Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Print this page Email this page Users Online: 529

 Table of Contents  
Year : 2014  |  Volume : 3  |  Issue : 4  |  Page : 283-286

Idiopathic multiple unerupted permanent teeth: A rare case report

1 Department of Orthodontics and Dentofacial Orthopedics, C. K. S. Teja Institute of Dental Sciences and Research, Tirupati, Andhra Pradesh, India
2 Department of Conservative Dentistry, C. K. S. Teja Institute of Dental Sciences and Research, Tirupati, Andhra Pradesh, India

Date of Web Publication10-Dec-2014

Correspondence Address:
Sandra Vani
Department of Orthodontics and Dentofacial Orthopedics, C. K. S. Teja Institutions of Dental Sciences, Tirupati - 517 501, Andhra Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2277-8632.146659

Rights and Permissions

A disturbed eruption process creates a clinical situation that is challenging to diagnose and treat. The clinical spectrum of tooth eruption disorders includes both syndromic and nonsyndromic problems ranging from delayed eruption to a complete failure of eruption. Failure of permanent teeth to erupt without obvious etiology is a rare dental anomaly. Various local and systemic factors have been implicated in failure of eruption of multiple permanent teeth. The present case report discusses the clinical and radiographic details of a 21-year-old asymptomatic and nonsyndromic patient with multiple unerupted permanent teeth.

Keywords: Idiopathic, permanent dentition, primary teeth, unerupted teeth

How to cite this article:
Vani S, Nooney A, Raju KS, Hemadri M. Idiopathic multiple unerupted permanent teeth: A rare case report. J NTR Univ Health Sci 2014;3:283-6

How to cite this URL:
Vani S, Nooney A, Raju KS, Hemadri M. Idiopathic multiple unerupted permanent teeth: A rare case report. J NTR Univ Health Sci [serial online] 2014 [cited 2022 Dec 8];3:283-6. Available from: https://www.jdrntruhs.org/text.asp?2014/3/4/283/146659

  Introduction Top

Tooth eruption has been defined as the movement of a tooth in an axial and occlusal direction from its developmental position within the jaw to its final functional position in the occlusal plane. [1] The eruption pattern of deciduous and permanent teeth is usually comprehensive and takes place at different chronological age levels. A significant deviation in eruption of tooth, premature eruption and delayed tooth eruption are commonly noted in a clinical practice. [2] Possible etiologies for failure of eruption of teeth fall into two broad categories: systemic and local factors. Some of the systemic conditions that can lead to delayed or failed eruption are genetic disorders such as cleidocranial dysplasia, Gardner syndrome and osteopetrosis. [3],[4] Endocrine derangements like hypothyroidism can also cause generalized underdevelopment and delayed eruption of the dentition. [5],[6] In general, systemic causes lead to widespread impact on most of the dentition, as opposed to local factors that tend to affect a smaller number of teeth.

Local causes are varied and range from physical barriers to local metabolic disturbances, trauma and infection. [7],[8] Probably, the most common local factor is mechanical obstruction either integral or peripheral to the tooth. Barriers can also be of soft tissue origin, as in tumors and cysts. [9] Nonsyndromic multiple eruption disorders are rarely reported. [10],[11],[12],[13],[14],[15]

Apparently, this indicates that most of the multiple unerupted teeth are often associated with different local, systemic, and genetic factors. This case report describes a patient with multiple unerupted permanent and deciduous teeth for which there is no obvious explanation. He has no associated systemic illness, no underlying endocrine dysfunction and no associated genetic abnormality.

  Case report Top

A 21-year-old male patient in good general health came with the chief complaint of multiple missing teeth in upper and lower jaws and wanted to have prosthesis made for the same. His past medical history was completely unremarkable. Born to nonconsanguineous parents, he was the product of full-term pregnancy and an uncomplicated delivery with no history of radiation or unusual drug therapy during gestation. No one in the family had unerupted teeth or missing teeth.

On general examination, patient was moderately built and nourished and did not exhibit any physical or skeletal abnormality and showed no signs of mental retardation. To rule out any associated syndromes, metabolic and hormonal disorders, patient was referred to a physician under whose supervision, multiple tests, including karyotyping, thyroid function tests, parathormone levels, hormone assays, serum calcium, and phosphorous levels were carried out. The results of the investigations were within normal limits.

Intra-oral examination [Figure 1] revealed multiple retained deciduous teeth with respect to 55, 54, 53, 63, 65, 73, 74, 83 and 84, with only permanent maxillary and mandibular central incisors present. Root stump of maxillary left first primary molar was retained. The anatomy of erupted teeth was normal. A complete anterior deep bite was present. No oral mucosal lesions were found. On palpation, there is bulging in relation to unerupted teeth with no signs of pain or crackling.
Figure 1:

Click here to view

Panoramic radiograph [Figure 2] revealed 9 retained deciduous teeth, 13 unerupted permanent teeth in the maxilla and 16 unerupted teeth (2 deciduous, 14 permanent) in the mandible. In total, the patient has 29 unerupted teeth: 13, 14, 15, 16, 17, 18, 22, 23, 24, 25, 26, 27, 28, 75, 85, 32, 33, 34, 35, 36, 37, 38, 42, 43, 44, 45, 46, 47, and 48. Permanent maxillary right lateral incisor was congenitally missing. Impacted teeth were crowded in maxillary and mandibular anterior region. In the mandibular arch, they were very close to the inferior border of mandible. Root development was complete for all unerupted permanent teeth except third molars. Unerupted deciduous teeth in mandible showed no evidence of root formation. Roots of maxillary second molars, mandibular lateral incisors, canines, first premolars, first and second molars were aberrantly angulated. Jaw bones showed normal trabecular pattern and density.
Figure 2: Panoramic radiograph showing unerupted and
malpositioned permanent teeth with complete development of
roots and presence of many deciduous teeth with incomplete root

Click here to view

  Discussion Top

The case described, represents unique characteristics of multiple unerupted permanent teeth, multiple retained deciduous teeth, unerupted mandibular primary second molars, and congenitally missing lateral incisor in an asyndromic male patient.

Multiple unerupted permanent teeth is a rare finding and frequently found to be associated with syndromes such as cleidocranial dysplasia, Gardner syndrome, Zimmerman-Laband syndrome and Noonan's syndrome. [16],[17],[18],[19] Primary teeth are retained in conditions like hemifacial atrophy, hypopitutarism, hypothyroidism, cherubism, gingival fibromatosis, and cleft palate. [16] On account of the fact that family history, medical history, clinical examination, biochemical and hematological reports were non-contributory in our patient, all the above conditions were excluded. Intra-oral examination of the patient revealed relatively normal jaws and oral soft tissues excluding involvement of local etiological factors such as the presence of mucosal barrier, supernumerary teeth, tumors, and scar tissue.

Many nonsyndromic cases of multiple unerupted teeth reported were supernumerary or a combination of supernumerary and permanent teeth. [20],[21],[22] Our patient had no supernumerary teeth. Only three cases of similar nature but varying severity have been reported.

O'Connell and Torske [4] described a case with full retarded eruption of both deciduous and permanent dentition. Bayar et al. [23] have reported three cases with multiple impacted teeth involving both jaws in which no syndrome or systemic conditions have been detected. Dalampiras et al. [24] described a case of 13-year-old boy with retained primary teeth and retarded eruption complete permanent dentition.

Impaction of succedaneous teeth due to over retention of primary teeth has been reported widely in the literature. [17],[21],[25] Involvement of both succedaneous and nonsuccedaneous teeth in our patient establishes the fact that failure of eruption of teeth or lack of eruptive forces led to retention of primary teeth. The presence of over retained primary teeth as seen in this patient is considered a consequence rather than a cause for failure of eruption. Since there is no eruptive mechanism most of the primary teeth roots are not resorbed and retained. This may be one of the predictable causes for delayed exfoliation of primary teeth.

Mandibular deciduous second molars on both sides failed to erupt in our patient. Yildirim et al. [26] have reported a case of multiple impacted permanent teeth along with five impacted primary teeth. Impactions and tooth eruption failures involving the primary teeth are rare. Second primary molars have been the teeth most frequently involved. Impaction of primary teeth may be associated with the eruptive and developmental disturbances in their permanent successors. [27],[28] During the embryological developmental course as it occurs in the premolar region, permanent tooth bud changes its position from the region around the occlusal surface of the primary molar to an interradicular position on the primary molar. In the present case mandibular second premolars are located occlusal to the primary second molars as in the cases reported by Memarpour et al. and Borsatto et al. [29],[30] It may be assumed that abnormal position of premolars is due to early arrest in the eruption of the primary primordium preventing the migration of permanent tooth germ to an interradicular position below the non-erupting primary molar as under normal condition. Instead it will erupt independently and obtain a position occlusal to the primary molar. [31]

Most of the teeth involved had completed root development, a fact which confirms that root formation is independent of the eruption process. Root dilacerations were seen not only in mandibular first and second molars, but also in mandibular lateral incisors, canines and first premolars and maxillary second molars too. Vedtofte et al. [32] reported an association between root anomalies and eruptive disorders in permanent molars, but the finding has not been quantified. Kaban et al.[33] states that the follicle of unerupted molars near the inferior border begins to curve, resulting in "hooked" roots. Root deflection may be due to the local disturbance leading to failure of eruption and presence of dilacerated roots determines a poor prognosis. In this case, failure of posterior dentoalveolar development resulted in excessive anterior overbite.

In our patient, lack of eruptive force from the dental follicle combined with idiopathic displacement of secondary tooth germs resulted in many unerupted permanent teeth.

  Conclusion Top

Failure of permanent teeth to erupt can be attributed to genetic, systemic and local causes. Retained deciduous teeth with multiple unerupted permanent teeth in this case were not associated with systemic or local etiology. Hence, diagnosis of idiopathic failure of eruption was made. Interdisciplinary management is essential in such cases for optimal outcome to restore function and esthetics. Orthodontic-assisted eruption will not be possible in this case due to lack of sufficient number of permanent teeth for conventional anchorage and ideal location for placement of microimplants. Aberrantly impacted teeth with divergent roots require extensive bone removal contraindicating surgical extractions. Therefore, placement of overdentures subsequent to endodontic treatment was planned.

  References Top

Cahill DR. Eruption pathway formation in the presence of experimental tooth impaction in puppies. Anat Rec 1969;164:67-77.  Back to cited text no. 1
Cunha RF, Boer FA, Torriani DD, Frossard WT. Natal and neonatal teeth: Review of the literature. Pediatr Dent 2001;23:158-62.  Back to cited text no. 2
Proffit WR, Fields HW. Contemporary Orthodontics. 3 rd ed. St. Louis: Mosby; 2000.  Back to cited text no. 3
O'Connell AC, Torske KR. Primary failure of tooth eruption: A unique case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87: 714-20.  Back to cited text no. 4
Proffit WR. Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod 1978;48:175-86.  Back to cited text no. 5
Proffit WR, Vig KW. Primary failure of eruption: A possible cause of posterior open-bite. Am J Orthod 1981;80:173-90.  Back to cited text no. 6
Bosker H, ten Kate LP, Nijenhuis LE. Familial reinclusion of permanent molars. Clin Genet 1978;13:314-20.  Back to cited text no. 7
Brady J. Familial primary failure of eruption of permanent teeth. Br J Orthod 1990;17:109-13.  Back to cited text no. 8
Ireland AJ. Familial posterior open bite: A primary failure of eruption. Br J Orthod 1991;18:233-7.  Back to cited text no. 9
Nadine AM. Case of new unerupted and impacted teeth in a man 21 years of age. Dent Cosm 1935;77:304-6.  Back to cited text no. 10
Quinn JH. Aberrant, unilateral, triple mandibular impactions. Oral Surg Oral Med Oral Pathol 1956;9:932-4.  Back to cited text no. 11
Valiathan M, Valiathan A, Iyer M. Impactions in orthodontics. J Philipp Dent Assoc 1999;51:22-8.  Back to cited text no. 12
Tanaka E, Kawazoe A, Nakamura S, Ito G, Hirose N, Tanne Y, et al. An adolescent patient with multiple impacted teeth. Angle Orthod 2008;78:1110-8.  Back to cited text no. 13
Karacayli U, Gocmen-Mas N. Multiple abnormal unerupted mandibular permanent molar teeth: A case report. Int J Morphol 2009;27:65-8.  Back to cited text no. 14
Nagpal A, Sharma G, Sarkar A, Pai KM. Eruption disturbances: An aetiological-cum-management perspective. Dentomaxillofac Radiol 2005;34:59-63.  Back to cited text no. 15
Cooper SC, Flaitz CM, Johnston DA, Lee B, Hecht JT. A natural history of cleidocranial dysplasia. Am J Med Genet 2001;104:1-6.  Back to cited text no. 16
Zuccati GC, Doldo T. Multiple bilateral impactions in an adolescent girl. Am J Orthod Dentofacial Orthop 2010;137:S163-72.  Back to cited text no. 17
Chodirker BN, Chudley AE, Toffler MA, Reed MH. Zimmerman-Laband syndrome and profound mental retardation. Am J Med Genet 1986;25:543-7.  Back to cited text no. 18
Yalcin S, Gurbuzer B. Multiple impacted teeth in the maxilla. Oral Surg Oral Med Oral Pathol 1993;76:130.  Back to cited text no. 19
Babu V, Nagesh KS, Diwakar NR. A rare case of hereditary multiple impacted normal and supernumerary teeth. J Clin Pediatr Dent 1998;23:59-61.  Back to cited text no. 20
Sivakumar A, Valiathan A, Gandhi S, Mohandas AA. Idiopathic failure of eruption of multiple permanent teeth: Report of 2 adults with a highlight on molecular biology. Am J Orthod Dentofacial Orthop 2007;132:687-92.  Back to cited text no. 21
Sharma A. A rare non-syndrome case of concomitant multiple supernumerary teeth and partial anodontia. J Clin Pediatr Dent 2001;25:167-9.  Back to cited text no. 22
Bayar GR, Ortakoglu K, Sencimen M. Multiple impacted teeth: Report of 3 cases. Eur J Dent 2008;2:73-8.  Back to cited text no. 23
Dalampiras S, Christina B, Stanko P. Full retarded eruption of permanent dentition: Report of a rare case (8-year follow up). Eur J Dent Med 2012;4:34-7.  Back to cited text no. 24
Nagaveni NB, Umashankara KV, Manjunath S. Multiple impactions in non-syndromic patient: A case report. Indian J Dent Adv 2012;4:952-5.  Back to cited text no. 25
Yildirim D, Yilmaz HH, Aydin U. Multiple impacted permanent and deciduous teeth. Dentomaxillofac Radiol 2004;33:133-5.  Back to cited text no. 26
Hayashi-Sakai S, Taguchi Y, Noda T. Failure of tooth eruption involving a mandibular primary first molar: A case report. J Dent Child (Chic) 2005;72:16-20.  Back to cited text no. 27
Otsuka Y, Mitomi T, Tomizawa M, Noda T. A review of clinical features in 13 cases of impacted primary teeth. Int J Paediatr Dent 2001;11:57-63.  Back to cited text no. 28
Memarpour M, Rahimi M, Bagheri A, Mina K. Unerupted primary molar teeth positioned inferior to the permanent premolar: A case report. J Dent (Tehran) 2012;9:79-82.  Back to cited text no. 29
Borsatto MC, Sant'Anna AT, Niero H, Soares UN, Pardini LC. Unerupted second primary mandibular molar positioned inferior to the second premolar: Case report. Pediatr Dent 1999;21:205-8.  Back to cited text no. 30
Kjaer I, Fink-Jensen M, Andreasen JO. Classification and sequelae of arrested eruption of primary molars. Int J Paediatr Dent 2008;18:11-7.  Back to cited text no. 31
Vedtofte H, Andreasen JO, Kjaer I. Arrested eruption of the permanent lower second molar. Eur J Orthod 1999;21:31-40.  Back to cited text no. 32
Kaban LB, Needleman HL, Hertzberg J. Idiopathic failure of eruption of permanent molar teeth. Oral Surg Oral Med Oral Pathol 1976;42: 155-63.  Back to cited text no. 33


  [Figure 1], [Figure 2]

This article has been cited by
1 Multiple eruptive delay as a variant of primary eruption failure. A preliminary case report.
Gustavo Armando Ruíz-Mora, Luis Ernesto Arriola-Guillén, Aron Aliaga-Del Castillo, Yalil Augusto Rodríguez-Cárdenas, Rocío Esther Avalos-Hernández
Journal of Stomatology, Oral and Maxillofacial Surgery. 2022;
[Pubmed] | [DOI]
2 Oral and systemic manifestations of congenital hypothyroidism in children. A case report.
Carmen Ayala,Obed Lemus,Maribel Frías
Journal Oral Of Research. 2015; 4(5): 329
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Case report
Article Figures

 Article Access Statistics
    PDF Downloaded716    
    Comments [Add]    
    Cited by others 2    

Recommend this journal