The Effect of First Permanent Tooth Eruption on Dental Arch Dimension

AUTHORS

Sara Ghadimi 1 , Mandana Tosifian 2 , Ali Baghalian 1 , Bahman Seraj 1 , *

1 Pediatric Dentistry Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

2 Dentist, Tehran, Iran

How to Cite: Ghadimi S, Tosifian M, Baghalian A, Seraj B. The Effect of First Permanent Tooth Eruption on Dental Arch Dimension, Iran J Ortho. 2019 ; 14(2):e99738. doi: 10.5812/ijo.99738.

ARTICLE INFORMATION

Iranian Journal of Orthodontics: 14 (2); e99738
Published Online: January 22, 2020
Article Type: Research Article
Received: November 26, 2019
Revised: December 29, 2020
Accepted: December 30, 2019
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Abstract

Background: Crowding is one of the most prevalent types of malocclusion as well as a major problem in clinical orthodontics. It is essential to know the cause of crowding in order to achieve a better treatment.

Objectives: A longitudinal analysis of arch dimension changes in late primary and early mixed dentition periods in children was designed and investigated the effect of eruption of precedence on the arch size in the samples under study.

Methods: This longitudinal study was carried out on 32 children aged 5.5 - 6.5 years who had no erupted permanent dentition. Impression was taken and the arch perimeter, depth and width as well as tooth size were measured by a digital calliper and a brass wire on casts. After eruption of the first permanent tooth, the second impression was taken; the above-mentioned parameters were measured on the second casts. Data were analysed by ANOVA test.

Results: Four pattern of eruption of precedence were as follows: maxillary 1st molar, mandibular incisors, Mandibular 1st molars and simultaneous eruption of maxillary and mandibular 1st molars. With eruption of mandibular central incisors, inter canine width and overjet increased by 0.81 and 0.27 mm, respectively. The mandibular arch perimeter increased by 2.25 mm with simultaneous eruption of maxillary and mandibular permanent first molars. The maxillary arch perimeter increased by 1.25 mm and 1.50 mm with eruption of maxillary first molars and simultaneous eruption of maxillary permanent first molars, respectively.

Conclusions: Eruption precedence had a significant effect on changing mandibular inter canine width, maxillary arch perimeter, mandibular arch perimeter and overjet.

Copyright © 2020, Iranian Journal of Orthodontics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Crowding is one of the most common malocclusions and an important problem in clinical orthodontics (1). White and Barrow reported the prevalence of mandibular incisor crowding to be 14% at age 6 and 51% at age 14 (2). Also, prevalence of dental crowding is variable among different populations as the study of Normando et al. showed the prevalence of dental crowding was significantly higher in Arara-Laranjal than Arara-Iriri population (3).

Mandibular anterior crowding in mixed dentition period makes the children, their parents and paediatric dentists worried (4). Although the role of genetic and environmental factors in aetiology of crowding is still under question, new evidence suggests that dental crowding, which has been caused by over processed modern foods, is a common malocclusion in post-industrial humans (5). Thus, knowledge of the factors involved in crowding and its anticipation is of great significant in achieving a better treatment. Mandibular anterior crowding is defined as the difference between tooth size and arch size, which causes malocclusion (6). Crowding of incisors is not merely due to tooth-arch size discrepancy and more variables are involved in this difference (7).

According to Linden classification (8), crowding is divided into three types based on its causes: (1) hereditary disorder in harmony between tooth size and arch length; (2) environmental factors like dental caries and extraction; (3) delay type which is seen after puberty.

Barber (9) has introduced some of these environmental factors, and believes that crowding can be due to unusual muscular forces, ectopic eruption pattern and occlusal forces, which cause mesial displacement and loss of arch length and consequently dental caries. Lavelle (10) has also proposed that age and race play a role in crowding. Some researchers are in agreement with the theory of the presence of relationship between tooth size and arch size in crowding (1). That is why no study has been conducted in this regard to obtain a closer connection between these two variables. On the other hand, because crowding is seen in many patients even after orthodontic retention periods, this issue has probably more details and influential factors that need to be investigated in future research and maybe one of the factors that could influence crowding is arch changes related to the eruption precedence of permanent teeth.

2. Objectives

Since crowding is multifactorial, this study was aimed to explore the effect of eruption precedence of the first permanent teeth on the arch size changes and developing crowding.

3. Methods

The study protocols were approved by the Regional Committee for Medical Research Ethics (Code #5076).

After making arrangements with Social Welfare Department of Saveh city, taking letters of permission for Kasra and Minoo kindergartens and taking informed consent from the children’s parents, 81 children aged 5.5 - 6.5, including 42 girls and 39 boys, who had no erupted permanent tooth were included in this study.

The inclusion criteria consisted of presence of all primary dentition, being in late primary dentition period, absence of dental restorations or caries that had caused degradation of marginal ridge and absence of loose primary teeth. A form was also prepared to record the data. Samples being selected, each child was given a code, and personal information was recorded in the first part of the form with a specific code. Then, intraoral examinations were performed, and presence or absence of spacing and crowding, type of occlusion and presence of tooth abrasion were analysed, and the obtained data were recorded in the second part of the form. Next jaw impressions were taken and wax bite was also registered.

Since taking the children’s impression with alginate was difficult in kindergartens, putty impression material (Speedex, Swiss) was chosen. The impression was checked for absence of bubble and accurate recording of all the teeth. Also, a part of vestibule depth was analysed. The impressions which did not fulfil the above-mentioned requirements were repeated again. The impressions were disinfected by spray (Deconex, Switzerland). Then, casts were prepared with type IV plaster (ERNST, Germany) because of high resistance against abrasion, scratch and damage. The quality of casts was evaluated. The inter-canine width from the tip of primary canine cusps and inter molar width from the central fossa of primary second molars were measured by a digital calliper (INSIZE, USA, 0.01). A brass wire was used to measure the arch perimeter of jaws.

The wire was extended in a curve line from distal surface of second primary molar on one side around the tooth arch on the contact points and incisal edges to the distal surface of primary second molar of the other side. Then, the wire was placed on a millimeter ruler and perimeter size was recorded. The overbite and overjet values of the casts prepared from the first stage impressions were calculated by probe. To measure the length or depth of arches, a line tangent to the distal surfaces of primary second molars was drawn, and a line perpendicular to this line was drawn from the central incisors. The distance between the intersection of these two lines and the midpoint of central incisors was recorded by a digital calliper as the arch length. Each measurement was done twice in two different times, and the mean value obtained was recorded as the final measurement. The children under study were examined once a month until their first permanent tooth was fully erupted. Following the full eruption of the tooth, the second putty impression (Speedex, Swiss) was taken. The casts were prepared with Moldano plaster the same as the first stage and were trimmed by orthodontic method. Then, the above-mentioned parameters were measured on them, and the obtained data were recorded in the given form. From 81 children included in the study, 32 of them, including 18 girls and 14 boys were subjected to second stage impression taking, and the rest of them were lost because the study was lengthy.

4. Results

From 81 children included in the study, 32 children (18 girls and 14 boys) experienced two-stage impression technique, and the rest of samples were lost because of the longitudinal nature of the study.

The data obtained from the measurement of casts were analysed statistically. Description of data is presented in details in the Tables 1-3.

Table 1. Description of the Arch Sizes by mm (N = 32)
MinimumMaximumMean ± SD
Inter molar width.man*.131.4840.1833.41 ± 1.66
Inter molar width.man.232.1740.8634.04 ± 1.73
Inter molar width.max.134.1346.0938.33 ± 2.08
Inter molar width.max.234.2846.3438.89 ± 2.04
Inter canine width.man.120.2225.4822.77 ± 1.45
Inter canine width.man.220.5426.0023.28 ± 1.56
Inter canine width.max.124.5333.1528.61 ± 1.75
Inter canine width.max.224.6733.3128.99 ± 1.77
Over bite.1-4.003.001.25 ± 1.39
Over bite.2-2.003.001.46 ± 1.08
Over jet.10.004.001.76 ± 0.72
Over jet.20.004.001.75 ± 0.75
Arch perimeter.man.162.5079.5071.12 ± 3.89
Arch perimeter.man.263.0081.0072.03 ± 3.97
Arch perimeter.max.171.0087.5077.49 ± 3.81
Arch perimeter.max.271.0088.0078.09 ± 3.73
Arch depth.man.120.0728.2224.20 ± 1.63
Arch depth.man.220.6828.1724.67 ± 1.58
Arch depth.max.122.6530.0127.01 ± 1.61
Arch depth.max.222.8530.9027.63 ± 1.69

Abbreviations: *max, maxilla; man, mandible; 1, first stage data in primary dentition period; 2, second stage data after eruption of the first permanent tooth

Table 2. Description of Arch Size Changes After Eruption of the First Permanent Tooth
MeanStd. DeviationStd. Error
*Diff.inter molar width.man
Lower central0.540.380.11
Lower first molar0.800.380.10
Upper first molar0.120.500.25
Both lower and upper first molar0.971.411.00
Diff.inter molar width.max
Lower central0.450.410.12
Lower first molar0.460.260.06
Upper first molar0.990.460.23
Both lower and upper first molar0.910.980.69
Diff.inter canine width.man
Lower central0.810.500.15
Lower first molar0.400.290.07
Upper first molar-0.040.020.01
Both lower and upper first molar0.660.120.09
Diff.inter canine width.max
Lower central0.470.300.09
Lower first molar0.340.380.09
Upper first molar0.270.450.22
Both lower and upper first molar0.300.670.47
Diff.over bite
Lower central0.500.670.20
Lower first molar0.030.120.03
Upper first molar0.250.500.25
Both lower and upper first molar0.000.000.00

Abbreviations: *man, mandible; max, maxilla; diff, difference

Table 3. Description of Arch Size Changes After Eruption of the First Permanent Tooth
MeanStd. DeviationStd. Error
*Diff. overjet
Lower central0.270.460.14
Lower first molar-0.160.360.09
Upper first molar0.000.400.20
Both lower and upper first molar-0.500.700.50
Diff.arch perimeter.man
Lower central0.680.640.19
Lower first molar0.990.580.15
Upper first molar0.500.000.00
Both lower and upper first molar2.250.350.25
Diff.arch perimeter.max
Lower central0.110.780.23
Lower first molar0.660.720.18
Upper first molar1.250.500.25
Both lower and upper first molar1.500.700.50
Diff.arch depth.man
Lower central0.330.440.13
Lower first molar0.620.570.14
Upper first molar0.220.190.09
Both lower and upper first molar0.600.700.50
Diff.arch depth.max
Lower central0.761.400.42
Lower first molar0.440.520.13
Upper first molar0.700.510.25
Both lower and upper first molar0.920.570.41

Abbreviations: *man, mandible; max, maxilla; diff, difference

As for the eruption precedence, the first permanent tooth erupted in four different modes: 11 cases with eruption of mandibular central incisors, 5 cases with eruption of maxillary first molar, 9 cases with eruption of mandibular first molar and 7 cases with simultaneous eruption of maxillary and mandibular first molars. Figure 1 illustrates the frequency of eruption precedence of central incisors or first molars in the studied samples.

Frequency of eruption precedence of central incisors/first molars in the studied samples
Figure 1. Frequency of eruption precedence of central incisors/first molars in the studied samples

Further, the changes of variables with different eruption precedence (central incisor or first molar) were analysed by ANOVA, whose results are shown in Table 4. The findings showed eruption precedence had a significant effect on mandibular inter canine width, maxillary arch perimeter, mandibular arch perimeter and overjet.

Table 4. Association of Measured Variables with Different Statuses of Eruption Precedence of the First Permanent Teeth
Eruption PrecedenceP Value
Inter-molar width man> 0.05
Inter-molar width max> 0.05
Inter-canine width man0.003
Inter-canine width max> 0.05
Arch perimeter man0.006
Arch perimeter max0.022
Arch depth man> 0.05
Arch depth max> 0.05
Overbite> 0.05
Overjet0.038

The inter-canine width was significantly higher in the group with eruption of mandibular central incisors than the other three groups. With eruption of mandibular central incisors, inter-canine width increased by 0.81 mm. The overjet significantly increased by 0.27 mm in the group with eruption of mandibular central incisors. The mandibular arch perimeter was significantly higher in the group with simultaneous eruption of maxillary and mandibular first molars than the other three groups. With simultaneous eruption of maxillary and mandibular permanent first molars, the mandibular arch perimeter increased by 2.25 mm. The maxillary arch perimeter was significantly higher in the group with eruption of maxillary first molar and the group with simultaneous eruption of maxillary and mandibular permanent first molars than the other two groups. With eruption of maxillary first molar, arch perimeter increased by 1.25 mm, and with simultaneous eruption of maxillary and mandibular permanent first molars, the arch perimeter increased by 1.50 mm.

5. Discussion

A challenging issue in orthodontics is anterior dental crowding before and even after orthodontic treatment. Lopez-Areal et al. compared crowding rate in 51 patients before treatment, after treatment and after retention period and found that maxillary incisor crowding and arch length change recurred over time (11).

Although crowding is the most common type of malocclusion (12, 13), presence of short period of mandibular anterior teeth crowding has been accepted as a normal developmental stage (14). This crowding is compensated by increased inter-canine width, labial position of permanent incisors relative to primary incisors and backward movement of canine to primate space (14). Aminabadi et al. conducted a study on 105 children aged 5 - 7.5 years whose mandibular permanent incisors had erupted on the lingual side of primary incisors. They showed that considering all the three groups with balanced space, additional space and shortage of space as a whole, 70.45% of them lost their primary incisors without any trouble and only 14.8% needed extraction of primary incisors (15). Incisor crowding is observed in both adolescents and adults (16). Jonsson et al. observed a significant increase in mandibular anterior crowding over a 25-year follow-up of patients (17).

Warren et al. (1) analysed the relationship of tooth size with arch length in two periods in a geographical region among a similar number of girls and boys and reported that maxillary and mandibular perimeter reduced over time. However, mandibular crowding increased in the given time. In a study on 47 children, Sampson and Richards (18) studied the prediction of probable crowding in mandibular incisors and canines in mixed dentition period and concluded that the arch shape and mesiodistal size of incisors were important determinants of crowding. In their longitudinal study on 150 children, Sanin and Savara (7) investigated the factors affecting the alignment of mandibular anterior teeth. They concluded that labial position of central incisors, higher inclination of permanent molars in maxillary plane and small size of mandibular incisors in mesiodistal dimension reduced the extent of crowding. They studied the children in two stages. First, when the mandibular incisors and permanent first molars had erupted, and when all permanent teeth anterior to first molars were in occlusion and most subjects had second molars. In the present study, we also studied the children in two stages, but in our study the first stage was in the late primary dentition period and the second stage was when the first permanent tooth had been fully erupted. In the current study, eruption of central incisors and permanent first molars was taken into account, while in the study of Sanin and Savara (7), eruption of all incisors and permanent first molars was considered important. They also found that 89% of patients with dental crowding had also crowding in permanent dentition in early mixed dentition, and crowding was treated in only 11% of them.

It can be concluded from the above studies that arch perimeter, shape, size, alignment and inclination of incisors and permanent molars are important variables involved in mandibular anterior crowding. Some acquired habits such as finger sucking make the teeth lingual and cause mandibular anterior crowding. Thus, the importance of such attributes has to be explained to the parents, and in the case of presence of such habits, relevant therapies need to be implemented. In addition to the above-mentioned points, dental eruption precedence is an important element involved in crowding

Eruption of mandibular central incisors, mandibular first molars and maxillary first molars occurs in the age range of 6 - 7 years (19). In a number of children, central incisors erupt firstly, and in another group, molars erupt first (20). Based on this difference in the time of eruption, this hypothesis comes to mind that eruption precedence of mandibular first molars or central incisors can affect inter-molar and inter-canine width, arch perimeter, arch depth, overjet and overbite during transition from primary dentition period to permanent dentition period. Eruption of maxillary central incisors occurs in the age range of 7 - 8 years (19), which is about one year later than the eruption of maxillary permanent molars. Therefore, eruption of maxillary permanent first molars usually occurs first. Absence of simultaneous eruption of maxillary central incisors and permanent first molars diminishes the importance of eruption precedence in maxilla compared to mandible. Eruption precedence of permanent first molars or mandibular central incisors is one of the factors that have rarely been investigated in other studies. In fact, the relationship of this variable with other variables of children’s dental system, which is in mixed dentition period, has been almost disregarded.

In our study, there was a significant association between eruption precedence and inter-canine width. Inter-canine width increased more in the group with eruption of mandibular central incisors than the group with eruption of first molars. Intercanine width increase between the ages of 6 and 9 associated with the eruption of permanent incisors observed in other studies too (2, 21). This can be due to the larger mesiodistal size of permanent central incisors rather than primary central incisors, which exerts a force to the primary lateral incisors and primary canines and increases the inter- canine width.

In the current study, the mandibular arch length increased with simultaneous eruption of maxillary and mandibular permanent first molars. The maxillary arch perimeter had higher increase with eruption of maxillary first molar and simultaneous eruption of maxillary and mandibular first molars than with eruption of permanent central incisors. This can be due to the eruption of maxillary first molar buccodistally. However, further studies are required to find a definitive reason for this increase. Arsalan et al. showed that there was no significant differences in arch perimeter and arch depth during the transition from mixed to permanent dentition in all groups (22). This difference could be attributed to the permanent dentition which was evaluated in Arsalan et al. while in this study we evaluated early mixed dentition not the permanent dentition.

As eruption precedence affects dental crowding, dental crowding also affects tooth eruption. For instance, Moshkelgosha et al. carried out a study on 72 children aged 8 - 12 years and reported that eruption percentage of mandibular first premolar was significantly higher than that of canine in the children with dental crowding, while this eruption difference was not significant in children without dental crowding (23).

The arch dimensions change regularly during growth and development, but this change is lower in adulthood (24). In the present study, measurement of inter-canine width, inter-molar width, arch perimeter and depth, overjet and overbite was done on dental casts in two stages, including primary and mixed dentition periods.

Normando et al. showed that inter-canine-width, inter-molar-width and arch length were higher in Assurini population than Arara and Xicrin-Kaiap populations (25). The study of Ling and Wong on 358 children aged 12 years in south China indicated that, except in incisor area, boys had a higher arch width than girls, and these children had a larger arch width than Caucasian children (26). The results of the research by Zafarmand et al. on 3 - 5-year-old Filipino children showed inter-canine width and inter-molar width in girls and arch length in boys were significantly different between various age groups (27).

Heikinheimo et al. reported maxillary arch perimeter during transition from mixed dentition (8 - 9 years) to permanent dentition (13 - 14 years) significantly increased in both genders, while it was reverse in the mandible. Heikinheimo et al. showed intercanine width increased both in girls and boys from 7 to 10 years old and intermolar width increased between 7 and 15 years of age. Overjet was also increased between 7 to 10 years old and overbite increase was observed between 7 and 12 years old (28). Further, in this study canine-molar distance and incisor-molar distance in all four segments in this transition period were decreased, but incisor-canine distance was increased (29). A similar study by Wermerson showed maxillary and mandibular arch perimeter reduced more than maxilla during transition from mixed dentition to permanent dentition (30). In a forty-year follow-up study on 22 patients starting from age 13, Massaro et al. reported that anterior crowding and clinical crown height of posterior teeth increased and mandibular inter canine width, arch length and arch perimeter significantly decreased. Moreover, maxillary and mandibular inter-molar width slightly increased, but this difference was not statistically significant (31).

In the present study, inter molar width increased more after eruption of first permanent tooth than primary dentition period. Further, mandibular inter-canine width, maxillary and mandibular arch perimeter and overbite increased.

Based on the above studies, it can be concluded that inter-canine width, maxillary and mandibular arch perimeter and overbite increase slightly in transition from primary dentition to mixed dentition period. In addition, mandibular arch perimeter reduces in transition from mixed to permanent dentition period. However, these values decrease in permanent dentition (from about the age of 13). As for these changes after orthodontic treatment, Lopez-Areal et al. reported that inter-canine width, inter-molar width and overjet were almost the same after orthodontic treatment (11).

So it seems that eruption precedence of permanent teeth could be considered among the factors which could influence the crowding in arches.

5.1. Conclusions

The eruption precedence had a significant impact on mandibular inter-canine width, maxillary arch perimeter, mandibular arch perimeter and overjet.

Acknowledgements

Footnotes

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