Delayed Tooth Eruption in Children: A Guide for Parents

The front teeth are not erupting?

Dear Dr.
Yang,
My son is 10 years old, and a year ago, we discovered that his left central incisor had not erupted.
We visited a nearby dental clinic, where it was found that he had supernumerary teeth.
An oral surgeon removed the supernumerary teeth (the doctor mentioned there were about ten, the size of rice grains, occupying the space in the alveolar bone, so bone grafting was needed to fill the defect).
However, it has been a year, and the central incisor still has not erupted.
Three months ago, when he went for a check-up for cavities, an X-ray was taken, and the doctor said the permanent tooth is still inside but has not erupted, recommending that we see an orthodontic specialist.

Recently, I found an article online about orthodontic cases stating that a 15-year-old student underwent window surgery after having supernumerary teeth extracted to allow the deeply embedded central incisor to erupt.
However, since the patient had missed the optimal time for spontaneous eruption, they had to use the "eruption aid" technique.
This involves using a special orthodontic appliance to attach to the deeply embedded central incisor in the maxilla, gradually pulling it down over time to allow it to emerge.
1.
Is this type of orthodontic treatment suitable for a 10-year-old child? Will it be very expensive? Has he missed the natural eruption period for teeth at 10 years old?
2.
I have two other children who also had supernumerary teeth, and after extraction, their permanent teeth erupted without bone grafting.
Only my son had the bone graft.
Does the bone graft hinder the eruption of the central incisor?
3.
Can simply performing window surgery allow the central incisor to erupt? Additionally, his right central incisor was fractured about 1/6 due to a fall, and he had to undergo root canal treatment due to pain.
I recently read a news report about someone who broke the front of their incisor while eating pig's feet, and they used nano-composite material to repair the tooth, which has sufficient hardness.

4.
Can this material be used to repair my son's right central incisor, which has undergone root canal treatment? Is 10 years old an appropriate age for this type of repair? (Is the right central incisor still growing?) Or would he need a dental crown? What is the best age to get a crown?
I apologize for asking so many questions, but I am very concerned about his central incisors.

cornell, 40~49 year old female. Ask Date: 2005/08/02

Dr. Yang Hui reply Dentistry

1.
To determine if the teeth have fully erupted, it is necessary to examine the dental roots through X-rays, although sometimes the images may not be clear.
Additionally, comparing with a second set of X-rays can help identify any positional differences.
The cost of orthodontic treatment is difficult to estimate; if there is insufficient space for the teeth, it may be necessary to expand the space to allow for proper alignment.

2.
The condition of my younger son may be classified as an odontoma, which differs from the cases of my other two sons who have supernumerary teeth.
The actual situation and the type of bone graft material used can potentially affect tooth eruption.
3.
If a tooth lacks the ability to erupt, simply creating an opening will likely not allow the tooth to emerge.
Regarding newer technologies like nanoplastics, I cannot provide an answer.
However, if a tooth is fractured horizontally, a crown is generally more effective for long-term maintenance.
It is usually advisable to place a post and create a temporary crown, and then consider a more permanent solution around high school age.

Reply Date: 2005/08/02

More Info

Understanding delayed tooth eruption in children can be a source of concern for many parents, especially when it involves complex dental issues such as the presence of supernumerary teeth, bone grafting, and the potential need for orthodontic intervention. Your situation with your son, who is now 10 years old and has experienced delays in the eruption of his permanent front teeth, raises several important questions that deserve careful consideration.

1. Orthodontic Treatment for Delayed Eruption: The orthodontic technique you mentioned, which involves "fishing" for the unerupted tooth using special appliances, can indeed be applied to children as young as 10 years old. At this age, the dental development is still ongoing, and there is potential for the permanent teeth to erupt with the right intervention. However, the success of such treatments can depend on various factors, including the position of the tooth, the amount of space available, and the overall dental and skeletal development of the child. As for costs, orthodontic treatments can vary widely based on the complexity of the case and the specific techniques used, so it would be best to consult with an orthodontist for a detailed estimate.

2. Impact of Bone Grafting on Tooth Eruption: Bone grafting is often performed to support the area where teeth are missing or to encourage proper development of the jawbone. While it is a common procedure, there is a possibility that it could influence the eruption of adjacent teeth, depending on how the graft integrates and the overall healing process. However, in most cases, bone grafting should not significantly hinder the eruption of the permanent teeth if done correctly. Your son's situation should be monitored closely by dental professionals to ensure that the graft does not impede the eruption of his permanent front teeth.

3. Window Surgery for Tooth Eruption: Opening a window in the gum tissue (also known as an exposure procedure) can sometimes facilitate the eruption of a tooth that is impacted. This procedure allows the tooth to have a pathway to erupt, but it may not always guarantee that the tooth will come in on its own. The success of this approach can depend on the position of the tooth and the surrounding bone structure. It is essential to have a thorough evaluation by an oral surgeon or orthodontist to determine the best course of action for your son.

4. Restorative Options for the Right Front Tooth: Regarding the right front tooth that has undergone root canal treatment, using materials like nano-composite resins to restore the tooth is a viable option. These materials can provide a strong and aesthetic restoration, especially for children. However, the decision to use such materials or to place a crown (often referred to as a dental cap) will depend on the extent of the damage and the tooth's overall health. Generally, crowns are recommended when there is significant loss of tooth structure, while composite resins can be used for smaller restorations. The timing for placing a crown can vary, but it is often best done when the tooth has fully developed, which can be around the age of 12 or older.

In conclusion, it is crucial to maintain open communication with your dental care team, including your child's dentist, oral surgeon, and orthodontist. They can provide tailored advice based on your son's specific dental situation and help you navigate the best options for his dental health. Regular follow-ups and monitoring will be essential to ensure that any interventions are timely and effective. Remember, early intervention often leads to better outcomes, so addressing these concerns as they arise is key to managing your child's dental health effectively.

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