20 July 2022

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PFE: a rare eruption disorder

Lara Figini

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PFE is defined as incomplete tooth eruption despite the presence of a clear eruption pathway.  The primary failure eruption (PFE) was first described by Proffit and Vig in 1981, in which nonankylosed teeth fail to erupt owing to malfunction of the eruption mechanism. Mostly posterior teeth are affected, leading to a posterior open bite. The tooth affected by PFE is likely to become ankylosed when orthodontic force is applied. The disease is commonly seen unilaterally but bilateral involvement has also been reported. The cause of PFE is still not clear, but genetic predisposition is often implicated.
Few studies has systematically analysed the clinical and genetic features of PFE and its associated factors.
Therefore, the aim of the study published in 2018 was to systematically evaluate the literature from 2006 to 2017.

Materials and Methods
A systematic search was performed using the PubMed/Medline database for studies reporting on PFE following the PRISMA guidelines. The reference lists of all relevant articles were also screened manually. The article types included were case reports, case series, observational studies, review articles, and retrospective studies.

Results
17 articles reporting on PFE were included. These articles contain case reports (n = 5), case series (n = 3), observational study (n = 5), and retrospective analysis (n = 4). Overall, 314 patients were studied. In all the reported cases, the molars were affected. In 38 cases (24.3%), the primary teeth were affected, while in 118 patients (75.7%), the deciduous teeth were not affected. In 39 cases, additional dental anomalies were described. 

Conclusions
No studies reported PFE in teeth other than molars and premolars, indicating that PFE only affects these teeth.
As deciduous teeth were impacted by PFE in 38 patients, it can be said that PFE affects both dentitions. The dental anomaly most commonly reported in this study is alteration in the root morphology (n = 11), but the small number of reported cases indicates that additional dental anomalies are not significantly associate with PFE.
It is unclear whether only mutations in the PTH1R gene cause PFE because not all patients with PFE had the PTH1R mutation.
Infraocclusion of the posterior teeth of both sides, could help differentiate PFE from isolated ankylosis, which affects usually only one arch.

Generally, treatment depends on the patient’s age and the clinical situation. In young patients, direct or indirect composite build-ups could ensure occlusal stability and preserve alveolar bone level until an implant placement is possible.
In addition to the extraction of teeth affected by PFE, further surgical measure to correct the extreme posterior open bite may also be performed, however, few successful cases have been reported.

For additional information: Primary failure of eruption (PFE): a systematic review