Development of occlusion.

A. Occlusion  usually means the contact relationship in function. Concepts of occlusion vary with almost every specialty of dentistry.

Centric occlusion is the maximum contact and/or intercuspation of the teeth.

B. Occlusion is the sum total of many factors.

1. Genetic factors.

-Teeth can vary in size. Examples are microdontia (very small teeth) and macrodontia (very large teeth). Incidentally, Australian aborigines have the largest molar tooth size—some 35% larger than the smallest molar tooth group

-The shape of individual teeth can vary (such as third molars and the upper lateral incisors.)

-They can vary when and where they erupt, or they may not erupt at all (impaction).

-Teeth can be congenitally missing (partial or complete anodontia), or there can be extra (supernumerary) teeth.

-The skeletal support (maxilla/mandible) and how they are related to each other can vary considerably from the norm.

2. Environmental factors.

-Habits can have an affect: wear, thumbsucking, pipestem or cigarette holder usage, orthodontic appliances, orthodontic retainers have an influence on the occlusion.

3.Muscular pressure.

-Once the teeth erupt into the oral cavity, the position of teeth is affected by other teeth, both in the same dental arch and by teeth in the opposing dental arch.

-Teeth are affected by muscular pressure on the facial side (by cheeks/lips) and on the lingual side (by the tongue).

C. Occlusion constantly changes with development, maturity, and aging.

1 . There is change with the eruption and shedding of teeth as the successional changes from deciduous to permanent dentitions take place.

2. Tooth wear is significant over a lifetime. Abrasion, the wearing away of the occlusal surface reduces crown height and alters occlusal anatomy.

Attrition of the proximal surfaces reduces the mesial-distal dimensions of the teeth and significantly reduces arch length over a lifetime.

Abraision is the wear of teeth by agencies other than the friction of one tooth against another.

Attrition is the wear of teeth by one tooth rubbing against another

3. Tooth loss leaves one or more teeth without an antagonist. Also, teeth drift, tip, and rotate when other teeth in the arch are extracted.

Bell stage

The bell stage is known for the histodifferentiation and morphodifferentiation that takes place. The dental organ is bell-shaped during this stage, and the majority of its cells are called stellate reticulum because of their star-shaped appearance. Cells on the periphery of the enamel organ separate into three important layers. Cuboidal cells on the periphery of the dental organ are known as outer enamel epithelium.The cells of the enamel organ adjacent to the dental papilla are known as inner enamel epithelium. The cells between the inner enamel epithelium and the stellate reticulum form a layer known as the stratum intermedium. The rim of the dental organ where the outer and inner enamel epithelium join is called the cervical loop

Other events occur during the bell stage. The dental lamina disintegrates, leaving the developing teeth completely separated from the epithelium of the oral cavity; the two will not join again until the final eruption of the tooth into the mouth

The crown of the tooth, which is influenced by the shape of the internal enamel epithelium, also takes shape during this stage. Throughout the mouth, all teeth undergo this same process; it is still uncertain why teeth form various crown shapes—for instance, incisors versus canines. There are two dominant hypotheses. The "field model" proposes there are components for each type of tooth shape found in the ectomesenchyme during tooth development. The components for particular types of teeth, such as incisors, are localized in one area and dissipate rapidly in different parts of the mouth. Thus, for example, the "incisor field" has factors that develop teeth into incisor shape, and this field is concentrated in the central incisor area, but decreases rapidly in the canine area. The other dominant hypothesis, the "clone model", proposes that the epithelium programs a group of ectomesenchymal cells to generate teeth of particular shapes. This group of cells, called a clone, coaxes the dental lamina into tooth development, causing a tooth bud to form. Growth of the dental lamina continues in an area called the "progress zone". Once the progress zone travels a certain distance from the first tooth bud, a second tooth bud will start to develop. These two models are not necessarily mutually exclusive, nor does widely accepted dental science consider them to be so: it is postulated that both models influence tooth development at different times.Other structures that may appear in a developing tooth in this stage are enamel knots, enamel cords, and enamel niche.

TEMPOROMANDIBULAR JOINT

There are three kind of joints:
 

·  Fibrous
Two bones connected with fibrous tissue
Examples
suture (little or no movement)
gomphosis (tooth - PDL - bone)
syndesmosis (fibula & tibia, radius and ulna; interosseous ligament)

·  Cartilagenous
Two subtypes:
2a) primary: bone<--->cartilage (costochondral joint)
2b) secondary: bone<-->cartilage<-->FT<-->cartilage<--> bone (pubic symphysis)

·  Synovial
Two bones; each articular surface covered with hyaline cartilage in most cases
The bones are united with a capsule (joint cavity)
In the capsule there is presence of synovial fluid
The capsule is lined by a synovial membrane
In many synovial joints there maybe an articular disk
Synovial joints are characterized by the presence of ligaments
Synovial joints are classified according to the number of axes of bone movement: uniaxial, biaxial, multiaxial

the shapes of articulating surfaces: planar, ginglymoid (=hinged), pivot, condyloid

The movement of the joints is controlled by muscles

The temporomandibular joint is a synovial, sliding-ginglymoid joint (humans)

Embryology of the TMJ
Primary TMJ: Meckel's cartilage --> malleus & incal cartilage. It lasts for 4 months.
Secondary TMJ: Starts developing around the third month of gestation
Two blastemas (temporal and condylar); condylar grows toward the temporal (temporal appears and ossifies first)
Formation of two cavities: inferior and upper
Appearance of disk
Bones: glenoid fossa (temporal bone) and condyle (mandible)
 

Histology of the Periodontal Ligament (PDL)

Embryogenesis of the periodontal ligament
The PDL forms from the dental follicle shortly after root development begins
The periodontal ligament is characterized by connective tissue. The thinnest portion is at the middle third of the root. Its width decreases with age. It is a tissue with a high turnover rate.

FUNCTIONS OF PERIODONTIUM

Tooth support
Shock absorber
Sensory (vibrations appreciated in the middle ear/reflex jaw opening)

The following cells can be identified in the periodontal ligament:
a) Osteoblasts and osteoclasts b) Fibroblasts,  c) Epithelial cells
 

Rests of Malassez
d) Macrophages
e) Undifferentiated cells
f) Cementoblasts and cementoclasts (only in pathologic conditions)
The following types of fibers are found in the PDL
-Collagen fibers: groups of fibers
-Oxytalan fibers: variant of elastic fibers, perpendicular to teeth, adjacent to capillaries
-Eluanin: variant of elastic fibers
Ground substance

PERIODONTAL LIGAMENT FIBERS

Principal fibers
These fibers connect the cementum to the alveolar crest. These are:

a. Alveolar crest group: below CE junction, downward, outward
b. Horizontal group: apical to ACG, right angle
c. Oblique group: numerous, coronally to bone, oblique direction
d. Apical group: around the apex, base of socket
e. Interradicular group: multirooted teeth

Gingival ligament fibers
This group is not strictly related to periodontium. These fibers are:

a. Dentogingival: numerous, cervical cementum to f/a gingiva
b. Alveologingival: bone to f/a gingiva
c. Circular: around neck of teeth, free gingiva
d. Dentoperiosteal: cementum to alv. process or vestibule (muscle)
 e. Transseptal: cementum between adjacent teeth, over the alveolar crest
 

Blood supply of the PDL
The PDL gets its blood supply from perforating arteries (from the cribriform plate of the bundle bone). The small capillaries derive from the superior & inferior alveolar arteries. The blood supply is rich because the PDL has a very high turnover as a tissue. The posterior supply is more prominent than the anterior. The mandibular is more prominent than the maxillary.

Nerve supply
The nerve supply originates from the inferior or the superior alveolar nerves. The fibers enter from the apical region and lateral socket walls. The apical region contains more nerve endings (except Upper Incisors)

Dentogingival junction

This area contains the gingival sulcus. The normal depth of the sulcus is 0.5 to 3.0 mm (mean: 1.8 mm). Depth > 3.0 mm is considered pathologic. The sulcus contains the crevicular fluid
 

 
The dentogingival junction is surfaced by:
1) Gingival epithelium: stratified squamous keratinized epithelium 2) Sulcular epithelium: stratified squamous non-keratinized epithelium The lack of keratinization is probably due to inflammation and due to high turnover of this epithelium.
3) Junctional epithelium: flattened epithelial cells with widened intercellular spaces. In the epithelium one identifies neutrophils and monocytes.
Connective tissue
The connective tissue of the dentogingival junction contains inflammatory cells, especially polymorphonuclear neutrophils. These cells migrate to the sulcular and junctional epithelium.
The connective tissue that supports the sulcular epithelium is also structurally and functionally different than the connective tissue that supports the junctional epithelium.

Histology of the Col (=depression)

The col is found in the interdental gingiva. It is surfaced by epithelium that is identical to junctional epithelium. It is an important area because of the accumulation of bacteria, food debris and plaque that can cause periodontal disease.
Blood supply: periosteal vessels
Nerve supply: periodontal nerve fibers, infraorbital, palatine, lingual, mental, buccal

Alveolar bone (process)

1. The bone in the jaws that contains the teeth alveoli (sockets).

2. Three types of bone :

a. Cribriform plate (alveolar bone proper)

(1) Directly lines and forms the tooth socket. It is compact bone that contains many holes, allowing for the passage of blood vessels. It has no periosteum.

(2) Serves as the attachment site for PDL (Sharpey’s) fibers.

(3) The tooth socket is constantly being remodeled in response to occlusal forces. The bone laid down on the cribriform plate, which also provides attachment for PDL fibers, is known as bundle bone.

(4) It is radiographically known as the lamina dura.

b. Cortical (compact) bone

(1) Lines the buccal and lingual surfaces of the mandible and maxilla.

(2) Is typical compact bone with a periosteum and contains Haversian systems.

(3) Is generally thinner in the maxilla and thicker in the mandible, especially around the buccal area of  the mandibular premolar and molar.

c. Trabecular (cancellous, spongy) bone

(1) Is typical cancellous bone containing Haversian systems.

(2) Is absent in the maxillary anterior teeth region.

3. Alveolar crest (septa)

a. The height of the alveolar crest is usually 1.5 to 2 mm below the CEJ junction.

b. The width is determined by the shape of adjacent teeth.

(1) Narrow crests—found between teeth with relatively flat surfaces.

(2) Widened crests—found between teeth with convex surfaces or teeth spaced apart.

Introduction. The Jaws and Dental Arches

The teeth are arranged in upper and lower arches. Those of the upper are called maxillary; those of the lower are mandibular.

1. The maxilla is actually two bones forming the upper jaw; they are rigidly attached to the skull..
2. The mandible is a horseshoe shaped bone which articulates with the skull by way of the temporomandibular joint the TMJ.
3. The dental arches, the individual row of teeth forming a tooth row attached to their respective jaw bones have a distinctive shape known as a catenary arch.