended by ADA in 1968. PRIMARY DENTITION: Universal system for primary dentition uses uppercase letters. The entire primary dentition is as follow:
A B C D E F G H I J T S R Q P O N M L K
Midsagittal plane Right Left UNIVERSAL SYSTEM PERMANENT DENTITION: permanent teeth are numbered from 1-32. The following universal notation designates the entire permanent dentition: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
ADVANTAGES OF UNIVERSAL SYSTEM OF NOTATION Acceptable to computer language. Less confusing than palmer notation SYMBOLIC SYSTEM It is also known as zsigmondy/palmer notation or palmer notation system.
Introduced by adolph zsigmondy in 1861 & then modified for primary dentition in 1874.
Given by Palmer in 1870.
SYMBOLIC SYSTEM In this system arches are divided into quadrants with the entire primary dentition being notated as :
E D C B A A B C D E E D C B A A B C D E
e.g. max right central incisors- A| SYMBOLIC SYSTEM PERMANENT DENTITION: It is a four quadrant symbolic system, in which beginning from central incisors , teeth are numbered 1 through 8.
E.g. right max 1 st molar 6| LIMITATIONS OF PALMER NOTATIONS It is generally incompatible with computer and word processing systems.
More confusing. FDI SYSTEM Proposed by Federation Dentaire Internationale(FDI).
Adopted by WHO & other such as IADR.
It is atwo digit system given for both primary and permanent dentition.
FDI system of tooth notation for primary teeth 5- right max. quadrant 6- left max. quadrant 7- left mand. Quadrant 8- right mand. Quadrant
55 54 53 52 51 61 62 63 64 65 85 84 83 82 81 71 72 73 74 75 FDI notation for permanent teeth In this first digit indicate that is 1-4 & second digit indicate tooth within the quadrant.