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Pedia eruption
1. Importance of Primary Teeth
Smiling & self-esteem
Chewing and eating
Speech development
Aid proper jaw and face formation
Guide permanent teeth into place
2. Tooth eruption
“It is a series of metabolic events in the
alveolar bone characterized by bone
resorption & formation on opposite sides of
dental follicle but tooth does not contribute
to this process”
3. Tooth eruption
The interval between crown completion & beginning of eruption until
tooth is in full occlusion is 5 years for permanent.
Associated stage of root formation not chronologic or skeletal age.
¾ of the root formed.
Tooth reach occlusion before root completion
Sex difference in root completion ( girls).
4. STEPS OF TOOTH ERUPTION
1.Pre-emergent eruption - Pre-eruptive phase
a) resorption of the bone & primary tooth
roots
b) the eruption mechanism
2. Post-emergent eruption - Eruptive phase
5. STEPS OF TOOTH ERUPTION
2. Post-emergent eruption - Eruptive phase
a) post-emergent spurt - Eruptive phase
(Pre-functional)
b) Juvenile occlusal equilibrium
Eruptive phase (Functional)
c)Adult occlusal equilibrium
6. Development of the Tooth
• Initiation (Bud Stage)
– Early as 6th week of embryonic life
– All primary teeth and permanent molars arise from
the dental lamina
– Permanent incisors, canines, and premolars arise
from the primary predecessor
– Failure of initiation results in congenitally missing
teeth
• Excessive budding results in supernumerary
teeth
7. Factors related to tooth eruption
Elongation of the root.
Force of vascular tissues around & beneath root.
Growth of the alveolar bone.
Growth of dentin.
Growth & pull of the periodontal membrane.
Hormonal influences
Presence of dental follicle.
Pressure from muscles action.
Resorption of the alveolar crest.
8.
9. CHRONOLOGY OF THE HUMAN DENTITION
PRIMARY DENTITION
A.Hard Tissue Formation
B. Approximate Amount of Enamel at Birth
C. Enamel Completed
D.Eruption
E.Sequence of Eruption (Varies considerably)
F.Roots Completed
G. Sequence and Time of Exfoliation
10. - Primary Root completion 12- 18 months post
eruption.
- Teeth erupt when the root is 2/3 complete.
- Most favorable eruption sequence for primary
teeth both Maxillary & Mandibular:
ABDCE
- Tooth germs form at 6-8 wks IU
- enamel forms 4-6 months
CHRONOLOGY OF THE HUMAN DENTITION
PRIMARY DENTITION
11. (Varies considerably)
1. Centrals: Mandibular then maxillary
2. Laterals: Mandibular then maxillary
3. 1st Molars: Mandibular then maxillary
4. Cuspids: Mandibular then maxillary
5. 2nd Molars: Mandibular then maxillary
Usually the mandibular teeth erupt first
Eruption Sequence of primary
12. Primary dentition
Mandibular central: 6 mos
Mandibular lateral: 7 mos
Maxillary central: 7 ½ mos
Maxillary lateral: 9 mos
Mandibular 1st molar: 12 mos
Maxillary 1st molar 14 mos
Mandibular cuspid: 16 mos
Maxillary cuspid: 18 mos
Mandibular 2nd molar: 20 mos
Maxillary 2nd molar: 24 mos
Eruption sequence
13. Sequence and Time of Exfoliation
1. Central 6-7 yrs.
2. Laterals 6-8 yrs.
3. 1st Molars and Mandibular Cuspids 9-11 yrs.
4. 2nd Molars and Maxillary Cuspids 10-12 yrs.
Between 1-1/2 and 3-1/2 years
Roots Completed
18. Growth & Development of the Teeth
At birth the primary teeth have already formed
Permanent teeth are developing or beginning to mineralize
19. ERUPTION SEQUENCE & TIMING
Age 6: 16,26,36,46,41,31
Age 8: 42,32,11,12,21,22
Age 11: 33,34,43,44,14,24,
Age 12: 13,23,35,45,15,25
20. ERUPTION SEQUENCE & TIMING
Man. Canine then 1st 7 2nd premolar
(adequate arch length, prevent tipping of incisors)
( lingual tipping of incisors overbite )
( abnormal lip & oral habit collapse of anterior)
( passive Lingual arch SM in premature canine loss)
Man.2nd molar erupt before 2nd premolar
(mesial drifting 1st molar space of 2nd premolar)
21. ERUPTION SEQUENCE & TIMING
Loss of Max. primary molar
(1st molar drift& tip mesially canine labially blocked)
Eruption of 2nd Max. molar premolars
( loss of arch length)
Delayed eruption of the canine
( effect on alignment of anterior teeth)
26. At dental age 9
Root maxillary canines & second premolars is just beginning,1/3
root of the mandibular canines & first premolars completed.
Maxillary lateral incisors in place for 1 year
& root incisors and first molars nearly
complete.
30. Dental age 12
Eruption of the remaining succedaneous teeth (maxillary canine,
maxillary & mandibular second premolars) and, typically a few months
alter, the maxillary & mandibular second molars.
37. Variations in eruption
Epstein Pearls, Bohn Nodules
Natal and Neonatal teeth.
Teething: a natural phenomenon & systemic distress.
Eruption Hematoma (Eruption Cyst).
Ankylosed teeth.
Congenital factors influence eruption: Down Syndrome, Cleidocaial
Dysplasia.
Local factors influence eruption: infection, trauma.
38. Premature eruption of preliminary teeth
Tooth should be retained unless mobile
Natal teeth
Natal Teeth - born with teeth.
Neonatal - 30 days after birth
- don't remove. (unless very mobile and
worried about aspiration
• 85% of natal or neonatal Teeth are
mandibular incisor.
• (1) 11% Maxillary incisor
• (2) 3% Mandibular cuspids
• (3) 1% Maxillary cuspids/molar
43. Early eruption
Missing tooth
Impaction - failure to erupt
e.g., from too little gap after premature loss of deciduous
tooth
Delayed eruption
Malocclusion
Tilting (can occur early from germ rotation)
Infra-occlusion (not high enough)
Retained root fragment
Excessive drift
ERUPTION: Problems
44. FACTORS INFLUENCE THE ERUPTION
Local
Systemic
Congenital
Two rows of teeth
Ectopic eruption
Infected primary teeth
Ankylosis
Primary failure of eruption
Hypothyroidism
Down’s Syndrome
Achondroplastic Dwarfism
Cleidocranial Dysplasia
47. Premature loss & eruption time of
successors
Unilateral loss before 4-5 year delay eruption
Loss after 5 year decrease the delay
Loss at 8-9 year accelerate the eruption
48. ANKYLOSIS
Primary dentition
First molars most common
Typically require no treatment and exfoliate normally
Involved second molar maybe indication of agenesis of
succedaneous tooth
Treatment:
Prevent space loss
o Build-up occlusion surface of involved tooth
o Extract tooth and place space maintainer
49. ANKYLOSIS
Permanent dentition
Difficult to treat ankylosed permanent teeth
Create adequate space
Attempt to break area of ankylosis with luxation
Immediately apply orthodontic traction force (>50 G) or
Surgically reposition tooth and hold in position orthodontically (pulp
endodontic therapy necessary)
Ankylosed permanent teeth tend to re-ankylose.
50. Causes of delayed tooth eruption
1. Endocrine disorders
• Hypothyroidism
• Calcium/phosphorus metabolism problems
• Hypopituitarism
2. Genetic disorders and bone disorders
Ectodermal dysplasias
• Down syndrome
• Cleidocranial dysplasia
• Gaucher disease
• Osteoporosis
3. Local factors
• Tooth in path of erupting tooth,
insufficient space, impacted teeth
• Dental infection
• Radiation therapy
51. ECTOPIC ERUPTION/IMPACTIONS
Primary dentition
Extremely rare in primary dentition
Permanent dentition
Permanent molars
1st > 2nd; maxillary > mandibular
Incidence of 1st molar: - 2-3%
Suggested etiologies include
Small maxilla
Posterioly positioned maxilla
relative to cranial base
52. Etiologies of ectopic eruption
Molar path of eruption
• Mesio-distal dimension
• A synchronization between tuberosity
• Growth and molar eruption
• Retarded calcification and eruption
• Genetic
53. Treatment of ectopic eruption
Treatment
Mild: observation ( 2/3 of ectopically erupting 1st molars
will self-correct)
Moderate: brass ligature; spring; distalize 1st permanent
molar
Severe: extract primary molar and distalize 1st permanent
molar
54. Ectopic eruption
Permanent mandibular incisor
Common: typically erupt lingual to over- retained primary incisors
Rationale for treatment: allow teeth to move into area of attached gingival
Treatment: extract primary incisors; tongue pressure will typically push
incisors into place
55. Prevalence 1-2%
Reported incisor root resorption - 50%
Diagnosis
Palpation
Radiographic
─ Poor prognosis indicators
─ Permanent canine crown mesial of midline of lateral incisor root
─ Palatal displacement of permanent canine as viewed on cephalometric
Ectopic eruption
Permanent maxillary canines