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CASE REPORT
Year : 2005  |  Volume : 23  |  Issue : 1  |  Page : 46-48
 

Non-syndrome multiple supplemental supernumerary teeth


, Department of Dentistry, Guru Teg Bahadur Hospital cum University College of Medical Sciences, Delhi, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.16029

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   Abstract 

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 incidental findings during routine radiographic examination. Periodic examination is recommended to monitor the clinical behavior.


Keywords: Non-Syndrome, Supernumerary teeth, Supplemental


How to cite this article:
Kalra N, Chaudhary S, Sanghi S. Non-syndrome multiple supplemental supernumerary teeth. J Indian Soc Pedod Prev Dent 2005;23:46-8

How to cite this URL:
Kalra N, Chaudhary S, Sanghi S. Non-syndrome multiple supplemental supernumerary teeth. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2019 Sep 21];23:46-8. Available from: http://www.jisppd.com/text.asp?2005/23/1/46/16029


Supernumerary teeth are those that are in excess of normal complement and mimic the normal shape.[1] Supernumerary teeth have been reported in the literature over the years as a well-recognized clinical phenomenon.[2] Multiple supernumerary teeth are commonly associated with variable syndromes.[3] However the presence of multiple supernumerary teeth in the absence of any associated systemic condition / syndrome is unusual.[3]-[5] In such cases, the mandibular premolar region is the common site of occurrence.[6]

A case of non-syndrome multiple supplemental supernumerary teeth in mandibular premolar region of an adolescent male patient is presented.




   Case Report Top


A 15-year-old male patient presented to the department of dentistry, Guru Teg Bahadur Hospital with the chief complaint of pain in right lower back tooth for the last three days. Familial, medical and dental history was non-contributory. Extraoral examination did not reveal any abnormality. On intra-oral examination, a well-aligned full complement of teeth up to second molar was present in all quadrants with fair oral hygiene. A deep carious lesion with pulpal exposure was present in relation to 46 which was tender 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 presence 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 supplemental supernumerary tooth buds were present in relation to the 45 and the mesial root of 46.

A follow up Orthopantomograph (OPG) was then done to rule out presence of other supernumerary teeth elsewhere in the jaws. Three distinct, separate calcified structures resembling mandibular premolars were observed [Figure - 2]. These developing premolars were observed to be lying in their respective dental sacs with partially developed roots. Two were present on the right side of the mandibular arch and one on the left side. A general physician was consulted who confirmed that there was no associated syndrome. A root canal treatment was carried out for the abscessed tooth while no invasive procedure was considered for the supernumerary teeth. The patient and his mother were educated about the radiographic finding and adequately counselled. A decision was made to wait and watch.




   Discussion Top


Literature reports the prevalence of supernumerary teeth within the mandible and maxilla varying from 0.2-0.9%.[7] They may occur in any region of dental arch with a particular predilection for the maxilla.[8],[9] They may occur singly, multiple, unilaterally or bilaterally, and in one or both jaws [Figure - 3]. The presence of single supernumerary teeth associated with the permanent dentition is usually seen in the anterior maxilla.[10] Multiple supernumerary teeth are commonly associated with variable syndromes.[3] There is predilection of non-syndrome multiple supernumerary teeth to occur in the mandible with predominance to occur in the premolar area, followed by the molar and the anterior regions respectively.

The exact etiology of supernumerary teeth is still obscure although many theories have been proposed. Two popularly accepted theories are:

  • The dichotomy theory of tooth germs states that the tooth bud splits into two equal or different sized parts, resulting in two teeth of equal size or one normal and one dismorphic tooth respectively. This hypothesis is supported by animal experiments in which split germs have been cultivated in vitro.[11],[12]


Several researchers have also proposed that multiple supernumerary teeth are a part of post permanent dentition.[13],[14] The exact mode of inheritance has not been established; however a familial tendency has been noted.[15],[16]

Various authors have proposed different classifications of supernumerary teeth, based on their location in dental arches, or on their morphology. Terms like hyperdontia or accessory have also been used, but there exist minute distinguishing features. Accessory teeth do not resemble the normal form and have a morphology that deviates from the normal appearance of the teeth.[1] The term supplemental teeth however is used when the teeth are extra but have the shape and size of normal teeth.[17],[18] After a thorough review of literature available, an effort was made to simplify the classification and make it more lucid and communicable. In this context the following classification of supernumerary teeth is suggested.

The present case conforms to the below classification as a non-syndrome multiple supplemental supernumerary teeth. The presence of multiple supernumerary 'teeth is usually associated with problems of displacement, rotation, ectopic eruption of the adjacent teeth, resorption of the adjacent teeth and even the formation of primordial cysts.[5] An unexpected finding in the documented case is that the full complement of permanent dentition was present in normal occlusion, with none of the associated potential problems. The patient was completely asymptomatic and the presence of three supernumerary teeth was an incidental finding.

Usually supernumerary teeth are removed surgically, often due to retention of the permanent teeth in the region. In cases where the supernumerary teeth do not cause alterations in the eruption, position or integrity of the permanent dentition, a conservative approach is preferred.[19] Each case must be therefore considered individually concerning its treatment taking into account untoward developments like malocclusion, retention of permanent teeth or tendency for cyst formation etc. Close observation with regular radiographic controls is recommended.

 
   References Top

1.Bhaskar SN. Synopsis of Oral Pathology. St. Louis: C.V. Mosby 1961. p. 17.  Back to cited text no. 1    
2.Shafer WG, Hine MK, Levy BM. A textbook of Oral Pathology, 4th Ed. Philadelphia: WB Saunders Co.; 1993. p. 49.  Back to cited text no. 2    
3.Moore SR, Wilson DF, Kibble J. Sequential development of multiple supernumerary teeth in the mandibular premolar region- a radiographic case report. Int J Paediatr Dent 2002;12:143-5.  Back to cited text no. 3    
4.King NM, Lee AM, Wan PK. Multiple supernumerary premolars: their occurrence in three patients. Aust Dent J 1993;38:11-6.  Back to cited text no. 4  [PUBMED]  
5.Hegde SV, Munshi AK. Late development of supernumerary teeth in premolar region: A case report. Quintessence Int 1996;27:479-81.  Back to cited text no. 5  [PUBMED]  
6.Yousof WZ. Non-syndromal multiple supernumerary teeth: Literature review. J Can Dent Assoc 1990;56:147-9.  Back to cited text no. 6    
7.Saini T, Keene JJ Jr, Whetten J. Radiographic diagnosis of supernumerary premolars: Case reviews. ASDC J Dent Child 2002;69:184-90.  Back to cited text no. 7  [PUBMED]  
8.Primosch R. Anterior supernumerary teeth: Assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 8    
9.Nasif MM, Ruffalo RC, Zullo T. Impacted supernumerary teeth: A survey of 50 cases. J Am Dent Assoc 1983;106:201-4.  Back to cited text no. 9    
10.Zhu JF, Marcushamer M, King DL, Henry RJ. Supernumerary and congenitally absent teeth: A literature review. J Clin Pediatr Dent 1996;20:87-95.  Back to cited text no. 10  [PUBMED]  
11.Taylor GS. Characterstics of supernumerary teeth in the primary and permanent dentition. Dental Practioner and Dental Record 1972;22:203-8.  Back to cited text no. 11  [PUBMED]  
12.Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dent Child 1995;62:262-5.  Back to cited text no. 12  [PUBMED]  
13.Poyton GH, Morgan GA, Crouch SA. Reoccuring supernumerary mandibular premolars: Report of a case of postmature development. Oral Surg, Oral Med, Oral Pathol 1960;13:964-9.  Back to cited text no. 13    
14.Price C, Hoggins GS. A category of supernumerary premolars. Br Dent J 1969;126:224-8.  Back to cited text no. 14  [PUBMED]  
15.Mason C, Rule DC, Hopper C. Multiple supernumeraries: The importance of clinical and radiographic follow-up. Dentomaxillofacial Radiol 1996;25:109-13.  Back to cited text no. 15  [PUBMED]  
16.Sedano HO, Gorlin R. Familial occurrence of mesipdens. Oral Surg, Oral Med, Oral Pathol 1969;27:360-2.  Back to cited text no. 16    
17.Worth HM. Principles and practice of Oral Radiologic Intepretations. Chicago: Year Book; 1963. p. 101.  Back to cited text no. 17    
18.Pindborg JJ. Pathology of the Dental Hard Tissues. Philadelphia: WB Saunders; 1970. p. 27.  Back to cited text no. 18    
19.Koch H, Schwartz O, Klausen B. Indications for surgical removal of supernumerary teeth in the premaxilla. Int J Oral Maxillofac Surg 1986;15:273-81.  Back to cited text no. 19  [PUBMED]  


Figures

[Figure - 1], [Figure - 2], [Figure - 3]


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