We treated a case of eruption sequestrum in an 8-year 1-month old boy. The patient first came to our clinic with a chief complaint of discomfort in the mandibular. The literature relating to so-called eruption sequestra is reviewed. Two cases in which there were calcified fragments adjacent to the crowns of all four first. Eruption Sequestrum is an unusual disturbance, which consists of fragments of calcified mass overlying the crown of erupting permanent mandibular molar teeth .

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Eruption sequestrum – case report and histopathological findings. Eruption sequestrum is an uncommon disturbance in eruption and consists of small fragments of calcified tissue overlying the crowns of erupting permanent molar teeth, especially at the time of eruption of the mandibular first molars.

This erutpion reports a case of unilateral eruption sequestrum in a 7-year-old Brazilian boy and describes its histopathological findings. A white small fragment, 0.

Microscopic examination revealed large trabeculae with empty lacunae and a minimal amount of existing spongy bone consisting of acute inflammatory cells neutrophils. Signs of necrosis were found on the periphery. The histological analysis was consistent with non-vital bone and the diagnosis of eruption sequestrum was established.

Clinical and radiographic follow-up visits scheduled at short intervals and then every 6 months revealed normal postoperative conditions. Na periferia, sinais de zequestrum foram evidenciados.

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Eruption sequestrum ES is an uncommon condition first eguption as an osseous fragment overlying the crown of an erupting permanent molar prior to or immediately after the emergence of the cuspal tips through the oral mucosa 1.

ES consists of a small irregular bone spicule, but it can also correspond to the occlusal anatomy of teeth 2.

The position of this spicule overlies directly the central occlusal fossa, but within the soft tissue 3. ES may also be retained by tissue covering the distal marginal ridge of an erupting tooth 2. ES is usually observed at the time of eruption of the mandibular first molars, but it has been seqiestrum occurring with maxillary first molars and mandibular second molars 1,2.

This major occurrence in mandibular first molars can be due to these teeth with an ectopic path of eruption, with the mesial cusps at erupgion stage lying mesial to the distal root of the second primary molar 3. Thus, a small osseous fragment can occasionally separate from the contiguous sequrstrum and emerge through the alveolar bone.


In most cases, the small bone fragments are absorbed completely prior to eruption of the molar.

However, when the fragments are large or the eruption speed is slow, small bone fragments on the occlusal surface remain unresorbed and exposed to the mucosa prior to molar eruption, which forms ES 1. This can occur due to reduction of osteoclast activity and of bone resorption mediated by dental follicle during tooth eruption caused by apoptosis of reduced enamel epithelium 4. ES is a mass coronally of the erupting tooth with broader borders 3.

If seen radiographically before tooth eruption, its intraoral appearance may be predicted 1. Although ES has been reported as a fragment consisting of compact, non-viable bone 1,2,5Watkins 3 described a case composed of dentin and covered in areas by fragments of bacteria-infected cementum.

Thus further investigations should be performed to elucidate its microscopic aspects. The aim of this paper is to report eurption case of unilateral ES in a 7-year-old Brazilian boy and to describe its histopathological findings. No significant medical sesuestrum was reported.

There was neither history of oral-facial trauma nor abnormalities upon extraoral examination. Informed written consent was obtained from the patient’s mother and this report was approved by the institutional Ethics Committee Protocol Figures 1 to 3 illustrate the clinical and histopathological features of the case.

Intraoral examination revealed a small white fragment, approximately 0. There was neither history of pain nor evidence of dental caries or abnormality in other soft tissues.

Periapical radiograph did not show adequately this fragment. The treatment plan included surgical removal of this fragment.

A biopsy of the area was excised under local anesthesia. The extracted fragment was preserved in formalin for 72 h and submitted to histological processing for microscopic analysis.

Eruption sequestrum | definition of eruption sequestrum by Medical dictionary

The biopsy tissue was composed of a 0. The microscopic analysis showed non-viable bone tissue of large trabeculae with empty sequesttum, evidenced by lack of osteocytes in the lacunae.

A minimal amount of existing spongy bone consisted of acute inflammatory cells infiltrate neutrophils. Signs of necrosis were observed on the periphery. However, no signs of viable bone were evident throughout the specimen. The histological diagnosis was ES Fig. At the 1-week postoperative appointment, the patient was evaluated clinically, although no significant signs and sequesrtum were revealed.


After completion of the treatment, follow-up visits were scheduled every 6 months for monitoring dental plaque control as well as for clinical and radiographic assessment Fig. ES is an uncommon clinical finding. It is usually associated with the ssquestrum mandibular first molar 1,3,as described in the patient of this case. Although previously thought to have little clinical significance 1ES may retain biofilm accumulation and lead to pericoronitis, localized swelling, discomfort during mastication, and demineralization or dental eruptio if it remains for a prolonged time 2.

In addition, Maki et al. As its early recognition is important for preventing a future inadequate surgical intervention, the fragment was removed surgically in this patient, as in other cases 2. In an unusual case of ES, the specimen consisted of a small irregular calcified mass, composed of dentin and covered in areas by fragments of bacteria-infected cementum 3.

In the same case, histopathological examination showed non-vital bone, as reported elsewhere 1,2,5. Spongy osseous tissue with an inflammatory cell infiltrate and empty lacuna-like spaces were also identified, in accordance to similar preliminary findings 7.

Although ES is rare, it is important to describe its clinical and histological findings for helping clinicians diagnose sequestrim condition and updating microscopic descriptions.

Eruption sequestra in children. J Dent Child ; An unusual eruption sequestrum. Br Dent J ; Apoptosis of the reduced enamel epithelium sequestrumm its implications for bone resorption during tooth eruption.

Eruption sequestrae – three case reviews. Priddy RW, Price C. The so-called eruption sequestrum. Ann Acad Med Singapore ; J Clin Pediatr Dent ; Received May 22, Accepted November 8, All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.

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