Tooth Eruption and Shedding Ultimate 1

Tooth Eruption and
Shedding
Presented By: Dr. Swayam Mohapatra, 1st year PGT
Department of Pediatrics and Preventive Dentistry
Institute of Dental Sciences, SOA University
1
Contents
1. Definition
2. Phases of Eruption
3. Theories of Tooth Eruption
4. Shedding
5. Chronology of Human Dentition
6. Conclusion
7. Reference
2
Definition
Maury Massler and 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 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 and the overlying mucosa to appear and function in the oral cavity.
3
Mc Donald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. 9th Edn. Elsevier Health Sciences; 2010.
Pattern of Tooth Movement
• Eruptive movement begin with onset of root formation before the teeth are seen in
the oral cavity
• Divided into three phases:
Phase 2 Phase 3
Phase 1
Prefunctional eruptive Functional eruptive or
Pre-eruptive phase
or eruptive phase posteruptive phase
4
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 two directions :
• Bodily movement
• Eccentric movement
5
Bodily Movement of crown during teeth eruption: which occurs continuously as the jaw grows, is a movement of
the entire tooth germ
Eccentric movement of crown during teeth eruption: Relative growth in one part of the tooth while the rest of
the tooth remains constant
6
• During the early pre-eruptive phase, the successional permanent teeth develop
lingual and near to occlusal level of their primary predecessor
• The teeth are positioned lingually and near the apical third of the primary anterior
teeth at the end of this phase
• The change in the position of the permanent tooth germ is mainly due to:
• Eruption of the primary teeth
• Coincident increase in the height of the supporting tissues
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Eruptive Phase
The eruptive phase begins with the initiation of the root formation and ends when the teeth reach occlusal contact
Anatomic Stages of Tooth Eruption (Noyes and Schour)

Stage III: Emergence of crown
Stage I: Preparatory stage Stage II: Migration of the tooth tip into the oral cavity
(opening of the bone crypt) toward the oral epithelium (Beginning of clinical eruption)
Stage IV: First occlusal contact Stage V: Full occlusal contact Stage VI: Continuous eruption
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Stages of Tooth Eruption
Root begin their formation as a result of proliferation of both the epithelial root sheath and
mesenchymal tissue of the dental papilla and dental follicle
The erupting tooth moves to the bone of the crypt and the connective tissue of the oral
mucosa
The reduced enamel epithelium covering the crown comes in contact with the oral
epithelium
Reduced enamel epithelium proliferates and forms a thin attachment with the oral epithelium
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Tip of the crown enters the oral cavity by degenerating the membrane and breaking through the
double layered epithelium
Crown erupts further and the lateral border of the oral mucosa now becomes the Dento
gingival junction(DGJ)
The reduced enamel epithelium now surrounding like a cuff, becomes known as the
junctional or attachment epithelium
Erupting tooth continues to erupt occlusally as a result of active eruption, exposing more of
the clinical crown
Separation of the attachment epithelium from the crown and the resulting apical shift of the
attachment epithelium
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Changes in Tissues Overlying Teeth
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Initial changes seen in the tissues overlying the teeth, 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
Future eruption pathway appears as a zone with decreased and degenerated connective tissue fibers, cells, blood
vessels and terminal nerves which is due to the loss of blood supply to this area, as well as the release of enzymes that
aid in degradation of these tissues
Altered tissue space overlying the tooth becomes visible as an inverted funnel shaped area with the follicle fibers
directed towards the mucosa known as Gubernacular cord , which guides the tooth in its eruptive movements
12
13
Resorption of the overlying bony crypt takes place so that the tooth can erupt which is considered as a part of
remodeling growth carried out by the Osteoclasts that differentiate and resorb a portion of the bony crypt overlying the
erupting tooth
The eruption pathway increases in size facilitating the movement of the tooth. When the tooth nears the oral
mucosa, the reduced enamel epithelium comes into contact with the overlying mucosa and simultaneously the oral
epithelial cells proliferate and fuse into one membrane
Further movement of the tooth stretches and thins the membrane over the crown tip making the mucosa blanched
due to lack of blood supply to the area. Tooth that will erupt slightly remain stationary for few days and then again
erupt for which the supporting tissues are able to make adjustment to the eruptive movement
Each eruption movement result in more of the crown appearing in the cavity and further separation of the attachment
epithelium from the enamel surface
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Changes in Tissues around the Teeth
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Dental follicle is composed of delicate connective tissue but with gradual eruptive movement collagen fibers become
prominent, extending between the forming knot and the alveolar bone surface
First noticeable periodontal fiber bundles appear at the cervical area of the root which extend at an angle coronally
to the alveolar process and at the same time alveolar bone of the crypt is remodeled and the bone fills into conform the
smaller root diameter
With eruption in progress other collagen fibers bundles become visible along the forming root which are then
populated with fibroblasts and myo-fibroblasts, with contractile capabilities
16
In a very early stage of eruption process periodontal fibers attach on the root surface and in the alveolar bone as
cementogenesis proceeds with fibers release and reattach to stabilize the tooth and in this manner the tooth stabilizing
process is performed by the same group of fibers throughout tooth eruption
Alveolar bone remodeling continues during eruption, as the tooth moves occlusally, the alveolar bone increases in
height and changes shape to accommodate the crown and the actions are coordinated during the entire eruption process
throughout the life
17
Changes in Tissues Underlying Teeth
18
Changes take place in the soft tissue and fundic bone (bone surrounding the apex of the root) and space is provided
for the root to lengthen as the crown moves occlusally and there is increase in the height of the alveolar bone
Fine bony trabeculae appear in the fundic area as they compensate for tooth eruption, and provide some support at
the apical tissues
Root completion continues for a considerable time after teeth have been in function. This process takes place from
1 to 1.5 years in deciduous teeth and from 2 to 3 years in permanent teeth
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Post Eruptive Phase
• Begins when the teeth reach occlusion, and continues for long as each tooth remains in the oral cavity
• Alveolar process increases in height and the roots continue to grow or in other words the teeth continue to
move occlusally, which accommodates the jaw and allows for root elongation
• Most marked changes occur as the occlusion is established as alveolar bone density increases and the
principal fibers of the periodontal ligament establish themselves into separate groups orient about the
gingival third, the alveolar crest and the alveolar surface around the root
20
Richard Tencate. Oral histology: development, structure and function, 5th edition.
Mesial Drift
• When the occlusal wear is excessive, cementum is deposited on the apical third of the root and
in the furcation region to compensate for the hypereruption of teeth and some bone apposition
occurs at the alveolar crests. In addition to slight occlusal movement the teeth tend to move
anteriorly. This is termed Mesial Drift
• It results in bone resorption on the mesial wall and bone apposition on the distal wall of the
socket
• This phase is characterized by movements of the tooth that includes growing jaws, to
compensate for continued occlusal wear, to accommodate interproximal wear
21
Delayed Eruption
• Definition: Delayed tooth eruption (DTE) is the emergence of a tooth into the oral cavity at a time
that deviates significantly from norms established for different races, ethnicities, and sexes
Local Factors Systemic Factors Genetic Factors

• Physical • Nutritional Deficiency Syndromes such as:
Obstruction(supernumerary • Disturbance of the endocrine • Apert Syndrome
teeth, mucosal barrier, scar glands • Gardner Syndrome
tissue, and tumors) • Cleidocranial Dysostosis
• Gingival Hyperplasia
• Traumatic Injuries
• Cystic Transformations
• Ankylosis
• Arch length Deficiency
22
J Dent Health Oral Disord Ther. 2019;10(3):209‒212.
Theories of Tooth Eruption
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Root Elongation Theory Bone Remodeling Theory Periodontal Ligament Traction
Theory
• Apical growth of root results in an • Also known as Dental follicle theory
axially directed force that brings • Most accepted theory
about the eruption of the teeth • Osteoblasts and osteoclasts from the
dental follicle cause bone remodeling • This theory states that PDL are rich
• This theory is although not widely via resorption in the coronal area and in fibroblast which contain
accepted because teeth move greater bone apposition in the apical region contractile elements
distance during eruption than the
increase in root length • Forming a pathway through which • These fibroblasts contracts and
the tooth can passively erupt transmits the forces to collagen
• Teeth that are malformed and lack bundle fibres of PDL which leads to
roots also erupts in no of cases • This theory not accepted as bone application of axially directed force
deposition and resorption are seen as which causes eruption of tooth
a result of eruptive forces applied by
the tooth over the bone
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Hydrostatic Pressure Theory Pulp Constriction Theory
• This theory states that the hydrostatic • This theory states that growth of root
pressure difference between the dentin and constriction of pulp
tissue around the erupting crown and causes sufficient pressure to move
its apical extent is responsible for the tooth in axial direction
tooth eruption
• It is not accepted because in some
• It was observed that the tissue cases pulp less teeth also erupts
pressure apically was greater than
occlusally which theoretically • After premature extraction of
generates an eruptive force deciduous molar the premolar erupts
without any growth of dentin or pulp
• No association was found between constriction
the pressure gradient and the rate of
eruption
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Potential role of MT1-MMP: The MT1-MMP activity in the dental mesenchyme is essential for proper tooth
root formation and eruption. These studies point to an indispensable role for MT1-MMPmediated matrix
remodeling in tooth eruption through effects on bone formation, soft tissue remodeling and organization of the
follicle/PDL region
26
J Oral Health Dent Res, 3(1): 2023
Shedding of Deciduous Teeth
• Human dentition consists of two generations of dentitions that is Primary and
Permanent dentition
• The necessity of two dentitions exists because infant jaws are small and the size
and number of teeth they can support is limited. Since teeth, once formed, cannot
increase in size, a second dentition, consisting of larger and more teeth, is required
for the larger jaws of the adult
• The physiologic process resulting in the elimination of deciduous dentition is

known as Shedding or Exfoliation
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Pattern of Shedding
• Shedding of deciduous teeth is the result of progressive resorption of the roots of teeth
and their supporting tissues
• Pressure generated by the growing and erupting permanent tooth dictates the pattern of
deciduous tooth resorption
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Resorption of Anterior Teeth
• Position of the permanent anterior tooth germ is lingual to
the apical third of the roots of primary tooth so the
resorption is in the occluso-labial direction corresponding to
movement of permanent tooth germ
• Later the crown of the permanent tooth lies directly apical to

the root of primary tooth resulting in horizontal resorption
• This horizontal resorption allows the permanent tooth to erupt

into the position of the primary tooth
29
Resorption of Posterior Teeth
• Initiation is by the resorption of the inter-radicular bone
followed by resorption of the adjacent surfaces of the root of
primary tooth
• Meanwhile, there is increase in width of alveolar process in

order to compensate for lengthening roots of permanent tooth
• Subsequently the primary molars move occlusally which allows

premolar crowns to be more apical
• Premolars continue to erupt until the primary molars roots are

entirely resorbed and the teeth exfoliate and appear in the place of
molars
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Mechanism of Resorption and Shedding
• Three main reasons attributed for resorption and shedding are: loss of root, loss of bone and
increased force
• Permanent teeth exert pressure to induce differentiation of osteoblasts and odontoclasts,

which causes resorption of hard tissues and supporting structures of root
• During the process of resorption the pressure from tooth is first directed to the bone and
following its resorption the forces are directed to primary tooth
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• Resorption of teeth is multifactorial but the pressure from the erupting successional tooth plays
a key role because the odontoclasts differentiate at predicted sites of pressure
• Forces of mastication are also synergistically involved in the mechanism of shedding. Due to
growth and increased loading of jaws these forces far exceed the limit that the deciduous tooth
periodontal ligament can withstand, thereby causing trauma to the ligament and the initiation of
resorption
32
Chronology of Human Dentition
Chronology of dentition is based upon the data of
Logan and Kronfield reported in 1933
Careful review was done by Massler and Shcour in 1941
Morrees , Fanning and Hunt in 1963
Kraus and Jordan in 1965
Nystrom in 1977
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References
1. Berkovitz BK, Moxham Bl. Colored atlas of oral anatomy, histology and embryology. Mosby; 1992.
2. Bhaskar SN. Orban’s Oral histology and Embryology, 10th Edn. Elsevier publications; 2009.
3. Evlambia HH. Physiologic root resorption in primary teeth: molecular and histological events. J Oral Sci.
2007;49:1-12.
4. Mc Donald RE, Avery DR, Dean JA. Dentistry for the child and adolescent. 9th Edn. Elsevier Health
Sciences; 2010.
5. Richard Tencate. Oral histology: development, structure and function, 5th edition.
6. The mechanism of tooth eruption. British Dental Journal. 1996.pp.181-3.
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Tooth Eruption and

3. Theories of Tooth Eruption

5. Chronology of Human Dentition

Osborne concluded that eruptive movement is defined as the axial movement of

• Divided into three phases:

• During this phase, the growing tooth moves in two directions :

• Eruption of the primary teeth

• Coincident increase in the height of the supporting tissues

Anatomic Stages of Tooth Eruption (Noyes and Schour)

Local Factors Systemic Factors Genetic Factors

• The physiologic process resulting in the elimination of deciduous dentition is

• Later the crown of the permanent tooth lies directly apical to

• This horizontal resorption allows the permanent tooth to erupt

• Meanwhile, there is increase in width of alveolar process in

• Subsequently the primary molars move occlusally which allows

• Premolars continue to erupt until the primary molars roots are

• Permanent teeth exert pressure to induce differentiation of osteoblasts and odontoclasts,

Careful review was done by Massler and Shcour in 1941

Morrees , Fanning and Hunt in 1963

Kraus and Jordan in 1965

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