Archives of Medicine and Health Sciences

: 2016  |  Volume : 4  |  Issue : 2  |  Page : 292--293

Primary failure of eruption

Sunil Kumar Mishra1, Shail Kumari Mishra2, Pankaj Mishra3, Puja Hazari4,  
1 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Orthodontics and Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Conservative Dentistry and Endodontics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
4 Department of Maxillofacial Prosthodontics and Implantology, Peoples Dental Academy, Bhopal, Madhya Pradesh, India

Correspondence Address:
Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh


Primary failure of eruption (PFE) is a partially understood oral condition associated with tooth eruption failure. Failure of eruption may affect one or a number of teeth, in either the primary or the permanent dentition, and depending on the underlying etiology, it can be partial or complete absence of teeth in oral cavity. For proper diagnosis, the differential diagnosis of PFE should always begin with the exclusion of potential systemic and local factors which can affect the eruption of teeth.

How to cite this article:
Mishra SK, Mishra SK, Mishra P, Hazari P. Primary failure of eruption.Arch Med Health Sci 2016;4:292-293

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Mishra SK, Mishra SK, Mishra P, Hazari P. Primary failure of eruption. Arch Med Health Sci [serial online] 2016 [cited 2022 Sep 26 ];4:292-293
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Full Text

A 17-year-old female patient reported with chief complaints of multiple missing teeth and compromised esthetics. On examination, there was no relevant medical or dental history given by her. She had no relevant history of the similar condition in her family or relatives. The patient revealed that she had lost her few deciduous teeth with no eruption of permanent teeth. On intraoral examination, multiple retained deciduous teeth as well as few partially erupted permanent teeth with infraocclusion were present [Figure 1]. She had a very high arched palate. Orthopantomograph (OPG) along with chest X-ray and skull X-ray was advised to her. OPG revealed the presence of multiple impacted, partially erupted, and missing permanent teeth. The OPG shows the characteristic “resorption chimneys” visible as large radiolucent areas adjacent to the unerupted tooth-germ crowns, characteristics of PFE indicating adequate bone resorption and formation of eruptive pathway [Figure 2]. Chest X-rays and skull X-ray did not reveal any other obvious deformity.{Figure 1}{Figure 2}

Primary failure of eruption (PFE) is a rare condition that involves impeded eruption of teeth despite the lack of an identified local or general causative factor. The prevalence of PFE is very low, and approximately it affects 0.06% of the population.[1] It is more common in females, with a gender distribution of male:female as 1:2.25. Failure of eruption of teeth may be unilateral or bilaterally with a slight tendency for unilateral occurrence, and it involves both maxilla and/or mandible.[2]

A number of causes for failure of eruption have been cited in literature and it may be of both local and systemic origins. Local eruption disturbances may be due to impactions and retentions of teeth. Impactions may be due to supernumerary teeth, tumors, cysts, etc., which leads to a barrier for the erupting tooth germ. Retentions may be due to genetic disorders such as cleidocranial dysplasia, osteopetrosis, or Gorlin-Goltz syndrome. Systemic causes of retention of teeth may be due to rickets, anemia, malnutrition, congenital syphilis, tuberculosis, pseudohypoparathyroidism, etc.[3],[4]

PFE is considered to be caused by improper dental follicle activity. A defect at the molecular level has been found to be causative of PFE. It has been found that heterozygotic mutations parathyroid hormone 1 receptor genes are responsible for the disorder.[3]

Studies had proved that PFE demonstrates most of the characteristics such as commonly involved teeth are molar teeth; involved teeth may erupt into infraocclusion; involved permanent teeth tend to become ankylosed; orthodontically attempt to bring the affected teeth into the arch leads to ankylosis; and the condition may occur without affecting family members.[5]

Differential diagnosis of PFE should always begin with the exclusion of potential systemic and local factors hampering eruption of teeth. Many human syndromes of genetic origin can cause partial or complete absence of teeth. The case of partially erupted teeth requires differentiation between PFE and ankylosis. Multiple affected teeth suggest PFE whereas involvement of only some teeth indicates ankylosis. Endocrine disorders need to be ruled out before diagnosing it as PFE.[2],[3]

Treatment for patient with PFE should be carried out with caution considering the age of the patient so that a favorable change in the confidence and psychology of the patient can be gained. Embedded teeth can be brought into the arch by orthodontic means with the help of segmental osteotomy or osteodistraction; however, it is a very expensive and complex process. Next treatment option is surgical extraction of embedded teeth followed by prosthetic rehabilitation to improve function and esthetics. Initially, the removable prosthesis can be given to the patient, and once the craniofacial growth is completed, replacement of teeth by dental implants is considered.[6]

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