Nonsyndromic Delayed Eruption

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Case Report

Nonsyndromic delayed eruption of multiple teeth: A rare


case report
Valen Dela D’souza1, Prasanna Kumar Rao2, Raghavendra Kini2
Consultant Oral Diagnostician & Maxillofacial Radiologist, Mangaluru, 2Department of Oral Medicine and Radiology, A J Institute of Dental
1

Sciences, Mangalore, Karnataka, India

Abstract Dental eruption is a very finely regulated process. A delay in tooth eruption may be due to a disturbance
caused by local, systemic, or genetic abnormalities. Delayed eruption of multiple teeth in the absence of
any etiology is very rare. Here, we report a case of delayed eruption in a 16‑year‑old female patient with
multiple congenitally missing teeth and bilaterally ankylosed deciduous teeth with no underlying systemic
or genetic disease.

Keywords: Ankylosed teeth, congenitally missing teeth, delayed eruption, impacted teeth, nonsyndromic

Address for correspondence: Dr. Valen Dela D’souza, A.J. Institute of Dental Sciences, Kuntikana, Mangaluru - 575003, Karnataka, India.
E‑mail: valen.d.dsouza@gmail.com
Submitted: 02‑Aug‑2020, Revised: 14-Sep-2020, Accepted: 29‑Jan‑2021, Published: 19-Mar-2021

INTRODUCTION Nonsyndromic multiple eruption disorders are rarely


reported in the literature. Apparently, it indicates that
A broad range of variation exists in the normal eruption most cases of multiple unerupted teeth are associated with
times of deciduous and permanent teeth in human beings. different systemic and genetic factors. This case report
However, when the eruption time is grossly beyond the describes multiple unerupted permanent teeth in a healthy
extremes of normality, it is considered a pathologic state. patient with no systemic or genetic abnormality.[6‑10]
Possible etiologies for the failure of eruption of teeth may
be local, systemic or genetic.[1] CASE REPORT

Local causes are varied and range from the physical barriers A 16‑year‑old medically fit female patient visited our dental
to local metabolic disturbances, trauma and infection. The outpatient department with a complaint of irregularly placed
systemic conditions include rickets, cretinism and endocrine teeth for 10 years. Her family history revealed nonconsanguineous
dysfunction. The genetic disorders such as Cleidocranial marriage of parents. Her parents had similar complaints of
dysplasia, Gardner syndrome and osteopetrosis are crowding of teeth. The patient was moderately built and
also possible causes. In general, systemic causes lead to nourished and did not exhibit any physical or skeletal abnormality
widespread impact on most of the dentition, as opposed and showed no signs of mental retardation.
to local factors that tend to affect a smaller number of
teeth.[2‑5] The patient had generalized crowding and rotation in the
upper and lower arches [Figures 1 and 2]. The maxillary
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DOI: How to cite this article: D'souza VD, Rao PK, Kini R. Nonsyndromic
10.4103/jomfp.JOMFP_323_20 delayed eruption of multiple teeth: A rare case report. J Oral Maxillofac
Pathol 2021;25:S51-3.

© 2021 Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow S51
D’souza, et al.: Nonsyndromic delayed eruption

deciduous molars and mandibular deciduous incisors were


found to be retained and were not mobile. Percussion of
the retained deciduous molars produced a solid sound.

A digital panoramic radiograph (orthopantomagram [OPG])


was advised and undertaken. The radiograph revealed
bilaterally normal condylar and coronoid processes. Jaw
bones showed normal trabecular pattern and density. The
OPG further revealed impacted 13, 15, 25, 33, 35 and 45
and congenitally missing 12, 18, 22, 28, 31, 32, 38, 41, 42
and 48. Root formation of the permanent premolars and
molars was incomplete. A lack of periodontal ligament
space surrounding the primary deciduous molars was
noted, suggestive of ankylosed teeth [Figure 3].
Figure 1: Intraoral view of maxillary arch showing retained deciduous
teeth
To rule out any associated hormonal disorders, the patient
was referred to a physician under whose supervision,
thyroid function tests, parathormone levels, hormone
assays, serum calcium and phosphorous levels were carried
out. The results of the investigations were within the
normal limits.

Based on the history and clinical examination, the case


was diagnosed with nonsyndromic delayed eruption. The
patient was referred to the department of orthodontics for
the treatment of her primary complaint, the malocclusion.

DISCUSSION

The reported case presents a clinical situation of


congenitally missing permanent maxillary lateral incisors, Figure 2: Intraoral view of mandibular arch showing crowding and
retained deciduous teeth
mandibular central and lateral incisors, maxillary and
mandibular third molars and ankylosed deciduous molars
which ultimately led to delayed eruption.

Congenitally missing permanent teeth have a prevalence


of 0.5%–0.9%. After the third molars, second premolars
and lateral incisors are absent most frequently. Women
are more often affected when compared with men with a
predominance of 1.5:1.[11] The patient in our reported case
was female. Genetics has been suggested as an important
etiological factor, and autosomal dominant pattern of
inheritance has been considered to be predominant.[12] Figure 3: Orthopantomagram revealing multiple congenitally missing
Furthermore, congenitally missing teeth in permanent permanent teeth, ankylosed deciduous molars and impacted teeth
dentition are considered to be the most common reason
for primary tooth retention.[13] The agenesis of maxillary is defined as an anatomical fusion of the tooth cementum
permanent lateral incisors and mandibular permanent with the alveolar bone as a result of some disturbance in
central and lateral incisors in our case led to the retention their periodontal ligament.[15,16] There is a high incidence
of deciduous teeth. of ankylosed primary teeth in children between the age
group of 7 and 11 years.[17‑19] Many authors reported that
Bilateral ankylosed deciduous teeth, which is also seen in there was a hereditary component of ankylosis, based on
our case, are another rare condition.[14] An ankylosed tooth the observation of involvement of the second maxillary
S52 Journal of Oral and Maxillofacial Pathology | Volume 25 | Supplement 1 | March 2021
D’souza, et al.: Nonsyndromic delayed eruption

deciduous molars in the several members of the same family. 2. Proffit WR, Fields HW. Contemporary Orthodontics. 3rd ed. St. Louis:
Mosby; 2000.
[20‑23]
The patients family members in our case too had similar
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Journal of Oral and Maxillofacial Pathology | Volume 25 | Supplement 1 | March 2021 S53

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