Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2006  |  Volume : 24  |  Issue : 5  |  Page : 38--40

An impacted supplemental premolar in the mandible

M Koul, Rakesh Koul 
 Department of Dentistry, Shri. B. M. Patil Medical College and Hospital, Bijapur, Karnataka, India

Correspondence Address:
Rakesh Koul
Dept of Dentistry, Shri. B. M. Patil Medical College and Hospital, Bijapur - 586 103, Karnataka


Supernumerary teeth are rare anomalies of the maxillofacial complex that are more common in the maxilla than in the mandible. This article reports a case of an impacted supplemental type of supernumerary tooth in the mandibular arch, in the left premolar region. The etiology, types and treatment alternatives are discussed.

How to cite this article:
Koul M, Koul R. An impacted supplemental premolar in the mandible.J Indian Soc Pedod Prev Dent 2006;24:38-40

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Koul M, Koul R. An impacted supplemental premolar in the mandible. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2020 Dec 5 ];24:38-40
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Supernumerary teeth are present in addition to the normal complement of teeth in permanent / deciduous dentitions.[1] Their incidence is high in permanent dentition, affects both the sexes but are more common in males, with the male to female ratio of 2:1.[2] These occur in 0.3-3.8 percent of the population, out of which 90-98 percent are seen in the maxilla. These may be present singly or in multiples, unilaterally or bilaterally in the maxilla, the mandible or both and are commonly seen in the incisor region of the maxillary arch.[3] These teeth are commonly associated with various syndromes e.g., Cleidocranial dysostosis, Gardener's syndrome, with predilection of non-syndromic, multiple supernumeraries in the mandible, occurring predominantly in the premolar region followed by the molar and the anterior regions respectively.[4]

A case of non-syndromic impacted, single supplemental type of supernumerary tooth in the left premolar region of the mandible is presented.

 Case Report

A 15 year old male patient reported to the Dental Department of Shri B. M. Patil, Medical College and Hospital, Bijapur, with a chief complaint of a hard and painless protuberance since last two months on the tongue side of the left lower back teeth. Family, medical and dental histories were non-contributory.

Extra oral examination was normal. Intraorally, a well-aligned full complement of teeth up to second molars was present with fair oral hygiene.

On palpation, a hard immobile painless swelling was observed on the lingual aspect of mandible between 35 and 36. Intra oral periapical (IOPA) of 35 and 36 [Figure 1] and mandibular occlusal [Figure 2] radiographs were taken.

Occlusal radiograph revealed the presence of an additional tooth impacted on the lingual aspect of 35 and 36 and IOPA radiograph showed the presence of an impacted and vertically aligned supernumerary tooth in between 35 and 36. After the clinical and radiographic evaluations the condition was diagnosed as an impacted supernumerary tooth.

The supernumerary tooth was extracted under local anesthesia. The extracted tooth resembled a fully formed mandibular premolar [Figure 3].


Supernumerary premolars are said to represent between 8%[5] and 9.1%[6] of all supernumerary teeth. Although, literature reports increased occurrence of the supernumeraries in the maxilla,[7] supernumerary premolars are more likely to develop in the mandible and usually resemble premolars that are normal in shape and size.[8]

The etiology of supernumerary teeth is ambiguous, with different factors giving rise to different types of supernumeraries and combined etiological factors responsible for same. Amongst the various factors, are:

1. Disruption of normal embryonic processes.

a. Epithelial cell remnants[9]

b. Dichotomy of tooth germs.[10],[11]

c. Proliferation of dental lamina[12],[13]

2. Progress zone of dental lamina at the end of every tooth series or class gives rise to supernumerary teeth[14]

3. Atavism - This theory states that supernumeraries are a return to primitive dentition.[8]

4. Hereditary - While an autosomal dominant inheritance is suggested, there is increased incidence in male to female ratio indicates the possibility of sex - linked hereditary.[15] Mutant genes can also account for supernumeraries.[16]

Supernumerary teeth may be classified according to -


A. Morphology


B. Number



C. Location


Paramolar distomolar

Rudimentary teeth are smaller and tuberculate in shape,[17] whereas the term supplemental is used when the teeth usually resemble the teeth of a group with which they are associated i.e., incisors, canines, premolars and molars. Supernumeraries generally cause problems of malocclusion of local nature like tipping of adjacent teeth, rotation, bodily displacement, delayed eruption or prevent eruption of tooth of normal series. Also, they may lead to esthetic disharmony and functional distortion. Literature reports 82 to 90% of supernumeraries to be associated with pathologic changes and occasionally, may lead to the development of dentigerous cyst, primordial cyst and root resorption.[18]

The treatment options include:

1. Maintain in situ with regular follow-up.

2. Extraction if accompanied by pathologic changes.

3. Orthodontic treatment.

In this case no pathologic changes were observed, except for a hard asymptomatic immobile protuberance on the lingual surface of 35 and 36 that interfered, with the positioning of the tongue. The late development and detection of the protuberance at 15 years of age by the patient may be due to the characteristic of supernumerary teeth as they begin their calcification late.[19] The supernumerary tooth was extracted to correct this functional distortion.

The supernumerary tooth was categorized as supplemental, since the morphology of the extracted supernumerary tooth resembled the mandibular premolar with which it was associated i.e., 35 and was of normal size and shape with fully formed crown and root which is consistent with the observations of Stafne (1932).[8]


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