Tootheruption

GOOD MORNING
www.indiandentalacademy.com

Poet OGDEN NASH
must have known the
suffering
when he penned the
words ,
”..some tortures are
physical and some are
mental ,
But the one that is
both is DENTAL…!!! ”

EVOLUTION . . .EVOLUTION . . .www.indiandentalacademy.com

Evolutionary ConceptEvolutionary Concept
During evolution several significant changes
took place in the jaws and teeth. When the
reptilian evolve to mammalian , the dentition
went from “polyphydont ” (many set of teeth)
to “diphydont ” (only two sets of teeth) and
then to “homodent ” (all of same teeth) to
“heterodent”(different types of teeth like
incisors, canines , premolars and molars) .
There also arose the necessity for the teeth
and bones to develop somewhat
synchronously in order that the function of
occlusion could be facilitated.

Stages of tooth evolutionStages of tooth evolution
Graphically there are four stages of tooth
development:
 The reptilian stage (HAPLODONT)
 Early mammalian stage (TRICONODONT)
 Triangular stage (TRITUBERCULAR
MOLAR)
 QUADRITUBERCULAR MOLAR

The REPTILIAN stage
Represented by simplest form of tooth , the single
cone.
 Dentition includes many teeth in both jaws that limits
jaw movement.
There is no occlusion.Teeth mainly used for prehension or combat and
procurement of food.
Jaw movement confined to simple hinge movement.
…move towards future…the MAN.

Early mammalian (triconodont)
Exhibits three
cusps in line in
the posterior
teeth.
Not seen now except a few breeds of dogs
and other carnivores.

 Largest
cusp is in
middle,with
smaller cusp
anteriorly
and
posteriorly.

Tritubercular (triangular)stage
 According to some theories the triconodont
line of three to a three cornered shape , with
the teeth still bypassing each other more or
less when the jaw opened or closed.
 Usually seen in dogs and carnivores.
tiger
cheetah
Occlusion absent

Quadritubercular stage
It is the next stage of development created a projection on the
triangular form that finally occluded with the antagonist of the
opposing jaw.
During the time as an accommodation to the changes in
the tooth form and anatomy , the articulation of the jaws
changed accordingly.
The animals with dentition similar to that of humans are
anthropoid apes.
HELLLO…..frens !!! meet other members of my FAMILY…..HELLLO…..frens !!! meet other members of my FAMILY…..

Hi..myself GIBBONGIBBON

we are… GORILLAS’GORILLAS’
HA…HA…HAAA !!!HA…HA…HAAA !!!

HELLO….myself MONKEYMONKEY

DON’T run..I am
ORANGUTANORANGUTAN

The shapes of individual teeth in these animals are
very close to their counterparts in HUMAN MOUTH.
SKULL of CHIMPANZEE
NOTE the TEETH in OCCLUSION

Characteristics of DENTITION
The teeth of the vertebrates are characterized
depending upon :
MODE OF ATTACHMENT
ACRODONT : teeth attached to the jaw by a
connective tissue.
PLEURODONT : teeth are set inside the jaw.
THECODONT : teeth are inserted in the bony
socket.

Depending on the NUMBER OF SUCCESSIVE
SET
POLYPHYODONT : teeth replaced throughout life.
ex: SHARK
SHARK TEETH …so better TAKE CARE

Depending on the NUMBER OF SUCCESSIVE SET
DIPHYODONT : two sets of teeth.
Ex: HUMAN BEING
Step further towards CIVILIZATION…
PRIMARY DENTITION

so care for your TEETH…..
and SMILE
…..or BETTER choose yourself
PERMANENT DENTITIONwww.indiandentalacademy.com

Depending on the NUMBER OF SUCCESSIVE SET
MONOPHYODONT : one set of teeth .
Ex. SHEEP and
GOAT
GOAT
SHEEP

TYPE or SHAPE OF TEETH
HOMODONT : a single type of teeth
HETRODONT : having various type of
teeth . Ex. Human being

ORIGIN OF TEETH
 THEORY OF CONCRESCENCE
 The mammalian dentition was produced by the
fusion of two or more primitive conical teeth and
each tubercle with its corresponding root originated
as a single tooth.
 THEORY OF TRITUBERCULY
 Each of the mammalian teeth was derived from a
single reptilian tooth by secondary differentiation of
tubercles and roots.
 This theory is widely ACCEPTED.
 THEORY OF MULTITUBERCULY
 The mammalian dentition is a result of reduction
and condensation of primitive tuberculate teeth.

Development of TOOTH

CONTENTSCONTENTS
 PRIMARY EPITHELIAL BAND
 VESTIBULAR LAMINA
 DENTAL LAMINA
 BUD STAGE
 CAP STAGE
Enamel Knot
Enamel Cord
Enamel Niche
 BELL STAGE
Histodifferentiation and Morphodifferentiation
Structure of TOOTH GERM
DENTAL PAPILLA
BREAK UP of Dental Lamina
CROWN PATTERN Determination
 NERVE and VASCULAR SUPPLY
 Formation of PERMANENT DENTITION
 Hard tissue formation / CROWN STAGE
 ROOT FORMATION
 FORMATION OF SUPPORTING TISSUE

Development of TOOTH involves many
BIOLOGICAL PROCESS including
EPITHELIAL MESENCHYMAL relationship
 Morphogenesis
 Fibrillogenesis
 Mineralization

WHAT IS
ECTOMESENCHYME?ECTOMESENCHYME?
 When the histology of primitive Oral cavity is
Examined ,it can be seen to be lined by
primitive 2-3 layered epithelium covering an
Embryonic Connective Tissue which
because of its origin from Neural Crest is
termed ECTOMESENCHYME.

Primary Epithelial BandPrimary Epithelial Band
 After 37th
day of development, continuous
band of epithelium forms around the mouth
from the fusion of separate plates of
thickened epithelium.
 Roughly ‘Horse Shoe’ shaped.
 Gives rise to Vestibular lamina.
Dental lamina.

Vestibular Lamina Dental Lamina
Primary Epithelial Band

Vestibular LaminaVestibular Lamina
 Vestibule forms as a result of proliferation of
vestibular lamina into the ectomesenchyme.
 Its cells rapidly enlarge and then degenerate
to form CLEFT which becomes the vestibule
between the cheek and tooth bearing area.

Dental LaminaDental Lamina
 Within the Lamina itself continued and
localized proliferative activity leads to
formation of series of Epithelial Ingrowths
into the Ectomesenchyme at sites
corresponding to position of future
DECIDUOUS TEETH.
From THIS POINT development proceeds in
three stages :
 BUD stage
 CAP stage
 BELL stage

Bud StageBud Stage
 First epithelial incursion into the
ectomesenchyme of jaw.
 Simultaneous with the differentiation of each
dental lamina round and ovoid swelling arise
from basement membrane at ten different
point, corresponding to future deciduous
teeth.
 These are primordia of enamel organ ‘the
tooth bud’ .

TOOTH BUD and
DENTAL LAMINA
EIGHT WEEK
BUD STAGEBUD STAGE

CAP STAGECAP STAGE
TENTH WEEK
ENAMEL
ORGAN

BELL STAGEBELL STAGE
About 4
MONTHS
ENAMEL ORGAN
of DECIDUOUS
TEETH
PRIMORDUM of
PERMANENT
TOOTH
PRIMORDIUM of
FIRST
PERMANENT
MOLAR

Enamel organ (dental organEnamel organ (dental organ))
 Consists of:
 Peripherally located low columnar cells.
 Centrally located polygonal cells.
 Functions of Dental organ
 Determining shape of crown
 Initiating dentin formation
 Establishing dentinogingival junction
 Forming enamel
 As a result of increased mitotic activity (of cells
of tooth bud and surrounding mesenchyme)and
migration of neural crest cell into the area.
 The ectomesenchymal cells surrounding tooth
bud condense.

Enamel Organ(dental organ)Enamel Organ(dental organ)

Condensed EctomesenchymeCondensed Ectomesenchyme
 Immediately subjacent to enamel organ
known as DENTAL PAPILLA
 Tooth pulp
 Dentin
 That surrounds tooth bud and dental papilla
known as DENTAL SAC
 Cementum
 Periodontal ligament
 Dental organ,Dental Papilla and Dental
follicle constitute TOOTH GERM

Tooth GermTooth Germ

Cap stage(proliferation)Cap stage(proliferation)
 Tooth bud continues to proliferate BUT not
expand uniformly.
 Unequal growth in different parts of tooth bud
lead to cap stage.
 Outer enamel epithelium
 Peripheral cells covering convexity are
CUBOIDAL
 Inner enamel epithelium
 Peripheral cells covering concavity are
COLUMNAR

 Stellate reticulum (Enamel pulp)
 Polygonal cells in center of epithelial
enamel organ between inner enamel
epithelium and outer enamel epithelium
separate as intercellular fluid accumulate.
 Cells assume branched reticular network.
 Mucoid fluid rich in albumin.
 Gives cushion like consistency may
support and protect Enamel forming
cells

Oral Epithelium
Dental Lamina
Tongue
Tooth Germ
Meckel’s Cartilage
Lip
CAPCAP STAGESTAGE

DENTAL LAMINA
PERMANENT TOOTH BUD
ENAMEL CORD or SEPTUM
DENTAL PAPILLA
ENAMEL CORD

ENAMEL NICHE

ENAMEL KNOTENAMEL KNOT
The cells in the center of the ENAMEL ORGAN
are densely packed and form ENAMEL KNOT.
ENAMEL CORDENAMEL CORD
A vertical extension of ENAMEL KNOT that
arises in Increasing enamel organ.
The FUNCTION of both may be to act as a
reservoir of dividing cells for growing ENAMEL

Bell stage(HistodifferentiationBell stage(Histodifferentiation
& Morphodifferentiation)& Morphodifferentiation)
 As the invagination of epithelium deepens & the
margin continues to grow the enamel organ
assumes a bell shape.
 Inner Enamel EpitheliumInner Enamel Epithelium
 Consists of single layer of cell that
differentiate prior to Amelogenesis into tall
columnar cells called Ameloblasts.

 AMELOBLASTSAMELOBLASTS
 Attached to one another by
JUNCTIONAL COMPLEX.
 Attached to cells of stratum
intermedium by DESMOSOME.
 These exhert organizing influence on
the underlying mesenchymal cells in
dental papilla which later differentiate
into ODONTOBLASTS.
 High glycogen content.

 Stratum intermediumStratum intermedium
 Between the Inner Enamel Epithelium &
newly differentiated stellete reticulum
the epithelial cells differentiate into a
layer of flattened(squamous) cells called
stratum intermedium.
 Exceptionally high activity of alkaline
phosphatase.
 High degree of metabolic activity.
 Absent in part of tooth germ that
outlines the root portion of tooth but
does not form enamel.
 Along the inner enamel epithelium both
layer considered as single functional
unit responsible for formation of enamel.

 Stellate reticulumStellate reticulum
 Expand further due to accumulation of
intercellular fluid.
 Before enamel formation begins , stellate
reticulum collapses reducing the distance
between centrally located ameloblast and
nutrient capillaries near outer enamel
epithelium.
 Change begins at the height of the cusp
or incisal edge and progress cervically.

CollapsedAccumulation of intercellular fluid
Stellate ReticulumStellate Reticulum

 Outer enamel epitheliumOuter enamel epithelium
 Cells flatten to low cuboidal form.
 At the end of bell stage and preparatory
to formation of enamel the formerly
smooth surface is laid in folds.
 Between these folds the mesenchyme of
dental sac forms papillae and thus
provide rich nutritional supply for the
intense metabolic activity of avascular
enamel organ.

 Dental laminaDental lamina
 In all teeth except permanent molars the
dental lamina proliferates at its deep end
to give rise to enamel organ of
permanent teeth.
Distal extension

 Dental papillaDental papilla
 Enclosed in invaginated portion of enamel
organ.
 Before inner enamel epithelium produce
enamel the peripheral cells of mesenchymal
dental papilla differentiate into odontoblasts
under organizing influence of epithelium.
 First assume cuboidal form and later
columnar and acquire specific potential to
produce dentin.
 ‘Membrana preformativa’ – basement
membrane that separates the enamel organ
and dental papilla just prior to dentin
formation.

 Dental sacDental sac
 Before formation of dental tissue begins,
dental sac shows circular arrangement of
its fibers and resembles capsular
structure.
 With development of root, fibers of dental
sac differentiate into periodontal ligament
fibers that become embedded in
developing cementum and alveolar bone.

Gland of Serres
Oral Epithelium
Dental Lamina
Stellate Reticulum
Bud for Permanent Tooth
External Enamel Epithelium
Dental Papilla
Inner Enamel Epithelium

A - AMELOBLAST
B - BONE
D - DENTINE
DP - DENTAL PAPILLA
DF - DENTAL FOLLICLE
E - ENAMEL
EO - ENAMEL ORGAN
O - ODONTOBLAST
N - NECK OF TOOTH
HS – HERTWIG ROOT SHEATH
INITIAL STAGES ADVANCE STAGES

Advanced Bell StageAdvanced Bell Stage
 The boundary between the inner enamel
epithelium and odontoblasts outlines future
dentino-enamel junction and cervical portion
of enamel organ give rise to epithelial root
sheath of Hertwig.

Oral Epithelium
Inner Enamel Epithelium
Enamel and Dentin
formation starting at
Cusp tip
Dental
Papilla
Cervical Loop
Nerve Bundle
Alveolar Bone
ADVANCED BELL STAGEADVANCED BELL STAGE

AMELOBLASTS ENAMEL
STELLATE
RETICULUM
PRE DENTIN
ODONTOBLASTS
PULP
DENTIN
STRATUM
INTERMEDIUM
…magnified view showing HARD TISSUE FORMATIONHARD TISSUE FORMATION

COLUMNAR AMELOBLASTS
ENAMEL MATRIX
MINERALIZING DENTINE
PREDENTINE
ODONTOBLASTS
FIBROBLASTS OF PULP
HERTWIG’s ROOT SHEATH
VERTICAL SECTIONVERTICAL SECTION
through NECK ofthrough NECK of
TOOTHTOOTH

Hertwig’s Epithelial Root SheathHertwig’s Epithelial Root Sheath
and Root Formationand Root Formation
Root development begins after enamel and
dentin formation has reached future cemento-
enamel junction.
HERS is formed from enamel organ.
 Molds the shape of root
 Initiates dentin formation.
 Consists of outer and inner enamel epithelium
only.

 Prior to beginning of root formation , root
sheath forms EPITHELIAL DIAPHRAGMEPITHELIAL DIAPHRAGM
 The outer and inner enamel epithelium bend at
future CEJ into a horizontal plane narrowing the
wide cervical opening of the tooth germ.
 The proliferation of cells of epithelial diaphragm
is accompanied by proliferation of cells of
connective tissue of pulp which occurs in area
adjacent to the diaphragm.
 The free end of the diaphragm does not grow
into connective tissue but the epithelium
proliferates coronal to the epithelial diaphragm.
 The differentiation of Odontoblast & formation of
Dentin follow the lengthening of root sheath.

ROOT FORMATIONROOT FORMATION
INITIAL STAGES MIDWAY FINAL STAGE
APICAL FORAMENCERVICAL LOOP

At the same time the connective tissue of Dental sac
surrounding the root sheath proliferates and invades
continuous Double epithelial layer dividing it into network of
epithelial strands.
 Epithelium is moved away from the surface of dentin so that
the connective tissue cells come into contact with the outer
surface of the dentin and differentiate into cementoblast that
deposit a layer of cementum onto the surface of dentin.
 In last stages of root development the proliferation of the
epithelium in the diaphragm lags behind that of the pulpal
connective tissue.
Wide apical foramen is reduced first to width of
diaphragmatic opening itself and later is further narrowed by
apposition of dentin and cementum to the apex of the root.

EPITHELIAL DIAPHRAGM AND PROLIFERATION ZONE OF PULEPITHELIAL DIAPHRAGM AND PROLIFERATION ZONE OF PUL

ELONGATION
of HERS
CORONAL to
EPITHELIAL
DIAPHRAGM
ROOT
SHEATH
BROKEN

 In multi-rooted teeth:In multi-rooted teeth:
 Differential growth of epithelial diaphragm causes
division of the root trunk in 2/3 roots.
 During the general growth of enamel organ the
expansion of its cervical opening occurs in such a
way that long tongue-like extension of horizontal
diaphragm develops.
 Two extension in lower molars and three in upper.
 Before division of the root trunk occurs the free end
of these horizontal epithelial flaps grow towards
each other and fuse.
 The single coronal opening of the coronal enamel
organ is than divided into two-three openings.
 On the pulpal surface of dividing epithelial bridges
dentin formation starts and on the periphery of
each opening root development follows in the same
way as for single rooted teeth.www.indiandentalacademy.com

During of growth of TOOTH GERM…
EPITHELIAL
DIAPHRAGM
EXPAND
ECCENTRICALLY
PROLIFERAT
E
and UNITE
HORIZONTAL EPITHELIAL FLAPS

BEGINNING OF
DENTIN
FORMATION AT
BIFURCATION
DEVELOPMENT OF TWO ROOTED TOOTH
MESIAL DISTAL
FORMATION IN PROGRESS
as a result
ROOT ELONGATION OCCURS

InitiationInitiation
Specific cell of dental lamina have potential to
form enamel (dental) organ. Different teeth at
different time/definite time.
Initiation induction requires
ECTOMESENCHYMAL-EPITHELIAL
interaction.

LACK of INITIATION results in:
ABSENCE of either SINGLE TOOTH or MULTIPLE TEETH
MISSING LATERAL INCISORS
PARTIAL ANODONTIA
DECIDUOUS DENTITIONPERMANENT DENTITION
FLATTENING of ARCH
LEADING TO CROSS BITE

SUBMERGING LOWER 2nd
MOLAR
Due to
CONGENITAL ABSENCE
PERMANENT 2nd
PREMOLARS

OLIGODONTIA
IMPEDES THE
DEVELOPMENT
OF ARCH

ABNORMAL INITIATION results in :
Development of
SINGLE or MULTIPLE SUPERNUMERARY teeth
MESIODENS
CLIEDOCRANIAL DYSPLASIA

ProliferationProliferation
Enhanced proliferative activity ensues at point
of initiation and results in the BUD,CAP, and
BELL stages of development.
Proliferative growth causes regular changes in
the size and proportions of the growing tooth
germ.

HistodifferentiationHistodifferentiation
The cells become restricted in their functions.
They differentiate and give up their capacity
to multiply as they assume their new function
; this law governs all differentiating cells.
This phase reaches its highest development in
the BELL stage , just preceding the
beginning of formation and apposition of
DENTIN and ENAMEL.

DISTURBANCES during this stage may lead to…
DENTOGENESIS IMPERFECTA
SHORT Amber coloured tooth
MARKED Attrition
AMELOGENESIS IMPERFECTA : Hypoplastic typeAMELOGENESIS IMPERFECTA :Hypomineralized typeAMELOGENESIS IMPERFECTA :Hypomature type

MorphodifferentiationMorphodifferentiation
The morphologic pattern,or basic form and relative size
of the future tooth,is established by
morphodifferentiation,that is,by DIFFERENTIAL
GROWTH.
Morphodifferentiation therefore is IMPOSSIBLE without
proliferation.
The ADVANCED BELL stage marks not only active
histodiferentiation but also an important stage of
morphodifferentiation in the crown,outlining the future
DENTINOENAMEL JUNCTION.
The DENTINOENAMEL and CEMENTOENAMEL
junctions which are different and characteristic for
each type of tooth,act as BLUE-PRINT pattern.

Disturbances may effect the FORM and SIZE of the
tooth WITHOUT impairing the function of ameloblasts
and odontoblasts.
GEMINATION :incomplete
division of single tooth bud
TWINNING:complete division
of one tooth bud to create
two teeth
FUSION :union of the dentin
of two teeth,from two tooth
buds.
CONCRESCENCE:
union of cellular
Cementum of two teeth,from
two buds.
MICRODONTIA
PEG shaped LATERAL
MICRODONTIA of entire dentition in relation to basal boneMACRODONTIA Oversized LATERAL INCISORSMACRODONTIA of UPPER teeth in relation to basal bone

AppositionApposition
Apposition is the deposition of the MATRIX of
the hard dental structures.
Appositional growth of enamel and dentin is
characterized by regular and rhythmic
deposition of an extracellular matrix.
It is the fulfillment of the plans outlined at the
stages of Histodifferentiation and
Morphodifferentiation.
Both HYPOPLASIA and HYPOCALCIFICATION
can occur as a result of an insult to this
phase.

Factors affectingFactors affecting DEVELOPMENTDEVELOPMENT
 Systemic factorsSystemic factors
 ACCELERATING EFFECT :on the
whole very rare but reported to be due to
 Hyper thyroidism
 Hyper pitutarism
 Turner’s syndrome

 RETARDING AFFECT : more common in
permanent dentition due to
 Hypo thyroidism
 Hypo pitutarism
 Cleidocranial dysostosis
 Down’s syndrome
 Achondroplasia
 Hypovitaminoses ( A and D)
 Osteopetrosis

Eruption of Tooth andEruption of Tooth and
Theories ofTheories of
eruptioneruption

EruptionEruption
 Latin – ‘erumpere’ – to break out.
 Properly refers/understood to mean the
axial or occlusal movement of the tooth
from its developmental position within
the jaw to its functional position in the
occlusal position.

Theories of EruptionTheories of Eruption
Tooth eruption is an essential process for the
survival of many different species and although
the movement of teeth into function has been
the subject of extensive research there is no
consensus as to the mechanisms involved
Mechanism that brings about tooth movement is
still debatable and is likely to be a combination
of number of factors.

Most talked about theories are:
 Root formation(elongation)theory
 Bone remodeling theory
 Vascular pressure theory
 Periodontal ligament traction theory
 Pulp theory
 Genetic input theory

Root formation theoryRoot formation theory
Root formation follows crown formation and
involves cellular proliferation of new tissue that
must be accommodated by either movement of
the crown of tooth or resorption of bone at the
base of its socket.
It is the former that actually happens , but if
occlusal movement is prevented resorption of
bone at the base of socket occurs.
If root formation is to result in an eruptive force
the apical growth of root needs to be translated
into occlusal movement and requires the
presence of a fixed base.

BUT….BUT….

Bone at the base of socket cannot act as a
fixed base because pressure on bone results
in its resorption.
Some teeth move a distance greater than the
length of their roots.
Eruption movement can occur after
completion of root formation.
Experimental resection preventing further
root formation does not stop eruptive tooth
movement.
All indicating root formation cannot be
responsible for eruptive tooth movement.

STOPPEDSTOPPED
TOOTH GERM OCCLUSAL MOVEMENT
OF CROWN
BONE RESORPTION
BONE BONE

Advocates of root formation theory like a
postulated existence of “Cushion Hammock
Ligament”straddling the base of the socket from
one bony wall to the other sling.
Its function was to provide fixed base for
growing root to react against…
BUT
…the structure described as cushion hammock
ligament is Pulp delineating membrane that
runs across apex of the tooth and has no bony
insertion,it CANNOT act as FIXED BASE.

Bone remodeling theoryBone remodeling theory
Is important to permit tooth movement.
In animals that exhibit genetic deficiency of
OSTEOBLAST ,tooth eruption is prevented .
If tooth germ is removed experimentally and
dental follicle left intact an eruptive pathway is
forms in overlying bone.
Marks and Cahill have confirmed that tooth
has no active role in the process , since metal
or silicone replicas of calcified crowns ,
placed within follicle ,also erupts.

These experiment establish ABSOLUTE
requirement for DENTAL FOLLICLE to achieve:
Bony remodelling and tooth eruption.
Provides the source for new bone forming
cells and conduit for osteoblast derived from
Monocyte through its vascular supply.
RECENT STUDIES show that resorptive
process may be regulated by local growth
factors such as Transforming growth factor
Beta-1(TGF-ß1)and Epidermal growth factor
(EGF) produced within or around Dental follicle.

These growth factors seem to
Chemoattaract monocytes from the
peripheral bood vessels around the
dental follicle.
Resorptive process begins with the
formation of osteoclasts from
coalescence of the monocyte.

Factor necessary for tooth to erupt Intraosseously:
 Density of bone.
 Rate of bone resorption.
 The overlying tissue
 Bone
 Primary tooth root
 Gingiva
Must resorb to provide an eruptive path.
 Force must be generated to move the tooth
vertically.
Resorption over tooth seems to be dependent only
on the presence of coronal portion of the dental
follicle .

Vascular pressure theoryVascular pressure theory
CONSTANT suggested that blood pressure
provided the eruptive force but there has been
evidence for and against the theory.
FOR:
 Teeth develop in a vascular site and direct
relationship between conglomerates of beneath
the developing crown and number of cusps and
roots.
 Periodontal ligament has a rich vascular supply.
 Oscillatory movement of erupted teeth occurs in
synchrony with the pulse.
 Vasculature is under physiological control
throughout life.

Could theCould the
VASCULATURE beVASCULATURE be
source of ERUPTIVEsource of ERUPTIVE
FORCE…???FORCE…???

There is close relationship between Osmotic tissue
fluid pressure and Blood pressure.
 NESSNESS and SMALESMALE suggested that the pressures
derived from the vasculature would be exerted by
the tissue fluid.
 While tissue fluid osmolarity can reasonably be
anticipated to change Apical pressure…
Hypotensive rats show no changes in unimpeded
eruption rates.

 The Pulsatile nature of blood flow within the
follicle and periodontal ligament and its
significance for tooth eruption has been noted.
 Cyclic intermittent forces –impulses have been
shown to enhance cellular activity during bone
remodelling and gene expression within the
endothelium therefore their affects on bone
and the tooth.

Tooth develop,erupt and function in a vascular
site constantly exposed to PULSATIVE
forces arising from blood flow.
Repetative impulses acting on the calcified
crown similar to the action of a hammer on a
nail,are the likely the eruptive force.

BUT…..BUT…..
Even the resection of root and thus the
vasculature CANNOTCANNOT prevent the
eruption of tooth.

Periodontal ligament traction theoryPeriodontal ligament traction theory
The eruptive movement could be brought about a
combination of events envolving a force
initiated by the periodontal ligament fibroblasts.
This force is transmitted to the extracellular
compartment via FIBRONEXUS and to
collagen fibre bundle which align in an
appropiate inclination brought about by root
formation bring about tooth movement.
These fibre bundles have the ability to remodel for
eruption to continue and interferance with this
ability effects the process.

The removal bone to create eruptive pathway is
also dictated by the tissues surrounding the
tooth.
Evidence to support this view:
 Experiments delineating the role of follicle (from
which periodontal ligament forms)
 Experiments on continuously erupting Rodent
incisor designed to eliminate the effects of root
growth and vascular supply show that as long
as periodontal ligament tissue is available
tooth movement occurs.

 Drugs that interrupt proper collagen
formation in ligament also interfere with
eruption.
 Tissue culture experiment have shown
that ligament fibroblast are able to
contract a collagen gel which in turn
brings about movement of disk of root
tissue attached to that gel.

Before CONTRACTION
After CONTRACTION

Pulp theoryPulp theory
This theory suggeststhat a propulsive force is
generated by extrusion of pulp through
THREE mechanisms.
 Growth of DENTINE
 Interstitial PULP growth
 Hydraulic effects within VASCULATURE

Here in first stage ,
There is growth of dentine.
This causes interstitial growth of the pulp tissue
VASCULAR SYSTEM DEVELOPS
Hydraulic effects within the vasculature
causes eruption of teeth

BUT……BUT……
HERZBERGHERZBERG and SCHOURSCHOUR removed the
of RODENTS incisors and found that its
eruption rates were UNAFFECTED.

Genetic input theoryGenetic input theory
If tooth eruption is to be explained at the
cellular and molecular level ,a degree of
genetic control is highly likely. In normal
development of the occlusion,incisors
develop before premolars and this process of
eruption is disturbed in a number of Genetic
Disorders.

A classification of these relationships has been
represented by SANK.SANK.
 Inherited defects : amelogenesis imperfecta
 Disorders with supernumerary teeth or
crowding of teeth
 Growth retardation syndromes
 Miscellaneous disorders
 Hypophostasia
 Juvenile periodontitis
 Papillion lefevre syndrome

Although variety of theories have attempted to
identify the eruptive force , none been fully
supported by experimental evidence.
Specific changes in the cellular activity of bone
surrounding the erupting tooth provide
indirect information about the mechanics of
the process that need to be accounted for in
ANY theory of eruption.

Mechanics of eruptionMechanics of eruption
When a tooth starts to erupt there is change in
its momentum , therefore a force MUST be
present.
 The spherical bony crypt prior to calcification
of crown exists because forces are present
in the follicle that resists bone apposition.
Eventhough the magnitude and direction of the
individual forces cannot be determined,a
summation of their distribution can be
represented as series of RADIAL force
vector extending to the surface of a sphere.

 Calcification the crown provides a new mass against
which the force within the follicle can act.
Although the action force is such that the tooth will
move occulusally , the bone resorption initially
occurs in the opposite direction along the axis of
force.
 Bone remodeling around the erupting tooth results
from the action of many forces within the follicle.In
order for a tooth to move the action of eruptive force
must be greater than the sum of forces resisting its
movement.
 As the tooth erupts the dynamic relationships
between the surrounding alveolar bone , the eruptive
force and the erupting tooth influence the rate of
eruption.

SERIES OF RADIAL FORCE
VECTOR EXTENDING TO THE
SURFACE OF A SPHERE.
Calcification of the
crown provides a NEW
MASS against which the
force within the follicle can
act.
In order for a tooth to
move the action of
eruptive force must be
greater than the sum of
forces resisting its
movement.
As the tooth erupts the
dynamic relationships between
the surrounding alveolar bone ,
the eruptive force and the
erupting tooth influence the
RATE OF ERUPTION.

On emergence the resistance is greatly reduced
resulting in accelerated rate of eruption until
a new equilibrium of forces is established.
However eruption is only part of total pattern of
physiologic tooth movement , because teeth
also undergoes complex movement related
to maintaining their position in the growing
jaws and compensating for masticatory wear.

Physiologic tooth movementPhysiologic tooth movement
Is described as :
 Pre-eruptive tooth movement
 Eruptive tooth movement
 Post eruptive tooth movement

When deciduous tooth germ first differentiate
they are extremely small and there is a good
deal of space for them in the developing jaw.
Because the tooth germs grow rapidly, however
they become crowded together particularly in
the anterior of jaw.
Pre-eruptive tooth movementPre-eruptive tooth movement

 This crowding is gradually alleviated by the
lengthening of the jaws , which permits the 2nd
deciduous molar tooth germ to move backwards
and anterior tooth germ move forward.
 At the same time the tooth germs are also
moving bodily outward and upward , or
downward as the case may be , as the jaws
increases in length as well as in width and
height.
 Successional tooth germs develop on the lingual
aspect of their deciduous predecessor in the
same bony crypt. From this position the tooth
germ shift considerably as the jaw develop.

INCISORINCISOR and CANINECANINE
 Eventually come to occupy a position in their
own bony crypt on lingual surface of their
deciduous.
PREMOLARSPREMOLARS
 Also in their own bony crypt finally position
between the divergent roots of the deciduous
molars.

BONE BETWEEN DECIDUOUS
TOOTH
AND SUCCESSOR
ENAMEL OF PERMANENT INCISOR
DENTIN
DECIDUOUS INCISOR
ERUPTING INCISOR

ENAMEL DISSOLVED AWAY
DENTIN
FOLLICLE
ENAMEL SPACE
REDUCED ENAMEL
EPITHELIUM
ALVEOLAR BONE
PERMANENT TOOTH
AREA OF RESORPTION
ROOT OF DECIDUOUS TOOTH
PULP
GINGIVA
ERUPTING INCISOR

ERUPTING CANINE
RESORPTION OF ROOT
RERSORPTION OF BONEPERMANENT CANINE
DECIDUOUS CANINE
RESORPTION

DECIDUOUS FIRST MOLAR
ROOT RESORPTION
PERMANENT TOOTH GERM
ERUPTING PREMOLAR

PERMANENT MOLARPERMANENT MOLAR tooth germ
 No predecessors , develop from backward
extension of the dental lamina as there is little
space to accommodate these tooth germ.
 In MAXILLA : MOLAR tooth germ first
develop with their occlusal surface facing
DISTALLY,and can swing into position when
maxilla has grown sufficiently.
 In MANDIBLE : permanent MOLAR develop
with their axis showing MESIAL inclination ,
vertical later.

OCCLUSAL surface facing DISTALLY,and can
swing into position
MAXILLA

PERMANENT MOLAR develop with
their axis showing MESIAL
inclination , VERTICAL later.
MANDIBLE

ERUPTION OF MOLAR
Perm.FIRST MOLAR at 3 years
At 4 years 6 months
At 6 to 7 years

Pre eruptive movements of both deciduous and
permanent tooth germs are best thought of as
the movement required to place the teeth within
the jaw in a position for eruptive tooth movement.
Pre eruptive tooth movements are combination of
two factors:
 Total bodily movement of the tooth germ
 Growth , in which one part of the tooth germ
remains fixed while rest continues to grow ,
leading to change in the center of tooth germ. Ex:
deciduous incisor maintain their position relative
to oral mucosa as jaw increase in height.

HistologyHistology
As pre eruptive tooth movements occurs in a
intraosseous location , such movement is
reflected in the patterns of bone remodeling
within the crypt wall.
Ex: bodily MESIAL movement –bone resorption
occurs on mesial surface of crypt
(OSTEOCLASTIC activity) and bone deposition
on distal surface / wall as a “Filling in process”
Whether bony remodeling to position bony crypt is
important as a mechanism or whether its merely
an adaptive e response is DEBATABLE.

Eruptive tooth movementEruptive tooth movement
During this phase the tooth movement from
its position within the bone of the jaw to
the functional position in occlusion and
the principal direction of the movement is
occlusal or axial.

HISTOLOGYHISTOLOGY
Significant developmental event associated with the
eruptive tooth movement are:
 Formation of roots
 Periodontal ligament
 Dentogingival junction
The periodontal ligament develops only after root
formation has been initiated and once
established it must be remodeled to permit
continued tooth movement.

The architecture of tissue in advance of erupting
successional teeth from that found in advance of
deciduous teeth.
The fibrocellular follicle surrounding a successional
tooth retains its connection with the lamina
propria of oral mucous membrane by means of a
strand of fibrous tissue containing remnants of
the dental lamina known as GUBERNACULAR
CORD.

GUBERNACULAR CORD

“in dried skull holes can be identified in jaw on the
lingual surface of the deciduous teeth”
These holes which once contained the
gubernacular cord is known as
GUBERNACULAR CANAL.
As the successional tooth erupts its
gubernacular canal is rapidly widened by local
osteoclastic activity , delineating the eruptive
pathway for the tooth.

GUBERNACULAR CANALS

Once erupting tooth appears in the oral cavity its
subjected to environmental factor that help to
determine its position in dental arch.
Factors: Muscle forces -tongue
-cheek
-lips
Forces of contact of erupting teeth with other
erupting tooth or with other erupted tooth.
Once erupted it continues to erupt at the same rate
of 1mm every 3 month, only slowing as it meets
its antagonist in opposing arch.

Post eruptive tooth movementPost eruptive tooth movement
These are those movements made by the tooth
after it has reached its functional position in the
occlusal plane.
Divided into 3 categories:
 Movements made to accommodate growing
jaws
 Compensation for occlusal wear
 Accommodation for interproximal wear

 These are completed toward the end of 2nd
decade when jaw growth ceases.
 Recent studies have shown that
readjustment occurs between 14 and 18
years.
Movement made to accommodate the
GrowingGrowing JawsJaws

 Seen histologically as readjustment of the
position of the tooth socket achieved by
formation of new bone at alveolar crest
and on the socket floor to keep pace with
height of jaws.
 Apices of teeth move away 2-3mm away
from inferior dental canal (regarded as
fixed reference point)
 Seen relatively earlier in girls than boys
and is related to burst of condylar growth
that separates jaws and teeth , permitting
further eruptive movement .

Compensation forCompensation for OCCLUSALOCCLUSAL
wearwear
 Is often stated that it is achieved by continued
cementum deposition around apex of the tooth ,
but deposition of cementum occurs only after
tooth has moved .
 No evidence as such is present that forces
causing tooth eruption are still available to bring
about sufficient axial movement to compensate
axial wear.

Accommodation forAccommodation for INTERPROXIMALINTERPROXIMAL wear
Wear also occurs at the contact points between
teeth and their proximal surfaces.
This interproximal wear is compensated by process
known as MESIAL or APPROXIMAL DRIFT.
Factors which bring about drift:
 Anterior component of occlusal force
 Contraction of transseptal ligament
 Soft tissue pressure

Anterior component of force :Anterior component of force :
When teeth are brought in contact ,ex:when jaws
are clenched , a forwardly force is generated .
This force is a result of
 Mesial inclination of most teeth.
 Summation of intercuspal plane producing a
forwardly directed force.
In case of incisor which are inclined labially , it is
expected that they move in same direction BUT
infact they move MESIALLY explained by
“BILLIARD BALL ANALOGY”

Billiard ball analogyBilliard ball analogy
“…if the two touching balls are in line with the
pocket , no matter how the first ball is struck
second enters the pocket as it travels at right
angle to the common tangent between the two
balls…”
Following this example the CANINES and
INCISORS move in direction at right angles to
the common tangent drawn through contact
points. This leads to IMBRICATION often found
in older dentition.

BILLIARD BALL ANALOGY

 Cuspal inclination is a significant factor which
can be demonstrated by selectively grinding cusp
in such a way as to either enhance or even
reverse the direction of occlusal force.
 When opposing teeth are removed , thereby
eliminating the biting force the mesial migration
of teeth is slowed BUT not halted indicating the
presence of some other force.
Here the TRANSSEPTAL fibres of periodontal
ligament have been implicated.

Contraction of TransseptalContraction of Transseptal
ligamentligament
The periodontal ligament are important in maintaining
tooth position. It is suggested that transseptal fibre
running between adjacent teeth across the
alveolar process draw neighbouring teeth together
and maintain them in contact .
Evidence to support this:
 Relapse of orthodontically moved teeth is much
reduced if gingivectomy removing transseptal
ligament is performed.
 Demonstrated experimentally that in bisected tooth
the two halves separates from each other , if
however the transseptal ligament are previously
cut this separation does not occur.

 The approximal contacts are disked , teeth
move to reestablish contact ,however if the
teeth is also ground out of occlusion and
approximate surfaces disked the rate of drift
is slowed.
So until the contrary is demonstrated it must be
assumed that the Mesial Drift is achieved by
contractile mechanism associated with
transseptal ligament fibres and enhanced by
occlusal forces.

Soft tissue pressureSoft tissue pressure
The pressure generated by cheeks and tongue may
push teeth mesially. However if such pressure
from soft tissue is eliminated by constructing
acrylic dome over teeth mesial drift still occurs.
Suggesting soft tissue pressure does not have a
major role , however it does influence tooth
position even if it does NOT cause tooth
movement.

Shedding of deciduous teethShedding of deciduous teeth
The physiologic process resulting in
elimination of the deciduous dentition is
called SHEDDING or EXFOLIATION.

PATTERN of sheddingPATTERN of shedding
The shedding of deciduous teeth is the result of
progressive resorption of roots of teeth and their
supportive tissue , the periodontal ligament.
Most attention has been given to the removal of the
dental hard tissues , which is accomplished by
ODONTOCLASTS (very similar to multinuclear
osteoclasts)
In general the pressure generated by the growing
and erupting tooth dictates the pattern of
deciduous tooth resorption.

Because of the developmental position of permanent
INCISOR and CANINE tooth germs and their
subsequent physiologic movement in occlusal and
vestibular direction , resorption of roots of deciduous
incisors and canines begins on their LINGUAL
surfaces.
Later , these developing tooth germs occupy a position
directly apical to the deciduous tooth , which permits
them to erupt in a position formerly occupied by the
deciduous tooth.
Frequently and especially in case of permanent
mandibular incisors , this apical positioning of the
tooth germs does not occur , and permanent tooth
erupts lingual to the still functioning deciduous tooth.

EXFOLIATED
DECIDUOUS CANINE
DECIDUOUS MOLAR

TYPES OF ERUPTIONTYPES OF ERUPTION
Three distinct type of teeth are differentiated by their
eruption pattern :
 CONTINUOUSLY GROWINGCONTINUOUSLY GROWING
 Tooth formation and eruption occurs throughout
the life.
 Dental tissue are formed from a proliferative
base.
 Anatomic crown and root very similar
morphologically.
 Teeth have extensive wear.
 Eruption velocity relatively rapid , increases
whenever the velocity of wear increases or
antagonist tooth is removed.
 Ex. Incisor of rodents and lyomorphs.
RODENT

 Teeth stop forming once root formation is
complete.
 Well defined crown and root.
 Moderate occlusal wear.
 Height of clinical crown is maintained by
eruption and apical migration of epithelial
attachment without simultaneous deposition of
alveolar bone.
 As occlusal wear progress tooth eventually
loosens and exfoliates completely.
 Ex. Cheek teeth of cattle and sheep.
CONTINUOUSLY EXTRUDINGCONTINUOUSLY EXTRUDING
SHEEP
CATTLE

CONTINUOUSLY INVESTED TEETHCONTINUOUSLY INVESTED TEETH
 Human teeth belong to this type of eruption.
 Teeth stop forming after predictable amount of
root development has occurred.
 Distinct anatomic crown and root structure.
 Alveolar bone remodels in response to eruption.
 The clinical crown shortens as the tooth erupts to
maintain vertical height and occlusal function and
brings about alveolar bone with it.

ERUPTION RHYTHMERUPTION RHYTHM
The circadian rhythm in eruption is potentially
significant in clinical practice.
 The teeth intrude transiently in conjunction with
masticatory activity and then erupts significantly
overnight.
The mean daily eruption velocity was seen to be
71um/day.

CLINICAL SIGNIFICANCECLINICAL SIGNIFICANCE
 Timing of eruptionTiming of eruption
 Controlling intervention
 Excessive eruption of posterior teeth is a
major cause of the long face , and control of
eruption during growth seems to be key to
successful treatment.
 The amount of force , its direction and the
total hours of wear of appliance are often
considered the most important factor that
affect treatment outcome.

 Teeth erupt primarily during night with
little or no net eruption during the day , it
is quite possible that wearing the
appliance is affective during the night and
early morning period when the eruption is
most active.

 Daily rhythm in skeletal growthDaily rhythm in skeletal growth
 Skeletal growth requires an adequate levels
of HGH which increases in the night.
 The rhythm in tooth eruption also reflects
this soon after the child goes to sleep.
 The clinician should be aware that there is
a rhythm in skeletal growth and
modification of treatment may be therefore
be more effective during night than during
the day.

TEETHINGTEETHING
Teething is a term limited by common usage to
eruption of primary dentition which ususally begins
in fifth or sixth month of a child’s life.
In most cases eruption of teeth causes no distress
to the child but sometimes causes local irritation ,
which is usually minor but may be fewer enough to
disturb child’s sleep.

Clinical features of TEETHINGClinical features of TEETHING
 LOCALLOCAL SIGNSSIGNS
 Hypermia or swelling of the mucosa
overlying the erupting teeth.
 Patches of erythema on the cheeks.
 Flushing may also occur in the skin of
adjacent cheek.

TEETHING

 SYSTEMIC SIGNSSYSTEMIC SIGNS
 General irritability and crying.
 loss of appetite.
 Sleeplessness , restlessness
 Increased salivation and drooling
 Insanity
 Meningitis
 Increased thirst
 Circumoral rash
 Cough

Associated problemsAssociated problems
 SYSTEMICSYSTEMIC
 Fever
 Convulsions
 Diarrhea
 Vomiting
 Bronchitis
 Cholera
 Tetanus
 Infantile paralysis

 LOCALLOCAL
 Eruption hematoma
 Eruption sequestrum
 Ectopic eruption
 Transposition

REMNANTS OF ROOTS OF FIRST MOLAR

MISSING PERMANENT
LATERL INCISOR
PERMANENT CANINE
Causing resorption of
DECIDUOUS LATERAL INCISO
and CANINE

IMPACTED CANINE

TRANSPOSITION
Perm. CANINE
Deciduous
INCISORS

LOCAL FACTORSLOCAL FACTORS
 Aberrant tooth position
 Lack of space in arch
 Very early loss of predecessor
 Ectopic eruption
 Congenital absence of teeth
 Ankylosis of predecessor
 Retained tooth or persisting deciduous root remnants
 Arrested tooth formation (trauma)
 Supernumerary tooth
 Tumor
 Cyst
 Abnormal habit exerting muscular forces

THANK YOU…THANK YOU…

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