WELCOME

TO
“MIXED DENTITION”
 DEFINITION
The period during
which both primary & permanent
teeth are in the
mouth together is known as the
mixed dentition period.
Successional teeth : Those permanent
teeth that follow into a place in the arch
once held by primary tooth
E.g.-Incisors, Canines, Premolars

Accessional teeth : Those permanent

teeth that erupt posteriorly to the primary
teeth
E.g.-Molars
Phases of Mixed Dentition

# First transitional period

# Inter transitional period
# Second transitional period
 First Transitional Period

It is characterized by :

 The emergence of first permanent

molars
 The exchange of primary incisors
with permanent incisors
 Emergence of first permanent
molars

The location & relationship of first

permanent molar depends much upon the
distal surface relationship between the
upper & lower second primary molars.
 “Changes in Occlusion”
• Flush terminal plane may lead to:
- Class I [ with late mesial shift ]
- Class II
- End-to-end

• Mesial step may lead to:

- Class I [ normally ]
- Class III
• Distal step leads to:
- Class II
FLUSH TERMINAL PLANE (FTP)

Class II

Class I (desirable)

FTP
End-to-end
MESIAL STEP

Class III

Class I (desirable)
MESIAL
STEP
DISTAL STEP

ALWAYS
Class II
DISTAL
STEP
 Early Mesial shift

If the primary dentition is spaced dentition with flush

terminal relationship of second primary molars, the
eruptive forces of the permanent molar causes closing
of any existing spaces between the primary molars
(primate spaces) effectively causing a decrease in
arch length.
 Late Mesial shift

When no spaces exist, the erupting first permanent

molar is not able to close spaces. In these cases when
the primary molars exfoliate the permanent molars
migrate mesially to use up the Leeway space.
 Late Mesial shift

Class I
FTP Molar moves
into this
space
 Exchange of incisors

The permanent incisors are larger

than the primary teeth they replace.
This difference between the amount
of space needed for the
accommodation of the incisors & the
amount of space available for this is
called INCISAL LIABILITY.

7 mm 6 mm
(maxillary arch) (mandibular arch)
 “Overcoming Incisal Liability”

1) Interdental spacing of primary incisors

2) Intercanine arch width growth
3) Labial positioning of permanent incisors
4) Favorable size ratio between primary &
permanent incisors
1) Interdental spacing of primary
incisors
Good interdental spacing of primary incisors
allows for better alignment of the larger
permanent incisors.

Proper alignment Crowding

 2) Intercanine arch width growth
- Increased intercanine width creates more
room for the permanent incisors.
- Mandibular intercanine width increases
mostly during permanent incisor eruption.
- Maxillary intercanine growth occurs during
incisor eruption & continues unpredictable.
3) Labial positioning of the permanent
incisors
Permanent incisors erupt to a more labial
position & are angled more labially, thereby
increasing the arch length.

130*
160*

PRIMARY PERMANENT
 4) Favorable size ratio between the
primary & permanent incisors

Size ratio may be favorable or unfavorable.

• Favorable : large primary, small permanent
• Unfavorable : small primary, large permanent
 UGLY DUCKLING STAGE
(Broadbent phenomenon)
 It is a transient/self-correcting malocclusion
seen in the maxillary incisor region between
8-9 yrs of age.

 Erupting permanent canines displace the

roots of lateral incisors mesially, resulting in
transmission of force on to the roots of
central incisors which also get displaced
mesially.
 A resultant distal divergence of crowns of
two central incisors causes a midline
spacing. This situation has been described
by Broadbent as the UGLY DUCKLING
STAGE as children tend to look ugly during
this phase of development.
 Inter-transitional Period

In this period the maxillary & mandibular

arches consists of sets of primary &
permanent teeth i.e.
- permanent incisors
- primary canines & molars
- first permanent molars
Features of Inter-transitional period
• Under the influence of tongue, the
mandibular lateral incisors assume their
proper position in the arch & its initial lingual
location is eliminated.
• Small discrepancies are corrected by
pressure exerted by tongue & lips.
• No fixed intercusp relation is present, this
helps in mesial drift of mandibular teeth.
 Second Transitional Period
It is characterized by the replacement of the
primary molars & canines by the premolars &
permanent canines respectively.
The combined mesiodistal width of the
permanent canines & premolars is usually less
than that of the primary canines & molars.
This surplus space is called LEEWAY SPACE .
It is - 1.8 mm in Maxilla (0.9 mm each side)
- 3.4 mm in Mandible (1.7 mm each side)
LEEWAY SPACE
Features of Second Transitional Period
• Early Duckling stage is corrected.
• Arch loses its roundness.
• Most common sequence of eruption is :
4-3-5 in maxilla
3-4-5 in mandible
• This sequence is essential to prevent
crowding & utilization of Leeway space.
• The dental arch length & arch
circumference decreases with mesial
force.
MIXED DENTITION ( Late childhood )
 REFERENCES:
1. TEXTBOOK OF PEDODONTICS:
SHOBHA TANDON
2. DENTISTRY FOR CHILDHOOD AND
ADOLESCENT:
McDONALD, AVERY
3. TEXTBOOK OF ORTHODONTICS:
GURKEERAT SINGH