TOOTH ERUPTION THEORIES

Eruption refers to cutting of tooth through the gum. Derived from

Latin word ERUMPERE meaning to brea out.
Definition! "t is defined as the a#ia$ or occ$usa$ movement of the tooth
from its deve$opmenta$ position within the %aw to its functiona$ position in
the occ$usa$ p$ane.
&owever' eruption is on$( part of the tota$ pattern of ph(sio$ogic
tooth movement because teeth a$so undergo comp$e# movements re$ated to
maintain their position in the growing %aws and compensating for
masticator( wear.
PHYSIOLOGIC TOOTH MOVEMENT PATTERN
"t is divided into three phases!
a. Pre)eruptive tooth movement.
b. Eruptive tooth movement.
c. Post)eruptive tooth movement.
a) Pre-eruti!e Toot" Mo!e#ent$
*hen deciduous tooth gums first differentiate the( are ver( sma$$
and have enough space between them which is soon used because of the
+
rapid growth of the tooth gums and crowding resu$ts ,especia$$( in incisors
and canine region-.
.his crowding is re$ieved with growth of %aws in $ength' which
permits drifting of the tooth gums.
Permanent teeth with deciduous predecessors a$so move before the(
reach the position from which the( wi$$ erupt. /ut change in position of the
tooth germ depends on a number of factors such as bod( movement of
tooth germs' its growth or a re$ative change in position of associated
deciduous and permanent tooth germs.
.here appears to be a considerab$e change in
position between the permanent incisor tooth germ and its
deciduous predecessor in the first 0 (ears of $ife. .he same a$so
ho$ds for the permanent mo$ars.
1$$ these movements occur in association with
growth of the %aws which mae ana$(sis of individua$ tooth
movement difficu$t.
.hus' pre)eruption tooth movement shou$d be
considered as movement positioning the tooth and its cr(pt
within the growing %aws preparator( to tooth eruption.
0
%) Eruti!e Toot" Mo!e#ent$
During the phase of eruption tooth movement' the tooth moves from
its position within the bone of the %aw to its functiona$ position in
occ$usion.
.he principa$ direction of movement is occ$usa$ or a#ia$.
2aw growth continues in eruptive phase a$so so that movement in
p$anes other than a#ia$ movement is superimposed on eruptive movement.
&) Po't-eruti!e Toot" Mo!e#ent$
.his!
i- Maintains the position of the erupted tooth whi$e the %aw
continues to grow ,movement is in a#ia$ direction- and invo$ves
both the tooth and its socet and ceases when %aw growth is
comp$eted.
ii- 3ompensate for occ$usa$ and pro#ima$ wear' continue
throughout $ife and consist of a#ia$ and mesia$ migration
respective$(.
HISTOLOGY O( THE TOOTH MOVEMENT
a) Pre-eruti!e P"a'e$
4
Pre)eruptive tooth movement invo$ving drifting or
growth of the tooth germ' inc$udes remode$ing of the bon( wa$$
of the cr(pt.
.his is achieved b( se$ective deposition and
resorption of bone b( osteob$astic and osteoc$astic activit(.
/ut' such a bon( remode$ing is the cause of pre)
eruptive tooth movement or is ref$ected as a response to force
produced due to other factors' is unnown.
.here are instances which indicate norma$ se$eta$
morphogenesis might be invo$ved in determining tooth position.
.hus' marrow spaces of consistent configuration and
eruptive pathwa(s through bone form even in the absence of
associated teeth.
%) Eruti!e P"a'e
During the eruptive phase of ph(sio$ogic tooth movement
significant deve$opmenta$ events occur which inc$ude the formation of the
roots' the PDL' and the dentogingiva$ %unction.
i- Root 5ormation!
Root formation is initiated b( growth of &ER6' which initiates the
differentiation of odontob$asts from the denta$ papi$$a.
7
.he odontob$asts form root dentin' thus increasing $ength of the
tooth which is accommodated b( eruptive tooth movement' which begins
at appro#imate$( the same time as root formation is initiated.
6hort$( after the root formation cementum' PDL and the bone $ining
the cr(pt wa$$ are formed.
ii- PDL 3hanges!
1 number of structura$ changes are seen within the PDL which
cou$d be responsib$e for tooth movement.
5ibrob$asts of the PDL possess of intermediate fi$aments that consist
of contracti$e proteins' and a$so e#hibit fre8uent ce$$ to ce$$ contacts of the
adherence t(pe and a further specia$i9ation invo$ving the ce$$ membrane :
the fibrone#us.
.his describes a morpho$ogic re$ationship between the intrace$$u$ar
fi$aments of the fibrob$asts transmembrane proteins' ,which produced an
increased densit( of fibrob$asts ce$$ membrane-' e#trace$$u$ar fi$aments and
fibronectin ,which stics to a number of e#trace$$u$ar components-.
5ibrob$asts has the abi$it( to ingest and degrade e#trace$$u$ar
co$$agen whi$e forming new co$$agen fibri$s.
iii- 3hanges in tissues over$(ing erupting tooth
/one remova$ is necessar( for permanent teeth to erupt.
;
*hen the permanent tooth germ first deve$ops within the same cr(pt
as its deciduous predecessor and bone surrounds both tooth germs but does
not comp$ete$( c$ose over them.
1s the deciduous teeth erupts' permanent tooth germ becomes
situated apica$$( entire$( enc$osed b( bone' e#cept for a sma$$ cana$
,<ubernacu$ar cana$- that is fi$$ed with connective tissue and often contains
epithe$ia$ remnants of the denta$ $amina. .his connective tissue mass is
termed as <ubernacu$ar 3ord and ma( have a function in guiding the
permanent tooth as it erupts. 1s the successioa$ tooth erupts its
<ubernacu$ar cana$ widens due to osteoc$astic activit( de$ineating the
eruptive pathwa( for tooth.
1fter remova$ of the over$(ing bone there is $oss of the intervening soft
connective tissue between the reduced ename$ epithe$ium covering the
crown of the tooth and the over$(ing ora$ epithe$ium.
.his $oss of connective tissue and epithe$ium ma( be due to the
pressure from the erupting tooth which causes $oca$ ischemia and therefore
$oca$ necrosis' but other evidence indicates that this e#p$anation is too
faci$e.
.he changes taing p$ace in this connective tissue affect the
epithe$ia it supports and both the reduced denta$ epithe$ium and the
over$(ing ora$ epithe$ium begin to pro$iferate and migrate into disorgani9ed
=
connective tissue so that eventua$$( a so$id p$ug of epithe$ium forms in
advance of the erupting tooth. .he centra$ ce$$s of this epithe$ia$ mass
degenerate and form an epithe$ium)$ined cana$ through which the tooth
erupts without an( haemorrhage. .his epithe$ia$ ce$$ mass a$so forms D<2
: Dento)<ingiva$ 2unction>.
?nce the tooth has broen through the ora$ mucosa it continues to
erupt at the same rate of about +mm unti$ over 4 to 7 months unti$ it
reaches the occ$usa$ p$ane and meets its antagonist. Rapid eruptive
movement then ceases.
&) Po't-eruti!e P"a'e$
"nc$udes!
a. Movement made to accommodate growing %aws.
b. .hose made to compensate for continued occ$usa$ wear.
c. .o accommodate inter)pro#ima$ wear.
"n post)eruption phase tooth maes movements
primari$( to accommodate the growth of the %aws.
.he principa$ movement is in a#ia$ direction.
"t occurs entire$( between +7)+@ (ears of age and is
associated with cond($ar growth' which separates the %aws and
the teeth.
A
.hough there is bone deposition at the a$veo$ar crest
and on the socet f$oor but this is not responsib$e for tooth
movement.
Movements are a$so made to compensate for
occ$usa$ and pro#ima$ wear of the tooth.
.here is continuous deposition of cementum around
the apices to compensate for occ$usa$ wear. &owever' there is no
evidence' that the deposition of cementum causes tooth
movement.
Rather' it is be$ieved that the forces covering tooth
eruption are sti$$ present to cause sufficient a#ia$ movement of
tooth to compensate for occ$usa$ wear.
.o compensate for pro#ima$ wear and to maintain tooth contact
mesia$ or pro#ima$ drift taes p$ace. &isto$ogica$$(' this drift is seen as
se$ective deposition and resorption of bone on the socet wa$$s b(
osteob$astic and osteoc$astic respective$( and co$$agen remode$ing in tooth
the PDL and transepta$ $igament is observed under E$ectron Microscope
(a&tor' &au'in* Me'ia+ Drift
?cc$usa$ force.
Ligament contraction.
6oft tissue presence appear its position not movement.
@
MECHANISMS O( TOOTH MOVEMENT $ THEORIES
.he proper mechanism b( which tooth eruption occurs is
controversia$ and is $ie$( to be a combination of number of factors. .he
four main causes are! ,.heories-
a. /one remode$ing.
b. Root growth.
c. Bascu$ar pressure.
d. Ligament traction.
a) ,ONE REMODELLING THEORY
.he bone remode$$ing theor( states that se$ective deposition and
resorption of bone brings about eruption.
/ut' whether the bon( remode$ing that occurs around teeth causes or
is the effect of tooth movement is not nown.
e.g. in anima$s the genetic deficienc( of osteoc$asts prevents
eruption of teeth.
"f tooth germ is removed e#perimenta$$( and denta$ fo$$ic$e $eft
intact' an eruptive pathwa( sti$$ forms in the over$(ing bone. /ut if the
denta$ fo$$ic$e is removed no eruptive pathwa( forms. .hus' denta$ fo$$ic$e
proves to be the basic necessit( for bon( remode$ing and tooth eruption as
it is the source for new bone)forming ce$$s and conduit for osteoc$asts
derived from monoc(tes through its vascu$ar supp$(.
C
/one $ining ce$$s)osteob$asts a$so he$p in eruption.
%) ROOT (ORMATION THEORY
Root formation has a$so been proposed to bring
about eruption of teeth.
Root formation fo$$ows crown formation and
invo$ves ce$$u$ar pro$iferation and formation of new tissue that
must be accommodated b( either movement of crown of the
tooth or resorption of bone at the base of its socet.
"n most cases movement of crown occurs but if
prevented' resorption of bone occurs at the socet base. .his is
an important point as it i$$ustrates that if root formation causes
eruptive force' the apica$ growth of root needs to be converted
into occ$usa$ movement and re8uires a fi#ed base. /ut there is no
such fi#ed base' as bone at the base of the socet cannot act as a
fi#ed base because pressure on bone causes its resorption.
1dvocates of this theor( postu$ated the e#istence of a $igament'
the cushion)hammoc $igament at the base of the socet from
passing one bon( wa$$ to the other $ie a s$ing.
.he function of $igament was to provide a fi#ed base for the
growing root to react against. /ut the structure described as
3ushion)hammoc $igament is a pu$p de$ineating membrane that
+D
runs across the ape# of the tooth and has no bon( insertion. .hus it
cannot act as a fi#ed base.
3$inica$ observation a$so indicate that root formation is not the
cause for eruption. .his can be e#p$ained on the basis!
i- 6ome teeth move a distance greater than the $ength of their
roots.
ii- Eruptive movement can occur even after root comp$etion.
iii- E#perimenta$ resection of root does not stop eruptive tooth
movement.
/ut root formation ma( be a necessar( prere8uisite for eruption.
&) VASCULAR PRESSURE$
"t is be$ieved that arteria$ pu$se affects teeth movement' thus $oca$
vo$ume changes can produce $imited tooth movement.
/ut increase in pressure are primari$( responsib$e for tooth
movement is debatab$e because surgica$ remova$ of root and this $oca$
vascu$ature do not prevent tooth eruption.
-) PERIODONTAL LIGAMENT TRACTION$
.here is great dea$ of evidence that eruptive forces
$ie in denta$ fo$$ic$e)PDL comp$e#.
++
5actors such as drugs' vascu$ar supp$( bone
remode$ing' e#periments de$ineating ro$e of fo$$ic$e from which
PDL forms' if interrupted with the formation of $igament
interfere with eruption.
E#periments in vitro have shown that the $igament
fibrob$asts have the abi$it( to contract and transmit a contracti$e
force to the e#trace$$u$ar environment and in particu$ar to the
co$$agen fibre bund$es. 1$$ features e#ist in vitro to permit
simi$ar movement.
.hus' the fibrob$asts possess contracti$e fi$aments' which are in
contact with one another to permit summation of contracti$e forces
and e#hibit fibrone#us b( which such forces can be transmitted to
the co$$agen fibre bund$es. .hese not on$( remode$ but are a$so
inc$ined at the correct ang$e to bring about eruptive movement. .his
angu$ation of the $igament fibre bund$e is a prere8uisite for tooth
movement and the orientation is be$ieved to be estab$ished b( the
deve$oping root' creating f$ow $ines in the ge$)$ie denta$ fo$$ic$e.
"n summar(' eruptive movement cou$d be brought about b( a
combination of events invo$ving a force initiated b( the fibrob$asts.
.his force is transmitted to the e#trace$$u$ar compartment via
fibrone#uses and to co$$agen fibre bund$es which a$igned in an
+0
appropriate inc$ination brought about b( root formation bring about
tooth movement. .hese fibre bund$es must have the abi$it( to
remode$ for eruption to continue and interference with this abi$it(
affects the process.
+4
CHRONOLOGY O( HUMAN DENTITION OR ERUPTION
SE.UENCE
<iven b( Logan and Eronfe$d in +C44 and modified b( Mc31$$ and
6chour ,?rbans- +C77.
Toot" (or#ation of
ena#e+ or
#atri/ %e*in
A#t of ena#e+
#atri/ for#e- at
%irt"
Ena#e+
&o#+etion
Erution
ti#e
Rot
&o#+etion
Primary Dentition
Ma/i++ar0
3entra$ incisor
Latera$ incisor
3anine
5irst mo$ar
6econd mo$ar
Man-i%u+ar
+7 w in utero
+= w in
+A w in
+0)+; w in
+0)+C w in
;F=
0F4
+F4
3usps united
3usp tip sti$$
iso$ated
+ G mth
0 G mth
C mth
= mth
++ mth
A G mth
C mth
+@ mth
+7 mth
07 mth
+ G (r
0 (r
4 H (r
0 G (r
4 (r
3entra$ incisor +@ w in 4F; 0 G mth = mth + G (r
Latera$ incisor
3anine
+
st
mo$ar
0
nd
mo$ar
+@ w in
0D w in
+0)+; w in
+0)+; w in
4F;
+F4
3usps united
3usp tip sti$$
iso$ated
4 mth
C mth
; G mth
+D mth
A mth
+= mth
+0 mth
0D mth
+ G (r
4 H (r
0 H (r
4 (r
Permanent dentition
Ma/i++ar0
3entra$ incisor
Latera$ incisor
3anine
+
st
premo$ar
0
nd
premo$ar
+
st
mo$ar
0
nd
mo$ar
4
rd
mo$ar
4)7 mth
+D)+0 mth
7); mth
+ G)+ I mth
0 :0 H (r
1t birth
0 G ) 4 (r
A)C (r
6ometimes a trace
A)@ (r
@)C (r
++)+0 (r
+D)+0 (r
+D)+0 (r
=)A (r
+0)+4 (r
+A)0+ (r
+D (r
++ (r
+4)+; (r
+0)+4 (r
+0)+7 (r
C)+D (r
+7)+= (r
+@)0; (r
Man-i%u+ar
3entra$ incisor
Latera$ incisor
3anine
+
st
premo$ar
0
nd
premo$ar
+
st
mo$ar
0
nd
mo$ar
4
rd
mo$ar
4)7 mth
4)7 mth
7); mth
+ I ) 0 (r
0 H ) 0 G (r
1t birth
0 G ) 4(r
@)+D (r
6ometimes a trace
7); (r
7); (r
=)A (r
;)= (r
=)A (r
0 G)4 (r
A)@ (r
+0)+= (r
=)A (r
A)@ (r
C)+D (r
+D)+0 (r
++)+0 (r
=)A (r
++)+4 (r
+A)0+ (r
C (r
+D (r
+0)+7 (r
+0)+4 (r
+4)+7 (r
C)+D (r
+7)+; (r
+@)0; (r
+7
ERUPTION SE.UENCE
DECIDUOUS
M1J! 1 / D 3 E
M1KD! 1 / D 3 E
PERMANENT
M1J! = + 0 7 ; 4 A @
M1KD! = + 0 4 7 ; A @
L K?LL16 6.1<E6 ?5 31L3"5"31."?K.
CLINICAL CONSIDERATION
.he principa$ supporting tissues of the tooth)the
PDL and the bone of the %aw' possess a remarab$e P$asticit(
that enab$es the tooth to react either favorab$( or unfavorab$( to
its immediate environment. .his p$asticit( is used for
orthodontic tooth movements.
.hus' b( app$(ing forces to the tooth and b( re$(ing on the
bio$ogic responses of bone and PDL ma$a$ignment of teeth is
corrected.
De$a(ed eruption of teeth is encountered more often
as compared to premature eruption.
+;
6ometimes infants are born with erupted $ower
centra$s ,neonata$ teeth- which shou$d be removed as the(
prevent suc$ing.
Premature $oss of a deciduous tooth without c$osure
of the gap ma( $ead to ear$( eruption of its permanent
successors.
De$a(ed eruption F retarded eruption ma( a$so be
seen which occur due to either congenita$ s(stemic or $oca$
factors.
6(stemic 5actors inc$ude!
) Kutritiona$
) <enetic
) Endocrine
NOLLA1S STAGES O( CALCI(ICATION
6tage D : 1bsence of cr(pt.
+ : Presence of cr(pt.
0 : "nitia$ ca$cification or beginning of ca$cification.
4 : +F4
rd
crown ca$cification.
7 : 0F4
rd
crown ca$cification.
; : 3rown a$most comp$eted.
= : 3rown ca$cification comp$eted.
+=
A : +F4
rd
root ca$cification.
@ : 0F4
rd
root ca$cification
C : Root a$most comp$eted : open ape#.
+D : 1pica$ end constriction.
+A
Loca$ factors inc$ude!
Deciduous teeth with conse8uent drifting of
opposing teeth to b$oc the eruptive pathwa(.
6evere trauma : ma( cause e$imination of denta$
fo$$ic$e and hence PDL formation is prevented bone deposition
occurs which resu$ts in an($osis and eruption of tooth is
$indered.
Eruption c(st.
3rowding of teeth in sma$$ %aws : provide $itt$e
room for eruption often $eading to their impaction.
.hird mo$ars and canines are teeth most$( impacted.
) .hird mo$ars are $ast teeth to erupt and
a$$ the avai$ab$e space which occupied a$read(.
) 3anines become impacted due to their
$ate eruption.
TEETHING
.his occur during the eruption time in infants.
+@
) *hen a tooth breas through the ora$
epithe$ium' an acute inf$ammator( response occurs in the
connective tissue ad%acent to the tooth.
) 6(mptoms are those of pain' s$ight fever'
genera$ ma$aise and a$$ other signs of an inf$ammator( process.
RE(ERENCES
+. ?rban>s ?ra$ &isto$og( and
Embr(o$og( : ..E.
0. .encate 1.R. : Mechanism of
.ooth Eruption.
+C
CONTENTS
"K.R?DU3."?K
P1..ERK ?5 .??.& M?BEMEK.
&"6.?L?<M ?5 .??.& M?BEMEK.
ME3&1K"6M ?5 .??.& M?BEMEK.
3L"K"31L 3?K6"DER1."?K
0D