ISSN 0970 - 4388
Non-syndrome multiple supplemental supernumerary teeth
KALRA N.a, CHAUDHARY S.b, SANGHI S.c
Multiple supernumerary teeth without any associated systemic conditions or syndromes are not common. We document a case of
non-syndrome multiple supplemental supernumerary teeth in mandibular premolar region of an adolescent male patient, an inci-
dental findings during routine radiographic examination. Periodic examination is recommended to monitor the clinical behavior.
Key words: Non-Syndrome, Supernumerary teeth, Supplemental
Introduction nicable. In this context the following classification of su-
pernumerary teeth is suggested.
Supernumerary teeth are those that are in excess of nor-
mal complement and mimic the normal shape. Supernu- The present case conforms to the below classification as a
merary teeth have been reported in the literature over the
years as a well-recognized clinical phenomenon. Multiple
supernumerary teeth are commonly associated with vari-
able syndromes. However the presence of multiple super-
numerary teeth in the absence of any associated systemic
condition / syndrome is unusual.[3-5] In such cases, the man-
dibular premolar region is the common site of occurrence.
A case of non-syndrome multiple supplemental supernu-
merary teeth in mandibular premolar region of an adoles-
cent male patient is presented.
A 15-year-old male patient presented to the department
of dentistry, Guru Teg Bahadur Hospital with the chief com-
plaint of pain in right lower back tooth for the last three
Figure 1: IOPA showing two separate calcified structures
days. Familial, medical and dental history was non-contribu- resembling developing premolars in relation to the 45 and the
tory. Extraoral examination did not reveal any abnormal- mesial root of 46
ity. On intra-oral examination, a well-aligned full comple-
ment of teeth up to second molar was present in all quad-
rants with fair oral hygiene. A deep carious lesion with pul-
pal exposure was present in relation to 46 which was ten-
der on vertical percussion. A routine Intra oral Periapical
Radiograph (IOPA) of the tooth was caused out to assess
the periapical area. The radiograph of 46 revealed the pres-
ence of periapical radiolucency, with an associated finding
of two separate calcified structures resembling developing
premolars (Figure 1). The calcified structure was surrounded
by a radiolucent halo of the dental sac. These supplemen-
tal supernumerary tooth buds were present in relation to
the 45 and the mesial root of 46.
Professor and Head, bSenior Resident, cJunior Resident, Department
of Dentistry, Guru Teg Bahadur Hospital cum University College of Figure 2: OPG showing three distinct supplemental
Medical Sciences, Delhi, India supernumerary tooth buds resembling mandibular premolars
J Indian Soc Pedo Prev Dent - March 2005 46
A follow up Orthopantomograph (OPG) was then done to The exact etiology of supernumerary teeth is still obscure
rule out presence of other supernumerary teeth elsewhere although many theories have been proposed. Two popu-
in the jaws. Three distinct, separate calcified structures re- larly accepted theories are:
sembling mandibular premolars were observed (Figure 2). • The dichotomy theory of tooth germs states that the
These developing premolars were observed to be lying in tooth bud splits into two equal or different sized parts,
their respective dental sacs with partially developed roots. resulting in two teeth of equal size or one normal and
Two were present on the right side of the mandibular arch one dismorphic tooth respectively. This hypothesis is
and one on the left side. A general physician was consulted supported by animal experiments in which split germs
who confirmed that there was no associated syndrome. A have been cultivated in vitro.[11,12]
root canal treatment was carried out for the abscessed • Localized and independent hyperactivity of dental
tooth while no invasive procedure was considered for the lamina is the other accepted theory, which suggests su-
supernumerary teeth. The patient and his mother were pernumerary teeth are formed as a result of local, inde-
educated about the radiographic finding and adequately pendent, conditioned hyperactivity of dental lamina.[8,12]
counselled. A decision was made to wait and watch.
Several researchers have also proposed that multiple su-
Discussion pernumerary teeth are a part of post permanent denti-
tion.[13,14] The exact mode of inheritance has not been es-
Literature reports the prevalence of supernumerary teeth tablished; however a familial tendency has been noted.[15,16]
within the mandible and maxilla varying from 0.2-0.9%.
They may occur in any region of dental arch with a particu- Various authors have proposed different classifications of
lar predilection for the maxilla.[8,9] They may occur singly, supernumerary teeth, based on their location in dental
multiple, unilaterally or bilaterally, and in one or both jaws. arches, or on their morphology. Terms like hyperdontia or
The presence of single supernumerary teeth associated accessory have also been used, but there exist minute dis-
with the permanent dentition is usually seen in the ante- tinguishing features. Accessory teeth do not resemble the
rior maxilla. Multiple supernumerary teeth are commonly normal form and have a morphology that deviates from the
associated with variable syndromes. There is predilection normal appearance of the teeth. The term supplemental
of non-syndrome multiple supernumerary teeth to occur teeth however is used when the teeth are extra but have
in the mandible with predominance to occur in the premo- the shape and size of normal teeth.[17,18] After a thorough
lar area, followed by the molar and the anterior regions review of literature available, an effort was made to sim-
respectively. plify the classification and make it more lucid and commu-
HYPERDONTIA OR SUPERNUMERARY
According to morphology
According to number
Based on their location in dental arch
Paramolar Non-Syndrome Syndrome Associated
Distomolar Cleidocranial Dysplasia
Others Gardner’s Syndrome
Orodigito facial Dystosis
47 J Indian Soc Pedo Prev Dent - March 2005
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