SHEDDING OF

PRIMARY TEETH.
PROF. AHMED HELMY

Definition:
Shedding is a natural physiological elimination of the deciduous teeth as
a result of the resorbtion of their roots prior to the eruption of their permanent
successors.
Definition: Shedding is the physiological elimination of primary teeth at specific ages.

Contributing factors:
1- Increased masticatory forces.
2- Weakened supporting structures e. g. loss of cementum, alveolar bone
and periodontal attachment.
3- Pressure due to erupting successor.

trauma and inflammationocclusal stress, caries .. Etc.

Pattern:
Resorption of the roots of primary teeth starts at the lingual apical areas in
the anterior teeth and in the interradicular areas of molars. It is related to
where the erupting permanent successors are located.

Shedding of
Primary Teeth

Histological features of teeth undergoing

shedding:
Root surfaces exhibit resorption lacunae and clast cells are
often associated with these concavities. It is significant that
periodontal fibroblasts in the area show signs of impaired
function. The fact that programmed cell death is seen during
shedding that occurs at specific ages is consistent with the
concept that shedding is a genetically determined process.
It should be emphasized that the pulp tissue in teeth
undergoing shedding appears histologically normal except
that neural elements seem to be missing. Thus the pulp does
not contribute to the process of shedding and plays a passive
role in this process.

Clast cells: Cytological features:

Clast cells are large multinucleated cells with a ruflled border and numerous
lysosomes and mitochondria. Osteoclasts and odontoclasts are
morphologically similar and seem to have the same origin and mechanism of
action. The rationale for using different names for these cells is to reflect the
specific tissue that is being resorbed.

Mechanism of action during resorption of

mineralized tissues:
Clast cells act by isolating an area of hard tissue (bone, cementum, dentin
or even enamel) using clear cytoplasmic areas (no organelles) and through
plasma membrane associated enzymes that act as proton pumps, the
isolated area's pH is lowered making it acidic. This acidity breaks down the
hydroxyapatite crystals of the inorganic content and also denature the
collagenous organic matrix. Essentially denaturing makes the tightly
assembled collagen fibrils looser. The proteolytic enzymes both secreted
and within lysosomes in the clast cells are then able to break down this
collagenous organic matrix.

Shed incisor
(dentin)

Shedding of teeth usually

entails complete
destruction of the root.
Resorption lacuna can
be seen in cervical
region of the shed
tooth. In this
micrograph note the
reparative dentin
below the worn incisal
edge.
A, Resorption lacunae; B, Incisal edge of
shed tooth; C, Reparative dentin.

After termination of their resorption function, the odontoclasts lost their ruffled
borders and became detached from the resorbed surface. Most of the detached
odontoclasts had numerous large pale vacuoles and secondary lysosomes and
appeared to be in the process of degeneration.

The pattern due to physiological root resorption of a deciduous upper front

tooth (a) shows very regular polycyclic shallow lacunae representing a uniform
longterm ongoing process (b).

Tissue and cellular changes:

Shedding is an intermittent process with periods of
resorption involving alveolar bone, cementum and root dentin
resorption by clast cells, osteoclasts and odontoclasts,
respectively and recovery periods when osteoblasts and
cementoblasts replace part of the resorbed tissues. Eventually
more resorption takes place and when the tooth loses its
supporting periodontal tissues, it is shed. During this process
the primary teeth become loose during the periods of
resorption and tighten during the brief periods of apposition.

Intermittent resorption
During root resorption,
periods of resorption
are alternated by
periods of cementum
repair.
Cementoblasts
deposit cementum in
areas of resorption
forming a reversal
line. Some
cementoblasts
become embedded in
the cementum and
are then called
cementocytes.
A, Reversal line; B, Cementoblasts; C,
Cementocyte.

Retained, ankylosed, shortened and

submerged teeth:
-A retained

tooth is one that remains in the dental arch

beyond the age at which it is supposed to be shed. Many
conditions cause primary teeth to be retained for example
root ankylosis or the absence of a permanent successor.
-An ankylosed tooth is one that have its root( s) fused to
the alveolar bone.
-A shortened tooth is a retained primary tooth which is
smaller than the adjacent larger permanent teeth.
-A submerged tooth is a retained tooth that becomes
surrounded by alveolar bone. This condition is created by
the loss of adjacent primary teeth and the accompanying
resorption of their alveolar bone. When the permanent
successors erupt they have their own alveolar bone which
covers the retained tooth.

the bone and accompanying loss of periodontal ligament

attachment. Prevalence is between 7-14% in the primary dentition.

The most commonly affected teeth are mandibular

primary first molar, mandibular primary second molar,
maxillary first molar and maxillary primary second
Ankylosis can lead to:
molar in that order.
Loss

of arch length.
Extrusion of teeth of the opposite arch.
Interference with the eruption of succedaneous
teeth.

Remnants of deciduous teeth:

Parts of the roots of deciduous teeth which
are not in the path of erupting permanent teeth
may escape resorbtion. e.g. The lower E have
widely divergent roots, where the mesiodistal
diameter of lower 5 is smaller than the
distance between the roots of lower E, so part
of roots found deep in the bone ,and their fate
is;
a- Surrounded by cellular cementum.
b- Ankylosed to bone.
e-Resorbed.
d- Exfoliated.

Incomplete
physiologic
root
resorption
resulting in
retained root
tips of
deciduous
second
molar.

Physiologic resorption
of deciduous second
molar in the absence
of the second
premolar. Resorption
of a deciduous tooth
can occur even in the
absence of an
underlying permanent
tooth. However, the
resorption may be
delayed.

Congenitally Missing Teeth

Hypodontia - usually a single tooth missing
Frequency: 2-9%
Usually occurs with lateral incisors, second
premolars, and third molars
Key to diagnosis - count the teeth!!!

Missingteeth!!!

If the root of the primary tooth is resorbed by neighbouring permanent teeth

instead of the respective successor, we speak of undermining resorption.
This occurs more frequently in the upper than in the lower jaw and more
often in boys than in girls.
In descending order, this happens to
a) the distal roots of the upper second primary molars by the first
permanent molars
b) the lateral primary incisors by the permanent central incisors
c) the primary canines by the lateral incisors, more rarely by the permanent
first bicuspids.
This is caused mainly by a lack of space, but also by an unfavourable
inclination of the erupting teeth.
The consequences of undermining resorption are similar to those of premature
loss of the primary teeth or breakdown of the buccal segment (Stuetzzone)
due to caries (tooth migrations, tipping, rotations), i.e., lack of space in the
front teeth segment or in the buccal segment (Stuetzzone).

THANK YOU

Odontoclastic resorption at the pulpal surface of coronal dentin prior to

the shedding of human deciduous teeth.
odontoclastic resorption as a rule takes place at the pulpal surface of coronal
dentin. The process of this internal resorption of coronal dentin of deciduous
teeth clearly showed time-related histological changes. During the time the
roots were actively being resorbed, the pulpal tissue retained its normal
structure. However, when root resorption neared completion, inflammatory
cells started to gradually infiltrate into the pulp, and odontoblasts began to
degenerate. After that, multinucleate odontoclasts appeared, and resorption
proceeded from the predentin to the dentin. The odontoclastic activity was
initially detected only on the pulpal surface at the bottom areas of the crown.
It gradually spread towards the pulpal horn regions along the wall of the pulp
chamber. However, this internal resorption of coronal dentin did not continue
until the teeth were finally shed. After the elimination of resorption, the
resorbed dentin surface was repaired by a cementum-like deposition or
covered with fibrous connective tissue.

Histological change of pulp tissue during shedding of the deciduous tooth.

1. While the root was resorbed more than one half way, some normal pulp was
replaced by the connective tissue as in inflammation. Internal resorption could be
seen. 2. By the time deciduous root resorption was essential as complete, normal
pulp tissue was no longer present. 3. Because the nerve degenerated during
initial tooth resorption, there was no evidence that deciduous root resorption was
under nervous control. 4. in addition to odontoclasts, several other cells such as
fibroblast-like cells and macrophages, were actively involved in root resorption
during the shedding of deciduous teeth.