SHEDDING

 1. Describe the mechanism of exfoliation of

teeth. (C1)
 2. Describe the morphology and function of
Odontoclasts (C1)
 3. Relate the mechanism of exfoliation with
their clinical significance(C2)
TOOTH SHEDDING

Definition
 The physiologic process resulting in the
elimination of the deciduous dentition allowing
the succeeding perm teeth to take their
functional position is called as shedding or
exfoliation.
PATTERN OF SHEDDING

 Shedding of deciduous teeth is the result of

progressive resorption of roots of the teeth &
their supporting struct i..e the pdl
FORCES EXERTED BY ERUPTING PERMANENT
SUCCESSORS

 Resorption of the roots of the deciduous

incisors & canines begin on their
lingual surface.
❖ Later these
developing tooth
germs occupy a
position directly
apical to the
deciduous tooth.

❖ In mandibular
incisors the apical
positioning of the
tooth germs does not
occur and permanent
tooth erupt lingually.
 Resorption of the roots
of deciduous molars
often first begins on
their inner surface.

 With continued
growth of the jaws
and occlusal
movement of the
deciduous molars, the
successional tooth
germs lie apical to the
deciduous molars.
 When the bicuspids
begin to erupt,
resorption of the
deciduous molars is
again initiated and
continues until the
roots are completely
lost and the tooth is
shed.
HISTOLOGY OF SHEDDING
 Broughtby resorption of dental hard tissues
& destruction of supporting pdl.

 Cells
responsible for resorption of tooth --
ODONTOCLASTS
HISTOLOGY OF SHEDDING
Odontoclasts
 Similar to osteoclasts but
involved in removal of dental
tissues, so they are called as
odontoclasts.

 Derived
from the circulating
monocytes(TRAP positive).

 Theyare identified on light

microscope as large
multinucleated cells occupying
resorption bays (Howship’s
lacunae) on the surface of
dental hard tissue.
Odontoclasts;
dissimilarities with Similarities
osteoclast

• Large multinucleated giant

cells
• Occupy resorption bays
 Smaller and contain • Show ruffled border and
fewer nuclei clear zone.
 Produce smaller • Cytoplasm – rich in
resorption lacunae. mitochondria & vacuoles.
• Acid phosphatase activity
 Resorb dental hard seen within vacuoles.
tissues. • Process of resorption
 Seen also in pulp similar
chamber and root • Similar origin; TRAP
canal of resorbing +monocytes
deciduous teeth • Odontoclast differentiation
promoted by RANKL &
inhibited by OPG
Vacuolated cytoplasm
Ruffled border--extensive folding of the cell
membrane
Peripheral to ruffled border – Clear zone

CZ– Devoid of organelles, rich in filaments--

- actin and myosin.

CZ – Represents attachment apparatus of

odontoclasts.
Cytoplasm– Rich
in mitochondria

Highly
vacuolated, close
to ruffled border.

Acid
phosphatase
activity occurs in
these vacuoles
 Membrane specializations--Ruffled border &
clear zone appear after they contact resorbing
surface.

 Can resorb all the dental hard tissues in the

same way as osteoclasts.

 Dentinal tubules provide a pathway for easy

extension of odontoclast processes.
 PDL
cells undergoing resorption express
RANKL & to a lesser extent OPG.

 RANKL increases odontoclast formation

& initiates shedding.

 The odontoclastic activity is promoted by

RANKL and inhibited by OPG as in case
of osteoclast differentiation in bone
resorption.
Pressure
 Plays a role in shedding.

 If a successional tooth is missing, shedding of the

deciduous tooth is delayed.

 Increased force(erupting tooth,masticatory or

muscular) applied to a deciduous tooth can
initiate its resorption by damaging the
supporting apparatus.

 It determines the pattern & rate of shedding of

deciduous teeth.
MECHANISM OF SHEDDING

 Not yet fully understood.

 Pressure from erupting teeth plays a key role;

odontoclasts appear at sites of pressure.

 Cementoblasts are not responsive to hormones &

cytokines.

 So cementoblastic layer has to be damaged by

inflammatory process prior to resorption.
Odontoclasts express ATPase, cathepsin K & MMP-9
similar to osteoclasts.

Odontoclasts attach to hard tissue surface creating a

sealed microenvironment.

Membrane of ruffled border acts as proton pump

Add H+ ions to extracellular environment- acidification

Odontoclasts phagocytose & dissolve them

intracellularly.

Organic matrix is degraded by enzymatic secretions

of primary lysosomes.
Resorption of dental soft tissues- pulp and pdl ---
apoptotic cell death.
 CLINICAL CONSIDERATIONS

1. REMNANTS OF
DECIDUOUS
TEETH.

 Sometimes parts of
the roots of deciduous
teeth are not in the
path of erupting
permanent teeth and
may escape
resorption.
 2. RETAINED DECIDUOUS TEETH.

❖ Without permanent successors or successors are

impacted.

❖ Most common are upper lateral incisors.

CAUSES
 Congenital absence of perm successor
 Failure of eruption of perm successor

 Eruption of perm tooth in lingual or labial

position so that dec tooth escape from pressure
exerted by them
 Ankylosis of deciduous teeth or perm teeth.
SUBMERGED DECIDUOUS TEETH
 Remains below the
level of normal
occlusal plane of other
teeth.

 Most common cause:

Ankylosis due to
trauma.
 3. SUBMERGED DECIDUOUS TEETH.

❖ Cause can be trauma to

either the dental follicle
or the developing pdl,
eruption of tooth ceases.

❖ Because of continued
eruption of adjacent
teeth and increased
height of alveolar bone,
they appear
“submerged”.
 KEY POINTS

 Physiologic process
 Odontoclasts --- TRAP +ve Circulating monocytes.

 Factors responsible for resorption:

a) Pressure exerted by the erupting perm successor

b) Increased masticatory force.

Patterns of shedding.
Mechanism of shedding.
The resorption of soft tissue such as pdl & pulp –
apoptotic cell death.
 Clinical considerations