Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol. 1985; 59:420-425
Ireland AJ. Familial posterior open bite: a primary failure of eruption. Br J Orthod. 1991; 18:233-237
Proffit WR, Vig KW. Primary failure of eruption: a possible cause of posterior open-bite. Am J Orthod. 1981; 80:173-190
Bosker H, ten Kate LP, Nijenhuis LE. Familial reinclusion of permanent molars. Clin Genet. 1978; 13:314-320
Brady J. Familial primary failure of eruption of permanent teeth. Br J Orthod. 1990; 17:109-113
DiBiase AT, Leggat TG. Primary failure of eruption in the permanent dentition of siblings. Int J Paediatr Dent. 2000; 10:153-157
Frazier-Bowers SA, Koehler KE, Ackerman JL, Proffit WR. Primary failure of eruption: further characterization of a rare eruption disorder. Am J Orthod. 2007; 131:578.e1-11
Frazier-Bowers SA, Simmons D, Koehler K, Zhou J. Genetic analysis of familial non-syndromic primary failure of eruption. Orthod Craniofac Res. 2009; 12:74-81
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Sharma G, Kneafsey L, Ashley P, Noar J. Failure of eruption of permanent molars: a diagnostic dilemma. Int J Paediatr Dent. 2016; 26:91-99
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Primary failure of eruption – a review and case report

From Volume 12, Issue 4, October 2019 | Pages 140-144


Benjamin Marlow

MOrth RCS(Eng), BchD, MFDS(Ed)

Department of Orthodontics, Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK

Articles by Benjamin Marlow

Samantha Hodges

BDS(Hons), MSc, FDS, MOrth, FDS(Orth), FHEA, Consultant Orthodontist

Department of Orthodontics, Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK

Articles by Samantha Hodges


Partial or complete failure of tooth eruption may be due to several causes, including primary failure of eruption (PFE), and an accurate diagnosis is essential for appropriate management. This article reviews PFE and the possible treatment options. Case reports of two patients diagnosed with PFE are presented and their management discussed.

CPD/Clinical Relevance: Primary failure of eruption can be difficult to diagnose and differentiate from other causes of failure of eruption. This paper highlights the clinical presentation of PFE through a review of the literature and by illustration with two clinical cases.


Failure of eruption of first and second molars is rare, with the prevalence estimated at 0.01% for first permanent molars and 0.06% for second permanent molars.1,2 Eruption failure may result from a number of causes. These include mechanical interference with eruption or failure of the eruptive mechanism of the tooth so that the expected amount of eruption does not occur.3 Mechanical failure of eruption (MFE) is characterized by single tooth anklyosis, whereas primary failure of eruption (PFE) is a condition in which unimpeded, non-ankylosed teeth fail to erupt with an absence of systemic factors.3 Primary failure of eruption is diagnosed based on its clinical appearance, which is reported to include the seven features shown in Table 1.3 The last of these clinical features has been disputed. Advances in gene discovery and identification have been able to show a heritable basis of this dental phenotype,4,5,6,7,8 and recently mutations in parathyroid hormone 1 receptor (PTH1R) have been identified in several familial cases of PFE.9

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