Year : 2005 | Volume
: 23 | Issue : 2 | Page : 103--105
Supernumerary teeth: A case report
R Arathi1, R Ashwini2,
1 Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, India
2 Department of Community Dentistry, Manipal College of Dental Sciences, Mangalore, India
Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, A Constituent Institution of MAHE, Mangalore, Karnataka - 575001
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.
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Arathi R, Ashwini R. Supernumerary teeth: A case report.J Indian Soc Pedod Prev Dent 2005;23:103-105
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Arathi R, Ashwini R. Supernumerary teeth: A case report. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2021 Dec 5 ];23:103-105
Available from: https://www.jisppd.com/text.asp?2005/23/2/103/16453
The present case discusses hyperdontia in a 14-year-old male patient characterized by more number of teeth than normal. These extra teeth are termed as supernumerary teeth. They can be seen in almost any region of the dental arch. 
The supernumerary teeth may occur in both dentitions, but they are more frequently seen in the permanent dentition with the prevalence range of 0.1-3.4%. 
The prevalence of supernumerary teeth ranges from 0.8 to 2.1% in deciduous and permanent dentition, respectively.  Males were affected approximately twice compared to females with respect to permanent dentition. 
Etiology of development of supernumerary teeth is not clear. It may be due to dichotomy of the tooth bud  or due to hyper activity theory, suggesting that they are formed as a result of local, independent, conditioned hyperactivity of dental lamina. 
The supernumerary teeth 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. 
Multiple supernumerary teeth are usually associated with conditions such as cleft lip and palate or syndromes like cleidocranial dysplasia and Gardner's syndrome.
Cases involving one or two supernumerary teeth most commonly involve the anterior maxilla, followed by mandibular premolar region.  When multiple supernumerary teeth are present (>5) the most common site is mandibular premolars. 
Classification of supernumerary teeth may be on the basis of position  or form.  Positional variations include:
Mesiodens - present in the incisor region.Paramolars - present beside a molar.Disto-molars - present distal to the last molar.
Based on the shape they can be of four types:
Conical: peg shaped teeth.Tuberculate: made of more than one cusp or tubercle. They are barrel shaped, usually invaginated.Supplemental: resemble normal teeth. May be an incisor, premolar or a molar.
The supernumerary teeth can cause problems for the eruption and alignment of normal dentition. Associated problems can range from failure of eruption, displacement, crowding, adjacent teeth root resorption, formation of dentigerous cyst or they can be just asymptomatic. 
A boy, aged 14 years reported to our dental clinic with complaints of many teeth in the mouth. He gave a history that three teeth were already extracted in the upper anterior region as they were 'extra'.
Examination revealed presence of full set of permanent teeth [Figure 1] except the third molars with supernumerary teeth present in all the quadrants except the upper left quadrant. A thorough general examination was carried out to rule out the presence of any syndromes. Familial history was not contributory.
In the upper arch [Figure 2] supernumerary teeth resembled premolars, but slightly smaller in size present in between the normal appearing 14 and 15, displacing 16 bucally. The 11 and 21 were conical with central depression. Deep pits were also seen on the palatal fossa of 12 and 22. 13 was highly placed. The teeth on the left quadrant appeared well arranged. In the lower arch [Figure 3], there was one supernumerary teeth resembling premolar, on each quadrant with additional supernumerary teeth resembling an incisor mesial to canine on both sides. The patient had thus six erupted supernumerary teeth.
A mild swelling was seen on the rughae area palatal to canine on the right side occlusion was Class I on the left side, but on the right there was a scissor bite. As 16 was pushed buccally by the extra premolar.
An OPG [Figure 4] was taken to rule out any unerupted supernumerary teeth. To our surprise there were many unerupted supernumerary teeth. What appeared normal and well-arranged dentition on the upper left quadrant had two unerupted supernumerary teeth above the canine and I premolar with about 1/2 root completion. On the upper right side was one supernumerary teeth resembling an incisor located between the canine and lateral incisor probably on the palatal side. The swelling seen clinically on the palatal side was probably due to this unerupted supernumerary teeth.
In the lower arch, two unerupted supernumerary teeth were present resembling premolar mesial to the first permanent molar on the right side and one also resembling a premolar on the left side. Except for the one supernumerary teeth on the right side, which had about 1/2, root completely formed, the other two had very little root formed. The third molars were seen developing in the respective positions. The patient thus had six unerupted supernumerary teeth.
All the maxillary incisors had deep pits on the palatal aspects with the central incisors exhibiting dens invaginatus, extending considerably deep. The 16 and 26 exhibited two prominent roots (the disto buccal and palatal) and a rudimentary mesiobuccal root.
The patient presented in this case had total of 12 supernumerary teeth of which six were erupted and six unerupted and a history of extractions three of the clinically erupted teeth two were mesiodens and four parapremolars.
Following orthodontic consultation it was decided to surgically remove all the unerupted teeth. Two supernumerary teeth on the upper right quadrant, supernumerary teeth in the lower incisor region and one erupted supernumerary teeth in the lower premolar region were decided to be extracted followed by orthodontic alignment of remaining teeth. The 11 and 21 were decided to be endodontically treated followed by rehabilitation with post and core followed by crown restoration.
Clinical and radiographic identification of all the teeth is very important for a good treatment planning. It may be difficult to formulate an ideal treatment plan for all cases with supernumerary teeth. But an effort can definitely be made.
Treatment may vary from just extraction of supernumerary teeth or extraction followed by orthodontic correction to establish a good occlusion. In the present case, it was decided to extract all the erupted and unerupted supernumerary teeth. Since the patient had a full set of dentition, the only rehabilitation was to establish a good occlusion and endodontic treatment of 11 and 21 followed by post and core restoration. The palatal pit on the lateral incisors was decided to seal with glass ionomer cement.
The present case presents with both supplemental and tuberculate type of supernumerary teeth. The supernumerary teeth was found in the region of premolar predominantly and lower incisor region. Clinical crowns of molars showed no change, but 16, and 26 had a rudimentary mesiobuccal root.
The central incisor showed clear signs of tuberculate type with many cusps and dens invagination. We assume that the three teeth, which were extracted, may have been two normal looking central incisors and one supernumerary.
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