1. Submerged deciduous teeth

2. Definition
The affected teeth do not come to the level of adjacent normal occluding teeth or submerged teeth are always 0.5mm or more below the intact marginal ridges of the adjacent teeth
Occurs after eruption/emergence of teeth in the oral cavity
due to a “failure in eruption”

3. Causative Factors Exact etiology : controversial
might be caused ankylosis, impaction, absence of a permanent successor, gaps in the periodontal membrane, trauma, infection, failure bone growth, abnormal tongue pressure
Trauma
Damage dental follicle / developing PDL
Disrupt the eruption of the tooth & become ankylosed
Most commonly affected – mandibular E, then D

4. Prevalence
1.3% % based on pt age frequently in middle mix dentition; 8-9 yr old
10 times more in primary than permanent mostly mandibular 2nd primary molar followed by mandibular 1st primary molar

5. Complications Malocclusion
Retention and delayed resorption of deciduous roots thus preventing eruption of permenant teeth
If the permanent successor is absent, loss of dental arch space is likely
a midline discrepancy may occur because the mesiodistal width of the primary submerged tooth is greater than that of the contralateral premolar
overeruption of the opposing teeth and tilting of the adjacent teeth can occur
Insufficient development of width and height of supporting bone
Increased risk of caries

6. Diagnosis
Clinical examination reveals that the primary tooth is below the level of the occlusal plane
Tapping the tooth reveals an abnormal percussive “cracked teacup” sound
if there is ankylosis, the tooth is immobile
Rx - show lack of a well-defined PDL and lamina dura space and fusion of the root with bone
Depression in the marginal bone surrounding the submerged teeth, and often the permanent successor is lacking

7. Management Depends on whether the tooth are If tooth is not ankylosed
Ankylosed (mostly) or not
permanent successor is present or absent
If tooth is not ankylosed
waiting for normal exfoliation has been suggested
6 to 12 months relative to the unaffected contralateral tooth
If the premolar is present, spontaneous eruption is possible

8. Extraction is recommended if there is a progressive
To prevent tipping of the adjacent tooth & overeruption of the opposing tooth
restoration of the occlusal surface is recommended eg. stainless steel crown or composite resin buildup
Extraction is recommended if there is a progressive
deep infraocclusion below the gingival margin,
severe tipping
ectopic eruption of the permanent successor
formation of caries and abscess

9. If the permanent successor is absent,
the decision to extract depends on :
Condition of the tooth
Amount of root support
Degree of occlusion and
Patient’s preference
If a malocclusion exists,
referred to an orthodontist for evaluation, as extraction of the nonankylosed submerged tooth may influence future orthodontic treatment