9 – 11 years old – mixed dentition
Image adapted from CDC Gov.
All patients in this age group should have a panoramic radiograph to assess their dental development. At ages 9 to 10, most of the developmental changes are the root formation of the permanent teeth and there are normally minimal exfoliations or eruptions for an average patient. Normal eruption times have a large range. The dental age is often also poorly correlated with the skeletal or chronological age of the patient. The sequence of eruption and symmetry are hence more important than the timing.
At age 10, the maxillary canines should be palpable as a buccal bulge adjacent to the lateral incisors’ roots. If no bulge is present, an ectopic canine should be suspected and investigated for the need of interceptive treatment. Interceptive orthopaedic treatment can be performed at this age group, especially for skeletal Class IIIs and narrow palates. Only severe skeletal Class IIs with trauma or psychological (bullying) concerns should be treated at this age group as strong evidence has now shown no benefit of two-phase Class II treatment over one-phase Class II treatment (combined orthopaedic and comprehensive orthodontic treatments performed at puberty).
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