Abnormal premolar eruption: classification, aetiology, and treatment based on a case series study

Aim The aim of this case series study is to classify deviations in mandibular and maxillary premolar eruption according to aetiology, with a focus on the resorption pattern in the preceding primary molars. The purpose is also to give treatment guidance based on aetiology. Materials and methods Radiographic material from 64 cases with abnormal premolar eruptions were grouped into three eruptions phases: Phase 1, from tooth bud to early root formation, sub-grouped according to “ankylosis” or “not ankylosis” of the primary molars; Phase 2, from start of eruption to the penetration of gingiva, sub-grouped according to normal or abnormal resorption of the primary molars and Phase 3, eruption after penetration of gingiva. Results Phase 1: early ankylosis of primary molars, ectopic locations of the premolar crown, including occlusally displacement in relation to the primary molar, are demonstrated. Not ankylosed primary molar: different positions, even an upside-down position of the premolar, are demonstrated. The conditions are explained in relation to the early migration pattern of the premolar tooth bud. Regarding treatment, in cases with ankylosed primary molars these should be extracted as soon as diagnosed and in cases with not ankylosed primary molars these should be extracted when root formation of the premolars has started. The premolars should be observed and saved if possible. Phase 2: non-exfoliation of primary molar, aetiology and treatment of premolars depend on tissue types involved. In bone dysplasia, the eruption of premolars is delayed. In these cases, the primary molars should be extracted when eruptive movements of the premolars have started. In cases with ectoderm deviation, the crown follicle does not function normally during the resorption of the primary molars and the recommended treatment is extraction of primary molars before root closure of premolars. In cases in Phase 2 where the premolars were ankylosed these should be surgical removed. Phase 3: different aetiologies are highlighted, with focus on abnormal innervation and enzyme defects. The premolars are seemingly ankylosed, and surgery might be the only treatment. Conclusion The case series presented demonstrate how ectopic and arrested premolars have different aetiologies and as a consequence, different treatments. The study highlights several aspects in pathological eruption, which still need to be elucidated.