Orthodontic Diagnosis - Failure of Eruption of Teeth

The failure of teeth eruption occurs when one or more teeth fail to erupt in the mouth. This can happen as a result of many different reasons which can include the following: an obstruction from the primary teeth, bone which is surrounding the tooth or other mechanical factors. The two different types of eruption failure are called primary failure of eruption and mechanical failure of eruption. The primary failure of eruption has been found to be associated with the Parathyroid hormone 1 receptor mutation.

Primary failure of eruption

The term “primary failure of eruption” was first used in 1981 by William Proffit and Katherine Vig. This type of failure of eruption is usually caused by a genetic or familial background precursor. The prevalence of primary failure of eruption (PFE) is present in approximately 0.06% of the population. In this type of failure, teeth which are non-ankylosed fail to erupt. These teeth also don’t have a primary tooth that is blocking their path. These teeth have a tendency to erupt partially, but then fail to fully erupt as they would normally with time. Profitt stated that only the posterior teeth are the ones that are affected. The teeth which are distal to the affected tooth, are also impacted. Both the permanent and primary teeth can be equally affected. This condition often results in a posterior open bite for patients who have primary failure of eruption. This issue can occur within any quadrant of the mouth.

There are two different types of primary failure of eruption, Type I and II. Type I involves the failure of eruption of teeth distal to the most mesial affected tooth. Type II involves a greater eruption pattern, which is incomplete, among the teeth distal to the most mesial affected tooth. It is often difficult to diagnose between these two types of failure of eruption because the 2nd molar does not erupt for most patients until they are 15-years-old. Plenty of times, a patient will receive orthodontic treatment before they are 15. As a result, in order to properly diagnose between the two types, a patient needs to be over 15 and a definitive proof of un-eruption of the 2nd molar is required.


Managing teeth that have PFE commonly includes extracting the affected teeth, followed by an orthodontic space closure or the placement of a prosthetic implant with a bone graft. This option can only be used in cases where a single tooth is affected. If multiple teeth are affected, a segmental osteotomy can be performed in order to bring the entire segment into occlusion. However, this procedure has not been found to be highly successful. These teeth not usually responsive to the orthodontic force. Studies have shown that ankylosis of these teeth can also occur when force is applied.

Mechanical failure of eruption

Mechanical failure of eruption takes place when the affected tooth is ankylosed or joined to the bone around it. In cases of mechanical failure of eruption, the affected tooth has either partial or complete loss of PDL in a panoramic radiograph. The teeth distal to the affected tooth are also not impacted by the condition. On a percussion test, a tooth with mechanical failure of eruption will have a dull metallic sound.

Eruption failure related to syndrome

Many syndromes have been identified as relating to the failure of eruption of teeth. These syndromes include: Cleidocranial dysplasia, Osteoporosis, Rutherford syndrome, GAPO syndrome and Osteoglophonic dysplasia.

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