Tooth eruption Theories

Tooth eruption occurs when the teeth enter the mouth and become visible. Although researchers agree that tooth eruption is a complex process, there is little agreement on the identity of the mechanism that controls eruption. Some commonly held theories that have been disproven over time include: (1) the tooth is pushed upward into the mouth by the growth of the tooth's root, (2) the tooth is pushed upward by the growth of the bone around the tooth, (3) the tooth is pushed upward by vascular pressure, and (4) the tooth is pushed upward by the cushioned hammock. The cushioned hammock theory, first proposed by Harry Sicher, was taught widely from the 1930s to the 1950s. This theory postulated that a ligament below a tooth, which Sicher observed on under a microscope on a histologic slide, was responsible for eruption. Later, the "ligament" Sicher observed was determined to be merely an artifact created in the process of preparing the slide.

The most widely held current theory is that while several forces might be involved in eruption, the periodontal ligaments provide the main impetus for the process. Theorists hypothesize that the periodontal ligaments promote eruption through the shrinking and cross-linking of their collagen fibers and the contraction of their fibroblasts.

Although tooth eruption occurs at different times for different people, a general eruption timeline exists. Typically, humans have 20 primary (baby) teeth and 32 permanent teeth. Tooth eruption has three stages. The first, known as deciduous dentition stage, occurs when only primary teeth are visible. Once the first permanent tooth erupts into the mouth, the teeth are in the mixed (or transitional) dentition. After the last primary tooth falls out of the mouth—a process known as exfoliation—the teeth are in the permanent dentition.

Primary dentition starts on the arrival of the mandibular central incisors, usually at eight months, and lasts until the first permanent molars appear in the mouth, usually at six years. The primary teeth typically erupt in the following order: (1) central incisor, (2) lateral incisor, (3) first molar, (4) canine, and (5) second molar. As a general rule, four teeth erupt for every six months of life, mandibular teeth erupt before maxillary teeth, and teeth erupt sooner in females than males. During primary dentition, the tooth buds of permanent teeth develop below the primary teeth, close to the palate or tongue.

Mixed dentition starts when the first permanent molar appears in the mouth, usually at six years, and lasts until the last primary tooth is lost, usually at eleven or twelve years. Permanent teeth in the maxilla erupt in a different order from permanent teeth on the mandible. Maxillary teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) first premolar, (5) second premolar, (6) canine, (7) second molar, and (8) third molar. Mandibular teeth erupt in the following order: (1) first molar (2) central incisor, (3) lateral incisor, (4) canine, (5) first premolar, (6) second premolar, (7) second molar, and (8) third molar. Since there are no premolars in the primary dentition, the primary molars are replaced by permanent premolars. If any primary teeth are lost before permanent teeth are ready to replace them, some posterior teeth may drift forward and cause space to be lost in the mouth. This may cause crowding and/or misplacement once the permanent teeth erupt, which is usually referred to as malocclusion. Orthodontics may be required in such circumstances for an individual to achieve a straight set of teeth.

The permanent dentition begins when the last primary tooth is lost, usually at 11 to 12 years, and lasts for the rest of a person's life or until all of the teeth are lost (edentulism). During this stage, third molars (also called "wisdom teeth") are frequently extracted because of decay, pain or impactions. The main reasons for tooth loss are decay or periodontal disease.

MAXILLARY CENTRAL INCISORS

Viewed mesially or distally, a maxillary central incisor looks like a wedge, with the point of the wedge at the incisal (cutting) edge of the tooth.

Facial Surface- The mesial margin is nearly straight and meets the incisal edge at almost a 90° angle, but the distal margin meets the incisal edge in a curve. The incisal edge is straight, but the cervical margin is curved like a half moon. Two developmental grooves are on the facial surface.

Lingual Surface:- The lingual aspect presents a distinctive lingual fossa that is bordered by mesial and distal marginal ridges, the incisal edge, and the prominent cingulum at the gingival. Sometimes a deep pit, the lingual pit, is found in conjunction with a cingulum.

Incisal: The crown is roughly triangular in outline; the incisal edge is nearly a straight line, though slightly crescent shaped

Contact Points: The mesial contact point is just about at the incisal, owing to the very sharp mesial incisal angle. The distal contact point is located at the junction of the incisal third and the middle third.

Root Surface:-As with all anterior teeth, the root of the maxillary central incisor is single. This root is from one and one-fourth to one and one-half times the length of the crown. Usually, the apex of the root is inclined slightly distally.

TOOTH MORPHOLOGY

Descriptive anatomy

• Median sagittal plane: the imaginary plane in the center that divides right from left.
• Median line: an imaginary line on that plane that bisects the dental arch at the center.
• Mesial: toward the center (median) line of the dental arch.
• Distal: away from the center (median) line of the dental arch.
• Occlusal plane: A plane formed by the cusps of the teeth. It is often curved, as in a cylinder. We will speak often of the occlusal surface of a tooth.
• Proximal: the surface of a tooth that is toward another tooth in the arch.
• Mesial surface: toward the midline.
• Distal surface: away from the midline.
• Facial: toward the cheeks or lips.
• Labial: facial surface of anterior teeth (toward the lips).
• Buccal: facial surfaceof anterior teeth (toward the cheeks).
• Lingual: toward the tongue.
• Occlusal: the biting surface; that surface that articulates with an antagonist tooth in an opposing arch.
• Incisal: cutting edge of anterior teeth.
• Apical: toward the apex, the tip of the root.

Interarch relationship can be  viewed from a stationary (fixed) and a dynamic (movable ) perspective

1.Stationary Relationship

a) .Centric Relation is the most superior relationship of the condyle of the mandible to the articular fossa of the temporal bone as determined by the bones ligaments. and muscles of the temporomandibular joint; in an ideal dentition it is the same as centric occlusion

Centric occlusion is habitual occlusion where maximum intercuspation occurs

The characteristics of centric occlusion are

(1) Overjet: or that characteristic of maxillary teeth to overlap the mandibular teeth in a horizontal direction by 1 to 2 mm the maxilla arch is slightly larger; functions to protect the narrow edge of the incisors and provide for an intercusping relation of posterior teeth

(2) Overbite or that characteristic of maxillary anterior teeth to overlap the mandibular anterior teeth in a vertical direction by a third of the lower crown height facilitates scissor like function of incisors

(3) Intercuspation. or that characteristic of posterior teeth to intermesh in a faciolingual direction  The mandibular facial and maxillary lingual cusp  are centric cusps yhat contact interocclusally in the opposing arch

(4) Interdigitation, or that characteristic_of that tooth to  articulate with two opposing teeth (except for the mandibular central incisors and the maxillary last molars); a mandibular tooth occludes with the same tooth in the upper arch and the one mesial to it; a maxillary tooth occludes with the same tooth in the mandibular arch and the one distal to it.

2. Dynamic interarch relationshjps are result of functional mandibular movements that start and end with centric  occlusion during mastication

a. Mandibular movements are

(1) Depression (opening)

(2) Elevation (closing)

(3) Protrusion (thrust forward)

(4) Retrusion (bring back)

(5) Lateral movements right and left; one side is always the working side and one the balancing or nonworking side

b. Mandibular movements from centric occlusion are guided by the maxillary teeth

(1) Protrusion is guided by the incisors called incisal guidence

(2) Lateral movments are guided by the Canines on the working side in young, unworn dentitions (cuspid rise or cuspid protected occlusion); guided by incisors and posterior teeth in older worn. dentition (incisal/group guidance)

c. As mandibular movements commence from centric occlusion, posterior teeth should disengage in protrusion the posterior teeth on the balancing side should disengage in lateral movement

d. If tooth contact occurs where teeth should be disengaged, occlusal interference or premature contacts exist.

ARTICULAR SURFACES COVERED BY FIBROUS TISSUE
TMJ is an exception form other synovial joints. Two other joints, the acromio- and sternoclavicular joints are similar to the TMJ. Mandible & clavicle derive from intramembranous ossificiation.

Histologic

1. Fibrous layer: collagen type I, avascular (self-contained and replicating)
2. Proliferating zone that formes condylar cartilage
3. Condylar cartilage is fibrocartilage that does not play role in articulation nor has formal function
4. Capsule: dense collagenous tissue (includes the articular eminence)
5. Synovial membrane: lines capsule (does not cover disk except posterior region); contains folds (increase in pathologic conditions) and villi
   Two layers: a cellular intima (synovial cells in fiber-free matrix) and a vascular subintima
   Synovial cells: A (macrophage-like) syntesize hyaluronate
   B (fibroblast-like) add protein in the fluid
   Synovial fluid: plasma with mucin and proteins, cells
   Liquid environment: lubrication, ?nutrition
6. Disk: separates the cavity into two comprartments, type I collagen
   anterior and posterior portions
   anetiorly it divides into two lamellae one towards the capsule, the other towards the condyle
   vascular in the preiphery, avascular in the center
7. Ligaments: nonelastic collagenous structures. One ligament worth mentioning is the lateral or temporomandibular ligament. Also there are the spheno- and stylomandibular with debatable functional role.

Innervations
 

MAXILLARY CUSPIDS (CANINE)

The maxillary cuspid is usually the longest tooth in either jaw. canines are considered the corner stones of the dental arch They are the only teeth in the dentition with a single cusp.

Facial Surface:- The facial surface of the crown differs considerably from that of the maxillary central or lateral incisors. In that the incisal edges of the central and lateral incisor are nearly straight, the cuspid has a definite point, or cusp.  There are two cutting edges, the mesioincisal and the distoincisal. The distoincisal cutting edge is the longer of the two. The developmental grooves prominent on the facial surface  extending two-thirds of the distance from the tip of the cusp to the cervical line.  The distal cusp ridge is longer than the mesial cusp ridge

Lingual Surface:  Distinct mesial and distal marginal ridges, a well-devloped cingulum, and the cusp ridges form the boundries of the lingual surface. The prominent lingual ridge extends from the cusp tip to the cingulum, dividing the lingual surface into mesial and distal fossae.

Proximal: The mesial and distal aspects present a triangular outline. They resemble the incisors, but are more robust--especially in the cingulum region

Incisal: The asymmetry of this tooth is readily apparent from this aspect. It usually thicker labiolingually than it is mesiodistally. The tip of the cusp is displaced labially and mesial to the central long axis of this tooth.

Root Surface:-The root is single and is the longest root in the arch. It is usually twice the length of the crown.