Growth stjldies of the dentition:

A review
Coenraad F. A. Moorrees, D.D.S., Anna-Marie Gren, D.M.D.,
Laure M. 1. Lebret, D.M.D., Peter K. J. Yen, D.M.D., and
Franz J. FrShlich, Dr. Med. Dent.*
Boston, Mass.

0 cclusion of the teeth (that is, tooth alignment and intercuspation)

relates to a diversity of functional activities, the longevity of the dentition, and
facial esthetics. Orthodontists have the specific responsibility of safeguarding
the occlusion of the teeth early in man’s life cycle; in fact, their therapy is
conducted generally before dental maturation has been achieved, and the success
of orthodont.ic treatment depends in part on growth changes of the dentition and
face. Some phases of treatment and, in exceptional instances, the entire t,rcat-
ment, particularly of tooth alignment, may even be attained solely by guidance
of the ontogenetic growth process,
For these reasons, orthodontic research has focused to a large extent on
dental development and facial growt.h, but t,hc understanding of t,hese processes
is still fragmentary. Therefore, principles of guiding dental development (or
interceptive orthodontics, as it is called) cannot be fully established until suf-
ficient basic information is available.
Yet, ironically, interceptive orthodontics has been included among the pas-
sible contributions that general practitioners can make to child ca,rc, while the
growth diagnosis required for its rational planning often baffles the experienced
specialist. Nonetheless, a voluminous body of favorable clinical accomplishments
exists to encourage further exploration of mixed-dentition treatment.
To gain a perspective of dental development as a prerequisite for orthodontic
diagnosis in the mixed dentition, growth research at. the Forsyth Dental Center
has been concerned with topographic aspects, namely, attempts to (lefinc, the

600
vozume 55 Growth sbudies of dentitio?z 601
Wwnber 6

magnitude of change and particularly the differences in growth increments

among children.
It may be noted that our studies have been confined to the dentition as a
first step, and they deal only with the period beginning after completion of the
deciduous dentition at the age of 4, except for tooth formation that has been
studied from birth 0nward.l’ 2
Sillman”~ 4 has carefully documented the description of growth changes of
the gum pads and dental a.rches from shortly after birth until adulthood.
Thereby, he has clearly established the marked increments during the neonatal
period and their subsequent decrease with age. Although the increments from
4 to 18 years are comparatively small, their impact cannot be underestimated
as far as the alignment of the permanent teeth is concerned because the varia-
tions in the relationship of mesiodistal crown diameters of permanent teeth and
their predecessors, the migration of teeth in the dental arches, the changes in the
dimensions of the dental arches, and the individual differences in the timing and
sequence of the emergence of permanent teeth remain potential sources of
favorable and unfavorable trends in dental development for the individual child.

Material and methods

The developmental history of the normal dentition at 16 to 18 years of age

has been obtained by utilizing serial dental casts collected as part of the
“longitudinal studies of child health and development” at the School of Public
Health, Harvard University, under the direction of Dr. Harold C. Stuart. In
addition, serial dental casts were made available by Dr. Richard H. Stucklen,
who collected them at the Bayard School in Wilmington, Delaware. Detailed
description of this material and the criteria used for defining the normal range
of varia.tion for tooth alignmc>nt have been reported previously.’
The data have been analyzed, first, by grouping the observations on arch
length, arch breadth, and arch circumference (Figs. 1 and 2) on chronologic
age. The findings clearly suggested that growth changes were triggered by the

DECIDUOUS DENTITION PERMANENT DENTITION

I Intercanine i
r, distance 7
I

Fig. 1. Method of measuring the intercanine distance and arch length in the deciduous
and permanent dentitions.
602 Moorrccs et al.

Fig. 2. Method of measuring arch circumference from the distal surface of the deciduous
second molar or second premolar to its antimere.

36
r Intercanine distance
34
maxilla d I
T
32 II
7 I
II
30
I
I
mm I
28 I
I
I
I
26 I
I
I

I
8 IO 12 I‘ 1
YEARS

Fig. 3. Data obtained for the intercanine distance at various eruption stages for the dif-
ferent teeth (dental age] were plotted by referring to Hurme’@ mean ages of emergence.
Clinical eruption of the crown was plotted 0.8 year after emergence, except for the canine,
for which a one-year interval was used. Intermediate stages of crown eruption and paring
of data on combinations of two teeth overlapping in part of their eruption, although not
shown, were plotted also on the work sheet.
 Growth studies of dentition 603

emergence of the permanent teeth and, because of the large differences in the
level of maturation observed among children at any given age, this first analysis
TV~Xnot considered to represent dental development with sufficient precision.
The data were regrouped, thcrcfore, on the basis of dental age (that is,
various stages in the eruption of the permanent teeth), irrespective of chrono-
logic age, to discriminate between events that occurred during a specific phase
of dental development. Statistical analysis of the observations on arch length and
arch breadth, as well as spacing and crowding, was carried out both according
to the eruption status of single teeth and for combinations of teeth known to
overlap in part of their eruption (Ml-II; II-T,; C-Pm,; Pml-Pm,; Pm,-C).
Hurme’s6 standards of tooth emergence were used to scale the findings. F,or
instance, the intercanine distance at the time that the permanent maxillary
central incisors emerged and at the time that the lateral incisors emerged was
plotted at 7.5 and 8.7 years, respectively.
The eruption of one half of the tooth crown was recorded 4 months after
the age at emergence, and full eruption at 0.8 year after emergence, except that
for the canine a one-yrar span has been used (Fig. 3). These limits were ap-
proximated from the mean ages at successive levels of eruption.’ No provision
was made in the computer program for analyzing the data for the deciduous
dentition at consecutive whole-year intervals, because this information already
was available.”
Serial dental casts of persons with untreated malocclusions of the Class II
type were made available by Dr. Edward I. Silver and Dr. Henry C. Beebe
from a longitudinal survey conducted at the Forsyth Dental Center.*-lo

Findings

Vertical changes. Although the average amount of overbite is quite similar

(37 to 41 per cent of the crown height of the mandibular incisors) at 5 to 6 and
at 16 to 18 years (Table I), individual differences in the deciduous and permanent
dentitions of both sexes span a range from zero overbite to complete overlapping
of the mandibular incisors and more. Likewise, a marked (3 to 4 mm.) decrease
or a moderate (1.7 mm.) increase in the absolute overbite may occur with age.
The changes in overbite are shown graphically by grouping individuals in
three categories according to the amount of overbite at the age of 16 to 18 years,
in terms of zero to one third, one third to two thirds, and two thirds to complete

Table I. Overbite calculated as a percentage of the clinical crown height of the

mandibular left central incisor

Age range Mean 2 S.E.* S.D. Range

(years) Sex (per cent) (per cent) (per cent) Number
5 to 6 M 36.6 3.4 24.2 0 -106 50
F 39.3 3.8 24.9 0 -100 44

16 to 18 M 37.9 2.8 20.1 1.9-111 50

F 40.8 3.1 20.7 0 - 81 44
 604 Moorrees et al. AWL J. Ovthodontics
June 1969

overlapping (Figs. 4 to 6). Longitudinal records of the actual changes have

been obtained by connecting the entries for the degree of overbite at various
age levels for each individual by a line.
The findings show that deep overbite in the deciduous dentition can change
to a level considered to be within normal range at 18 years of age. In other cases

MALES

3 3-4 5-6 IO-11 16-N

AGE LEVELS

FEMALES

3 3-4 5-6 10-11 16-16

AGE LEVELS
Fig. 4. Longitudinal records of overbite in boys and girls who, at 16 to 18 years of age,
have zero to one-third overlapping of the crown of the mandibular left central incisor by
the maxillary left central incisor when the molar teeth are in occlusal contact.
 Volunze 55
Number 6 Growth studies of dentition 605

overbite increases markedly with age, and in some children the changes in over-
bite are erratic. It may be noted that none of the children studied received
orthodontic treatment and that their deciduous and permanent dentitions were
not mutilated by extractions. Moreover, inspection of the dental casts failed to
reveal an explanation of either a deepening or a raise in overbite.5

MALES
0

COMPLETE

3 3-4 5-6 IO-11 16- I8

AGE LEVELS

FEMALES

4” ,/’ i

COMPLETE-

3 3-4 5-6 IO- II 16- I8

AGE LEVELS

Fig. 5. Longitudinal records of overbite in boys and girls who, at 16 to 18 years of age,
have one-third to two-thirds overlapping of the crown of the mandibular left central
incisor by the maxillary left central incisor when the molar teeth are in occlusal contact.
606 Moorrecs et al. Am. .I. Orthodmtics
June 1969

These findings serve as a reminder that overbite is a symptom determined

not only by the position and inclination of the incisors but by an agglomeration
of factors involving disproportionate relationships bctwcen the heights of the
alveolar processes in the incisor and posterior segments of one or both jaws and
even disproportions of vertical facial de\-elopment (that is, the ra.tio between

COMPLETE

3 3-4 5-6 IO-11 16- 18

AGE LEVELS

FEMALES

3 3-4 5-6 10-I I 16-18

AGE LEVELS
Fig. 6. Longitudinal records of overbite in boys and girls who, at 16 to 18 years of age,
have two-thirds to complete overlapping of the crown of the mandibular left central
incisor by the maxillary left central incisor when the molar teeth are in occlusal contact.
 Growth studies of dentitiolz 607

maxillary and mandibular anterior and posterior face height.s) .I1 Consequently,
the correction of overbite should be conducted preferably during periods of
actjive vertical growth of the face.
Schematic description of destal dez~elopwaent. In the deciduous dcntition,
little change occurs in the interdental space between the deciduous incisors, but
the spaces between the deciduous molars close when the permanent first molars
emerge and the spaces between the deciduous canines and first molars also close
partially or completely.
The distal surfaces of the deciduous second molars generally form one plant,
unless tooth-size discrepancies exist between maxilla,ry and mandibular molars
or unless malocclusions of the Class II or Class III type prevail in the deciduous
dentition. Therefore, permanent first molars erupt in a cusp-t,o-cusp relation and
they remain in this transitional phase until the deciduous second molars arc lost.
Arch breadth, does not change materially in the deciduous dcntition from
the ages of 4 to 6 years but arch length decreases slightly, owing to the closure
of interdental spaces between the deciduous posterior teeth. Howvevcr, arch
breadth increases markedly (3 mm.) during emergence of the permanent maxil-
lary and mandibular incisors. Arch length also increases in the maxilla at this
time beca,use of the greater labial inclination of the maxillary incisors (Figs.
7 and 8).

INTERCANINE DISTANCE

mm30-

264’ 26-v’ ’ ’ ’ ’ ’ ’ ’ ’ ’ ’
4’ ’ 6’ ’ 8’ ’ ’ ’ ’ ’ ’
IO 12 14 4 6 8 IO 12 14
YEARS YEARS

28
_ mandible
26 -
Q
mm 24

Ml
I1 I I I 11 I 11 1 I I I I I
I h I II 1
20- 4 6 8 IO 12 14 2o Av 4 6 8 IO 12
YEARS YEARS

Fig. 7. Average intercanine distances in the maxillary and mandibular dentitions of boys
and girls, respectively, scaled according to dental age (tooth eruption). The arrows refer
to the mean ages of emergence of permanent teeth.”
 Am. J. Orthodontics
608 Moormcs et 1~1. June 1969

ARCH LENGTH
32 32
ni;lxilla
30
a’
Ill~Xill~
I------
30 -
Q
mm 28 mm28-

26 26 -

I I I I I I I, 6 I I 24’ “v’ ; ’ ; ’ ’ ’ ’ ’ ’ ’ I
24’--b 4 6 8 IO 12 14 8 IO 12 14
YEARS YEARS

I I I I I I I I I I I 20 ~“‘;““““‘I
20- 4 6 8 IO 12 14 6 8 IO 12 14
YEARS YEARS

Fig. 8. Average arch lengths in the maxillary and mandibular dentitions of boys and girls,
respectively, scaled according to dental age (tooth eruption). The arrows refer to the
mean ages at emergence of permanent teeth.’

The average boy or girl has just enough space to accommodate the permanent
maxillary incisors, which are 7.4 mm. wider than their deciduous predecessors,
as a result of the changes in arch size and the interdental spaces between the
deciduous incisors.lZ
In the mandible, the difference in the combined mesiodistal crown diameter
of the four deciduous and permanent incisors avcragcs 5.1 mm. Initially, ap-
proximately 1.6 mm. of crowding occurs when the permanent mandibular lateral
incisors emerge, but this space lack is largely compensated after these teeth erupt
fully, following the increase in arch breadth that coincides with the incisor
transition.12a I3
During the second phase of dental tlevclopment, additional space becomes
available because deciduous molars exceed their permanent successors, the pre-
molars, in mesiodistal crown diameter (the so-called leeway space). It serves for
alignment of the permanent canine, which is larger than the deciduous canine
in crown size. Since the leeway space on each side is greater in the mandible
(2.2 mm.) than in the maxilla (1.2 mm.), ncntroclnsion of permanent molars
is achieved from the initial cusp-to-cusp relation by- grcatcr mesial shifting of
the mandibular mo1ar.l”
Exactly how the leeway space is utilized depends on the sequence of shedding-’
 Growth studies of dentition 609

and eruption of the maxillary and mandibular posterior teeth and the molar
occlusion. If the latter teeth already intercuspate, their mesial shift may be
minimal when the deciduous second molar is maintained in one jaw while its
antagonist in the opposing jaw is lost. In this context, one must recall that loss
of tooth substance, as in cases of earious lesions in the distal surfaces of
deciduous maxillary second molars, may lead to early mcsial shifting of perma-
nent maxillary first molars into distoclusion from the normal transitory phase
of cusp-to-cusp relation. The opposite may occur in the mandible, in which
instance neutroclusion of permanent first molars results.
The second phase of dental development is not concluded before the second
premolars arc present. The clinical implication of this obvious fact may be an
undue prolongation of the treatment time that could have been anticipated.
The changes in the intercanine distances occur during the eruption of central
and lateral incisors, as stated, except for a small increment in the maxilla follow-
ing the emergence of the canine. The mean increase in the intercanine distance
is virtually completed after full eruption of the crown of the permanent lateral
incisors (Fig. 7).
The changes in arch length, in terms of average trends (Fig. 8), may be
summarized as follows :
1. Slight decrease initiated before the emergence of the permanent
first molars, owing to closure of the spaces between deciduous molars.
2. Small increase during the eruption of permanent incisors in the
maxilla but negligible in the mandible.
3. Decrease following the shedding of deciduous molars, especially the
second molar.
The first and second decreases in arch length (1 plus 3) exceed the increase
associated with the incisor emergence (2) ; in the average child, therefore, arch
length is shorter at 18 years than at 4 years, especially in the mandible.
Arch circunzfere?bce. The changes in arch length and breadth affect arch
circumference or, in essence, the space available for alignment of the teeth.
Between the ages of 5 and 18 years, maxillary arch circumference increases
slightly in the average boy (1.3 mm.) and in the average girl (0.5 mm.), while
in the mandible a mean decrease of 3.4 and 4.5 mm. occurs in boys and girls,
respectively. The individual variations in the changes in arch circumference are
considerable, as shown in Fig. 9 which depicts the range of variation encountered
at the limits of plus and minus 2 standard deviations in individuals with normal
tooth alignment at 18 years of age.
These individual variations arc explained by differences in the amount of
interdental space in the deciduous dentition, the changes in arch breadth and
arch length, the ratio of mesiodistal crown diameters of deciduous teeth and
their permanent successors, and the sequence of shedding and emergence of the
permanent posterior teeth. In the final analysis, these variables constitute the
determinants of tooth aligmnent during dental devclopment.15l I6
Tooth migratio?z. Apart from the mcsial shifting of permanent first molars
into the leeway space following the loss of deciduous second molars, mesial shift-
ing of these teeth occurs as a physiologic phenomenon. It has been measured
610 Moorrees et al. Am. J. Orthodontics
June 1969

I I I I I I I I I . ..._.............
11 I I I I I I I I I 11
.:...:: ,....,
..,.. ..,...._..,
,..., :::...: .. .. ::....::.‘.‘.:
:;: ....‘.....‘,.,.... . ... . .. . ..‘.:.::.: .. ...t.:.:.::::.:::..,
..,.,.,........ :...: .. . .. . . .._..,, ,.,.,“~.,,(,,
:::.;: M
:..;:;. ...,.;.
... .,. .____,,..
:.:,:::::.: . .. . .‘.,:;.;.:...~‘,.
.....::,..~‘,.‘.: .. . ..I...
I
~:.::::::..:~I::,.: “‘.‘.‘.:::::.::,
.,.., (,, ;,.,.,:::;;::.:... Id
..‘,‘,,‘,.:.,:‘.,.,,
‘;.,‘, .:. ;,. .,.;, ,..,..
:........,..,, :,::.:.::::
‘.‘.. M I
I
::::..::: .,.,..... :,;.>:‘.....:.,: ::::.:. ‘,...,. ‘?
‘.‘.‘.’ .:::::.. . .. .:.:::::.: ....‘....,‘.:.:.::: ‘.‘.‘. ..::;.:.; ..,::I: .,.I_~.:.~,;~,~;,.:,:,~~t::,~.~~.
.1: :: .:-::.: .,.,.,:;:.::‘: :.:...::::::,.: ,.,...,‘,
:;;;:y.~. ,..;.,.:..~..‘,.‘~;,:,y.
,., MAXILLA
t fit: ;:.:.;,::.:....,‘,.,.::.;:..;:: .... ;..:::.,...,. : : ,.,‘,.,. ‘.. . : : :.;::l:~:::~~‘..,.::‘,~,.:;;..:.::,:,:

.::.....:::,
. . ... ..y.....::::::::..:. ‘:..‘...‘:.‘..:::::.:...::::::::::::::::..::
:.,::: ,::.:,.: .‘,.;,.,.,.,,,.,.,.:.;,,.y,,;,:;,j,,
. ...,.._,.. ..: .. .:... .::::;:,.
.. ,......::; .. ...... .‘.,..,,,.,,.,:
.
. .. .. . . . I 16”
M ‘M
I
,:,. MANDIBLE
. ... .:..:::
. ._...::;:..:.::. ,._.,.;.,..‘.‘....,.,,::::::.:.:‘.:::.::::::::::~~
,‘.,..‘..........‘..,.,. :.:.: ..,. . .. . ..,.,. .,. ., .... :;;:;,::,:
,.. .....’.
I Ill IIIII I II I l I 11 11 ”
-10 -8 -6 -4 -2 0 f2 +4 +6 -t8 +I0 mm
DECREASE m INCREASE 0

INCREMENTS IN DENTAL ARCH CIRCUMFERENCE FROM 5 TO 18 YEARS

Fig. 9. Increments (mean + 2 standard deviations) in the circumference of the maxillary

and mandibular dental arches (dm,-dm,; Pm,-Pm,] of boys and girls, respectively, between
5 and 18 years of age.

for the maxillary teeth in part of the normal sample with reference to the rugae
in the apex of the palatal vault that served as a relatively stable area.17
The extent of mesial shifting for the maxillary molars after their emergence
t,o 18 years of age averaged 3.95 mm., wit.h a range from 2 to as much as 6.5 mm.
For the deciduous and permanent maxillary canines, a mcsial shift of 3.07 mm.
(range from 1.5 to 6.5 mm.) has been observed between the ages of 5 and 18
years. Physiologic mesial shifting was shown to continue after eruption of the
permanent teeth (excluding third molars) in that both first molars and canines
shifted 1.3 mm.
Class II malocclusion. Dental development in the untreated malocclusion
sample is of specific interest to the orthodontist in determining whether or not
self-correction occurs. Examination of these serial dental casts revealed differ-
ences among the Class II malocclusions conforming essentially to Angle’s
classification. Yet the Division 1 category was divided into two subgroups-(l)
one characterized by moderate overjet, severe crowding of permanent maxillary
incisors, and a V-shaped maxillary dental arch and (2) one characterized by
flaring and spacing of incisors, marked overjet, and a parabolic arch form. In
addition, a borderline category (that is, malocclusion characterized by upright,
well-aligned maxilla.ry incisors and a slight to moderate overjet) was found to
occupy an intermediate status between the Class 11, Division 1 and Division 2
malocclusions defined in the classic sense (Fig. 10).
The grading of the malocclusion sample into four subgroups has been based
on the last dental cast in each series at approximately 12 years of age. In general,
it is difficult to distinguish between these subgroups in the deciduous dentition
because of their similarity at an early age with semicircular maxillary dental
arch shape, upright position of deciduous maxillary incisors, and spacing of the
incisors, conforming to the usual morphologic pattern except for their distal arch
relationship.
 Volume 55
h’unzbe? 6 Growth studies of dentitiola 611

class II/div. 1, V-shaped class lI/div. 1, flaring and spacing

class lI/div. 2
Fig. 10. Subdivision of the Class II malocclusions into four subgroups.

Overbite in the deciduous dentitions of persons classified in the Class II,

Division 2 group was greater than for those in the Class II, Division 1 group,
but prediction as to whether a case of deep overbite will end in either category is
not reliable if based only on this symptom, because of the marked differences
in overbite among individuals in the Division 1 subgroups.“, lo
Longitudinal findings from the ages of 6 to 12 years showed an aggravation
(90 per cent) of the distal canine relationship in the Division 2 group, and no
 Am. J. Orthodontics
612 Moorrees et al. June 19FS

class II/div. 1, V-shaped class Il/div. 1, flaring and spacing

A C A C M

A C M
+

o-

+ EE
o- -

E
-

A arch length
c intercanine distance
M intermolar distance

A C M
class II/div. 2
Fig. 11. Percentage frequencies of positive and negative standard score values for arch
length, the intercanine and the intermolar distances in individuals with untreated Class II
malocclusion.

improvement occurred with age in the other three subgroups. Self-correction of

distoclusion of molars and canines was noted in only one out of ten individuals
classified in the borderline group for whom a marked but unexplained increase
in the mandibular arch length had been observed.
Comparison of the arch dimensions among persons in the four subgroups
of the Class II malocclusion sample has been made by expressing differences
from the normative data in terms of standard scores (Fig. 11).
 Growth studies of dentition 613

The arch length is short in the Class II, Division 2 group because of the
retroclined incisors, all standard scores having a negative sign. It is larger than
average (85 per cent) in the flaring and spacing group, as may be expected,
while the V-shaped and borderline groups correspond more nearly to the norm,
with equal distribution of positive and negative standard score values.
In contrast to the short arch length, arch breadth (that is, the intercanine
distance) is greater than average in the Division 2 group and in the borderline
group. It is smaller than average in the V-shaped group. The intermolar distance
in the Class II, Division 2 group has a normal distribution because the standard
score values of this dimension are equally distributed around zero (Fig. 11))
and in the other three subgroups the intcrmolar distances are smaller than
arerage, with a predominance of negative standard scores (75 to 83 per cent).
Individual variation. Considerable attention has been given in our studies
to defining the differences among children in their progress toward maturation,
as stated above.15 To illustrate the extent of such differences, a chart is re-
produced showing developmental records of nine subject.s.

AVAILABLE SPACE INTERCANINE DISTANCE

MANDIBLE
mm
MAXILLA 36-

A
34-

32-t
30- t

2 26-

0 26-

9 24-

z
cc4 22-
”

6 20-

ARCH LENGTH MESIODISTAL CROWN DIAMETER

mm mm
32- 78-

I1t+I
30 76-

28 4’ 74-

26- 72-

24- 70

:I
22- 68

2DL 66-

64-

MANDIBLE

Fig. 12. Available space, arch length, intercanine distance, and combined mesiodistal
crown diameters of the teeth in the deciduous dentition (3 to 4 years of age) and in
the permanent dentition (16 to 18 years of age) obtained from nine persons. (Arrow-
heads refer to findings in the permanent dentition; tails of arrows refer to the correspond-
ing findings in the deciduous dentition.)
614 Moorrccs ot cd.

The data in Fig. 12 have been arranged from left to right on the basis of
the greatest amount of available space in the tlrcitluous dentition. ‘l’hc~location
of the arrowheads refer-s to the findings for a~;lilable space, arch I(~ng~l~.int cr-
cxninc distances, untl mwiotlistal vrowri cliamctc~rx (Pna2-t’na9) in tlic pvrmarwnt
dcntition at the age of 16 to 18 years. Thcl c~ndsof the tails of the arrows irtdicatc
the corwxponding dries for the dccitluous dentition in the same chiltl at age 1.
The direction of the arrows and their lengt,hs show direction and amount of
change between these two age levels. It is cvidcnt that the changes are cwwcling1.v
variable in t,he growth rwortls of these nine p~~r~~ns.In addition, the increments
in arch size, the changes in available spacc~, and the differences in the C~‘OWJ
size of tlcciduous (f/m,-dvl~,) and p?lYni~~lP~lt (t’m-I’?l12) tWtl1 arc not, (‘OI’J’CliLt(~(l.”
Because of ma~ketl individual variations, misetl-dentition analysis reyuircs
at,tention to a numbc~~ of variables. Some of thcsc variablw can bc defined wit,11
considerable precision, such as lJlf?i~SUJ’ilJg’ mcsiotlistal crown diamc>tws or pCr~Jlil-
nent incisorx and thn remaining dwidnous teclth OJI dental casts. The leC\W>-
space’ c can be dt+c~imiritvl I,- mcasu~in~ uneruptctl ~lY~JllOlill3 and wnines 011
l?it~iOglYlJJJS when the latter arc taken spwifically for’ this p~rposc, tllilt is, with
the central beam perpendicular to the filrtl.
In addition to the wown diamctcrs ot’ uneiwpted teeth, their approsimatc
time of emergence can be assessed by wf~~rriri, 07to tlic amount of root length at-
tained at the t,ime of the initial examination, the table of awrage time intervals
between at.tainmcnt of root-formation stages, and the fact that I~r*errrola~s gcn-
cra.lly emerge in the mouth with one llidf to tlucck quarters of their root lcngthls
(Table II and Fig. 13).
Moreover, the space available for an uneruptcd tooth in the dental arqch, its
distance from the alveolar crest,, and its inclination as well as the amount of
wsorption or loss of the deciduous pr~~dcccssor are helpful if one wislic>s 1.0
obtain grcatcr precision in estimating the actual cmergencc.‘”
On the basis of the growth diagnosis, the use 0.f space-mairrtairrirrg or space-
rcga.ining appliances, such as lingual nrclics, IlCa(lgcilr appliances, arid removable
appliances, together wit,h judicious cstraction of deciduous or pcrmancnt t&h,
may 1X prcscrihctl t,o iuflucnce tllc tlXrlsitiolld Stil@JS of tlental tlcvelopmcnt~ in a
Cavorable tlirrction.

Table II. Mean time interval between four stages of root formation

Canine lf’irst premolar J’cconrl prcmolur

mean time mean time mcax time
iderval interval int/‘l.Val
Stage interval SCX (years) (wars) (wars)
Root 1/ to yz M 2.3 1.7 1.6
F 1.8 1.7 1.3

Root l/4? to 3/1 M 1.6 1.4 1.4

F 1.2 1.1 1.2

Root 3/a to root length M 0.G 0.5 0.9

complete F 0.6 0.7 0.7
 Growth studies of dentition 615

ROOT DEVELOPMENT AT TOOTH EMERGENCE

% <: Pm, Pm,

1OOr

80

60

40

20

80

60

40

20

0
l/4 l/2 3/4 R,’ l/4 l/2 3/4 R; l/4 l/2 3/4 R;

l Full root (open apex)

Fig. 13. The extent of root formation at emergence of the permanent mandibular canine
and premolars.

The findings presented serve to illustrate the dynamic aspect of occlusion in

the! growing child as well as the diversity in developmental trends among indi-
viduals. Mixed-dentit.ion treatment, therefore, requires a highly individualized
approach which should bc instituted only after a definite indication has been
established by thorough analysis of clinical records at the time of consultation.
The presence of sagittal and vertical arch discrepancies greatly adds to the
complexity of mixed-dentition diagnosis, and the timing of treatment also be-
comes more difficult. Moreover, one must also determine whether and to what
extent early treat,mcnt facilitates or shortens the second phase of treatment that
all too frequently is required, once the premolars and permanent canines have
rrupted.
It may be concluded that mixed-dentition treatment of Classes I and II
malocclusions can be the most efficient orthodontic care for a specific patient if
warranted by a carefully made analytical diagnosis.20
REFERENCES
1. Moorrces, C. F. A., Fanning, E. A., and Hunt, E. E., Jr.: Age variatioxl of formation
stages of ten permanent teeth, J. D. Res. 42: 1490-1901, 19G3.
2. Moorrees, C. F. 9., Fanning, E. A., and Hunt, E. E., Jr.: Formation and resorption of
tlwee deciduous teeth in children, Am. J. Phy~. Anthrop. 21: 205-214, 1963.
 3. Sillman, J. H.: Dimensional changes of the dental arches: I,ongitudinal study frour
birth to 25 years, AM. J. ORTHODONTICS 50: 824-842, 1964.
4. Hillman, J. IT.: Some aspects of individual ~lcntal dorclopmcwt, Anr. J. ~)R1’1lODONTTCS
51: l-25, 1965.
5. Moorrees, C. F. A.: The dentition of the growiug child, Camljridge, Mass., 1959, Harvard
University Press.
6. Hurmc, 1’. 0.: Ranges of normalcy in the eruption of permanent teeth, J. Dent. Childrru
16: 11-15, .1949.
i. Moorrecs, C. E’. A.: Variability of dental and facial development, J. New lVork Acatl.
Sv. 134. . 946-857
I f 1966 .
8. Silver, E. T.: Forsyth orthodontic survey of untrcatcd caws, Anz. J. OKTJI~I~NTICS fi-
ORAL %KGEK\i 30: 635-659, 19tt-r.
.0 Friihlicll, I!‘. J.: A longitudinal study of untreatwl Class II type malowlusion, 1’r.
Europeau Orthodont. Sot., pp. 137-151, 1961.
10. Frlihlich, E’. J.: Changes in untreated Class IT type malocclusions, Angle Orthodontist
32: 167.170 1962.
11. Moorrecs, c: F. A.: Occlusion, J. Periodont. 38: 751-760, 1967.
12. Moorrees, C. F. A., and Chadha, J. M. : Available space for the incisors during dental
development--A growth study based on physiologic age, Angle Orthodontist 35: 12-22,
1965.
13. Moorrces, C. F. A., and Reed, R. B.: Changes in dental arch dimensions expressed on the
basis of tooth eruption as a measure of biologic age, J. I). Res. 44: 129-339, 1965.
14. Moorrees, C. F. A., and Chadha, J. M.: Crown diameters of corresponding tooth groups in
the deciduous and permanent dentition, J. U. Res. 41: 466-470, 1962.
15. Moorrees, C. F. A.: Normal variation in dental tlcvelopment determined with reference
to tooth eruption status, J. I). Res. 44: 161-173, 1965.
16. Moorrees, C. F. A., and Xeed, B. B.: Corrc~lations among crown diametrrs of human teeth,
Arch. Oral Biol. 9: 685-697, 1964.
17. I.ebret, L.: Physiologic tooth migration, J. I). Res. 43: 610-618, 1964.
18. Gr@n, A. M.: Prediction of toot.11 emergence, J. I). Hw. 41: 573-585, 1962.
19. Moorrecs, C. F. A., Fanning, E. A., Gr@n, A. M., and Lebret, L.: The timing of ortho-
dontic twatment in relations to tooth formation, Tr. European Orthodont. Sot. 38: 87-101,
1962.
20. Moorrees, C. F. A., and Gr@n, A. M.: Principles of orthodontic diagnosis, Angle Ortho-
dontist 36. 258-262, 1966.

140 The Fcnwny