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Multiple unerupted teeth – an interesting challenge

From Volume 12, Issue 4, October 2019 | Pages 134-139


Naeem Adam


GPT Newcastle Dental Hospital

Articles by Naeem Adam

Andrew Flett

FDS (Orth) RCS Eng, MOrth RCS (Eng), MClinDent (Orth), MJDF RCS (Eng)

Consultant Orthodontist, Nottingham University Hospitals NHS Trust, Nottingham, UK

Articles by Andrew Flett

Cara Sandler

BDS, MFDS, PG Cert, Orthodontic Registrar ST1

DCT1, Maxillofacial Surgery, Royal Sussex County Hospital, Brighton, UK

Articles by Cara Sandler

Email Cara Sandler


This paper describes primary failure of eruption and presents some of the theories about the aetiology of this clinical condition. It also covers single ankylosed teeth as well as cases that present with multiple unerupted teeth. The various approaches to the clinical management of this not uncommon problem are discussed, along with the pros and cons of some of these techniques.

One difficult clinical challenge is documented, where a 14-year-old patient presented with 19 unerupted permanent teeth and, with the help of rare-earth magnets and upper and lower fixed appliances, within a two-year period a good result was achieved.

CPD/Clinical Relevance: Clinicians encounter teeth that have failed to erupt on a regular basis. Appropriate diagnosis and treatment planning of these cases, and subsequent effective clinical management, is imperative to ensure the most favourable outcome for our patients.


Permanent teeth may fail to erupt because of obstruction, or disruption, of the eruptive mechanism. Eruption may be obstructed by the presence of pathology, ectopic tooth position, interferences from adjacent teeth or lateral forces from the tongue.1 Teeth may also fail to erupt due to primary failure of eruption (PFE) or ankylosis. The latter is defined as the fusion of cementum to bone in at least one area lacking a periodontal ligament space.2

Primary failure of eruption (PFE) is defined as incomplete tooth eruption despite the presence of a clear eruptive pathway.1 There is no ankylosis and it is the eruptive mechanism itself that is disturbed.2 This article will review the literature on PFE and failure of eruption from ankylosis. We also present a case of multiple unerupted teeth, treated with the use of neodymium iron boron magnets, as well as the more conventional deployment of gold chains to facilitate orthodontic traction.

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