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CASE REPORT
Year : 2006  |  Volume : 24  |  Issue : 5  |  Page : 11-14
 

Non-syndrome associated multiple supernumerary teeth: A report of two cases


Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamil Nadu - 608 002, India

Correspondence Address:
Ullal Anand Nayak
No. 18, faculty quarters, Annamalai Nagar - 608 002, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


PMID: 16891742

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  Abstract 

Multiple supernumerary teeth are usually associated with syndromes. On the contrary, multiple supernumerary teeth without association with any syndromes are very rare. This article presents a report of two cases with multiple supernumerary teeth not associated with any syndrome and emphasizes the routine advice of orthopantomogram whenever a single supernumerary tooth is detected irrespective of whether the patient has any syndrome or not.


Keywords: Multiple impacted, supernumerary teeth


How to cite this article:
Nayak UA, Mathian V M, Veerakumar. Non-syndrome associated multiple supernumerary teeth: A report of two cases. J Indian Soc Pedod Prev Dent 2006;24, Suppl S1:11-4

How to cite this URL:
Nayak UA, Mathian V M, Veerakumar. Non-syndrome associated multiple supernumerary teeth: A report of two cases. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2020 Jan 27];24, Suppl S1:11-4. Available from: http://www.jisppd.com/text.asp?2006/24/5/11/26029



  Introduction Top


A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch.[1] Supernumerary teeth were first reported between AD 23 and 79.[2] The etiology of supernumerary teeth still remains unclear. One theory suggests that these teeth are formed because of local, independent, conditioned hyperactivity of the dental lamina.[3],[4] Another theory states that the supernumerary tooth is formed because of dichotomy of tooth bud[3]. Hereditary and environmental factors are also considered important etiological factors in the occurrence of supernumerary teeth. Autosomal dominant trait has been suggested by Sedano and Gorlin.[5]

Brook found that supernumerary teeth were present in 0.8% of primary dentitions and 2.1% of permanent dentitions when 2,000 school children were surveyed.[6] While there is no significant sex distribution in primary supernumerary teeth, males are affected approximately twice as frequently as females in the permanent dentition.[7]

Luten in 1967 suggested the following order of decreasing frequency: upper lateral incisors (50%), mesiodens (36%), upper central incisors (11 %) followed by bicuspids (3%).[8]

Supernumerary teeth may be classified according to morphology as conical, tuberculate, supplemental and odontoma; according to their location as mesiodens, paramolar and distomolar. They can also be classified based on whether or not they are associated with any syndrome as non-syndrome associated supernumerary teeth and syndrome associated supernumerary teeth.[1],[9]

Multiple supernumerary teeth are reported to be associated with few syndromes namely Cleft lip and palate, Cleidocranial dysostosis, Gardner's syndrome, Chondroectodermal dysplasia etc. Multiple supernumerary teeth not being associated with any syndrome are very rare.[10]

Case 1

An 18-year old male reported with the chief complaint of pain in his maxillary permanent first molar. The family and medical histories were non-contributory. General extra-oral examination did not show any significant findings.

Intraoral examination revealed a temporary restoration in 26, which was tender to percussion. Five supernumeraries [three in the maxillary arch [Figure - 1][Figure - 2] and two in the mandibular arch [Figure - 3] were present. The two supernumerary teeth in the mandibular arch resembled a premolar.

The following was the dentition observed clinically



An Intra oral periapical radiograph was advised in relation to 26 to evaluate the deep caries status and an Orthopantomograph was advised to rule out the presence of any impacted supernumerary teeth.

The Orthopantomograph revealed eight impacted supernumerary teeth [Figure - 4].



The patient was informed about the presence of additional number of teeth and was advised extraction of the same. Intra oral periapical radiograph of 26 revealed deep caries involvement and widening of the periodontal ligament space and hence root canal treatment was advised.

As the general and extra oral examination were non-contributory, the diagnosis of non-syndrome associated supernumerary teeth was made. The patient was not willing for extraction of supernumerary teeth. The patient was explained about the consequences of impacted supernumerary teeth and advised regular follow-ups.

Case 2

A thirteen years old male reported to the department of Pedodontics and Preventive Dentistry, RMDC & H with the chief complaint of non-eruption of a tooth.

The family, medical and dental histories were non-contributory. General examination and extra-oral examination did not show any abnormality.

Intraoral examination revealed that the patient was in the late mixed dentition. A soft tissue covering the unerupted maxillary left central incisor was found. Dental caries was observed in 36 and 46 and 55 was mobile. A supernumerary tooth was found in the place of maxillary left central incisor [Figure - 5] and[Figure - 6]. The following was the dentition observed during clinical examination.



Intra oral periapical radiograph of 11, 21 [Figure - 7] and occlusal radiograph of upper anterior region [Figure - 8] were advised. Both the radiographs confirmed the presence of supernumerary tooth, which caused non-eruption of maxillary left central incisor.

Extraction of supernumerary tooth and surgical exposure of 21 was planned and performed successfully [Figure - 9]. Patient was asked to report after 1 week for suture removal.

During the follow up visit, the patient wanted to correct his malaligned teeth. So an Orthopantomograph was advised. To our surprise, it revealed four additional supernumerary teeth in the following regions [Figure - 10].



As the four supernumeraries did not cause any problem, they were left in place and patient was advised to report regularly for periodic check up.


  Discussion Top


Multiple supernumerary teeth by itself are a rare condition. Yusof in 1990 reviewed most of the cases reported in the English literature from 1969 to 1990.[11] He reported a predilection of non-syndrome multiple supernumerary teeth to occur in the mandible. When analyzed according to specific sites for both jaws, there was a predominance of the multiple supernumerary teeth to occur in the premolar area. This was true even for our cases, as the supernumeraries were found in the premolar area. Smith (1969)[12] has reported a case where 21 year old male patient had 19 supernumerary teeth without evidence of any disease and Mody et al (1987)[13] reported a case of 19 year old female with 16 supernumerary teeth, none of which were present in the upper anterior region, the most common site for supernumerary teeth.

Removal of a supernumerary tooth preventing permanent tooth eruption usually results in the eruption of the tooth, provided adequate space is available in the arch to accommodate it.[16] However, in our second case, prior to extraction of supernumerary tooth (mesiodens) in the anterior region, the central incisor was surgically exposed, to find out if there was any fusion between the supernumerary tooth and the central incisor. Being confirmed that fusion was not present, the supernumerary tooth was extracted.

Although the majority of authors recommend exposure of the unerupted tooth when the supernumerary is removed, Di Biase found 75% of incisors erupted spontaneously after removal of the supernumerary and he insists conservative management without exposure.[17]

The current literature supports the surgical removal of unerupted supernumerary teeth, although this may cause damage to adjacent teeth and structures, particularly in the mandibular premolar region resulting in the loss of vitality and root malformation of adjacent teeth. The surgical removal of supernumerary teeth should always be based on the possible pathological sequelae associated with supernumerary teeth. The most common complications associated with the supernumerary teeth in the premolar area are cyst formation (9%) and damage to neighbouring teeth (13%).[14]

As Hopcraft suggests that the incidence of pathological sequelae being relatively low for the premolar cases,[18] we felt prudent to radiographically monitor the impacted supernumerary teeth in the premolar area rather than its removal.

Not all supernumerary teeth require extraction. If it is asymptomatic, it can be left in situ and kept under observation. It should also be noted that whenever a single supernumerary tooth is seen, an orthopantomogram should be advised as a part of routine investigation to rule out the presence of multiple supernumerary teeth, if any.

 
  References Top

1.Garvey MT, Barry HJ, Blake M. Supernumerary teeth - An overview of classification, Diagnosis and Management. J Can Dent Assoc 1999;65:612-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Weinberger BW. An introduction to the History of Dentistry. MO. CV. Mosby Co: St. Louis; 1948. p. 514.  Back to cited text no. 2    
3.Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dentist Child 1995;62:262-5.  Back to cited text no. 3  [PUBMED]  
4.Levine N. The clinical management of supernumerary teeth. J Can Dent Assoc 1961;28:297-303.  Back to cited text no. 4    
5.Sedano HO, Gorlin R. Familial occurrence of mesiodens. Oral Surg Oral Med Oral Pathol 1969;27:360-2.  Back to cited text no. 5    
6.Brook AH. Dental Anomalies of number, form and size: Their prevalent in British School Children. J Int Assoc Dent Child 1974;5:37-53.  Back to cited text no. 6  [PUBMED]  
7.Kinirons MJ. Unerupted premaxillary supernumerary teeth. A study of their occurrence in males and females. Br Dent J 1982;153:110.  Back to cited text no. 7  [PUBMED]  
8.Luten JR. The prevalence of supernumerary teeth in primary and mixed dentitions. ASDC Journal of Dentistry for Children 1967;34:346-53.  Back to cited text no. 8    
9.Rajab LD, Hamdan MA. Supernumerary teeth: review of the literature and a survey of 152 cases. Int J Pediatr Dent 2002;12:244-54.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Scheiner MA, Sampson WJ. Supernumerary teeth: a review the literature and four case reports. Aust Dent J 1997;42:160-5.  Back to cited text no. 10  [PUBMED]  
11.Yusof WZ. Non-syndrome multiple supernumerary teeth. J Can Dent Assoc 1990;56:147-9.  Back to cited text no. 11  [PUBMED]  
12.Smith JD. Hyperdontia - Report of a case. J Am Dent Assoc 1969;79:1191-2.  Back to cited text no. 12  [PUBMED]  
13.Mody RN, Kekre MM. Multiple supernumerary teeth - A short case report. J Pierre Fauchard Acad 1987;1:69-70.  Back to cited text no. 13  [PUBMED]  
14.King NM, Lee AMP, Wan PK. Multiple supernumerary premolars: their occurrence in three patients. Aust Dent J 1993;38:11-6.  Back to cited text no. 14    
15.Bodin I, Julin P, Thomson M. Hyperdontia: IV Supernumerary premolars. Dentomaxillofac Radiol 1981;10:99-103.  Back to cited text no. 15    
16.Mitchell L, Bennett TG. Supernumerary teeth causing delayed eruption - a retrospective study. Br J Orthod 1992;19:41-6.  Back to cited text no. 16  [PUBMED]  
17.Di Biase DD. The effects of variations in tooth morphology and position on eruption. Dent Pract Dent Rec 1971;22:95-108.  Back to cited text no. 17  [PUBMED]  
18.Hopcraft M. Multiple supernumerary teeth - case report. Aust Dent J 1998;43:17-9.  Back to cited text no. 18  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10]


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