Lecture 2 Tooth Eruption and Shedding

TOOTH ERUPTION AND
SHEDDING
Lecture 2 on TOOTH ERUPTION AND SHEDDING
Dr. Amit Gupta

Reader
Department Of Oral Pathology
1
CONTENTS
 Introduction
 Physiologic tooth movement
a) Pre eruptive tooth movement
-Histology
b) Eruptive tooth movement
-Histology
c) Post eruptive tooth movement
-Histology
 Mechanisms of tooth movement
Five mechanisms:-
- Root formation
- Hydrostatic pressure
- Bony remodeling
- Dental follicle
- Periodontal ligament
2
CONTENTS
 Basis for tooth eruption:-
- Cellular basis
- Molecular basis
- Genetic basis
 Pattern of shedding of teeth
 Histology of shedding
 Mechanism of shedding
 Problems in tooth eruption
 Problems in tooth shedding
 Future challenges
3
INTRODUCTION
Eruption word is derived from the Latin word

“ERUMPERE” meaning to “break out”.
Refers to the axial or occlusal movement of the tooth

from its developmental position in the jaw to its
functional position in occlusal plane.
Eruption is only a part of physiologic tooth
movements because teeth undergo complex
movements.
Physiologic tooth movement is described as:-

- Pre eruptive tooth movement
- Eruptive tooth movement
- Post eruptive tooth movement
DENTITION
During all these 3 stages, there is progression from
primary to permanent dentition which involves the
shedding (exfoliation) of primary teeth.
 Diphodont : Two sets of dentition in humans

- Deciduous and Permanent dentition
- Mixed dentition: Presence of both dentitions
Primary dentition:
2 to 6 years of age
Mixed dentition:
6 to 12 years
Permanent dentition:
> 12 years
MECHANISMS OF TOOTH
ERUPTION
1. BONE REMODELLING
The growth pattern of the maxilla and mandible

supposedly moves teeth by selective deposition and
resorption of bone in the immediate neighborhood
of tooth.
Major proof is when a tooth is

removed without disturbing its
follicle, an eruptive pathway
still forms within bone as
osteoclasts widen the
gubernacular canal.
 Role of DENTAL FOLLICLE:-
Studies have shown that the

reduced dental epithelium
initiates a cascade of
intercellular signals that
recruit osteoclasts to the
follicle.
By providing a signal and chemo attractant for osteoclasts, it

is possible that the dental follicle can initiate bone
remodeling which goes with tooth eruption
Teeth eruption is delayed or absent in animal models
and human diseases that cause a defect in osteoclast
differentiation.
DRAWBACK:-
If the dental follicle is also removed no eruption path
develops. So not sure if bone remodeling plays a
significant role in tooth eruption.
2. ROOT FORMATION
Root formation would appear to be the obvious

cause of tooth eruption since as it causes an
overall increase in the length of the tooth along
with the crown moving occlusally.
DRAWBACK:-
Clinical observation, experimental studies, and
histological analysis argue strongly against such a
conclusion as rootless teeth do erupt.
Some teeth erupt a greater distance than the total

length of their roots
Teeth will still erupt after the completion of root

formation or when the tissues forming the root--
the papilla, Hertwig's epithelial root sheath, and
periapical tissue--are surgically removed.
HYDROSTATIC PRESSURE
The teeth move in their sockets in synchrony with the
arterial pulse, so local volume changes can produce limited
tooth movement.
Ground substance can swell from 30% to 50% by

retaining additional water, so this could create pressure.
Differential pressure between the tissues below and above

an erupting tooth as been reported.
DRAWBACK:-
Surgical excision of the growing root and associated tissues
eliminates the periapical vasculature without stopping
eruption, this means that the local vessels are not
absolutely necessary for tooth eruption.
PERIODONTAL LIGAMENT:-
Available evidences strongly indicate that the force for
eruptive tooth movement resides in PDL
The PDL and the dental follicle from which it forms are
implicated in the process of tooth eruption linked to the
contractility of fibroblasts
The use of selective poison (cytochalasin) disrupt the cell

cytoskeleton and contractility and show response in
relation to movement
SHEDDING OF TEETH
Physiologic process resulting in the complete

elimination of the deciduous dentition
The need for two dentitions exists because with the

increase in jaw growth more and larger teeth are
required for the adult
PATTERN OF SHEDDING
Result of progressive resorption of
roots of deciduous teeth and its
supporting tissues
Pressure generated by the erupting

permanent tooth dictates the pattern
of deciduous tooth resorption
 Initially, pressure is against the root surface of deciduous tooth
and resorption occurs on the lingual surface
 Later these developing tooth germs occupy a position directly

apical to the deciduous tooth
 In mandibular incisors the apical positioning of the tooth germs

does not occur and permanent tooth erupt lingually
RESORPTION OF DECIDUOUS
MOLARS
Resorption of the roots of
deciduous molars first begins
on their inner surfaces because
the early developing bicuspids
are found between them
With continued growth of the

jaws and occlusal movement of
the deciduous molars, the
successional tooth germs lie
apical to the deciduous molars
When the bicuspids begin to
erupt, resorption of the
deciduous molars is again
initiated and continues until
the roots are completely lost
and the tooth is shed
HISTOLOGY OF SHEDDING
Odontoclasts are resorbing
cells derived form monocyte
-macrophage lineage
Giant multinuclear cells with

4-20 nuclei
Resorption occurs at the

ruffled border which greatly
increases the surface area of
the odontoclast in contact
with bone
DISTRIBUTION OF
ODONTOCLASTS DURING
TOOTH RESORPTION
Found on surfaces of the roots
in relation to advancing
permanent tooth
Single rooted teeth shed before

root resorption is complete
Odontoclasts are not found in

pulp chambers of these teeth
Shed element following “shedding of primary
incisor’’
Complete resorption of roots
Resorption lacunae seen

(arrow)
Most of coronal pulp is intact

In molars, the roots are completely
resorbed and crown is partially
resorbed
Odontoblasts layer is replaced by

odontoclast
Sometimes all the dentin is removed

and the vascular tissue is seen beneath
the translucent cap of enamel.
TOOTH RESORPTION AND
REPAIR
Resorption is not a continuous process but have
also periods of repair
Resorption predominates repair
Repair is achieved by cells resembling
cementoblasts
Final repair tissue resembles cellular cementum
but is less mineralized
MECHANISM OF RESORPTION
AND SHEDDING
Pressure from the erupting successional tooth as

appearance of odontoclasts at the site of pressure
Membrane of ruffled border act as proton
pumpadding hydrogen ions to extracellular
regionacidifyingmineral dissolution
Increased forces of mastication with increase in
jaw size leading to trauma to the PDL
Apoptotic cell death in PDL
ERUPTION TO SHEDDING OF MANDIBULAR
INCISOR
5 months At birth 1 year
2 years 3.5 years

4.5 years
Deciduous 1st molar
RETAINED PRIMARY TEETH
Without permanent
successors or
successors are
impacted
Most common are

upper lateral incisors
SUBMERGED PRIMARY TEETH
Cause can be trauma to either the dental follicle

or the developing periodontal ligament
Because of continued eruption of adjacent teeth
and increased height of alveolar bone, they
appear “submerged”
REMNANTS OF DECIDUOUS
TEETH
Sometimes parts of the
roots of deciduous teeth
are not in the path of
erupting permanent teeth
and may escape resorption
Remnants consists of
dentin and cementum
Most frequently found in
permanent premolars
especially in the region of
lower 2nd premolars
REFERENCES
 TENCATES, A textbook on Oral Histology
 ORBAN’S, A textbook on Oral Histology
 JAMES AVERY, Essentials of Oral Histology
 http://www.columbia.edu/itc/hs/dental/d9903/lectures/lectu
re4.pdf
 Gorski et al., 1988a,b, Localisation of eruption molecules
 Cahill et al. (1988) Concept of Eruption molecules
 Oral Biology and Medicine International and American
Associations for Dental Research 13(4):323-335,2002
THANK
YOU

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TOOTH ERUPTION AND

Lecture 2 on TOOTH ERUPTION AND SHEDDING

Dr. Amit Gupta

Eruption word is derived from the Latin word

Refers to the axial or occlusal movement of the tooth

Physiologic tooth movement is described as:-

 Diphodont : Two sets of dentition in humans

The growth pattern of the maxilla and mandible

Major proof is when a tooth is

Studies have shown that the

By providing a signal and chemo attractant for osteoclasts, it

Root formation would appear to be the obvious

Some teeth erupt a greater distance than the total

Teeth will still erupt after the completion of root

Ground substance can swell from 30% to 50% by

Differential pressure between the tissues below and above

The use of selective poison (cytochalasin) disrupt the cell

Physiologic process resulting in the complete

The need for two dentitions exists because with the

Pressure generated by the erupting

 Later these developing tooth germs occupy a position directly

 In mandibular incisors the apical positioning of the tooth germs

With continued growth of the

Giant multinuclear cells with

Resorption occurs at the

Single rooted teeth shed before

Odontoclasts are not found in

Complete resorption of roots

Resorption lacunae seen

Most of coronal pulp is intact

Odontoblasts layer is replaced by

Sometimes all the dentin is removed

Pressure from the erupting successional tooth as

5 months At birth 1 year

2 years 3.5 years

Most common are

Cause can be trauma to either the dental follicle

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