Supernumerary teeth: Report of four unusual cases Supernumerary teeth denotes as teeth formed in excess of the normal dental formula. [1] It can be single or multiple, unilateral or bilateral, malformed morphologically or normal in size and shape, and erupted or impacted. [2],[3],[4] In the primary dentition, the incidence is said to be 0.3% to 0.8% and in the permanent dentition 1.5% to 3.5%. [5] The prevalence of supernumerary teeth in the general Caucasian population ranges between 1% to 3%, [6] with prevalence of 2.7% and 3.4% among Japanese [7] and Hong Kong [8] Chinese populations, respectively. There appeared to be an increased frequency for males of nearly 2 : 1, [2],[9] and more than 90% of all supernumeraries occur in the maxilla with a strong predilection for the premaxilla. [2] Maxillary anterior supernumerary may erupt into the oral cavity or remain unerupted. It is found that approximately 25% are erupted, while rests are unerupted. [10] The etiology of the supernumerary teeth still remains unclear. Phylogenetic process of atavism, [11] the dichotomies of the tooth bud, [12] hereditary, and a combination of genetic and environmental factors-unified etiologic explanation [13] have been suggested. A hyperactive dental lamina is where the localized and independent hyperactivity of dental lamina is the most accepted cause for the development of the supernumerary teeth. [1],[12] However, the presence of supernumerary teeth may be part of developmental disorders such as Cleft lip and palate, Cleidocranial dysostosis, Gardners syndrome, Ellis-van Creveld syndrome More Details, Ehlers-Danlos syndrome More Details, Incontinentia Pigmenti, and Tricho-Rhino-Phalangeal syndrome. [2] Generally, supernumerary teeth can be classified as either supplemental or rudimentary. Supplemental teeth have morphology similar to a tooth of the normal dentition, while rudimentary teeth are small, conical, or tuberculate. The term mesiodens denotes a supernumerary tooth located between the maxillary central incisors. [14] Single supernumeraries occur in 76% to 86% of cases, double supernumeraries in 12% to 23% of cases, and multiple supernumeraries in less than 1% of cases. [2],[15],[16] Most of the supernumerary teeth are asymptomatic. However, mesiodens that remains unerupted causes over-retained maxillary primary incisors, delayed or ectopic eruption of permanent central incisors, displacement and rotation of adjacent teeth, [17] crowding, development of median diastema, [2],[18] eruption into the floor of the nasal cavity, [1] and less frequently formation of primordial or follicular cysts [19] with significant bone destruction, and root resorption of adjacent teeth. [2] When these complications are anticipated, surgical removal of the supernumerary tooth followed by orthodontic treatment is indicated. Early surgical intervention is preferred treatment to prevent clinical problems and to minimize further complications. The case report documented four unusual cases of supernumerary teeth presented as multiple non syndromic supernumeraries in the premaxilla, supernumerary tooth with macrodontia of permanent incisor, inverted mesiodens, and supernumerary causing concomitant extrusion and intrusion of adjacent teeth. Case 1 A 12-year-old boy reported to the Department of Pedodontics and Preventive Dentistry, Rohtak, with the chief complaint of delayed eruption in relation to upper left front teeth and irregular arrangement of those present. A thorough general examination was carried out to rule out the presence of any syndrome. Medical and family histories were non-contributory. Intraoral examination revealed permanent dentition with a supernumerary tooth, made up of more than one cusp or tubercle present palatal to 11 displacing it in a labial direction. Furthermore, a soft tissue buldge was seen associated with unerupted 21 labially [Figure 1]a. Radiographic examination revealed presence of another supernumerary in relation to 21 hindering its eruption [Figure 1]b. Buccal object rule was applied and tooth was found to be in palatal position. On consultation, it was decided to remove both the supernumerary, surgically wait till eruption of 21, followed by orthodontic alignment of remaining upper teeth. Following extraction [Figure 1]c, 21 erupt spontaneously within 3 months. Orthodontic treatment was started to align the incisors [Figure 1]d. The patient is now under regular review regarding future-fixed orthodontic treatment.
Posted on: Tue, 28 Jan 2014 15:37:39 +0000