Eruption & Establishment of the Dentition

Many of the slides of this topic will be canceled Reminder ,At the picture these are different stages of tooth formation bud stage ,cap stage ,bell stage And during the late period of bell stage we begin to see hard tissue formation until the full crown is formed and after that the root starts to form the tooth starts to go up ,so the going up of the tooth related to tooth formation

Tooth Eruption

Its a process whereby a tooth moves from its developmental position in the jaw into its functional position in the mouth, as a result its a continuous process, for example sometimes we call the tooth when the tooth starts to appear in the mouth eruption which is wrong,it should be called emergence ..now whats the difference ?! ^^Emergence ..when the first part of the tooth appears in the mouth which is one of the stages of eruption(brief stage of eruption) ^^Eruption ..is a continous process that has many stages ^^functional eruption ..when the tooth reaches contact with the opposite tooth Its also The process by which developing teeth emerge through the overlying bone, soft tissues & oral mucosa In Addition .. its found that even if the root reaches contact ,if the apposing tooth is removed the tooth may erupt for one or two mm that means eruption doesnt end so we dont have an evidence that eruption ceases after occlusal contact because sometimes teeth may go over-eruption or super eruption upon removal of antagonist tooth Thats why is A continuous process ending only with the loss of the tooth

Purpose of tooth eruption

Entering the oral cavity Contacting teeth of the opposing arch Functioning in occlusion & mastication

Phases of eruption Generally we have 3 different stages ..

Pre-eruptive phase Its the phase that begins from the Initiation of tooth development until crown is completed Pre-functional eruptive phase Its the phase that begins from Initiation of root development until the Establishment of occlusal contact and the tooth is not in function yet Post-eruptive functional phase protracted phase It starts when the occlusal contact is established and afterwards , Note: tooth erupt after they reach contact because if the apposing tooth is removed they can go up slightly ,the tooth is all the time erupting and what prevents the tooth from erupting is the apposing tooth Concerned with development & maintenance of occlusion

Now What happens in these phases ?! Pre-eruptive Phase Movements in response to positional changes of adjacent developing crowns ,sometimes the tooth it self before the crown is completed can move because of the response to adjacent crowns Sometimes we have Movements in response to changes in the maxilla and the mandible as the face grows downwards and forwards,when the face grows downwards and forward the jaw changes it position these momvements can be medial lateral anterior posterior not necessarily vertical movement Usually Teeth make mesial and distal movements during lengthening of the jaws Also when the successor teeth moves in relation to their predecessors this cause changing in the position of the predecessor tooth

Movement of successors at first they share the same crypt and later own each tooth has it own crept ,,at the picture .. first its located lingual to it after that it goes down and the other tooth starts to erupt and occupies a position below and lingual to the tooth In the case of deciduous molar the premolar located lingual to it with time the pre molar will come inside between the roots of the deciduous tooth ,which is important clinically because when the anterior deciduous teeth are lost ,the resorption is obliquely because of that in some children we see deciduous tooth and permanent successor tooth appearing in the mouth at the same time,but in premolar the resorption is not oblique but horizontal

Movement of permanent molars These teeth dont have predecessor so they erupt by them self because they are not successors Maxillary molars Develop within the tuberosities First we have first molar development then its moves ,then the tuberosity will be free for the second molar to develop then moves forward then its free for the third molar,this third molar remains within the tuberosity

Usally Occlusal surfaces slanting distally

mandibular molar

Develop in the rami

Occlusal surfaces slanting mesially

Movement of teeth

All of these are pre-eruptive ,before the vertical movement From this picture the doctor emphases that the important thing we should know that , the crown of this lower permanent canine its very close to the inferior border of the mandible the incisor it develops in the middle area of the occlousal plane and the inferior border of the mandible ..then it keeps moving ,but some teeth like mandibular canine goes down

Rates of eruption teeth dont erupt at the same rate Theres A balance between eruptive & resistive force,because when the teeth erupt they face resisitance so we should have balance Resistance (factors affecting eruption rate) Overlying soft tissues & alveolar bone Viscosity of surrounding PDL Occlusal forces But finally if the tooth wants to erupt the amount of eruptive force should be more than the amount of resistance TOOTH Upper central incisors Lower 2nd premolars 3rd molars Crowded dentition ERUPTION RATE 1 mm / month 4.5 mm / 14 weeks 1 mm / 3months < 1 mm in 6 months

Lower second premolar is among the fastest teeth that erupt which is 4.5 among 14 weeks (in one month 1.5 mm)

Rate of eruption Slow eruption until the tooth reaches the oral mucosa Its takes about 2 to 4 years for permanent teeth Note : the rate of eruption from the beginning until the end is not the same Rapid eruption as the tooth enters the oral cavity,once the tooth penetrate the oral cavity it penetrates fast When the tooth reaches the emergence 2/3s of root length has formed The Maximum rate is usually 1 mm / month ,but during to the study permanent molar may only need two months from emergence to functional eruption ,and as the time the tooth emergence become late the time needed to the functional eruption becomes longer Eruption slows as the tooth approaches the occlusal plane/contact No sex difference Racial differences may exist

Active eruption vs. passive eruption Active Axial movement of the tooth Passive Retraction of adjacent soft tissues

10

Pre-functional Eruptive Phase Starts with the initiation of root formation Ends when reaching occlusal contact The process of Root formation Proliferation of Epithelial Root Sheath Initiation of dentinogenesis in the root Formation of the pulp tissues An increase in follicular fibrous tissue

Movement at the root formed the tooth started to go up axially ,when the root is forming it needs a space it cannot penetrate but it moves up so there will be o Elongating for the roots o And usually when the tooth is moving enamel is protected by the Reduced enamel Epithelium , but once the tooth reaches very close to the oral mucosa the reduced enamel epithelium fuses with the oral epithelium creating an epithelial line canal through which the tooth erupts thats why the penetration without bleeding

11

 Penetration It involves .. Entrance into the oral cavity Enamel cuticle covers enamel No bleeding because of the fusion of the epithelial tissue Intra-oral occlusal/incisal movement Until contact with opposing crown occurs Clinical crown vs. Anatomical crown

Reminder .. The clinical crown the part of the crown that appears clinically in the mouth ,usually that part of crown is covered by some gingivae thats why the clinical crown is shorter than the anatomical crown which is the actual crown of the tooth ,with age the amount of the visible crown becomes bigger so with age clinical crown becomes bigger than anatomical crown

12

Changes in tissues

Overlying erupting teeth Surrounding erupting teeth Underling erupting teeth Overlying erupting teeth The tooth is moving up , the thing that happens to the area above the tooth is called eruption pathway, The tooth is a maxillary tooth so it wants to go down ,they found that this area is an inverted triangle ,its a degeneration area because we dont see nerves we dont see blood vessels

Zone of degeneration Blood vessel decrease in number Nerves break down and degenerate
13

 Inside the degeneration zone we can identify an area called Gubernacular cord at the periphery of the degenerative zone Imagination ..imagine this is the tooth and this tooth is surrounded by bone the area that is above the cusp of the tooth which located at the apex of bone this is the orifice of bone that the tooth has to pass through this area is called Gubernacular cord ,its a part that fills a space above the tooth called Gubernacular canal Note .. Gubernacular canal is only related to permanent teeth(including successor and non successor teeth in order to these to erupt they have to penetrate bone they have to create their own canal ) , deciduous teeth always erupt without overlying bone as the tooth approximate the surface of bone the canal becomes bigger and bigger ,the canal for the central is bigger than the one to the lateral Follicular fibers directed toward the mucosa Gubernacular canal contains the gubernacular cord The cord is composed of a central strand of epithelium its important because when the tooth reaches close the mucosa to connect between the reduced enamel epithelium and the outer epithelium which is important for the tooth to reupt without bleeding , and the cord is surrounded by connective tissue

14

cells that are important in eruption .. Osteoclasts Their function is .. Resorption of overlying bone (In successor teeth) resorption of the root of the predecessor Osteoblasts Build up of resorbed areas after tooth movement

Resorption of primary teeth o Begins within 1 year of root completion,permenant teeh doesnt undergo resorption o Similar to bone resorption o Dentine and cementum are reabsorbed but not enamel o By osteoclasts cells

15

Factors affecting rate of root resorption

Increased masticatory loads Less resorption when deciduous teeth are splinted,because when they are splinted(put them together ) the load will distribute, after removal of successor germs Resorption is not continous all the time we have Rest periods and active periods Reparative tissue may be formed But always resorption is more dominant than repair ,if something goes wrong when repair is the dominant over resarption this leads to the loss of the PDL & ankylosis to surrounding bone for the deciduous tooth ..(the tooth becomes attached directly to te bone)

Ankylosed primary teeth,, Important ,, the most teeth affected the mandibular second deciduous molars Failure of continuing eruption Position remains constant in the jaw Height of alveolar bone increases Tooth sinks gradually below the levels of adjacent teeth Called submerged teeth

16

 Submerging may continue to an extent where teeth become completely buried within bone

Shedding of primary teeth The tooth got lost when the root of this tooth is lost ,because it has no mechanism of attachment Primary dentition from about 2 to 7 years ,when last deciduous tooth erupts and starts t function which is the second molar , until the first incisor is lost Mixed dentition from 7 to 13 years During mixed dentition period nearly 50 teeth are accommodated in the jaw

this picture shows a fusion between reduced enamel epithelium and oral mucosa

17

Development of dentogingival junction The tooth continues to go up until fusion ,it goes up without bleeding the area of REE remains at the tooth ,when the tooth finally erupted part of the enamel is still fused with the reduced enamel epithelium ,this epithelium is called junctional epithelium ,its The part of epithelium that covers the cervical margin of enamel, and its the remnant of REE REE, these cells are exhaustive (weak and very old they are not able to protect) They are the remnants of enamel organ , they are the cells that build the crown they can easily penetrated by bacteria ,causing gingivitis

Sorry for any mistakes. What others think of you is not your business Time heals almost everything, give the time Some time ;) Alaa Adas ,!

18