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LOCAL FACTORS THAT INFLUENCE ERUPTION

Presented by:Dr. Shady A. M. Negm

Bachelor's Degree of Dental Surgery, School of Dentistry, Pharos University.

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1. Infection:-• Near the eruption time

cause early eruption “soft tissue tearing, bone resorption”

• Before long period cause late eruption “healing and fibrosis”.

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2. Supernumerary teeth:

Cause late eruption.  

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3. Gingival fibromatosis:

Very hard tissue of the gum.

It prevents eruption.

It is hereditary condition, treated by gingivectomy

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• 4. Ankylosed teeth:It is a dental situation in which the roots of the tooth lose their normal attachment to the bone (small ligament) and become directly fused to the bone.  

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Diagnosis:

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• 1- The diagnosis of an ankylosed tooth is not difficult to make. Ankylosis can be partially confirmed by tapping the suspected tooth and an adjacent normal tooth with a blunt instrument and comparing the sounds. The ankylosed tooth will have a solid sound, whereas the normal tooth will have a cushioned sound because it has an intact periodontal membrane that absorbs some of the shock of the blow. 

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• 2- The radiograph is often a valuable aid in making a diagnosis. A break in the continuity of the periodontal membrane indicating an area of ankylosis is often evident radiographically.

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Problem associated

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1- Submerged tooth.  

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• 2- Malposition of tooth.  

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• 3- Super eruption of apposing tooth.  

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• 4- Delayed eruption or impaction of permanent tooth.

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A. Primary teeth

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• Extensive bony ankylosis of the primary tooth may prevent normal exfoliation, as well as the eruption of the permanent successor.

• The mandibular primary molars are the teeth most often observed to be ankylosed.Ankylosis involved second molar may be indication of agenesis of succedanous tooth. 

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Causes

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• 1- The cause of ankylosis in the primary molar areas is unknown. 2- The observation of ankylosis in several members of the same family lends support to the theory that it follows a familial pattern.3- Very slow root resorption was observed for most of the ankylosed teeth.

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Management

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• 1- In the management of an ankylosed tooth, early recognition and diagnosis are extremely important. 2- The eventual treatment may involve surgical removal and place space maintainer.3- However, unless a caries problem is unusual or loss of arch length is evident, the dentist may choose to keep the tooth under observation or build up occlusal surface. 4- A tooth that is definitely ankylosed may at some future time undergoes root resorption and be normally exfoliated.

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• 5- When patient cooperation is good and recall periods are regular, a watchful waiting approach is best.6- In situations in which permanent successors of ankylosed primary molars are missing, attempts have been made to establish functional occlusion using stainless steel crowns, overlays, or bonded composite resins on the affected primary molars. This treatment is successful only if maximum eruption of permanent teeth in the arch has occurred. 

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• 7- If adjacent teeth are still in a state of active eruption, they will soon bypass the ankylosed tooth.

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B. Permanent teeth

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• The incomplete eruption of a permanent molar may be related to a small area of root ankylosis. If the permanent tooth is exposed in the oral cavity and at a lower occlusal plane than the adjacent teeth, ankylosis is the probable cause.

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Causes

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• 1-  Familial.2- Unerupted permanent teeth may become ankylosed by inostosis of enamel. The process follows the irritation of the follicular or periodontal tissue resulting from chronic infection.

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Management

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• 1- The removal of soft tissue and bone covering the occlusal aspect of the crown should be attempted first, and the area should be packed with surgical cement to provide a pathway for the developing permanent tooth.2- Luxation technique effective in breaking the bony ankylosis. 

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• 3- If the rocking technique is not immediately successful, it should be repeated in 6 months. A delay in treatment may result in a permanently ankylosed molar.4- Surgery exposure + orthodontics traction + RCT.

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