Primary failure of tooth eruption: what is the etiology, diagnosis, and treatment?
This summary is based on the article published in the Dental and Medical Problems journal: Primary Failure of Tooth Eruption – Etiology, Diagnosis and Treatment (Issue 50 (3) 2013)
Primary failure of eruption (PFE) is a rare condition that involves impeded eruption of teeth despite the lack of an identified local or general causative factor. Since molar teeth are mainly concerned, a typical clinical image presents extensive lateral open bite. A characteristic radiological feature depicts large radiolucent fields around embedded tooth germs.
Research performed in recent years has provided evidence that a defect of the eruption mechanism on a genetic background is responsible for the disorder. The introduction of genetic testing has enabled definitive verification of diagnosis in suspected patients, although because of the high cost, it is not yet available for routine clinical application.
Diagnosis of PFE may be difficult due to its rare occurrence and absence of clinically evident cause of eruption impediment in particular. Moreover, the conventional orthodontic-surgical methods employed for bringing unerupted teeth into the dental arch are futile in the case of PFE, since the application of orthodontic force to the involved tooth inevitably results in ankylosis with all its adverse consequences. Competent diagnosis of PFE enables early abandonment of orthodontic means doomed to failure and the introduction of only effective prosthetic and surgical solutions.
- The selection of the specific treatment modality depends mainly on the severity of the disorder and the patient’s age.
- The main therapeutic goal in children is to ensure the proper development of the stomatognathic system; therefore, emphasis should be put on regaining the chewing function which is particularly reduced in PFE patients.
- Restoration of masticaory function as well as maintenance of the OVD may be provoded by means of a removable, soft tissue supported by prosthesis, which children easily adapt to.
- Removable prosthesis serve as a temporary solution over the developmental period and should be replaced every few months to avoid restricting proper craniofacial growth.
- Management of adult patients generally depends on the severity of the disorder expressed by the number of affected teeth and their eruption status.
- Partially embedded teeth located relatively close to the occlusal plane may be covered with crowns provided that an adequate crown/root ratio is maintained.
- Extraction of unerupted teeth followed by the insertion of dental implants seems to be an optimal therapeutic option in mild to moderate cases, although bone grafting might often be necessary prior to implantation.
- Ankylosis preceding application of the orthodontic forces is the major problem in PFE management, which may be overcome by means of advanced surgical procedures, such as segmental osteotomy or osteodistraction.
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