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CASE REPORT
Year : 2006  |  Volume : 24  |  Issue : 5  |  Page : 15-17
 

Permanent molars: Delayed development and eruption


Department of Pedodontics and Preventive Dentistry (A Constituent Institution of MAHE), Manipal College of Dental Sciences, Mangalore - 575 001, Karnataka, India

Correspondence Address:
R Arathi
Department of Pedodontics and Preventive Dentistry Manipal College of Dental Sciences, Mangalore (A Constituent Institution of MAHE, Manipal) Light House Hill Road, Mangalore - 575 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


PMID: 16891743

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  Abstract 

Delayed development and eruption of all the permanent molars is a rare phenomenon, which can cause disturbance in the developing occlusion. The eruption of permanent first and second molars is very important for the coordination of facial growth and for providing sufficient occlusal support for undisturbed mastication. In the case described, the first permanent molars were delayed in their development and were seen erupting at the age of nine and a half years. Severe disparity between the left and the right side of the dentition with respect to the rate of development of molars were also present.


Keywords: Delayed development, delayed eruption, permanent molars


How to cite this article:
Arathi R, Suprabha B S, Pai S M. Permanent molars: Delayed development and eruption. J Indian Soc Pedod Prev Dent 2006;24, Suppl S1:15-7

How to cite this URL:
Arathi R, Suprabha B S, Pai S M. Permanent molars: Delayed development and eruption. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Jul 15];24, Suppl S1:15-7. Available from: http://www.jisppd.com/text.asp?2006/24/5/15/26030



  Introduction Top


Development and eruption of permanent teeth is a fairly organized process. There are few teeth in the permanent dentition that show aberrations either in the shape, development or eruption. But such aberrations in relation to permanent molars especially involving all the first, second and third molars in the dentition is extremely rare.[1]

Delayed or failure of eruption can be attributed to a range of medical conditions and genetic alterations.[2],[3] But in some cases, it can also be associated with no systemic conditions or genetic alteration and the etiology remains unexplained.[4] The tooth is said to be delayed in its eruption when it is delayed by at least 1 year from its average time of eruption.[4],[5] In this article the author reports a case of delayed development and eruption of permanent molars and other associated features.


  Case Report Top


A 9-year-old female patient visited the dental clinic with a complaint of unerupted permanent molars in all the quadrants. Clinical examination revealed the absence of permanent molars in all the four quadrants [Figure - 1]. The soft tissue over the ridge distal to the deciduous second molar was mildly pale in color. Her dental presentation was as follows:

The upper left deciduous canine was extracted prematurely, as it was grossly decayed and probably was associated with periapical bone loss explaining the early eruption of the succeeding permanent canine. The lower deciduous canines were slightly mobile. There was no associated medical history and the patient had a normal physical and mental development.

OPG revealed the presence of unerupted first permanent molars in all the 4 quadrants [Figure - 2]. The roots were about complete in the lower molars and lesser in case of upper molars. Both upper and lower molars on the left side had erupted through the bone and were in the soft tissue. The developing second molar was seen on the left side with about 1/3 crown calcification in both upper and lower quadrants. Interestingly no evidence of calcification was present on the right side. A follicular radiolucency was seen in relation to lower right second molar. There was a gross disparity between the left and right side with respect to the second molar.

Upper left permanent canines showed of the root development and was positioned much inferiorly compared to the permanent canine on the right side whose root was just about completed.

Second premolar on the lower right quadrant was congenitally missing. The rest of the teeth were within normal limits in their development and eruption.

Since the roots of the permanent first molars were just complete, it was decided to keep the patient under observation. The patient was reevaluated 6 months later, it was seen that the upper and lower first permanent molars on the left side had completely erupted out of the soft tissue [Figure - 3]. But the first molar on the right lower quadrant was still partially covered by the soft tissue and on the right upper quadrant was almost covered completely by the soft tissue except for a small area of the cusp tip that was exposed. The left premolar and both the right and left permanent canines in the lower dentition were seen erupting through the soft tissue. Upper left permanent canine had erupted completely and was in occlusion. OPG showed calcification in right second molars which was absent in the first OPG [Figure - 4]. There was no trace of the developing third molar in any of the quadrants.


  Discussion Top


Delayed development and eruption of the permanent molars can cause disturbance in the developing occlusion. The eruption of permanent first and second molars are very important for the coordination of facial growth and for providing sufficient occlusal support for undisturbed mastication.[2] Thus delayed eruption of the permanent molars can impede functional occlusion which eventually may cause malocclusion.

Delayed eruption of permanent first, second or both the molars is commonly associated with other aberrations of which hypodontia is common.[6] In the present case lower right premolar was congenitally missing and other premolars were in different stages of development. The dental age of the unerupted first permanent molar was about 5-6 years exhibiting a lag of about 3-4 years. The dental age of the second permanent molar on the left side was about 4-5 years and on the right lower side was about 2-2 years. Normally there is not much disparity between the left and the right side. But in the present case there is at least 2-3 years disparity between the left and the right side, which is very rare. The first evidence of calcification of the third molar is radiographically seen at about 7-8 years, which is absent in the present case.

Rasmussen[6] went to the extent of renaming such molars that erupt late as '9 year molar' and '15 year molar' for the first and second permanent molars respectively and its presence is also associated with lack of several other teeth. In the present case, the congenitally missing second premolar in the left lower quadrant may be thus explained.

Futatsuki et al[7] discussed similar cases of delayed eruption of first molars and noted that in some cases it was associated with congenital absence of several teeth. Interesting was the association made between the missing second permanent molar and delayed eruption of the first permanent molar. Thus a possibility of congenitally missing second molar in the present case was analyzed. The amount of tooth development of the last unerupted molar suggested it to be the third molar. There are situations where the tooth distal to the missing molar has migrated mesially and occupied the position much mesially. But this could only be confirmed following the eruption of the last unerupted teeth by analyzing its configuration and occlusal anatomy.

The key factor in the prognosis of such a case is the age of the patient. When the roots of the unerupted tooth are completely formed the chances of successful treatment decreases.[8] Treatment for failure of eruption of permanent molars depends on several factors, the most important being the age. Different options for the treatment of delayed eruption include observation, surgical exposure and luxation or removal of any obstacle and lastly extraction. The usual treatment with a favorable prognosis is exposure and luxation. Molars luxated prior to root completion, erupted spontaneously and continued their normal root development. Palma et al[2] have proposed a treatment protocol for the management of patients with delayed eruption based on the type of abnormality and age [Table - 1].

It may be emphasized that the late erupting first permanent molar be observed and carefully evaluated by studying the crown- root development and comparing it with the normal. It is very important to avoid any kind of surgical or orthodontic intervention to bring the teeth to the mucosal surface when they are still immature for eruption.

 
  References Top

1.Johnsen DC. Prevalence of delayed emergence of permanent teeth as a result of local factors. J Am Dent Assoc 1971;14:100-6.   Back to cited text no. 1    
2.Palma C, Coelho A, Gonzalez Y, Cahuana A. Failure of eruption of first and second permanent molar. J Clin Pediatr Dent 2003;27:239-46.   Back to cited text no. 2  [PUBMED]  
3.Valmaseda-Casetllon E, De-La Rosa-Gray, Gay-Escoda. Eruption disturbance of the first and second permanent molars: Result of treatment in 43 cases. Am J Orthod Dentofac Orthop 1999;116:651-8.  Back to cited text no. 3    
4.Kaban LB, Needleman HL, Hertzberg J. Idiopathic failure of eruption of permanent molar teeth. Oral Surg 1976;42:155-63.  Back to cited text no. 4    
5.Tomizawa M, Yonemochi H, Kohno M, Noda T. Unilateral delayed eruption of maxillary permanent first molar-4 case report. J Pediatr Dent 1998;20:53-6.  Back to cited text no. 5  [PUBMED]  
6.Rasmussen P. '9-Year molar' aberrantly developing and erupting, Report of cases. J Clin Pediatr Dent 1998;22:151-3.   Back to cited text no. 6  [PUBMED]  
7.Futatsuki M, Matsumoto T, Nakata M. Clinical findings on delayed eruption of first molars: Report IAPD Conference: Chicago; 1993.  Back to cited text no. 7    
8.Andersson L, Blomlof B, Feiglin B, Hammarstron L. Tooth ankylosis, clinical, radiographic and histological assessment. Int J Oral Surg 1984;13:423-31.  Back to cited text no. 8    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

    Tables

[Table - 1]


This article has been cited by
1 Human Life History Evolution Explains Dissociation between the Timing of Tooth Eruption and Peak Rates of Root Growth
Dean, M.C. and Cole, T.J.
PLoS ONE. 2013; 8(1)
[Pubmed]



 

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   Abstract
   Introduction
   Case Report
   Discussion
   References
   Article Figures
   Article Tables

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