Supernumerary teeth case report

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					                                                                                                                     ISSN 0970 - 4388

Supernumerary teeth: A case report


Supernumerary teeth are the teeth present in addition to the normal set of teeth. They may be single, multiple, unilateral or
bilateral erupted or unerupted and in one or both jaws. Multiple supernumerary teeth are rare in individuals with no other
associated diseases or syndromes. Our case presents with 12 supernumerary teeth in permanent dentition, of which six were
erupted and six unerupted and a history of extraction of three teeth with no associated syndrome.

Key words: Associated, nonsyndromic, permanent teeth, supernumerary teeth

The present case discusses hyperdontia in a 14-year-old male            1.   Mesiodens - present in the incisor region.
patient characterized by more number of teeth than nor-                 2.   Paramolars - present beside a molar.
mal. These extra teeth are termed as supernumerary teeth.               3.   Disto-molars - present distal to the last molar.
They can be seen in almost any region of the dental arch.[1]            4.   Parapremolars - present beside a premolar.

The supernumerary teeth may occur in both dentitions, but               Based on the shape they can be of four types:
they are more frequently seen in the permanent dentition                1. Conical: peg shaped teeth.
with the prevalence range of 0.1-3.4%.[2]                               2. Tuberculate: made of more than one cusp or tubercle.
                                                                           They are barrel shaped, usually invaginated.
The prevalence of supernumerary teeth ranges from 0.8 to                3. Supplemental: resemble normal teeth. May be an inci-
2.1% in deciduous and permanent dentition, respectively.[3]                sor, premolar or a molar.
Males were affected approximately twice compared to fe-                 4. Odontome: does not resemble any teeth but is only a
males with respect to permanent dentition.[4]                              mass of dental tissue.

Etiology of development of supernumerary teeth is not clear.            The supernumerary teeth can cause problems for the erup-
It may be due to dichotomy of the tooth bud[5] or due to                tion and alignment of normal dentition. Associated prob-
hyper activity theory, suggesting that they are formed as a             lems can range from failure of eruption, displacement, crowd-
result of local, independent, conditioned hyperactivity of              ing, adjacent teeth root resorption, formation of dentiger-
dental lamina.[6]                                                       ous cyst or they can be just asymptomatic.[1]

The supernumerary teeth may be single, multiple, unilat-                Case Report
eral or bilateral, erupted or unerupted and in one or both
jaws. Multiple supernumerary teeth are rare in individuals              A boy, aged 14 years reported to our dental clinic with com-
with no other associated diseases or syndromes.[7]                      plaints of many teeth in the mouth. He gave a history that
                                                                        three teeth were already extracted in the upper anterior
Multiple supernumerary teeth are usually associated with                region as they were ‘extra’.
conditions such as cleft lip and palate or syndromes like
cleidocranial dysplasia and Gardner’s syndrome.                         Examination revealed presence of full set of permanent teeth
                                                                        [Figure 1] except the third molars with supernumerary teeth
Cases involving one or two supernumerary teeth most com-                present in all the quadrants except the upper left quadrant.
monly involve the anterior maxilla, followed by mandibular              A thorough general examination was carried out to rule out
premolar region.[8] When multiple supernumerary teeth are               the presence of any syndromes. Familial history was not con-
present (>5) the most common site is mandibular                         tributory.
                                                                        In the upper arch [Figure 2] supernumerary teeth resembled
Classification of supernumerary teeth may be on the basis               premolars, but slightly smaller in size present in between
of position[1] or form.[8] Positional variations include:               the normal appearing 14 and 15, displacing 16 bucally. The
                                                                        11 and 21 were conical with central depression. Deep pits
Associate Professor, Department of Pedodontics and Preventive           were also seen on the palatal fossa of 12 and 22. 13 was
Dentistry and b Associate Professor, Department of Community            highly placed. The teeth on the left quadrant appeared well
Dentistry, Manipal College of Dental Sciences, Mangalore, India         arranged. In the lower arch [Figure 3], there was one super-

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                                                       Supernumerary teeth

numerary teeth resembling premolar, on each quadrant with              In the lower arch, two unerupted supernumerary teeth were
additional supernumerary teeth resembling an incisor me-               present resembling premolar mesial to the first permanent
sial to canine on both sides. The patient had thus six erupted         molar on the right side and one also resembling a premolar
supernumerary teeth.                                                   on the left side. Except for the one supernumerary teeth on
                                                                       the right side, which had about 1/2, root completely formed,
A mild swelling was seen on the rughae area palatal to ca-             the other two had very little root formed. The third molars
nine on the right side occlusion was Class I on the left side,         were seen developing in the respective positions. The pa-
but on the right there was a scissor bite. As 16 was pushed            tient thus had six unerupted supernumerary teeth.
buccally by the extra premolar.
                                                                       All the maxillary incisors had deep pits on the palatal as-
An OPG [Figure 4] was taken to rule out any unerupted su-              pects with the central incisors exhibiting dens invaginatus,
pernumerary teeth. To our surprise there were many                     extending considerably deep. The 16 and 26 exhibited two
unerupted supernumerary teeth. What appeared normal and                prominent roots (the disto buccal and palatal) and a rudi-
well-arranged dentition on the upper left quadrant had two             mentary mesiobuccal root.
unerupted supernumerary teeth above the canine and I pre-
molar with about 1/2 root completion. On the upper right               The patient presented in this case had total of 12 supernu-
side was one supernumerary teeth resembling an incisor                 merary teeth of which six were erupted and six unerupted
located between the canine and lateral incisor probably on             and a history of extractions three of the clinically erupted
the palatal side. The swelling seen clinically on the palatal          teeth two were mesiodens and four parapremolars.
side was probably due to this unerupted supernumerary
teeth.                                                                 Following orthodontic consultation it was decided to surgi-

Figure 1: Presence of supernumerary teeth                              Figure 3: Supernumerary teeth in the lower arch

Figure 2: Supernumerary teeth in the upper arch                        Figure 4: The OPG view

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                                                      Supernumerary teeth

cally remove all the unerupted teeth. Two supernumerary               root.
teeth on the upper right quadrant, supernumerary teeth in
the lower incisor region and one erupted supernumerary                The central incisor showed clear signs of tuberculate type
teeth in the lower premolar region were decided to be ex-             with many cusps and dens invagination. We assume that
tracted followed by orthodontic alignment of remaining                the three teeth, which were extracted, may have been two
teeth. The 11 and 21 were decided to be endodontically                normal looking central incisors and one supernumerary.
treated followed by rehabilitation with post and core fol-
lowed by crown restoration.                                           References

Discussion                                                            1.   Thérèse MG, Barry HJ, Blake M. Supernumerary Teeth -An
                                                                           Overview of Classification, Diagnosis and Management, J Can
                                                                           Dent Assoc 1999;65:612-6.
Clinical and radiographic identification of all the teeth is          2.   Regezi and Sciubb. Oral Pathology, W. B. Saunders Co. 2nd Ed.
very important for a good treatment planning. It may be                    1993.
difficult to formulate an ideal treatment plan for all cases          3.   Brook AH. Dental anomalies of number, form and size: Their
with supernumerary teeth. But an effort can definitely be                  prevalence in British schoolchildren. J Int Assoc Dent Child
made.                                                                 4.   Kinirons MJ. Unerupted premaxillary supernumerary teeth. A
                                                                           study of their occurrence in males and females. Br Dent J
Treatment may vary from just extraction of supernumerary                   1982;153:110.
teeth or extraction followed by orthodontic correction to             5.   Liu JF. Characteristics of premaxillary supernumerary teeth: A
                                                                           survey of 112 cases. ASDC J Dent Child 1995;62:262-5.
establish a good occlusion. In the present case, it was de-           6.   Levine N. The clinical management of supernumerary teeth. J
cided to extract all the erupted and unerupted supernumer-                 Can Dent Assoc 1961;28:297-303.
ary teeth. Since the patient had a full set of dentition, the         7.   Scheiner MA, Sampson WJ. Supernumerary teeth: A review of
only rehabilitation was to establish a good occlusion and                  the literature and four case reports. Aust Dent J 1997;42:160-5.
                                                                      8.   Mitchell L. Supernumerary teeth. Dent Update 1989;16:65-9.
endodontic treatment of 11 and 21 followed by post and                9.   Yusof WZ. Non-syndromal multiple Supernumerary teeth:
core restoration. The palatal pit on the lateral incisors was              Literature review. J Can Dent Assoc 1990;56:147-9.
decided to seal with glass ionomer cement.                            Reprint requests to:
                                                                      Dr. R. Arathi,
The present case presents with both supplemental and tu-              Associate Professor,
berculate type of supernumerary teeth. The supernumerary              Department of Pedodontics and Preventive Dentistry,
                                                                      Manipal College of Dental Sciences,
teeth was found in the region of premolar predominantly               A Constituent Institution of MAHE,
and lower incisor region. Clinical crowns of molars showed            Mangalore, Karnataka - 575001,
no change, but 16, and 26 had a rudimentary mesiobuccal               India

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