Primary failure of eruption and tooth resorption

The number of adult patients who seek an orthodontic treatment is increasing. These Primary failure of eruption (PFE) is defined as the partial or complete failure of eruption of at least one posterior tooth, without any mechanical obstacle. A better understanding of the biological mechanisms involved in PFE would enable to refine the diagnostic and prognostic criteria. This rare disease is currently related to PTHR1 gene variants. This gene codes for a transmembrane receptor involved in bone metabolism. However, there is few evidence associating PFE and bone remodeling abnormalities such as external root resorption. External root resorption is the loss of cementum and dentin tissues, resulting from the activation of clastic cells.

Human teeth affected by PFE were extracted and histological sections were made after fixation of the tissues in 4% PFA. The observations were correlated with three-dimensional imaging by cone beam computed tomography (CBCT) carried out in the preoperative phase.

Histological and radiographic analysis confirm the presence of ankylosis area in patients with no history of orthodontic treatment. Large areas of resorption of external root replacement were detected.

The results call the causal link between the appearance of ankylosis areas and the establishment of orthodontic traction in patients with PFE into question. The installation of an orthodontic force in this context could be only an aggravating factor, accelerating the processes of ankylosis or triggering them more prematurely.

With or without orthodontic treatment, teeth with PFE are likely to progress to ankylosis and resorption of replacement external root.