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Concepts of occlusion Australian evidence.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 82247-256 (1990)
Concepts of Occlusion: Australian Evidence
T. BROWN, G.C. TOWNSEND, L.C. RICHARDS, ANI) V.B. BURGESS
Department of Dentistry, The University of Adelaide, Adelaide, South
Australia 5000
Dental occlusion, Tooth size, Craniofacial growth,
KEY WORDS
Australian aborigmals
ABSTRACT
Longtudinal studies of aboriginal children over a 20-year
period have drawn attention to the wide variation in morphologicalfeatures of
the dentition and the way in which occlusal relationships develop. This paper
summarizes some important determinants of optimal occlusal development,
namely, tooth size relationships within and between dentitions, the patterns of
alveolar growth, and tooth migrations during the transition from primary t o
permanent teeth and the nature of growth changes in the dental arches.
Dental occlusion constantly changes throughout life in response to changing
functional requirements. Observations limited to cross-sectional material
provide an incomplete, and sometimes misleading, concept of dental occlusion
and masticatory function.
Morphological variations in the craniofacia1 structures of past and present Australasian populations are well-documented in an
extensive literature spanning the last century. Reviews, bibliographies, and, in some
instances, original data are provided in
many reports (for exam le, Morant, 1927;
Hrdlicka, 1928; Campbe 1 et al., 1936; Fenner, 1939; Abbie, 1963; Howells, 1973;
Brown, 1973;Thorne, 1976; Houghton, 1978;
Prokopec, 1979; Thorne and Wolpoff, 1981;
Kean and Houghton, 1982; Brown, 1982;
Pietrusewsky, 1984; Macho and Freedman,
1987). Most descriptions have been concerned with metric and nonmetric features
of the skull, but the dentition has also received considerable attention, particularly
with respect to regional differences, phylogenetic chan es, crown morphology, and, more
recently, tfle effects of Western foods and
food habits that are replacing the more traditional forms of hunting, gathering, and
agriculture in many regions (Campbell,
1925; Campbell and Barrett, 1953; Taylor,
1962; Barrett, 1969; Lombardi and Bailit,
1972; Hanihara, 1976; Townsend and
Brown, 1979;Brace, 1980; Smith et al., 1981;
Molnar et al., 1983; Corruccini and Pacciani,
1983; Sekikawa et al., 1986).
The majority of investigations have been
cross-sectional in design using museum material of varying antiquity or field observations of contemporary groups. Studies such
f
@ 1990 WILEY-LISS, INC
as these are limited, as they relate t o populations and individuals at the time of examination; they can provide only indirect information on growth changes and the effects of
agmg and changing functional requirements
on the craniofacial structures. However,
knowledge of the various determinants of
occlusal relationships throughout the life of
an individual provides additional valuable
insights into the nature of dental occlusion
and masticatory function, which have important implications for population comparisons and the study of evolutionary changes
in the face and dentition. In some circumstances, the examination of museum material representing earlier populations that
lived under harsher environmental conditions than exist today provides the only
means to study occlusal adaptation in dentitions and jaw structures subjected to heavy
loading through both masticatory and nonmasticatory use (Richards and Brown, 1981;
Richards, 1983,1987).
This paper is based on records obtained
during a longitudinal growth study of aborig~
~~~
Received May 13, 1988; accepted July 6, 1988.
Address reprint requests to Professor T. Brown, Department of
Dentistry. The University ofAdelaide, Adelaide, South Australia
5000.
This paper was presented as a n introduction to the Symposium
"The Face and Dentition ofAustralasian Populations" a t the 57th
Annual Meeting, American Association of Physical Anthropolog s t s , Kansas City, March 1988.
248
T. BROWN ET AL
inals from Yuendumu in Central Australia
conducted between 1951 and 1971. Data
from this source are being used for a variety
of projects concerned with genetic and environmental interactions on dental morphology, facial growth, and dental occlusion.
While acknowledging the multiplicity of factors concerned with the development, maintenance, and degeneration of occlusal relationships in human populations, the paper
addresses three factors that are relevant
during the early phases of occlusal development, namely, tooth size associations within
and between primary and permanent dentitions, compensatory alveolar growth, and
growth changes in dental arch relationships.
their subsequent alignment into optimal esthetic and functional positions (Moorrees,
1959). Suboptimal occlusion, as found in
many modern Western dentitions, most commonly results from inadequate space for the
emerging permanent teeth, poor alveolar
growth, and at times dysharmonious jaw
relationships. Our studies of the developing
aboriginal dentition have helped to clarify the
ways in which some of these factors interact
(Brown et al., 1980a, 1980b; Townsend and
Brown, 1981).
Table 1 shows the correlations between
the coronal diameters of maxillary and mandibular teeth of Yuendumu children. Sexspecific correlations were averaged by the
z-transformation method of Fisher (1958).
SUBJECTS AND METHODS
Two main trends are apparent: first, all
The longitudinal study of Australian ab- coefficients are significant and reasonably
original children and adults, which provided high, indicating strong tooth size relationdata for the present analyses, was carried ships between arches in both deciduous and
out at Yuendumu, a small community lo- permanent dentitions; second, coordination
cated about 285 km northwest of Alice in size was generally reater for buccolinSprings in the Northern Territory of Austra- gual than mesiodistal fiameters, perhaps a
lia. All subjects were of pure aboriginal an- reflection of the tendency for dimensions of
cestry, and they belonged predominantly to the skull to be more highly correlated in the
the Wailbri tribe, although a few were Pin- coronal plane than in the sagittal (Brown,
tubi people, who are the western neighbours 1969).When the mesiodistal tooth diameters
of the Wailbri. The objectives of the growth of single teeth were combined, a third trend
study with descriptions ofYuendumu and its became evident: the coefficients for compeople were outlined by Barrett et al. (1965a) bined tooth size of all teeth anterior to the
and Brown and Barrett (1973). Further de- permanent first molar were greater than
tails of the methods used in the various those for sin le teeth. It is interesting to note
aspects of the study including subject selec- that the toot size associations in the aborigtion, analytic procedures, and computer inal children were generally stronger than
techniques are provided in the relevant ref- those reported for North American whites
from Oregon (Arya et al., 1974) and for Japerences cited in this report.
anese (Yamada, 19771, suggesting a particuTOOTH SIZE RELATIONSHIPS
larly close control over interarch tooth size
The size relationships between teeth of relationships in the aboriginals.
Size relationships between primary teeth
opposing dental arches and between primary
teeth and their permanent successors are and their permanent successors are also imimportant during the emergence of teeth and portant factors in occlusal development, as
!i
TABLE: 1. Corrrlation coefficients for. corrr~sporit~ing
( ' r o w t i diamctc~rs112 thc maxilla arid mundihlr,'
1)cciduous
tooth
Mesiodistal
N
r
Huccolingud
N
r
dil
dii
(1 c
dm I
dmr
18
18
37
132
40
141
148
157
0.77
0.71
0.64
0.77
0.73
155
162
0.89
0.61
0.77
0.74
0.84
Permanent
tooth
11
172
166
159
161
I'
c
I'
I
1'2
155
MI
M2
d i l to dmz
15
I I to
0.83
' Data from Hrown et a1. (1980b).
'All coefficients differ from zero at P
< 0.01.
Mrsiodistnl
N
r
1'2
171
1:12
151
0.67
0.58
0.72
0.76
0.66
0.66
0.73
0.85
'
Huccolingual
N
r
170
152
I50
0.72
0.58
0.75
0.70
0.78
0.71)
160
154
172
124
0.78
249
DENTAL OCCLUSION IN ABORIGINALS
there is a space deficiency of almost 30% in
the incisor region, this is compensated by a
size excess of more than 30% in the case of
the second primary molar relative to the
second premolar in the maxilla and more
than 40% in the mandible (Brown et al.,
1980b).
The leeway space, expressed as the size
excess of the primary canine and molars
compared with their ermanent successors
on one side of the ental arch, must be
adequate for unimpeded emergence and
alignment of the canine and premolars during the second phase of dental development,
which takes place between the ages of 9 and
12 years. Table 3 shows that the leeway
space in aboriginal children tends to exceed
that reported for a North American Caucasian population for which longitudinal data
were used, especially in the mandible.
Brown et al. (1980a) calculated leeway spacing from cross-sectional data for a number of
other o ulations for a comparison that confirme t e relatively large size of this dimension in Australian aboriginals. The effects of
adequate and inadequate leeway space on
occlusal ali ment are shown in the two
aborigmal c ildren illustrated in Figures 1
and 2.
Observations of contemporary aboriginal
children support the view that coordination
of tooth size, both within and between denti-
the determine to a large extent the availabi ity of space for emerging teeth. Table 2
summarizes these associations, which were
stronger for buccolingual diameters than for
mesiodistal diameters. The coordination of
total tooth size, expressed as the combined
mesiodistal diameters of all teeth anterior to
the permanent first molar, was greater than
for any other single tooth comparison. The
coordination of total tooth size between dentitions was also stronger in the aboriginals
than in the North American white children
reported by Moorrees and Reed (1964).Thus,
from the available comparative
data, t e coordination of crown size within
and between dentitions in the aboriginal
children appears to be higher than in North
American whites and Japanese. It is likely
that the biological control and growth coordination exerted during odontogenesis determine relative crown diameters, thereby
affecting the establishment of occlusal relationships many years later.
When the primary teeth are exfoliated at
between 6 and 12 years of age, the resulting
spaces within the dental arch may be excessive, adequate, or deficient for the emerging
permanent successors. It is interesting that
the differences in mesiodistal diameters between ermanent and primary teeth decrease rom the earlier to the later erupting
permanent teeth. For example, although
P
B
Judgina
BK
f?
P
TABLE 2. Correlation coefficients for crown diameters of deciduous teeth and permanent successors1
Teeth comnared
Deciduous
dil
di:!
dc
dmi
dmL
dil to dm,
Permanent
11
12
C
PI
PL
II to P,
Maxilla
Mesiodistal
N
r
38
73
154
153
152
33
0.57
0.54
0.25
0.36
0.44
0.65
Mandible
Buccolingual
N
r
38
72
150
156
153
0.56
0.31
0.41
0.41
0.58
Mesiodistal
N
r
21
44
144
147
146
19
0.52*
0.38*
0.35
0.45
0.42
0.68
Buccolingual
N
r
21
40
125
151
150
0.53"
0.62
0.42
0.47
0.60
'
1)ata from Brown et al. (1YllOb).
*Coefficient differs from zero a t P < 0.05: all other coefficients differ from zero at P < 0.01
TABLE 3. Leeway space calculated in individual children from longitudinal data showing mcans a n d standard
deviations (in parentheses)'
Maxilla
GrouD
Australian aboriginak?
North American Caucasoids,"
'
Mandible
Males
Females
Malps
Fpmalpn
1.5 (1.1)
1.2 (0.9)
1.4 (1.1)
1.5 (0.9)
2.9 (1.2)
2.2 (0.9)
3.3 (0.8)
2.6 (0.9)
Calculated in mm as the difference between combined mesiodistal diameters of t h e deciduous canine a n d molars and the permanent
pccessors on one side of the dental arch.
sData from Brown et al. (1983).
Data from Muorrees and Chadha (1962).
250
T. BROWN ET AL.
Fi 1 Dental development in a n aboriginal girl with adequate leeway space and alveolar
devefopment. The mandibular incisor crowding a t age 8 has almost disappeared at age 15 years.
Leeway space is 3.2 mm in the maxilla and 4.8 mm in the mandible.
tions, is an essential component of the developmental processes that determine the mode
of dental occlusion and its functional efficiency. Australian aboriginal children display a high level of coordination in tooth
relationships, and they also benefit from
liberal leeway spacing, an important advantage during emergence of the postincisor
dentition. It could be postulated that during
evolutionary reduction of tooth size, the size
relationships between primary and permanent dentitions may have changed also leading t o a reduction in the leeway dimension
and less space for good tooth alignment,
particularly in the mandible. Unfortunately,
it is unlikely that data representing both
primary and permanent dentitions will become available in an adequate number of
precontemporary populations to test this
concept.
ALVEOLAR GROWTH AND TOOTH MIGRATION
Occlusal relationships are established as
part of the ongoing maturation of the facial
skeleton extending from early childhood
through adolescence to adulthood. This pe-
riod is characterized by extensive alveolar
growth, remodelling of the jaws, rotation of
the face relative to the cranial base, and
tooth migrations along directions that are
correlated with the pattern of jaw rotation
(Bjork and Skieller, 1972). The growth processes have a profound effect on final tooth
positions and relationships. It has been
shown in longitudinal cephalometric studies
with implants, for example, that the mesial
migration of mandibular incisors and molars
during growth is significantly associated
with growth variables such as resorption of
the ramus and the direction of condylar
growth (Bjork and Skieller, 1983). The same
authors analyzed growth records of Danish
children re orting a forward migration of
incisors an molars of 3.2 mm and 5.2 mm,
respectively, which led to a shortening of
mandibular arch length by 2.0 mm on average. The degree of forward migration of the
dentition and the accompanying alveolar development are major determinants of the
differences in the facial profiles of modern
populations. As assessed by comparative radiographic cephalometry, these differences
8
DENTAL OCCLUSION IN ABORIGINALS
251
Fig. 2. Dental development in an aboriginal girl with inadequate leeway space and alveolar
develo ment Crowding has persisted in the mandibular incisors and developed in the maxillary
premofars. Leeway space is 2.0 mm in the maxilla and 3.1 mm in the mandible.
reside almost entirely in the midfacial or
alveolar region (Brown, 1988).
Information on the patterns ofjaw growth,
tooth mi ation, and alveolar development
in indivi uals can be obtained by the examination of standardized longitudinal cephalograms. Ideally, serial cephalograms should
be su erimposed on metallic implants inserte in mandible and maxilla at the beginning of the observation period. However, a
reasonable interpretation of growth directions and magnitudes can be gained by superimposing the successive records according to the structural method of Bjork and
Skieller (1983).Thus, further understanding
of these growth mechanisms in living populations is dependent on the availability of
serial growth records. The anal sis of facial
growth in Australian Aborigina s is proceeding, but as the method is exceedingly timeconsuming and cannot be automated, our
findings to date must be considered to be
preliminary (Bjork et al., 1984). Figure 3
illustrates growth changes in the craniofa-
f
cp
P
’\
...
Fig. 3. Facial growth in a n aboriginal boy as traced
from lateral cephalograms at ages 7,12, and 16 years.
252
T.BROWN ET AL
cia1 profile of an aboriginal boy between 7
and 16 ears. Growth of the jaws and their
remode ling and rotation relative to the cranial base are highlighted by this form of
growth analysis, which also emphasizes the
straightening of the facial profile with age,
the increase in facial height, and the rotation
of the occlusal plane.
Figures 4 and 5 show alveolar growth,
tooth migrations, and jaw remodelling in the
mandible and maxilla of the same boy. During the 9-year eriod, there was substantial
alveolar growt and migration of the entire
dental arches occlusally and forward. In the
mandible, the forward migration of the first
permanent molars was 7.4 mm, compared
with 4.4 mm for the incisors, leading to a
reduction in dental arch length of 3.0 mm.
The reduction was due partly to closure of
the leeway space and partly to an increase of
5 mm in intermolar arch breadth over the
P
K
growth period. The overall advantage of the
tooth migrations and alveolar development
was provision of additional space anterior to
the coronoid process for unimpeded emergence and alignment of the later erupting
teeth, including third molars. Alveolar
growth and tooth movements were also
marked in the maxilla, leading to a reduction
of 2.5 mm in arch depth during the period.
Midfacial pro athism increased also. Although only a ew complete analyses of facial
growth have been completed for the aboriginals, it is our feeling that the pattern
described above, which contrasts with that
referred to above for the Danes, is characteristic of this contemporary Australian population.
In many industrialized populations, masticatory function is not vigorous; hence there
is less stimulation for midfacial growth and
development of the alveolar processes. As a
P
E
E
9
-3
P
r;
h
I
I
1
I
I
I
I
I
Fig. 4. Mandibular alveolar growth and tooth migrations in an Aboriginal boy between 7 and 16 years.
Fig. 5. Maxillary alveolar growth and tooth migrations in an Aboriginal boy between 7 and 16 years.
253
DENTAL OCCLUSION IN ABORIGINALS
consequence, the provision of space for optimal occlusal development is often inadequate, resulting in varying degrees of tooth
crowding, malocclusion, and third molar impaction (Brash, 1956; Davies, 1972; Corruccini, 1984). The absence of appreciable
interproximal attrition in modern populations also increases the possibility of tooth
crowding (Begg, 1954).
GROWTH CHANGES IN THE DENTAL ARCHES
Studies presently under way are extending our knowledge of dental arch development in the aboriginal children from Yuendumu by using a number of breadth and
depth variables to describe growth changes
in the arches and to identify various patterns
of differential growth between maxillary and
mandibular arches. In common with the pattern of arch development in Caucasian children, the dental arches of aboriginals undergo considerable changes in size and shape
during growth. Our previous studies have
DENTAL ARCH PLDT
SUBJECT: 330
SEX: H AGE 8.22 Y R I
10
SCALE
1.5
1
ii
12
13
14
15
16
17
YRB
Yas
YRS
YRI
YRE
YRI
YRS
YRB
Maxilla
shown that, on the average, there is a reduction in dental arch depth and an increase in
breadth, as shown in Figure 6 (Barrett et al.,
196513; Brown et al., 1983, 1987). However,
the age changes in the upper and lower
arches are not necessarily similar in magnitude and direction, resulting in constantly
changing occlusal relationships in the sagittal and coronal planes.
An interesting type of growth change,
shown in Figure 7, is marked by a greater
increase in maxillary arch breadth than in
mandibular breadth. It occurs in about 70%
of the aboriginal males and 40% of the females. This growth pattern leads to a variant
of dental occlusion termed alternate intercuspation, which resembles the transverse
dental arch relationships found in many species of herbivorous animals. It may be
present from an early age or may develop to
various degrees of expression at later ages.
We believe that alternate intercuspation,
which would be regarded as a malocclusion
SUBJECT. 254
DENTAL ARCH PLOT
SCALE
1.5
'
SEX: M AGE: 7
YRL
8.39 YRL
9 97 Yas
1
1 1 . 7 6 YRB
12 76 YRC
1 4 . 7 6 YRB
15 76 YRE
16.76 YRE
17.76 YRE
1 8 . 7 6 YRE
Maxllla
25
0
1
:
:
:
:
:
:
0
50
:
:
: A
Handlble
Fig. 6. Changes in the dental arches of an Aboriginal
boy between 8 and 17 years showing similar breadth
increases in maxilla and mandible and progressive reduction in arch depth.
1
25
:
:
:
:
:
:
50
:
:
:
1
Mandible
Fig. 7. Changes in the dental arches of an Aboriginal
boy between 7 and 19 years showing divergent breadth
increases in maxilla and mandible and progressive reduction in arch depth.
254
T. BROWN ET AL.
and termed scissors bite if assessed accord- dynamic quality of dental occlusion in the
ing to modern clinical concepts, is in reality full functional dentition of preindustrialan efficient adaptation to masticatory func- ize groups. These clinical concepts are often
tion involving wide, powerful crushing and used by anthropologists to describe dentigrinding strokes accompanied by progres- tions of skeletal populations.
The value of longitudinal studies of dental
sive tooth attrition. The growth pattern leading to alternate intercuspation was illus- development, craniofacial growth, and tooth
trated and described in detail previously occlusion lies in the clearer insight that such
(Brown et al., 1987). Contrasting with alter- studies provide into the range of variation in
nate intercuspation, the unworn and inter- growth patterns between individuals and
locking cusps of modern dentitions can be the extent of variations within the same
regarded as another example of the regres- individual over time. Although many longision in morphology and function that follows tudinal studies of modern Caucasian populathe adoption of softer preprepared diets.
tions have been undertaken, opportunities
for recording craniofacial and dental development in other groups have been very few
THE VALUE OF LONGITUDINAL STUDIES
in the past, and they are likely to diminish in
The majority of studies dealing with den- the future.
titions and craniofacial structures of human
Our investigation of aboriginal children
populations have, of necessity, been cross- from Central Australia has provided a
sectional. This approach has provided an unique op ortunity to study the changing
immense pool of data for investigators to nature of ental occlusion in a
trace evolutionary trends in dental morphol- ple who had abandoned their unter-gathOf peaogy and describe population similarities and erer life-style in favour of a settlement existdifferences. Unfortunately, the cross-sec- ence with access to a plentiful supply of
tional design can throw no light on the extent water, European foods, and other amenities.
of variation within individuals for morpho- The aboriginals, however, are still tribally
logical characters that are affected by age or oriented, hold traditional beliefs, and pracchanging function. Some dental features, tise many of the customs of former days.
such as the size of tooth crowns and their When supplemented by the examination of
nonmetric characters, are not affected by age skeletal material representing earlier abalone unless masticatory or nonmasticatory original populations, the studies increase
tooth wear or pathological processes alter our understanding of the nature of dental
crown morphology. Others are subject to age relationships and functional occlusion, parchanges that are quite substantial.
ticularly as they are affected by normal deFor example, the mode of dental occlusion velopmental rocesses, age changes, heavy
is not a static entity, but one that changes occlusal loa(Qing, and pathological condithroughout life according to natural growth tions.
processes, superimposed environmental conThis paper, based on longitudinal observaditions, and changing functional demands. tions, has drawn attention to some aspects of
In a disease-free dentition, changes in tooth dental occlusion that are important during
positions and occlusal relationships are min- the years of active facial growth and tooth
imal after adulthood is reached. However, in emergence. In particular:
dentitions subject to heavy or unusual forms
of occlusal loading, tooth morphology, tooth
Strong coordination of tooth size bepositions, and dental occlusion are subject to
tween the primary teeth and their percontinuing change throughout life.
manent successors and between maxilConcepts about dental occlusion have delary and mandibular teeth within the
veloped primarily from a need to establish
same dentition tends to reduce the
clinical objectives and criteria for the restochances of discrepant occlusion due to
ration of maloccluded or otherwise impaired
irregularities in the size relationships
dentitions. With few exceptions, these conbetween succedaneous or opposing
cepts have been based on observations of
teeth.
modern dentitions not subjected to the heavy
Liberal leeway spacing in the aboripfunctional demands faced by earlier opulanal children, especially in the manditions. As a result, concepts of “norma occluble, combined with rominent alveolar
sion”convey a sense of static morphology and
bone growth, providpes adequate space
unchanging relationships; they ignore the
B
a
P
aoup
DENTAL OCCLUSI(IN IN ABORIGINALS
for the permanent teeth to emerge into
good occlusal alignment. Interproximal
tooth attrition assists in this process to
some extent.
3. The size and the shape of the dental
arches continually change during
growth, the arch depths reducing considerably, and the arch breadths increasing to a lesser extent. Dental arch
development, together with the characteristic occlusal and forward movement
of the dentition during growth, maintains tooth relationships in the aboriginals, who are enerally free of major
crowding or ot er forms of malocclusion, and capable of vigorous and efficient masticatory function.
a
Concepts of so called “normal occlusion,^'
as used in clinical procedures as well as in
anthropological contexts, should be modified
to take into account the dynamic character of
dental occlusion as it existed in the fully
functional dentitions of human populations
until relatively recent times.
ACKNOWLEDGMENTS
The authors acknowledge with gratitude
the assistance provided by Mrs. S.K. Pinkerton and Miss F. Rowett in data analysis and
preparation of the illustrations. The material used for the research was gathered with
the financial support of NIDR Grant DE
02034 to M.J. Barrett and T. Brown. Currently the research is supported by the National Health and Medical Research Council,
Canberra, Australia.
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