August 2020 Delayed Eruption Know the eruption dates approximately but most important is the sequence of eruption If tooth fails to erupt within 6 months of its antimere or there is a significant deviation from the normal sequence eg a 2 erupting before a 1 investigate In Part 2 M ID: 910995
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Slide1
Delayed Eruption
MJDF/MFDS WoS Study Group
August 2020
Slide2Delayed Eruption
Know the eruption dates approximately, but most important is the
sequence
of eruption. If tooth fails to erupt
within 6 months
of its antimere, or there is a significant deviation from the normal sequence (e.g. a 2 erupting before a 1), investigate. In Part 2 MJDF you may be given a cephalogram or OPG of a child with delayed eruption and be expected to realize that there is something wrong!
Slide3Aetiology (local factors)
Absence- v unusual in a central, more common with maxillary laterals, and 5s.
Crowding
Delayed exfoliation of primary tooth
Supernumeraries
Odontomes- a benign tumour of odontogenic origin
Pathology- e.g. cyst
Dilacerations- may be developmental or as result of trauma.
Abnormal position of crypt e.g. ectopic canines
Impaction- usually because of crowding
Retained primary teeth- ankylosed
Premature loss of primary teeth- leading to bone deposition/gingival hypertrophy??
Primary failure of eruption- usually confined to buccal segments and very rare- failure of the eruptive mechanism due to ankylosis and infraocclusion is a secondary failure of eruption
Slide4Aetiology (systemic factors)
Cleidocranial dysostosis— a disorder of bone leading to delayed eruption and multiple supernumeraries
Hereditary gingival fibromatosis
Down’s syndrome
CLP
Hypothyroidism
Hypopituarism
Hypoparathyroidism
Gardner’s syndrome- bowel polyps (premalignant). Boney osteomata and soft tissue tumours
Von Recklinghausen’s neurofibromatosis
Slide5Aetiology (Cont’d)
MEDICATION (rare):
Those which cause gingival overgrowth- e.g. phenytoin, ciclosporin, calcium channel blockers (commonly Amlodipine)
Slide6Supernumerary Teeth
Additional to normal series. 2% of permanent dentition, 1% of primary. More common in males than females. Also commonly found in cleft palate.
-Conical (mesiodens)- conical or peg-shaped, most commonly between upper centrals. Often cause a median diastema
-Tuberculate (barrel shaped)- associated with failure of eruption.
-Odontome- rare.
Complex
and
compound
types.
NB The presence of a
supernumerary is the most common reason for failure of eruption of maxillary central
, but failure of eruption could be caused to any tooth by a supernumerary.
Slide7Dilacerations and Odontomes
Dilacerations are developmental in 70% of cases, most commonly in females with no history of trauma. May also arise due to cysts or supernumerary teeth in 7% of cases, or secondary to trauma to the primary dentition in the remainder- usually in boys.
Odontomes- thought of as supernumeraries- hamartomatous malformations that may be
complex
or
compound
(resembling a collection of tooth tissue).
Slide8Infra-occlusion
Caused by ankylosis.
Suspect missing teeth if deciduous tooth is retained. It is common to see infra-occlusion of second deciduous molar if premolar is missing. Infraocclusion has been reported at 55%, with up to 8.3% suffering significant infra occlusion.
Early extraction may be indicated if wishing to preserve vertical bone height.
If retaining an infraoccluded tooth, it can be built up with composite or an
onlay
(e.g. E-max) to maintain occlusal height and avoid over-eruption of opposing teeth/tipping of adjacent teeth.
Slide9Ectopic Canines
1.5% of the population. 10% are bilateral. MOST are
palatally
placed.
37% of patients with palatally-displaced canines have missing or diminutive laterals or absent second premolars. If canines are not palpable by 10 to 11 years old, radiographic examination should be carried out, and patient should be referred if concerns regarding position. Do not wait too long!
Localisation
- parallax radiographs
Treatment options:
A) Extraction of the C
B) Surgical exposure & orthodontic alignment
C) Surgical removal of impacted canine
D) Transplantation
E) No active treatment/leave and observe
Slide10Management of Delayed Eruption (Incisors)
Removal of obstruction
: 90% of impacted incisors will erupt within 18 months of removal of a supernumerary.
Most incisors will align spontaneously, but 34% require orthodontic alignment
Surgical intervention
: open or closed exposure and bonding of gold chain
Extraction
: if severely dilacerated (obviously a last resort option)