3. • Introduction
• Definition
• Pattern of tooth movement
• Development of dentition
• Theories of tooth eruption
• Shedding of decidous teeth
• Pattern of shedding
• Mechanism of Resorption and Shedding
• Chronology of human dentition
• Sequence of primary teeth eruption
• Anomalies of tooth formation and eruption
• Disturbances of eruption
• Disturbance of exfoliation
4. • The word eruption properly refers to the cutting of the tooth through the gum.
• It is derived from the Latin word erumpere, meaning "to break out".
• It is generally understood to mean the axial or occlusal movement of the tooth
from its developmental position in the occlusal plane.
• The emergence of the tooth through the gingiva is the first clinical sign of
eruption.
• However, eruption is only part of the total pattern of physiologic tooth
movement, because teeth also undergo complex movements related to
maintaining their position in the growing jaws and compensating for masticatory
wear.
INTRODUCTION
5. DEFINITION
Maury Massler and Schour (1941) : defined eruption
as a process whereby the forming tooth migrates from
its intraosseous location in the jaw to its functional
position within the oral cavity.
James K Avery : defined eruption as the movement of
the teeth through the bone of the jaws and the
overlying mucosa to appear and function in the oral
cavity.
6. Eruptive movements begin with the onset of the root formation, well before
the teeth are seen in the oral cavity.
Movements leading to eruption of tooth can be divided into 3 phases:
Phase 1: The pre-eruptive phase.
Phase 2:The prefunctional eruptive or eruptive phase.
Phase 3: The functional eruptive or post eruptive phase.
PATTERN OF TOOTH MOVEMENT
7. PRE-ERUPTIVE PHASE
• The pre-eruptive phase of tooth movement is
preparatory to the eruptive phase.
• It consists of the movement of the developing tooth
germs within the alveolar processes prior to root
formation.
• During this phase, the growing tooth moves in two
directions to maintain its position in the expanding jaws
viz. bodily movement and eccentric movement.
8. • Bodily movement, which occurs continuously as the jaw grows, it is a
movement of the entire tooth germ. This causes bone resorption in
the direction of tooth movement and bone apposition behind it (Fig.
14.1).
9. • Eccentric growth refers to relative growth in one
part of the tooth while the rest of the tooth remains
constant (Fig. 14.2). For example, the root
elongates, yet the crown does not increase in size.
10. ERUPTIVE PHASE
The eruptive phase begins with the initiation of the root formation and ends when the teeth reach occlusal
contact.
Anatomic stages of tooth eruption: Given by Noyes and Schour (Fig. 14.3).
Stage I: Preparatory stage (opening of the bone crypt)
Stage II: Migration of the tooth toward the oral epithelium.
Stage III: Emergence of crown tip into the oral cavity.(Beginning of clinical eruption)
Stage IV: First occlusal contact.
Stage V:Full occlusal contact.Stage
Stage VI: Continuous eruption.
11.
12. Changes in Tissues Overlying Teeth.
• The initial changes seen in the tissues overlying the
teeth,prior to clinical emergence of the crown is
the alteration of the connective tissue of the dental
follicle to form pathway for the erupting teeth.
• Histologically, the future eruption pathway appears
as a zone with decreased and degenerated
connective tissue fibers, cells, blood vessels and
terminal nerves. These changes are probably due to
the loss of blood supply to this area, as well as the
release of enzymes that aid in degradation of these
tissues.
• An altered tissue space overlying the tooth
becomes visible as an inverted funnel shaped area
with the follicle fibers directed towards the
mucosa. This is called the gubernacular cord (Fig.
14.4). This structure guides the tooth in its eruptive
movements.
13. • For successful tooth eruption, there must be some
resorption of the overlying bony crypt so that the tooth can
erupt. This can be considered as a part of remodeling
growth. Osteoclasts differentiate and resorb a portion of
the bony crypt overlying the erupting tooth.
• The eruption pathway, which is at first small, increases in
dimension thus allowing movement of the tooth.
• When the tooth nears the oral mucosa, the reduced
enamel epithelium comes into contact with the overlying
mucosa.
• Simultaneously, the oral epithelial cells proliferate and fuse
into one membrane.
14. • Further movement of the tooth stretches and thins the
membrane over the crown tip. At this stage, the mucosa
becomes blanched because of the lack of blood supply to
the area.
• The tooth that will erupt slightly remain stationary for few
days and then again erupt. In this manner, the supporting
tissues are able to make adjustment to the eruptive
movement
• Each eruption movement result in more of the crown
appearing in the cavity and further separation of the
attachment epithelium from the enamel surface.
15. Changes in Tissues around the Teeth
• The tissues around the teeth also undergo changes during
tooth eruption.
• Initially the dental follicle is composed of delicate connective
tissue. Gradually as eruptive movement commences, collagen
fibers become prominent, extending between the forming knot
and the alveolar bone surface.
• The first noticeable periodontal fiber bundles appear at the
cervical area of the root and extend at an angle coronally to
the alveolar process. At the same time, the alveolar bone of
the crypt is remodeled and the bone fills into conform the
smaller root diameter.
16. • Very early in the eruptive process, periodontal fibers attach
on the root surface and in the alveolar bone as
cementogenesis proceeds.
• Alveolar bone remodeling continues during eruption, as the
tooth moves occlusally, the alveolar bone increases in height
and changes shape to accommodate the crown.
• These actions are co-ordinated during the entire eruption
process as well as they are throughout the life.
17. Changes in Tissues Underlying Teeth
• Changes also occur in the follicular tissues underlying the developing teeth.
• These changes take place in the soft tissue and fundic bone (bone surrounding the apex of the root).
• As the tooth erupts, space is provided for the root to lengthen, primarily due to the crown moving occlusally
and the increase in the height of the alveolar bone.
• Changes in fundic regions are, thus, believed to be largely compensatory to the lengthening of the root.
• They compensate for tooth eruption, and provide some support at the apical tissues.
• Some authors describe this as a bony ladder. The ladder becomes denser as alternate layers of bone plates and
connective tissue are laid down.
• At the end of the prefunctional eruptive phase, when the tooth comes into occlusion, about one-third of the
enamel remains covered by the gingiva, and the root is incomplete.
• At this time the bony ladder is gradually resorbed and one plate at a time to make space for developing root tip
• Root completion continues for a considerable time after teeth have been in function
• This process takes place from 1-1.5 years in decidous teeth and 2-3 years in permanent teeth
18. POSTERUPTIVE PHASE.
• The posteruptive phase, begins when the teeth reach occlusion, and continues for long as each tooth remains in the
oral cavity.
• During this phase or process, the alveolar process increases in height and the roots continue to grow. In other
words, the teeth continue to move occlusally, which accommodates the jaw and allows for root elongation. The
most marked changes occur as the occlusion is established.
• Alveolar bone density increases and the principal fibers of the periodontal ligament establish themselves into
separate groups orient about the gingival third, the alveolar crest and the alveolar surface around the root (Fig.
14.5).
19. THEORIES OF TOOTH ERUPTION
• Root elongation theory
• Pulpal constriction theory
• Growth of periodontal tissues
• Pressure from muscular action
• Resorption of the alveolar crest
• Hormonal theory
• Foreign body theory
• Cellular proliferation theory
• Vascularity theory
• Blood vessel thrust theory
• Periodontal ligament contraction theory
• Dental follicle theory
• Bony remodeling theory
20. -Root elongation theory
• According to this theory, the simplest and most obvious mechanism of
eruption would be that the crowns of the Explanation teeth are pushed into
the oral cavity by virtue of growth and elongation of the roots.
• Evidence for the theory: Root of tooth elongates as crown erupts into the
oral cavity.
• Evidence against the theory:
Rootless teeth often erupt without the
concomitant elongation of the root, submerged
teeth often continue the formation of their
roots but do not erupt.
21. -Pulpal constriction theory
This theory states that the growth of the root dentin and the subsequent constriction
of the pulp may cause sufficient theory pressure to move the tooth occlusally.
Evidence for the theory: The pulp is progressively constricted by growth of root
dentine.
Evidence against the theory: Pulpless teeth erupts at the same rate as the normal
teeth, premolar will often "jump“ Into occlusion after the premature extraction of the
deciduous molar without any appreciable growth of dentine or pulpal constriction.
22. -Growth of periodontal tissues
• Pull by surrounding connective tissue: Underwood suggests that the connective
tissue surrounding the tooth tissues may function in pulling the tooth into the oral
cavity. This theory is invalidated by histological examination of the direction of the
periodontal fibers during tooth eruption, which shows that the periodontal fibers are
being pulled by the tooth and not vice versa.
• Alveolar bone growth: Herman believed that the growth of the alveolar bone might
push or squeeze the tooth out of its alveolus and into the oral cavity. However, X-ray
and histological sections show that the bone does not actually touch the tooth. In
addition, this mechanism
can operate only upon single conical roots
but not on multirooted teeth.
23. -Pressure from muscular action
• Berten suggested that the action of
the musculature of the cheeks and lips
upon the alveolar process might serve to action squeeze the
crown of the tooth out into the oral cavity like a pumpkin seed
from between the fingers. This process continues until the tooth
is in occlusion, being halted by the antagonism of the teeth. The
theory, however, fails to explain the teeth eruption in cases of
unilateral facial paralysis.
24. -Resorption of the alveolar crest
Resorption of the alveolar crest would serve to
expose the crown of the tooth into the oral cavity.
This theory is not alveolar crest tenable since
histological examination shows that the alveolar crest
is the site of the most rapid and continuous growth of
bone.
25. -Hormonal theory
Sir Arthur Keith suggested that the hormones secreted by
the thyroids and pituitary glands might govern the
eruption of the teeth.
This theory does not attempt to explain the mechanism
of the eruption of the teeth, and only points out the fact
the hormones may affect the eruption of the teeth.
26. -Foreign body theory
• Gottlieb's foreign body theory, states that a
calcified body such as the tooth tends to be
exfoliated by the tissues just as does any foreign
body.
27. -Cellular proliferation theory
Noyes points out that the
tremendous pressure,
which is evolved from cellular proliferation, provides the
growing theory plant with sufficient force to break
through hard obstacles. Similarly, the osmotic pressure
and forces resulting from cellular proliferation in the pulp
and surrounding tissues may account for the eruption of
the teeth.
28. -Vascularity theory
Constant (1896) points out the fact that the tissues, which lie between the
developing tooth and its bony surrounding possess a very rich vascular supply.
He said that the blood pressure exerted in the vascular tissue which lies
between the developing tooth and its bony surroundings is the active
mechanical factor in the process known as eruption of teeth.
Evidence for the theory: Submerged teeth often erupt under the influence of
hyperemia, the hyperemia in periodontitis causes a supra eruption of teeth
29. -Blood vessel thrust theory:
This theory proposed that eruption involves the
blood supply to the tooth like the Vascularity theory.
The blood theory generates the force by
hydrodynamic and hydrostatic forces within the blood
vessels.
30. -Periodontal ligament contraction theory ( most accepted)
• Suggests that the contractile element within the periodontal ligament, collagen
constriction and constriction due to contraction theory fibroblasts are responsible.
• Furthermore, there is evidence that the actual force required to move the tooth is
linked to the contractility of fibroblasts. When fibroblasts are plated onto silicone
rubber, they crawl about and in doing so create wrinkles or folds in the rubber
indicating that tractions forces are associated with locomotion.
• A model system consisting of a well lined by a perforated mesh (mimicking the
cryptal bone) and containing a gel plated with fibroblasts and a slice of root dentin
has shown that not only there is three dimensional network established but also
this network generates sufficient force to raise the root slice from the bottom to
the top of the well.
31. -Dental follicle theory
• It is clear that the dental follicle is essential to
achieve the bony remodeling required to
accommodate tooth movement, for it is from this
tissue that the osteoblasts differentiate.
32. -Bony remodeling theory:
• Bony remodeling of the jaws has been linked to tooth eruption as in the pre eruptive phase;
the inherent growth theory pattern of the mandible or maxilla supposedly moves teeth by
the selective deposition and resorption of the bone in the immediate surroundings of the
tooth.
• When the developing premolar is removed without disturbing the dental follicle, an eruptive
pathway still forms overlying the enucleated tooth. Whereas, if the dental follicle is removed
no eruptive pathway is formed.
• Furthermore, if the tooth germ is replaced by a metal or silicone replica, and the dental
follicle is retained the replica will erupt, with the formation of an eruptive pathway.
These observations clearly demonstrate that "programed bony remodeling can and does occur,
i.e. an eruptive pathway forms in bone without a developing and
growing tooth. Second, they show that the dental follicle is involved
but perhaps only indirectly.
34. SHEDDING OF DECIDUOUS TEETH
• The human dentition like those of most mammals consists of two generations.
• The first generation is known as the deciduous dentition and the second as the
permanent dentition. The necessity of two dentitions exists because infant jaws
are small and the size and number of teeth they can support is limited. Since
teeth, once formed, cannot increase in size, a second dentition, consisting of larger
and more teeth, is required for the larger jaws of the adult.
The physiologic process resulting in the elimination of the
deciduous dentition is called shedding or exfoliation.
35. PATTERN OF SHEDDING
The shedding of deciduous teeth is the result of
progressive resorption of the roots of teeth and
their supporting tissues.
In general, the pressure generated by the
growing and erupting permanent tooth dictates
the pattern of deciduous tooth resorption
36. Resorption of Anterior Teeth
• The position of the permanent anterior tooth germ
is lingual to the apical third of the roots of primary
tooth hence the resorption is in the occluso-labial
direction, which corresponds to the movements of
the permanent tooth germ (Fig. 14.6).
37. • Later the crown of the permanent tooth lies directly
apical to the root of primary tooth, which causes
resorption to proceed horizontally.
• This horizontal resorption allows the permanent
tooth to erupt into the position of the primary
tooth.
38. Resorption of Posterior Teeth
• The growing crowns of the premolars initially are
situated between the roots of the primary
molars. The initiation is by the resorption of the
inter-radicular bone followed by resorption of
the adjacent surfaces of the root of primary
tooth (Fig. 14.7).
39. Mechanism of Resorption and Shedding
• The exact causes of resorption and shedding of deciduous teeth cannot be underlined however three main reasons have been
attributed to this which are loss of root, loss of bone and increased force.
• Kronfield was one of the first researchers to suggest role of stellate reticulum and dental follicle in shedding mechanism. As
permanent teeth grow they exert pressure to induce differentiation of osteoclasts and odontoclasts, which causes resorption of
hard tissues and supporting structures of root.
• Osteoclasts are bone resorbing cells derived form monocyte-macrophage lineage with giant multinuclear cells with 4 to 20
nuclei. Osteoclasts cells have striated border and are housed in Howship's lacunae (Fig. 14.8) which attach to the resorbing front
of hard tissue and release acid phophatse.
40. • This disrupts collagen network and releases crystals which are digested by the vacuoles of
osteoclasts. The disrupted collagen is then destroyed by fibroclasts (Fig. 14.9).
• Resorption occurs at the ruffled border which greatly increases the surface area where the
osteoclasts are in contact with bone
• ™
During the process of resorption, the pressure from tooth is first directed to the bone, and
following its resorption, the forces are directed to primary tooth
• ™
Although resorption of teeth is multifactorial, the pressure from the erupting successional tooth
plays a key role because the odontoclasts differentiate at predicted sites of pressure. It must be
however noted that presence of succedaneous teeth is a contributor in resorption not
prerequisite.
41. • Forces of mastication are also synergistically
involved in the mechanism of shedding. Due to
growth and increased loading of jaws, these forces
far exceed the limit that the deciduous tooth
periodontal ligament can withstand, thereby
causing trauma to the ligament and the initiation of
resorption.
42. CHRONOLOGY OF HUMAN DENTITION
• The regular sequence of eruption suggests that it is under genetic control while the same is
an event highly subject to nutritional, hormonal and disease states.
• Disturbances of the normal sequence and ages of tooth eruption are one of the contributing
factors to the development of malocclusion and consequently of significance to us as
Pedodontists.
• At birth jaws contain the partly calcified crowns of 20 deciduous teeth and beginning of
calcification of the 1st permanent molars. Eruption of deciduous dentition begins at an
average of 71/2months of age and terminates at about 29 months.
• Dental eruption is then quiescent for nearly 4 years. At the age of 6 years, the jaws contain
more teeth than at any other time; 48 teeth are filling the body of mandible. After this
extreme activity there is a 2.5 years of quite period until 10.5 years of age.
43. • Then during the next 18 months the remaining 12 deciduous teeth
are lost and 16 permanent teeth erupt. The 6years of period of the
mixed dentition from 6 to 12 years is the most complicated period of
dental development and the one in which malocclusion is most likely
to develop.
• A long and valuable period of 3 to 7 years of quiescence follows
before eruption of the lower 3rd molars to complete the dentition.
• The 3rd molars do not begin calcification until 9th years of age and
their eruption from the 16th years onwards heralds the completion
of dento facial growth and development(Figs 14.10 and 14.11).
44.
45. SEQUENCE OF PRIMARY TEETH
ERUPTION
The eruption process of the primary teeth
happens in a programmed sequential order.
It begins around 6 to 7 months of age and
completes by around 30 to 36 months of age.
46.
47. ANOMALIES OF TOOTH FORMATION
AND ERUPTION
INTRODUCTION
• Both the primary and permanent dentitions may be affected by variations in the
number, size, and form of the teeth, as well as the structure of the dental hard
tissues.
• These variations may be exclusively genetically determined, brought about by
either local or systemically acting environmental factors, or possibly from a
combination of both genetic and environmental factors acting together. The same
interplay of influences may affect the eruption and exfoliation of primary teeth, as
well as the eruption of permanent teeth.
• This considers a range of conditions involving abnormalities of the number, size,
form, and structure of teeth and their eruption.
48. MISSING TEETH
Hypodontia is the term most often applied to
a situation where a patient has missing teeth
as a result of their failure of development.
Anodontia describes the total lack of teeth of
one or both dentitions.
Oligodontia is a term used to describe a
situation where multiple⎯usually more than
six⎯teeth are missing.
49. EXTRA TEETH
• Extra teeth (supernumerary teeth) have been
reported to occur in 0.2-0.8% of Caucasians in the
primary dentition and 1.5-3% in the permanent
dentition in the same populations. There is a male to
female ratio of approximately 2 : 1.
• Patients with supernumerary primary teeth have a
30-50% chance of these being followed by
supernumerary permanent teeth. Teeth which
resemble those of the normal series are referred to
as supplemental teeth while those of less typical,
often reduced, form-sometimes further described as
tuberculate or conical-can be termed accessory
supernumerary teeth.
50. ABNORMALITY OF TOOTH SIZE
Crown size
Teeth which are obviously larger than normal are referred to as megadont or
macrodont whereas teeth which are smaller than normal are termed microdont.
Crown size is often related to root size, so teeth with large crowns often have
large (broad) roots, teeth with small crowns tend to have small (slender) roots.
51. Root size
Root length appears to be subject to some racial
variation, with shorter roots being seen in people
of Oriental background and larger roots in patients
of African origin.
52. ABNORMALITY OF TOOTH FORM
Abnormality of crown
Fusion and gemination
Some cases of megadont crowns are as a result of fusion of adjacent tooth germs
(fusion), or attempts at developmental separation of a single tooth germ to produce
two separate teeth (gemination) and a variety of terms have been used for such
situations.
The term 'double teeth' has been applied to cover both situations.
53. Accessory cusps
Extra cusps are not uncommon in the human
dentition and may occur in both the primary and
permanent dentition, most commonly affecting
molar teeth. In the primary dentition the most
common accessory cusps are seen either on the
mesiobuccal aspects of the maxillary first molar
or the mesiopalatal aspect of the maxillary
second molar, the latter being similar to the cusp
of Carabelli seen on the first permanent molar.
Treatment:
Selective grinding, repeated over a period of
time, will reduce the height of the cusp and allow
deposition of reactionary dentine on the pulpal
surface of the dentine. Single visit
sectioning of the cusp from the tooth.
54. Invaginated teeth
This term refers to the presence of an invagination in the crown of the tooth, forming an infolding lined by
enamel within the crown of the tooth, sometimes extending into the root. An invagination of enamel
epithelium into the dental papilla during development leads to the formation of the abnormality. The terms
invaginated tooth or dens invaginatus can be used.
Invaginated teeth may cause problems because of the development of caries and
pulpal pathology. This can occur soon after tooth eruption, with the child presenting
an acute abscess or facial cellulitis. In such cases the radiograph will invariably
demonstrate incomplete root formation as well as periapical rarefaction
55. Evaginated teeth
Evaginated teeth, or dens evaginatus, most commonly affect the premolar
teeth.
Permanent molar teeth may also be affected. Typically there is a small
tubercule on
the occlusal surface of the premolar in the central part of the fissure
pattern.
The condition is more common in patients of Chinese descent and has
been estimated to occur in 1-4% of the group.
56. ABNORMALITY OF ROOT FORM
Taurodontism
• The term taurodontism (literally⎯bull-like teeth,
resembling a bull's neck) is used to describe
molar teeth in which the body of the tooth is
enlarged vertically at the expense of the roots.
• The normal constriction of a tooth at the level
of the amelocemental junction is frequently
reduced or absent in affected teeth. The
mechanism leading to taurodontism is the late
invagination (or failure) of Hertwig's root
sheath, which maps out the shape of root
formation.
• Taurodont teeth may also be
described as pyramidal, cuneiform, or
fused. The root canal morphology
may have implications when
endodontic treatment or extraction is
required.
57. Accessory roots
An accessory (also known as extra or
additional) root/root canal refers to the
development of an additional number
of roots/root canals in teeth compared
with that described in dental anatomy
Accessory roots may occur in almost any
tooth. In the primary dentition this most
commonly affects the molars but the
primary canines and maxillary incisors
can also be affected.
58. ABNORMALITY OF TOOTH STRUCTURE
Regional odontodysplasia
This is an uncommon developmental anomaly,
typically affecting the primary teeth and
corresponding permanent successors within a
segment of the dentition.
The anterior teeth are more commonly
affected than the posterior teeth and the
defect may cross the midline.
The term 'ghost teeth' is sometimes applied to
reflect the radiographic appearance seen.
Affected patients may present with abscesses
prior to the eruption of the teeth. The
abnormal teeth have poorly developed crowns
with enamel and dentine changes, large pulp
59. DISTURBANCES OF ERUPTION
Introduction:
Considerable variations exist in the timing of eruption of the
permanent dentition.
There may be some racial variation and eruption may also be
influenced by environmental factors such as nutrition and illness.
Eruption times of permanent teeth in females tend to be slightly
ahead of the corresponding eruption times in males; this
becomes a more marked difference with the later erupting
teeth.
60. Premature eruption
Early eruption of the permanent
dentition may occur in children
with precocious puberty and
children with endocrine
abnormalities, particularly those
of the growth or thyroid
hormones.
61. Natal and neonatal teeth
• The mandibular central incisor is the most common natal or neonatal tooth. Occasionally
maxillary (central) incisors or the first molars may appear as natal teeth.
• Tooth is markedly loose it should be extracted as it is unlikely to form a useful part of the
dentition. Firm application of Spencer-Wells forceps to the tooth crown is advised, followed
by minor local curettage to remove remains of the developing tooth-germ at that site.
62. Delayed eruption
• Delayed eruption of primary teeth may arise from either systemic or local factors.
It may be associated with prematurity or low birth weight.
• Delayed eruption of teeth of both dentitions may occur in association with Down
syndrome and Turner's syndrome.
• Delayed eruption may also be associated with nutritional abnormalities or endocrine disorders such as
hypothyroidism or hypopituitarism.
• Cleidocranial dysplasia is an autosomal dominant condition characterized by aplasia
or hypoplasia of the clavicles and widespread cranial changes.
• Permanent tooth eruption is often delayed or there is failure of eruption, partly because of the number
of supernumerary teeth.
63. DISTURBANCES OF EXFOLIATION
Premature exfoliation
Premature exfoliation may also be seen in cases of
severe congenital neutropaenia, cyclical
neutropaenia, Chediak-Higashi syndrome (where it
is associated with gross periodontal destruction)
and in the Langerhans cell histiocytoses
64. Delayed exfoliation
• Infraocclusion
-The terms infraocclusion, submerged teeth and ankylosed teeth are often used to
describe teeth which have failed to come into normal occlusion or, more typically,
have remained in their relative position in the arch while other teeth have continued to
erupt.
-This is most commonly seen when one or more premolars fails to develop, hence the primary molars have
no stimulus to become resorbed. As the adjacent permanent teeth erupt alveolar growth occurs, but in
some cases the primary molars become ankylosed within the bone and fail to alter their position.
• There is a time range in which teeth erupt⎯but this range will affect the dentition as a whole.
• Dentitions falling substantially outside this range, or individually affected teeth delayed by 6 months,
should be investigated.
• Premature exfoliation always demands investigation.
• There is a place for a conservative approach to the management of infraoccluded primary teeth.
Treatment:
Removal of infraoccluded primary molars.
66. REFERENCES
• Paediatric Dentistry - Third Edition by
Richard Welbury.
• The Reference Manual of Pediatric Dentistry 2021 2022
• Shobha Tandon 3rd edition
• Nikhil Marwah 4th edition
• Pediatric Dentistry 4th edition S.G Damle
• Illustrated pediatric dentistry PR Chockalingam
• Guna SM, Tenny J. Longitudinal study of age and order of
eruption of primary teeth in Indian children. J Clin Exp Dent
2010;3:e113–6.
• Evlambia HH. Physiologic root resorption in primary teeth:
molecular and histological events. J Oral Sci 2007;49:1–12
