Tooth Eruption & Space Management: What Orthodontists Should Watch For

Tooth eruption may not alwaxfys fit the predictable biological timeline. A delayed or ectopic eruption can derail the entire arch balance silently, cause future malalignment, space loss, and even root resorption¹.  

Common challenging consequences, include 1 

• Ectopic eruption 

• Delayed eruption 

• Primary failure of eruption (PFE)  

Eruption Anomalies: What to Look For ^{1, 2} 

Delayed Eruption 

This means a tooth hasn’t erupted by its expected age. Common causes include 

• Local Factors: Thick Gums, or supernumerary teeth, retained primary teeth 

• Systemic Factors: Malnutrition, genetic syndromes such as cleidocranial dysostosis, and thyroid problems (Hypothyroidism) 

Why it Matters: If not treated early, delayed eruption can cause poor aesthetics, crowding, and long-term gum issues.  

Ectopic Eruption 

Tooth eruption in the wrong position or direction is called ectopic eruption. This is often seen in the first permanent molars and maxillary canines. 

Always Watch for 

• Loss of arch length 

• Root resorption of nearby teeth 

• Midline shifts 

Primary Failure of Eruption (PFE) 

PFE is a rare issue where teeth don’t erupt without any physical blockage. This is often connected with genetic mutations, like PTH1R, and affects posterior teeth. 

Key Challenge: These teeth resist orthodontic movement and may become ankylosed if pressurized. 

Space Management: Practical Tips That Work 

Space problems generally start with something small, such as losing a primary molar too early. If not managed properly, it can trigger issues like midline shift, bite problems, or crowding. 

What Research Shows³ 

A study has shown that after early molar loss: 

• Molar didn’t tip forward 

• Arch length and inter-canine width increased 

• Canines moved into the gap 

Takeaway: A space maintainer is not always required, but careful evaluation is crucial. 

Diagnosing Space Problems³ 

First, identify the eruption anomaly; then evaluate the space and skeletal relationships. This will give a clear picture of whether the space needs to be maintained, recovered, or created. 

What to Include in Diagnostic Workup 

• Clinical Exam: Conduct intraoral and extraoral evaluation 

• Study Model: Assess arch length as well as tooth size using digital calipers 

• CBCT Scan: Visualise both bone support and eruption path in 3D 

• Radiographs: Use panoramic and periapical radiographs for assessing eruption and root development 

• Cephalometric Analysis: Examine the contribution of skeletal to crowding. 

If the length of the arch is shorter than the total tooth size, then crowding is inevitable. In such a scenario, early space management is extremely crucial. 

Space Management: Why is it Important? 

Space management goes beyond just preventing crowding; it’s about protecting the eruption root, shaping alignment, and minimizing the need for extractions or surgeries. 

Why it Matters? 

• Primary teeth loss at an early age can cause molar drift; thus, limiting the space for the successors⁴. 

• Delayed eruption may cause midline shifts, arch imbalance and impaction⁵ 

• In 40% of the people closed primary dentition indicates future crowding⁶. 

Timely space management can save patients from long-term orthodontic complications. 

Choosing the Right Space Maintainer 

Here’s a quick guide to common options: 

Table 1: Tips to Select Right Space Maintainers³  

Clinical Tip 

A lack of space in baby teeth is a red flag of future crowding. Early identification and treatment are crucial before adult teeth emerge. 

Final Thought 

Space management and tooth eruption are connected to each other. A vigilant eye on spacing and eruption can prevent future orthodontic complications. Small steps of today, such as spotting PFE or using space maintainers, are crucial for maintaining long-term dental health and patients’ smiles.  

References  

1. Alamoudi RM, Alharbi DM, Alzahrani NS, Aldoughan MA, Alharbi AS, Alrashed6i8 SM. Tooth Eruption Disorders from Delayed Eruption to Ectopic Eruption Management. 

2. Roulias P, Kalantzis N, Doukaki D, Pachiou A, Karamesinis K, Damanakis G, Gizani S, Tsolakis AI. Teeth eruption disorders: A critical review. Children. 2022 May 24;9(6):771.  

3. Koaban A, Alotaibi SS, Nakha KM, Huraib SB, Alhassan MH, Rubayan AR, Alzahir KZ, Alhamdan LA, Alshehri ZA, Hamza SM, Alqahtani BA. Orthodontic Space Management in Pediatric Dentistry: A Clinical Review. Cureus. 2024 Dec 19;16(12). 

4. Gandhi JM, Gurunathan D. Short-and long-term dental arch spatial changes following premature loss of primary molars: a systematic review. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2022 Jul 1;40(3):239-45. 

5. Malashenko N, Lykhota K, Dakhno L. Optimizing orthodontic treatment for delayed eruption of permanent anterior teeth: A prospective study using a modified appliance. The Saudi Dental Journal. 2025 Oct;37(7):54. 

6. Sun KT, Li YF, Hsu JT, Tu MG, Hung CJ, Hsueh YH, Tsai HH. Prevalence of primate and interdental spaces for primary dentition in 3-to 6-year-old children in Taiwan. Journal of the Formosan Medical Association. 2018 Jul 1;117(7):598-604.