Eruption and Shedding

Department Of Pedodontics & Preventive Dentistry

 Introduction

✓ The word eruption properly refers to the cutting of the tooth through the gum.

✓ It is derived from the Latin word erumpere meaning to break out.

✓ It is generally understood to mean the axial or occlusal movement of the tooth

from its developmental position in the occlusal plane.

✓ The emergence of the tooth through the gingiva is the first clinical sign of
eruption.
 Different definitions of eruption given
by different scientists
✓ Mavry Massler & Schour (1941)- defined eruption as a process whereby the forming tooth
migrates from its intraosseous location in the jaw to its functional position within the oral
cavity.

✓ Osborne - concluded that eruptive movement is defined as the axial movement of the tooth
which brings the crown of the tooth from its developmental position within the bone of the
jaw to its functional position in the occlusal plane.

✓ James K Avery – defined eruption as the movement of the teeth through the bone of the
jaws & the overlying mucosa to appear & function in the oral cavity.
 Phases of tooth eruption

3 Phases-

✓ Phase 1 - The Pre eruption phase: from the initiation of tooth development to
completion of the crown.

✓ Phase 2 - The prefunctional eruptive or eruptive phase: begins once roots begin to
form.

✓ Phase 3 - The functional eruptive or post eruptive phase: after teeth have emerged,
concerned with development and maintenance with occlusion.
Pre eruptive Phase-

✓ The pre - eruptive phase of tooth movement is preparatory to the eruptive phase.

✓ It consists of the movement of the developing tooth germs within the alveolar processes
prior to root formation.

✓ During this phase the growing tooth moves in 2 direction to maintain its position in the
expanding jaw, i.e. bodily movement & eccentric movement.

✓ Bodily movement is the shift of the entire tooth germ

✓ Eccentric movement is the relative growth in one part of the tooth, leading to the change
in the center of the tooth germ.
Eruptive Phase-

✓ This phase begins with the initiation of the root formation & ends when the teeth reach
occlusal contact.

Anatomic stages of tooth eruption given by Noyes & Schour -

Stage I - Preparatory stage (opening of the bone crypt)

Stage II - Migration of the tooth towards the oral epithelium
Stage III - Emergence of crown tip into the oral cavity
(Beginning of clinical eruption)
Stage IV - First occlusal contact
Stage V - Full occlusal contact
Stage VI - Continuous eruption
Changes in tissues overlying teeth –

In initial changes, Prior to clinical emergence of the crown is the alteration of the
connective tissue of the dental follicle to form pathway for the erupting teeth.

An altered tissue space overlying the tooth becomes visible as an inverted funnel
shaped area with the follicle fibers directed towards the mucosa. (This is Called
as Gubernacular cord). This structure guides the tooth in its eruptive
movements
✓For successful tooth eruption there must be some resorption of the overlying
bony crypt so that the tooth can erupt.

✓When the tooth reaches near the oral mucosa the reduced enamel epithelium
comes into contact with the overlying mucosa, simultaneously the oral
epithelial cells proliferate & fuse into one membrane.

✓The tooth that will erupt slightly remain stationary for few days & then again
erupt.
Post eruptive Phase-

✓ The post eruptive phase, begins when the teeth reach occlusion & continues for long as
each tooth remains in oral cavity.

✓ During this phase or process, the alveolar process increases in height & the roots continue
to grow.

✓ The most marked changes occur as the occlusion is established. Alveolar bone density
increases & the principle fibers of the PDL establish themselves into separate groups
orient about the gingival 3rd the alveolar crest & the alveolar surface around the root.

✓ Later in life attrition may wear down the occlusal surfaces of the teeth. The teeth erupt
slightly to compensate for loss of tooth structure & to prevent over closure.
 Theories of tooth eruption

✓It is a process that has been the subject of scientific enquiry since 1778 when
Hunter attributed the mechanism to root elongation.

✓Most teeth erupt during periods of active craniofacial growth & therefore
eruption should be considered as a part of a multifactorial event.
 Mechanism of tooth eruption is
explained by various theories

✓ Root elongation theory - According to this theory the simplest & most obvious
mechanism of eruption would be that the crowns of the teeth are pushed into the oral
cavity by virtue of growth & elongation of the roots.

Evidence for the theory - Root of tooth elongates as crown eruptes into the oral cavity.

Evidence against the theory – Rootless teeth often erupt without the concomitant
elongation of the root, submerged teeth often continue the formation of their roots but do not
erupt.
✓Pulpal constriction theory – This theory states that the growth of the root dentin
& the subsequent constriction of the pulp may cause sufficient pressure to move
the tooth occlusally.

Evidence for the theory - The pulp is progressively constricted by growth of root
dentin.

Evidence against the theory - Pulp less teeth erupts at the same rate as the normal
teeth, premolar will often “jump” into occlusion after the premature extraction of
the deciduous molar without any appreciable growth of dentin or pulpal constriction
✓Growth of periodontal tissues –

Pull by surrounding connective tissue - Underwood suggests that the

connective tissue surrounding the tooth may function in pulling the tooth into
oral cavity.

Alveolar bone growth - Herman believed that the growth of the alveolar bone
might push or squeeze the tooth out of its alveolus & into the oral cavity.
✓Pressure from muscular action –

Berten suggested that the action of the musculature of cheeks & lips upon the
alveolar process might serve to squeeze the crown of the tooth out into the oral cavity
like a pumpkin seed from between the fingers.

✓Resorption of the alveolar crest –

Resportion of the alveolar crest would serve to expose the crown of the tooth into the
oral cavity.
✓Hormonal theory –

Sir Arthur Keith suggested that the hormones secreted by the thyroids &
pituatary glands might govern the eruption of the teeth.

✓Foreign body theory –

Gottlieb’s foreign body theory, states that a calcified body such as the tooth tends
to be exfoliated by the tissues just as does any foreign body.
✓Cellular proliferation theory –

Noyes points out that the tremendous pressure which is evolved from cellular
proliferation provides the growing plant with sufficient force to break through hard
obstacles.

✓Vascularity theory –

Constant (1896) points out the fact that the tissues which lie between the
developing tooth & its bony surrounding possess a very rich vascular supply. He
said that the blood pressure exerted in the vascular tissue which lies between the
developing tooth & its bony surroundings is the active mechanical factor in the
process has eruption of teeth.
✓Blood vessel thrust theory –

This theory proposed that eruption involves the blood supply to the tooth like the
vascularity theory.

✓PDL contraction theory –

Suggests that the contractile element within the PDL, collagen constriction &
constriction due to fibroblasts are responsible. Furthermore, there is evidence that the
actual force required to move the tooth is linked to the contractility of fibroblasts.
✓Dental follicle theory –

It is clear that the dental follicle is essential to achieve the bony remodeling
required to accommodate tooth movement.
✓Bone remodeling theory –

Bone remodeling of the jaws has been linked to tooth eruption as in the pre-
eruptive phase, the inherent growth pattern of the mandible or maxilla supposedly
moves teeth by the selective deposition & resorption of the bone in immediate
surroundings to the tooth. When the developing premolar is removed without
disturbing dental follicle, an eruptive pathway still forms overlying the tooth.
Whereas, if the dental follicle is removed no eruptive pathway is formed.
 Shedding

The physiologic process resulting in the elimination of the deciduous

dentition is called as shedding or exfoliation.
✓The shedding of deciduous teeth is the result of progressive resorption of the
roots of teeth & their supporting tissues.

✓In general the pressure generated by the growing & erupting permanent teeth
dictates the pattern of deciduous tooth resorption.
 Resorption of anterior teeth

✓The position of the permanent anterior tooth germ is lingual to the apical third of
the roots of primary tooth hence the resorption is in the occlusolabial direction
which corresponds to the movements of the permanent tooth germ.

✓Later the crown of the permanent tooth lies directly apical to the root of primary
tooth, which causes resorption to proceed horizontally.

✓This horizontal resorption allows the permanent tooth to erupt into the position of
the primary tooth.
 Resorption of posterior teeth

✓ The growing crowns of the premolars initially are situated between the roots of the primary
molars.

✓ The initiation is by the resorption of the inter-radicular bone followed by resorption of the
adjacent surfaces of the root of primary tooth.

✓ Meanwhile, the alveolar process is growing to compensate for lengthening roots of the
permanent tooth. As this occurs the primary molars move occlusally this allows the premolar
crowns to be more apical.

✓ The premolars continue to erupt until the primary molars roots are entirely resorbed & the
teeth exfoliate.
 Mechanism of Resorption &
Shedding

✓3 reasons for resorption are-

- Loss of root
- Loss of bone
- Increased force

Kronfield was one of the 1st researchers to suggest role of stellate reticulum &
dental follicle in shedding mechanism.
✓ As permanent teeth grow they exert pressure to induce differentiation of osteoclasts &
odontoclasts , which causes resorption of hard tissues & supporting structures of root.

✓ Osteoclasts are bone resorbing cells derived form monocyte – macrophage lineage with
giant multinuclear cells with 4 -20 nuclei.

✓ Osteoclasts cells have striated border & are housed in howship’s lacunae which attach to the
resorbing front of hard tissue & release acid phosphate. This disrupts collagen network &
release crystals which are digested by the vacuoles of osteoclasts.

✓ The disrupted collagen is then destroyed by fibroblasts.

✓ Resorption occurs at the ruffled border which greatly increases the surface area where the
osteoclasts are in contact with bone.
✓During the process of resorption the pressure form tooth is first directed
to the bone & following its resorption the forces are directed to primary
tooth.

✓Although resorption of teeth is multifactorial.

✓Forces of mastication are also involved in the mechanism of shedding.

✓Recently Evlambia HH, 2007 demonstrated a new concept in the

shedding of primary teeth. He explained that this process is regulated in
the same manner as bone remodeling involving receptor ligand system
(RANK)- i.e. receptor activator of nuclear factor of kappa B, which
stimulates osteoclast formation.
 Consequences
Remnants of deciduous teeth

✓ Sometimes parts of the roots of the deciduous teeth that are not in the path of eruption
remain embedded in the jaw for a considerable time.

Retained deciduous teeth

✓ Deciduous teeth may be retained for a long time beyond their usual shedding schedule. Such
teeth are usually without permanent successor or their successors are impacted.
✓ Retained deciduous teeth are most often the upper lateral incisor, less frequently the
mandibular second primary molars & rarely the lower central incisors.
Chronology of Human Dentition