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Retarded eruption of all permanent teeth. An extreme case report

Presenting problem:  A 14 year old male patient with delayed eruption of all permanent teeth with the exception of maxillary first permanent molars was referred to our clinic. The clinical examination of the patient showed no signs of abnormality. Mental and physical development was normal for his age and there were no signs or symptoms supporting the presence of syndromes related to eruption problems. Blood tests were within normal limits and there was no history of such a problem in the family. Radiological examination showed that all permanent first molars were present but only the maxillary first molars had erupted. In order to achieve spontaneous eruption of their permanent successors a general practitioner extracted the central primary mandibular incisors. However no eruption of the permanent successors was observed over a period of two years.Clinical management:  A decision was made to surgically expose the crowns of the permanent central incisors in the lower jaw in order to promote spontaneous eruption. A year after the operation these teeth together with the mandibular third molars were partially erupted. No other teeth had erupted at this stage.Discussion:  A case of delayed eruption of all permanent teeth is very rare, especially when it is not related to any known syndrome. The pathogenesis is a diagnostic riddle and the treatment demands a very careful approach.