ORIGINAL RESEARCH

Clinical and Radiographical Measurements of Supraeruption

and Occlusal Interferences in Unopposed Posterior Teeth
Mohammed M Al Moaleem1, Amit Porwal2, Mohammed A Qahhar3, Feras A Al Qatarneh4, Seham A Areeshi5,
Mohammad BF Aldossary6

A b s t r ac t
Aims and objectives: This study compared the supraeruption of teeth for study casts (SCs) and panoramic radiographs (PRs) and its relation to
tooth type, arch, facial sides, presence of occlusal interferences, and type of tooth movements.
Materials and methods: A total of 65 patients with their SCs and PRs were recruited. Supraerupted tooth type, arches, sides involved, and the
presence of occlusal interferences were recorded. The SCs for supraerupted teeth were photographed, and supraeruption from PRs was recorded
from the patients’ files. The values were transferred to a software program and assessed.
Results: The highest frequency was observed among the younger-age group and molars in both arches. Working side (WS) and retruded cuspal
position (RCP) interferences were recorded the highest. Supraeruption values of 0.7–1.2 mm accounted for 47.5% (38) of the total. Tilting and
tipping of teeth were the highest, followed by buccolingual displacement. Kappa tests showed good intraexaminer reliability and Bland–Altman
plot showed 95% confidence interval band.
Conclusions: No significant differences were observed in the supraeruption values between the type of tooth among different subgroups of
SCs and PRs. Significant differences were recorded between the types and sites of teeth, with a higher ratio observed in molar teeth, mandibular
arch, and young age group. RCP and WS were the most recorded occlusal interferences and buccolingual displacement, and tilting and tipping
were the most noticeable occlusal tooth movements.
Clinical significance: Diagnosis and measurements of supraeruption are essential, useful, and significant steps before treatments for replacement
of missing tooth/teeth as well as corrections of occlusal interferences during different mandibular movements.
Keywords: Occlusal interferences, Overeruption, Panoramic radiograph, Study casts, Supraeruption.
The Journal of Contemporary Dental Practice (2021): 10.5005/jp-journals-10024-3143

Introduction 1,2
Department of Prosthetic Dental Science, College of Dentistry, Jazan
Supraeruption is defined as a measure of excess tooth movement University, Jazan, Saudi Arabia
starting from the cusp tip to the carve passing over the canine, 3
Altuwal General Hospital, Ministry of Health, Jazan, Saudi Arabia
premolars, and molars.1 Supraeruption of the posterior teeth 4
Royal Medical Services, Aman, Jordan
is one of the common clinical findings in daily dental practice. 5,6
College of Dentistry, Jazan University, Jazan, Saudi Arabia
Postponed replacement of extracting teeth often leads to extrusion
Corresponding Author: Mohammed M Al Moaleem, Department of
of the opposing tooth into the edentulous space, which results
Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan,
in masticatory insufficiency and temporomandibular joint (TMJ)
Saudi Arabia, e-mail: drmoaleem2014@gmail.com
disorders.2–4 When a fixed or removable prosthesis is planned on the
opposing edentulous arch, re-establishing a functional posterior How to cite this article: Al Moaleem MM, Porwal A, Qahhar MA, et al.
Clinical and Radiographical Measurements of Supraeruption and
occlusion requires a comprehensive dental treatment plan.5,6
Occlusal Interferences in Unopposed Posterior Teeth. J Contemp Dent
The first permanent molars in either the maxillary7–9 or Pract 2021;22(7):784–792.
mandibular arch10–12 are the most commonly missing posterior
Source of support: Nil
teeth, followed by the premolars in the maxillary arch.13 Other
studies5,14 concluded that mandibular posterior teeth are more Conflict of interest: None
likely to be extracted than maxillary posterior teeth, and with the
increase in age, posterior teeth are more likely to be extracted and
lost bilaterally. relationship between the supraeruption of teeth and oral or
Supraeruption of teeth can be classified based on the extent of patient factors. In addition, they investigated the relationship of
supraeruption from the occlusal plane into mild (supraerupted tooth tooth positional interferences following posterior tooth loss during
extends between 0.1 mm and 1.5 mm), moderate (1.6–3.5 mm), and different mandibular arch movements.
severe (exceeds 3.5 mm).1,15,16 Based on the amount of reduction Craddock et al.5 stated that the average amount of supraerupted
required for supraerupted tooth, it can also be classified into teeth ranges from 1.68 to 3.99 mm of the teeth without opposition,
conservative, semiconservative and nonconservative.2 with values of 1.03 and 1.91 mm recorded for the mandibular and
A group of studies5,17–19 investigated the type and extent of maxillary arches, respectively. Kiliaridis et al.20 registered that 24%
supraeruption and tooth movements associated with posterior of unopposed teeth had more than 2 mm overeruption among 82%
teeth without their antagonist. These studies also recorded any of the examined subjects with unopposed teeth. Another study

© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons
Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
 Measurements of Supraeruption and Occlusal Interferences

quantified the occlusal change of unopposed teeth to be mostly of Russell’s periodontal index, i.e., the presence of considerable
within the border of 2 mm.19 mobility in accordance with Miller’s mobility index (1995). 21,22
No previous study in Saudi Arabia or Jazan City had investigated A tooth with the previous RCT can be considered a failed RCT when
supraeruption and the associated complications. The present study retreatment cannot be performed due to any reasons/under any
aimed to measure and compare the amount of supraeruption of existing condition.23
teeth from study casts (SCs) and panoramic radiographs (PRs) and its The second part included the registration of involved
relation to tooth type, arch, sides, and the causes of tooth extraction supraerupted teeth (premolars and molars), side (right or left),
among subpopulations in Jazan City. The presence of occlusal and arch (maxillary or mandibular). Supraeruption is defined as
interferences during different mandibular movements and the type the movement of a tooth or teeth above the normal occlusal
of tooth movements at the adjacent or opposite arch of the extraction plane.24 The presence or absence of occlusal interferences during
site were also recorded and detected. The study hypotheses were as different mandibular movements, such as retruded cuspal position
follows: No differences exist in the values of supraerupted teeth from (RCP), protrusive (PRO), working side (WS), and non-WS(NWS)
SCs or PRs. No association exists between the presence of an occlusal interferences, was assessed by using an articulating paper and
interference and supraeruption of unopposed posterior teeth. No recorded as mentioned in the work of Craddock and Youngson.1
tilting or drifting in tooth position occurs following the loss/extraction An articulating paper (red and blue) measuring 80 microns was held
of an antagonist in posterior teeth. No occlusal interferences are by a Millers’ forceps and used to detect the presence or absence of
associated with unopposed posterior teeth. occlusal interferences.
The third part involved the design of occlusal analysis of the
SCs of each participant. All the SCs were prepared from an alginate
M at e r ia l s and Methods dust-free impression material (ZETALGIN CHROMATIC, Zhermack,
Study Design Germany). The impressions were poured with improved die stone
Eighty subjects were recruited from dental clinics, College of type IV (DURGUIX, Protechno, Advanced Products for Dental Labs,
Dentistry, Jazan University in this cross-sectional clinical and Vilamalla, Girona, Spain) to construct SCs with a standard base
radiographic comparative study. All the patients were recruited length (Fig. 1A) as prescribed by Craddock et al.5
from the pool of the patients who reported for treatment to the All SCs involvingthe supraerupted tooth/teeth were mounted
college. The supraerupted teeth selected from these subjects were on a table at a 25 cm distance from the camera and on the occlusal
unopposed posterior teeth in the maxillary or mandibular arches. surface positioned parallel to the table top. A digital camera
Ethical clearance was obtained from the ethical committee, college (Cyber-shot® S750 Digital Camera DSCS750, Sony, Japan) with 18.1
of Dentistry, Jazan University (CODJU—19211). Details of the study megapixels was mounted on a tripod stand (Benro Tripod T-600 Ex,
were discussed with the subjects before the clinical examination Copyright Beniro Industrial Inc., China) perpendicular to the long
and collection of data, and written consent was obtained. This study axis of the axial line of the supraerupted tooth, with the occlusal
has been carried out in accordance with the guidelines of the World surface positioned parallel to the table top (Fig. 1B). All the captured
Medical Association Declaration of Helsinki. photographs were transferred to a personal computer. Later, a
line was drawn passing from the buccal tips of the last tooth to
Study Samples and Criteria the canine in the supraerupted arch1 by AutoCAD 2000 program
According to the number of patients attended for prosthodontic (Pinnacle System, Middlesex, UK). Finally, the amount of tooth
treatments in the previous 5 years. The sample size of about 80 structure outside or lower than this line was recorded (mm) as the
participants was verified based on a G*Power software (http:// amount of supraeruption (Fig. 1B) by atrained investigator (M.M).
www.gpower.hhu.de/en.html) with the self-assurance amount The supraeruption values were measured, recorded, and
altered at 85%, power adjusted at 80%, and a reasonable outcome divided into three modified scales (0.1–0.6, 0.7–1.2, and >1.3 mm) in
amount. This study included patients who attended dental clinics accordance with previous studies.1,5 Then the status of supraerupted
from December 2019 to February 2020 and their clinical and radio and opposing/adjacent teeth or arches wasregistered as “yes” or
graphic examinations were performed. The inclusion criteria “no” for the following conditions: no occlusal changes, buccolingual
for the participants were aged 18 years old or above and the displacement of supraerupted teeth, presence of tilting, rotating,
presence of anterior and posterior vertical stops with at least one drifting, or tipping in mesial or distal of edentulous areas, presence
supraerupted posterior maxillary/mandibular tooth. The extracted of occlusal wear, and presence of open contact.1,17
teeth should have been in the posterior areas of any arch and had The fourth part concerned the measurements of the extent of
been extracted in the past 3 years at least. The subjects should supraeruptionin the teeth of participants based on their PR files.
have not had received any previous prosthodontic nor orthodontic The panoramic digital radiograph machine used in this study was
dental treatments. tomography x-ray system model PaX-Flex3D (Germany) operated
at 30% magnification. Supraeruption was calculated by drawing a
Clinical and Radiographic Evaluation straight line joining the tips of buccal cusps between the canine and
The first part of the clinical study was related to the collection the last tooth of arch on the supraerupted teeth side. The amount
of personal and demographic data, such as different age groups of supraeruption was calculated as the Figure 1C as mentioned by
(18–32, 33–47,and ≥48 years), years passed since extraction (3–5 Kim et al.25
and ≥5 years), and the cause of tooth loss (periodontal disease,
dental caries, failed root canal treatment (RCT) and others such as Data Analysis
pathological or dental trauma). A tooth was classified as requiring Data were collected and summarized in an Excel sheet (Office
extraction due to dental caries when the crown had been destroyed 2010) on acomputer. The results of descriptive statistical analysis
by caries and was nonrestorable. However, extraction due to were represented as mean, frequency, percentages, and standard
periodontal disease was considered if it satisfied the eighth criterion deviation (SD) using Statistical Package for Social Science software

The Journal of Contemporary Dental Practice, Volume 22 Issue 7 (July 2021) 785
 Measurements of Supraeruption and Occlusal Interferences

Figs 1A to C: (A) SCs after trimming; (B) Measurements of supraerupted tooth compared with adjacent teeth from SC; (C) Measurements of
supraeruption from PR

program version 21 (Chicago, Illinois, USA). Thecomparisons the number of years since tooth loss, and values of supraerupted
and association between different age groups and types of teeth (mm) from the SCs and PRs, included in this study (Table 1).
supraerupted tooth variables with the clinical, SC, and PR findings Table 2 shows the association between supraeruption and
were determined using Chi-square (Fisher’s exact) test with different age groups with other parameters. Dental caries was the
p ≤ 0.05 considered as significant. The Kappa test score for nominal most common cause of tooth loss among younger-age groups,
data was used to detect agreements in the presence or absence accounting for almost 21 supraerupted teeth (38.9%) in the
of occlusal interferences during different mandibular movements. 18–32-year-old and 20 supraerupted teeth (37%) in 33–47-year-old
In addition, intraexaminer reliability by Bland–Altman plot 7 for subjects/subgroups. With the increase in age, periodontal diseases
continuous data was applied to assess and demonstrate the became the most common cause of tooth loss (50%), showing a
degree of agreement between two samples, and supraeruption significant difference at p = 0.039. A highly significant difference
measurements (SC and PR) were carried out by the same examiner was observed in the status of supraerupted teeth and the opposing
on different occasions. arches with the different age groups with p >0.001. Buccolingual
displacement of supraerupted teeth (19–23.8%]) and tilting or
tipping in mesial or distal of edentulous are as [20(25.0%)] were the
R e s u lts most significant parameters among the subgroups. No significant
A total of 80 supraerupted teeth in the posterior area of both differences were noted between the different age groups and
arches was included in this in vitro comparative study. The values other variables.
of supraeruption (mm) from the PRs presented in this section Similarly, a highly significant difference was recorded between
were gained after a 30% magnification reduction. Table 1 shows the arch and tooth type with p >0.001, in which molars in both arches
the descriptive statistics of the subjects, including the age groups, accounted for the highest numbers and included 23 (28.8%) and 27

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 Measurements of Supraeruption and Occlusal Interferences

Table 1: Descriptive demographic data of subjects and supraeruption (mm) from SC and PR (n = 80)
Variable Subgroups Number (n) Percentage Mean Standard deviation
Age groups(years) 18–32 35 43.8 36.988 11.480
33–47 28 35.0
>47 17 21.2
Years since toothloss 3–5 years 58 72.5 4.350 1.736
>5 years 22 27.5
Supraeruptionfrom SC No supraeruption 6 7.5 0.7162 0.466
0.1–0.6 mm 27 33.7
0.7–1.2 mm 38 47.5
>1.3 mm 9 11.3
Supraeruption in mm from PR No supraeruption 4 5.0 0.7250 0.464
0.1–0.6 mm 29 36.3
0.7–1.2 mm 38 47.5
>1.3 mm 9 11.2

Table 2: Association between the frequency and % of variables in relation to different age groups [Chi-square or Fisher’s exact test (n = 80)]
Variable Age groups 18–32 N% 33–47 N% >47 N% Total N% p values
Years since toothloss 3–5 year      27 (46.6) 17 (29.3)            14 (24.1) 58 (72.5) 1.54
>5 years      8 (36.3) 11 (50.0)    3 (13.7) 22 (27.5)
Causes of tooth loss Periodontal disease 0.00 (00) 3 (50.0)    3 (50.0) 6 (7.5)      0.039*
Dental caries     21 (38.9) 20 (37.0)    13 (24.1) 54 (67.5)
Failed RCT     10 (71.4) 3 (21.4)                      1 (7.1) 14 (17.5)
Others      4 (66.7) 2 (33.3) 0.00 (00) 6 (7.5)
Supraerupted tooth/teeth Maxillary premolars      5 (41.7)     3 (25.0)   4 (33.3) 12 (15.0) 0.94
Maxillary molars     11 (47.8)     6 (26.1)    6 (26.1) 23 (28.8)
Mandibular molars      4 (22.2) 12 (66.7)    2 (11.1) 18 (22.5)
Mandibular molars     15 (55.6)     7 (25.9)    5 (18.5) 27 (33.8)
Side Right     19 (55.9) 11 (32.4)    4 (11.8) 34 (42.5) 0.101
Left     16 (34.8) 17 (37.0)    13 (28.3) 46 (57.5)
Site (arch) Maxilla     13 (54.2)     7 (29.2)    4 (16.7) 24 (30.0) 0.135
Mandible      8 (30.8) 14 (53.8)    4 (15.4) 26 (32.5)
Both arches     14 (46.7)     7 (23.3)    9 (30.0) 30 (37.5)
Presence of occlusal inter- No interferences      2 (33.3)     2 (33.3)    2 (33.3) 6 (7.5) 0.345
ferences during mandibular RCP      6 (33.3)     9 (50.0)    3 (16.7) 18 (22.5)
movements
PRO      8 (72.8)     2 (18.2)    1 (9.1) 11 (13.6)
WS      7 (31.8)     7 (31.8)    8 (36.4) 22 (27.2)
NWS      5 (45.5)     5 (45.5)    1 (9.1) 11 (13.6)
More than one      7 (58.3)     3 (25.0)    2 (16.7) 12 (15.0)
Status of supraerupted and No changes    7 (100) 00 (0.00)       00 (0.00) 7 (8.8) >0.001*
opposing arches Buccolingual displacement of     14 (73.7)     4 (21.1)    1 (5.3) 19 (23.8)
supraerupted teeth
Presence of tilting or tipping in      9 (45.0) 11 (55.0)       00 (0.00) 20 (25.0)
mesial or distal of edentulous area
Presence of occlusal wear      5 (31.3) 10 (62.5)    1 (6.3) 16 (20.0)
Presence of open contact     00 (0.00)     2 (20.0)    8 (80.0) 10 (12.5)
More than one     00 (0.00)     1 (12.5)    7 (78.5) 8 (10.0)
*
Significant differences

(33.8%) maxillary and mandibular teeth, respectively. The numbers tooth and arch type (Fig. 2), no considerable differences in values
and percentages of mandibular molars [27(33.8%)] were higher than had been recorded between the SC and PR except in one case for
those of maxillary molars [23(28.8%)] (Table 3). each of maxillary premolars, molars, and mandibular premolars;
In the comparison of the amount of supraeruption (mm) all values were observed in the 0.7–1.2 mm supraeruption
between the data collected from SCs and PRs in relation to the subgroup. No significant differences were detected between

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 Measurements of Supraeruption and Occlusal Interferences

Table 3: Frequency and percentage of variables in relation to supraerupted tooth type [Chi-square or Fisher’s exact test (n = 80)]
Maxilla Mandibula Both arches Total
Variable Age groups N% N% N% N% p values
Age 18–32 13 (54.2) 8 (30.8) 14 (46.7) 35 (43.7) 0.124
33–47 7 (29.2) 14 (53.8) 7 (23.3) 28 (35.0)
>47 4 (16.7) 4 (15.4) 9 (30.0) 17 (21.3)
Years since teeth loss 3–5 year 16 (66.7) 18 (69.2) 24 (80.0) 58 (72.5) 0.598
>5 years 8 (33.3) 8 (30.8) 6 (20.0) 22 (27.5)
Causes of teeth loss Periodontal disease 4 (16.7) 1 (3.8) 1 (3.3) 6 (7.5) 0.145
Dental caries 13 (54.2) 23 (88.5) 18 (60.0) 54 (67.5)
Failed RCT 5 (20.8) 2 (7.7) 7 (23.3) 14 (17.5)
Others 2 (8.3) 0 (00.0) 4 (13.3) 6 (7.5)
Side Right 10 (41.7) 14 (53.8) 10 (33.3) 34 (42.5) 0.484
Left 14 (58.3) 12 (46.2) 20 (66.7) 46 (57.5)
Tooth type Maxillary premolars 5 (20.8) 1 (3.8) 6 (20.0) 12 (15.0)    0.000*
Maxillary molars 16 (66.7) 1 (3.8) 6 (20.0) 23 (28.8)
Mandibular premolars 1 (4.2) 11 (42.3) 6 (20.0) 18 (22.5)
Mandibular molars 2 (8.3) 13 (50.0) 12 (40.0) 27 (33.8)
Presence of occlusal inter- No interferences 4 (16.7) 1 (3.8) 1 (3.3) 6 (7.5) 0.114
ferences during mandibular RCP 2 (8.3) 8 (30.8) 8 (26.7) 18 (22.5)
movements:
PRO 7 (29.2) 3 (11.5) 1 (3.3) 11 (13.8)
WS 5 (20.8) 6 (23.1) 11 (36.7) 22 (27.5)
NWS 3 (12.5) 4 (15.4) 4 (13.3) 11 (13.8)
More than one 3 (12.5) 4 (15.4) 5 (16.7) 12 (15.0)
Status of supraerupted and No changes 2 (8.3) 1 (3.8) 4 (13.3) 7 (8.8) 0.705
opposing arches Buccolingual displacement of 8 (33.3) 5 (19.2) 6 (20.0) 19 (23.8)
supraerupted teeth
Presence of tiltingor tipping in 3 (12.5) 8 (30.8) 9 (30.0) 20 (25.0)
mesial/distal of edentulous area
Presenceofocclusal wear 6 (25.0) 6 (23.1) 4 (13.3) 16 (20.0)
Presenceofopencontact 3 (12.5) 4 (15.4) 3 (10.0) 10 (12.5)
More than one 2 (8.3) 2 (7.7) 4 (13.3) 8 (10.0)

Table 4: Intraexaminer agreement (Kappa test)

95% confidence
Type of occlusal strength of interval Strength of
interference Kappascore agreement agreement
RCP 0.89 0.7–1.2 Very good
PRO 0.71 0.6–1.2 Moderate
WS 0.89 0.7–1.2 Very good
NWS 0.61 0.1–1.3 Good

Table 4 shows the assessment of intraclinical examiner

reliability in the presence of occlusal interferences during
different mandibular movements using Kappa test scores for
nominal data. The findings reveal the incidence of occlusal
interferences in this study and the level of agreement was
determined by the same clinical examiner in two separate
examination times. Kappa test scores for all types of occlusal
Fig. 2: Comparison of supraeruption (mm) observed from SCs and
PRs interference subgroups ranged from very good (RCP and WS) to
moderate (PRO) and good (NWS).
The assessment was performed on the interclass correlation
the values of supraerupted teeth in both arches and toothtypes. coefficient for the measurement of supraeruption (mm) on the SCs
The recorded p-values were 0.051 and 0.131 for SCs and PRs, and PRs. The intraexaminer reliabilities were determined by drawing
respectively. a Bland–Altman plot 7 for continuous data. The two measurements

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 Measurements of Supraeruption and Occlusal Interferences

Figs 3A and B: Bland–Altman plot demonstrating intraexaminer agreement for SCs and PRs, respectively

fell between the 95% and 99% confidence interval bands for the et al. 5 and Fagin et al.,19 who recorded a supraeruption range
SCs and PRs (Fig. 3). between 0.0 mm and 3.99 mm with an average of 1.68 to 2 mm
for SC, and that by Kim et al.,25 who recorded a value 2.0 mm from
the PRs of supraerupted teeth. However, Craddock and Youngson1
Discussion recorded slightly higher supraerupted tooth values between 0.5
Nonreplacement of posterior teeth in both arches could result in mm and 5.4 mm. For teeth without supraeruption, the frequencies
malocclusion and TMJ disorders, which may disrupt the appropriate were 6 (7.5%) and 4 (5.0%) for the SCs and PRs, respectively, and
foundation of stomatognathic stability if left unattended. 3 they were considerably lower compared with those in the work of
Prosthodontic treatments in the presence of supraerupted teeth Craddock and Youngson,1 who observed that 17% of their samples
should be performed based on the indication and need in the showed no supraeruption. Third, the damage of occlusal and
presence of slight TMJ dysfunction.26 The literature recommends interdental contact not only occurs in relation to complete tooth
the use of positioning devices and prosthodontic measures to loss. This condition may also occur following dental caries, tooth
recapture the TMJ-complaining patients because of the favorable, fracture, loss or wear of either restorations, or tooth structures.17
long-term results achieved after using simpler methods.13,26 Dental caries is the most common cause of tooth loss among
Following this trend, Matsuda et al.27 and Livas et al.28 observed patients in Jazan subpopulation, coinciding with the findings of
that the amount of supraeruption inpatients who replaced their Gossadi et al. 22 and Noman et al., 29 who concluded that dental
missing teeth with removable partial denturesor sectional retainers caries accounted highest for the causes of tooth loss in southern
is considerably higher compared with those whose teeth were SA (Jazan region) and adjacent countries. Fourth, in relation to the
not opposed by any prosthesis. This comparative study aimed site of supraerupted teeth, contrary to the previous findings,5,25
to measure and compare the amount of supraeruption of teeth who mentioned that supraeruption was statistically higher in the
from SCs and PRs, to assess the presence of occlusal interferences maxillary arch, this study outcome demonstrated a higher number
in patients with supraerupted teeth, and to record the tooth of supraerupted teeth in the mandibular arches, as also reported
status in the adjacent or opposed arch of the extraction areas. by Craddock and Youngson.1 Al Moaleem30 in 2007 concluded
The overall values of supraerupted teeth (mm) showed a notably that mandibular teeth were the most extracted teeth among
slight variance among the examined subgroups of SCs and PRs subjects from Jazan City, supporting the similarity between our
in terms of age groups and different types of teeth without any findings and those observed by Craddock et al.18 Additionally,
significant differences (Fig. 3). The first hypothesis was accepted, the supraeruption on the left side was slightly higher [46(57.5%)]
given that no significant difference was observed in the values than the right side. Finally, supraeruption was most common in
of supraerupted teeth from SCs or/and PRs. In contrast to the the molar teeth, as also seen by Gossadi et al. 22 and Al Moaleem;30
supraeruption values from SCs and PRs, an occlusal interference was however, Craddock et al. 5 concluded that premolars are the most
present, and tilting or drifting into tooth position after extraction supraerupted teeth.
had been documented in most of the participants. Supraeruption is defined as a measurement of exceeding zero
Numerous parameters were involved in the descriptive from the cusp tip of the posterior teeth behind the canine.1 In the
statistics of this comparative study. First, the mean age ± SD of present study, the total mean values of supraeruption ranged
subjects in the current study was 36.988 ± 11.480 years, which between 0.0 mm and 3.0 mm, with the highest percentages
was less than that in the work of Craddock et al.1 in which the observed in the 18–32-year-old age group and among molars
mean age ± SD of participants was 50.9 ± SD 13.9 years. Second, in either maxillary or mandibular arches (Fig. 2; Tables 2 and 3),
the mean values of supraeruption without antagonizing among but showed no significant difference between the SCs and PRs.
participants recorded in this study reached 0.1–3.00 mm for the The values and findings matched the mean values recorded by
SCs and PRs. These values agree with those registered by Craddock previous researchers,5,19,25 who observed values ranging between

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 Measurements of Supraeruption and Occlusal Interferences

1.86 mm and 2 mm among younger-age patients. In addition, Youngson.1 In the current study, among the different age groups,
no substantial differences were detected between individual the types of supraerupted teeth (Tables 2 and 3), buccolingual
SCs and their respected PRs, and this result could be explained displacement of supraerupted teeth, and the presence of tilting or
by the small sample size and low number of years passed after tipping in mesial or distal of edentulous area were the most common
extractions (mostly under 35 years). Mandibular molars were the changes, with 23.8 and 25% in the supraerupted and opposing
most commontype of teeth recorded in the SCs and PRs [27(33.8%)] arches, respectively, with a significant difference observed among
compared with other types of teeth, including maxillary molar and all age groups and type of teeth. This finding could be explained
premolars or mandibular premolars. This result disagrees with the by bone density and the complex activity of the stomatological
findings of Craddock et al.5 who observed maxillary premolars as structure of the participants during the survival period, whereas
the most supraerupted teeth but coincides with other study1 who Craddock et al.17 demonstrated no clinically significant difference.
counted 61.8% of supraerupted teeth in the mandibular arch. This finding can be explained by the equilibrium theory, which
Results in Table 3 show that the highest values and percentage states that a force similar to that used for the maintenance of
of supraeruption ranged between 0.7 mm and 1.2 mm for the SCs buccolingual position exists in the unopposed teeth.32
and PRs and near to those mentioned in other studies. Craddock Considerable subjective evidence is available on tooth
and Youngson1 mentioned that approximately 32% of the teeth had positional deviations following the loss of an adjacent tooth,
supraeruption in excess of 2 mm and 6.7% in excess of 3 mm; one but limited literature exists. Teeth adjacent to the site of tooth
tooth demonstrated a supraeruption of 5.39 mm. Few studies19,20 loss may undergo nonvertical movements, whereas teeth mesial
identified a supraeruption greater than 2 mm in 24% of unopposed to the loss site undergo tipping distally. The degree of tipping
teeth, with 18% having no demonstrable supraeruption. Thus, 82% increases in the maxillary teeth and in subjects with a cusp-to-
of the teeth demonstrated supraeruption to a certain extent, which cusp buccal occlusion.17 This result disagrees with our conclusions
in terms of restoration could be clinically significant. (Table 4), in which mandibular teeth were recorded in 14 cases
Craddock et al.18 demonstrated typical findings similar to compared with the 6 cases noted in maxillary teeth. Craddock
the present study, which could be due to the similarities in et al.17 stated that rotation of the teeth distal to the extraction site
methodology, that is, using one examiner at different times, and was greater in the maxilla, and dissimilar findings were observed for
age of participants in both studies. Figure 3 reveals that the average mandibular and maxillary teeth registered in this comparative study
intraexaminer reliability in the measurement of supraeruption [14 (17.5%) and 6 (7.5%), respectively]. Craddock et al.5 mentioned
was very good for RCP and WS interferences, whereas it was good that relative wearing of teeth is associated with the increase in age
or moderate for NWS and PRO movements based on the Kappa and more prevalent in unopposed mandibular teeth; this condition
test for all occlusal interferences during mandibular movements. is inevident in our samples, which recorded 16 (20.0%) cases among
Comparable findings were confirmed by Craddock and Youngson the different age groups and types of teeth; this finding may be
and Craddock et al.1,18 due tothe inclusion of participants over 47 years, which accounted
Unopposed posterior teeth are more likely to be involved for 17 (21.2%) of the total sample size. No occlusal changes were
in RCP contacts or interferences than their matched controls.18 represented by seven samples, coinciding with the findings of
The initial RCP contacts are linked with the values/extent of Craddock et al.5,17
supraeruption of the unopposed teeth. The RCP wasthe second Assessment of the intraexaminer reliability for checking the
most occlusal interference in the current study and accounted for supraeruption by Bland–Altmanplots and Kappa test score for the
18 cases; whereas Craddock and Youngson1,31 observed 51% RCP agreement was registered 95–97% confidence interval band as
among their subjects. No associations between patient or tooth shown by the values recorded from SCs and PRs (Fig. 3) and Kappa
factors were found for NWS interferences; the only association test scores (Table 4). A good and satisfactory overall reliability was
found for these interferences was with PRO on the extraction observed in this study.
sites.18 WS interferences were associated with the tipping of teeth The minor drawbacks of this study were mostly due to the
mesial to the site of tooth loss. The current study outcome shows small number of clinical cases. In addition, the measurements
that WS interference was the most common type of occlusal of supraeruption were only performed in the occlusal direction.
interference in 22 cases (27.2%). A value near this percentage The use of recent materials and equipment for interocclusal
was recorded among the subjects in the study of Craddock.18 interferences registrations and cone-beam computed tomography
The presence and position of the teeth distal to the extraction for measurement of supraeruption is recommended. Finally, studies
sites were significant when modeling PRO interferences. PRO involving larger sample sizes would lead to more expressive
interferences are prevalent onsites with bounded tooth loss as outcomes.
shown in the samples examined by Craddock and Youngson1;
however, a limited number of such cases were noted among our
findings. Such results could be due to the younger age of our C o n c lu s i o n
participants and the shorter period of extractions compared with The following conclusions were drawn from the results of the
those of previous studies. current comparative study. No significant differences were observed
Practitioners should understand the associated tooth in the supraeruption values between the tooth type among
movement following extraction to provide the most appropriate different subgroups of SCs and PRs. While, significant differences
care for their patients.4 Thus, treatment planning must be supported were recorded between the types and sites of teeth, with higher
by the guidance of current evidence and should include the possible numbers and ratio noted in molar teeth, mandibular arch, and
scale needed to be appreciated by patients and practitioners. 3,26 with a younger-age group. The RCP and WS interferences were the
Significant differences were detected in the supraerupted teeth most recorded occlusal interferences. Buccolingual displacement,
relative to the age groups and tooth type similar to Craddock and tilting, and tipping in mesial or distal of edentulous area were the

790 The Journal of Contemporary Dental Practice, Volume 22 Issue 7 (July 2021)
 Measurements of Supraeruption and Occlusal Interferences

most noticeable occlusal tooth movements. The methodology 17. Craddock HL, Youngson CC, Manogue M, et al. Occlusal changes
used in the study can be justified based on good relation of the following posterior tooth loss in adults. Part 2. Clinical parameters
intraexaminer reliability using Kappa scoresand good confidence associated with movement of teeth adjacent to the site of posterior
tooth loss. J Prosthodont 2007;16(6):495–501. DOI: 10.1111/j.1532-
interval band based on Bland–Altman plot.
849X.2007.00223.x.
18. Craddock HL. Occlusal changes following posterior tooth loss
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2004;196(6):341–348; discussion 37. DOI: 10.1038/sj.bdj.4811082. 849X.2007.00239.x.
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management of supraerupted teeth prior to prosthetic treatment: evidence for the need to restore posterior bounded edentulous
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The Journal of Contemporary Dental Practice, Volume 22 Issue 7 (July 2021) 791
 Appendix

Appendix 1
CLINICAL AND RADIOGRAPHICAL MEASUREMENTS OF SUPRAERUPTION
INCIDENCE AND OCCLUSAL INTERFERENCES IN UNOPPOSED
POSTERIOR TEETH
File # ……………. Serial #

Part I—Personal and Demographic Data

• Age: 18–32, 33–42,and >43 years old
• History of extraction: 3–5 and>5 years
• Causes of extraction: periodontal, caries, failed RCT; others

Part 2—Clinical Examination Data

• Supraerupted tooth/teeth: maxillary premolars or molars; mandibular premolars or molars
• Supraerupted side: right or left
• Supraerupted site: maxilla, mandibula, or both
• Presence of occlusal interferences during mandibular movements (“yes”or “no”): No, RCP, PRO, WS, and NWS

Part 3—Diagnostic Cast Analysis Data

• Amount of supraeruption measured from cast: 0.1–0.6, 0.7–1.2,and >1.3 mm
• Status of the supraerupted and opposed tooth/teeth answerable by “yes” or “no”:
• No occlusal changes;
• Buccolingual displacement of supraerupted teeth;
• Presence of tilting or tipping in mesial or distal of edentulous area;
• Presence of occlusal wear;
• Presence of open contact;
• More than one.

Part 4—Radiographic Analysis Data

Amount of supraeruption measured from PR: 0.1–0.6, 0.7–1.2, and >1.3 mm.

792 The Journal of Contemporary Dental Practice, Volume 22 Issue 7 (July 2021)