Mechanism of Tooth Eruption

Phases:
1. Pre-eruptive phase
- the enamel organ lying within the developing jaw
reaches full size along with completion of tooth crown
calcification.
2. Eruptive or Pre-functional phase
- begins with root formation, periodontal ligament &
dento-gingival junction.
- it is completed when the tooth reaches the occlusal
plane.
*The crown penetrates the oral mucosa to
appear in the oral cavity.
3. Post-eruptive or Functional phase
- small tooth movements that occur after the tooth has
reached the occlusal plane.
*Post-eruptive tooth movement maintain the
position of the erupted tooth while the jaw continues to
grow & it compensates occlusal & proximal wear.

Mammalian Teeth Can Be Subdivided into 3 Broad
Categories On The Basis Of Their Eruptive
Characteristics:
1. Continuously Growing Tooth
- no gross separation between the anatomical crown &
anatomical root.
- continuous growth of the tooth at the apex &
continuous eruption occur throughout the life of the
animal.
- clinical crown is constantly replaced by root covered
with enamel in the progressive stages of development.
- with the loss of tooth substance due to occlusal
attrition, more tooth substance is extruded from the
socket to maintain the clinical crown
- this form of tooth is characteristic of animals with rapid
occlusal wear & eruption.
ex. Rodent incisor teeth
2. Continuously Extruding Tooth
- has a defined crown & anatomical root.
- as the tooth is worn, more of the anatomical crown
extrudes & epithelial attachment migrates apically.
- since no new tooth structure is being formed, it results
to gradual loosening & final exfoliation of the tooth.
- this tooth form is characteristic of the lower incisors of
sheep & cattle.
3. Continuously Erupting Tooth
- eruption does not occur by enlargement of the clinical
crown but rather by addition to the alveolar process.
- this is characteristic of human teeth.

Stages of Tooth Eruption:
(Classification)
1. Follicular growth (Steedle & Proffit)
Stage 1 Preparatory Stage (Noyes & Schour)
**INITIATION OF CALCIFICATION**
- The permanent tooth germs that bud from the
deciduous teeth generally assume a lingual position
relative to their precursors.
- As the deciduous teeth develop & erupt, the permanent
tooth follicles undergo somewhat complex migrations
from their initial to their pre-eruptive positions.
- Once the crown formation has begun, the follicles of
the posterior teeth move bucally.
- Eruptive movement of the tooth per se begins as soon
as the root begins to form.
2. Pre-emergent eruptive spurt
Stage 2 Migration toward the oral
epithelium
**INITIATION OF ROOT DEVELOPMENT**
- Root formation continues as the tooth begins a period
of rapid eruption in the occlusal direction.
- Two processes necessary for eruptive phase:
a) There must be resorption of the overlying bone &
of the overlying deciduous roots in the case of
permanent tooth.
b) The eruption mechanism itself must move the
tooth in the direction where the path has been cleared.
3. Post-emergent eruptive spurt
Stage 3 Emergence of crown tip into the
oral cavity
**GINGIVAL EMERGENCE**
- At the time of gingival emergence, the rate of human
tooth eruption is at its greatest.
- Eruption rate slows as the tooth approaches the
occlusal plane.
4. J uvenile occlusal equilibrium
Stage 4 First occlusal contact
**FIRST OCCLUSAL CONTACT**
- Once the permanent tooth reaches occlusion, occlusal
movement stops or incredibly slows down for several
years.
- This period of relative quiescence ends at the
beginning of puberty, when the second active phase of
eruption begins.
5. Circumpubertal occlusal eruptive spurt
Stage 5 Full occlusal contact
**PERIOD OF QUIESCENCE &
PUBERTAL GROWTH**
- Occurs between 11 & 16 years of age, the teeth in
occlusion begins a second active eruption phase lasting
for 2-3 years.
- This period is characterized by increase in lower facial
height.
- Facial tissues undergo a period of accelerated growth
with:
>lengthening of the facial & masticatory muscle
>lowering of the mandible & the associated soft tissues
- This eruptive spurt slows as the face reaches maturity
& a state of relative equilibrium re-established by 18
years of age.
6. Adult occlusal equilibrium
Stage 6 Continuous eruption
**PERIOD OF ADULTHOOD**
- Once physical maturity is reached, vertical tooth
movement does not stop abruptly.
- Throughout life, small increase in lower facial height &
continued eruption occur.
- Lower facial height increases by:
* 0.3 mm/year in the second decade
* 0.1 mm/year in the third decade
* 0.07 mm/year in the seventh decade


- Mesial & occlusal eruption continuous in life:
> interproximal & occlusal attrition
> tooth loss
> marked occlusal abrasion
> periodontal breakdown

Theories of tooth eruption:
2 MAIN CLASSES:
a) The tooth is pushed out of the bone by forces
generated beneath & around the tooth.
b) The tooth is pulled out as a result of tension
developed in the periodontal ligament.

Factors that influence tooth eruption:
1. Gubernacular Cord
- remnants of dental lamina & connective tissues
contained in the gubernacular canal, which is found in
successional teeth.
- connects the follicles of permanent teeth to the oral
mucosa & has an important role in controlling the
movement of the developing teeth through the growing
jaws.
- provides a path of least resistance & is actively
engaged in pulling the tooth out from the underlying
tissues.
2. Alveolar bone growth
- continued alveolar bone deposition results in the
eruption of teeth to their occlusal location.
3. Root growth
- pressure generated from the growing root-end may
result in the resorption at the base of the alveolar socket.
4. Intrapulpal pressure
- once a tooth has penetrated into the oral cavity, there
must be some form of pressure change favoring
eruption; & such change of pressure may be derived
from the vascular pressure within the pulp cavity.
5. Periodontal ligament
- Three theories:
a) The cross-linking & shrinkage of collagen fibers
tractional forces are generated within the
oblique fiber system of the periodontal ligament due to
the cross-linking and aggregation that occurs during the
collagen maturation.
b) The contractility & mobility of fibroblasts
fibroblasts within the periodontal ligament may
generate an eruptive force either by their contractility or
locomotor activity.
c) The thixotropic gel-like nature of the periodontal
membrane