1. Mohammed Almuzian, University of Glasgow, 2014 Page 1
Primary failure of eruption (PFE), Localized Failure of eruption , Multiple
failure of eruption
LocalizedFailure of eruption
1. Primary failure of eruption (PFE).
 Eruption pathway cleared,
 No erupting movement along path.
 Teeth distal to affected tooth also involved.
Definition
Primary failure of eruption is characterized by non syndromic eruption failure
of permanent teeth in the absence of mechanical obstruction with no obvious
local/systemic causative factor
Classification
1. Complete failure of tooth eruption (primary retention)
2. Initial eruption prior to the eruption failure (secondary retention).
Aetiology
Rare condition of unknown aetiology
1. Significant genetic influence suggested (PTH1 gene). Ahmad et al., 2006
2. Commonly family history
Prevalence
1. 1% in first molar.
2. May be unilateral or bilateral.
3. More common in females.
4. More commonly affects molars.

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Diagnosis
1. Effect on vertical facial growth, the bite distal to the first affected tooth is
usually open.
2. Permanent teeth may become ankylosed.
3. Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful.
4. May be associated with infra-occluded deciduous teeth, in particular E's.
Treatment, Proffit 1981 and Ireland 1991
 No orthodontic solution, will tend to intrude the rest of options dentition
 Consider restorative options, e.g. Crown build-ups
 May consider segmental osteotomy
 Extraction
2. Mechanicalfailure of eruption (MFE)
 Radiographic appearance of submergence due to ankylosis.
 No clear path of eruption.
 Teeth distal to mostmesially affected tooth apparently normal
3. Indeterminate failure of eruption (IFE)
 Distinction between PFEand MFE not clear.
 Too young to determine whether teeth distal to most mesially affected tooth are
affected or normal.
Multiple failure of eruption
1. Local factors
 Mucosal barrier
 Supernumerary
 Arch length deficiency
 Trauma to primary teeth
 Radiation

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 CLP
 Missing teeth
2. Systemic factors
a. Genetic disorders
 CLD
 Osteoporosis
 Gardner syndrome
b. Endocrinal disorders
 Hypo thyrodisim
 Hypo pitiutarisim
 Hypo parathyrodisim
c. Nutriotnal
 Vita D defficency
d. Others
 Drugs lik phenytol
 Coelic diseases
3. Idiopathic
 PFE
I. Lingual arches can be used to provide attachment to extrude multiple teeth after
their failure of eruption like Jerusalem approach (Becker, 1997) in the
management of multiple failures of eruption associated with Cleidocranial
Dysplasia. With the Jerusalem Approach, all primary teeth & supernumerary
teeth are extracted at the age of 10– 12, closed exposure with bonding of the
permanent incisor teeth is performed to start their alignment using the heavy
lingual and bucco-labial arch. These arch remain in the place to be used during
the second phase of closed surgical exposure and alignment of the remaining

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permanent teeth at the of 13 years. Another approaches which are available for
the management of multiple failures of eruption associated with CCD are The
Belfast– Hamburg (all surgical exposure and alignment done at one time at the
age of 9 years, Unerupted permanent teeth are exposed at phase I, then at phase
II (one year later) the surgical exposure with orthodontic brackets are placed to
start alignment (Behlfelt, 1987). The Bronx approach developed recently by
Berg in 2011 is similar to the Belfast– Hamburg approach but involve
additionally another Phase 3 where orthognathic surgery, bone augmentation
and dental implants are placed under at the same time. While the Toronto–
Melbourne approach involves three stages. Stage I: at age of 6 years, the
primary incisors are removed. Stage II: at 9– 10 years where primary canines
and molars are removed while in stage III involve removing the supernumerary
tooth and surgical exposure of the permanent dentition at later age. (Smylski
1974;Hall, 1978)