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