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Tooth Eruption

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  1. Tooth Eruption

  2. Tooth eruption is defined as “ The movement of a tooth from its site of development within the alveolar process to its functional position in oral cavity,” Massier and Schour, 1941

  3. Active Eruption Active Eruption & Passive Eruption Passive Eruption

  4. Stage of tooth eruption • Pre-eruptive • Intraosseous movement • Eruptive mucosal penetration preocclusal eruption • Post-eruptive

  5. Pre-eruptive stage • Deciduous teeth • Permanent teeth

  6. Eruptive stage Mechanism of eruption

  7. Post-eruptive stage 1. accommodation for growth 2. compensate for occlusal & interproximal wear (mesial drift) 3. supraeruption

  8. ฟันสึก attrition abrasion erosion

  9. Factors consideration in tooth eruption • development of periodontium, root, pulp, alveolar bone • speed of eruption • events during eruption • eruptive pathway: gubernacular canal • 3D movement • inheritable position

  10. Development of Dental Follicle • cementoblasts • periodontal ligament • alveolar bone

  11. Reduced EnamelEpithelium

  12. Gubernacular canal Gubernacular cord Eruptive Pathway

  13. FORCES of Tooth Eruption • Root Formation • Pressure( Pulp and Hydrostatic ) • Periodontal Ligament • Bone Remodeling and Dental Follicle

  14. Root growth • relation of root growth and eruptive movement:Carlson (1944) • remove HERS • supraeruption • rootless tooth :Gowgiel 1961, 1967 CONTRA

  15. Pulp growth • Antimitotic drugs inhibit mitotic activity of pulp cell :Sicher (1962)Ness & Smale (1959) • Vitamin D deficiency & overdose: Bryer

  16. Hydrostatic pressure • King & Bryer -> sympathetectomy • Main (1961) -> Hypotensive drugs • Hassel & McMinn (1972) -> measure fluid pressure

  17. Periodontal Ligament • Berkovitz & Thomas (1969) -> root resection • Michaeli et al (1982) -> degenerate PDL • Ness (1967) -> PLF • Bellows et al (1983) -> PLF

  18. dental follicle • Control resorption and formation of bone around tooth germ: Cahill & Mark 1974,1980,1983,1987 • no dental follicle, no eruption • PDL , alveolar bone and cementum are derivative of Dental Follicle

  19. Bone remodeling • Apposition & resorption of bone • Vit A and D def. Bone growth • Metal and Acrylic replica:Marks & Cahill (1984)

  20. Molecular biology of Bone Remodeling • Influx of monocytes at the onset of eruption • appearance of osteoclasts • signaling molecules

  21. signaling molecules • CSF-1 • EGF • IL-1 • TGF alpha • TGF beta-1

  22. Problem ????? • In vitro / in vivo • nature of experimental animal ……extrapolation • experimental design…isolate single system

  23. Conclusion of FORCES of Tooth Eruption Multifactorial Multifactorial (However, “Dental Follicle” Activity & Bone Remodeling have the Highest Potential)

  24. Clinical Application 1. Timing of Eruption 2. Unerupted Tooth (Embedded) 3. Tooth Impaction 4. Position of newly Erupted Successors 5. Dental Treatment Consideration on Newly Erupted Tooth 6. Denture and Supra-Erupted Tooth

  25. Exfoliation or Shedding ( Of Deciduous Teeth )

  26. Mono-Phyodontism Di-Phyodontism Poly-Phyodontism

  27. Patternof Shedding • Resorption of roots • anterior/posterior • Shedding of crown

  28. Cause of shedding • Pressure from permanent teeth • loss of bone…weakening of supporter • trauma and inflammation…occlusal stress, caries .. Etc.

  29. Histology of Sheding - Gubernacular Canal - Osteoclasts - Odontoclasts - PerioDontal Ligament

  30. Clinical Application • Remnants of Deciduous Teeth • Retained Deciduous Teeth • Submerged Deciduous Teeth

  31. The End