|Year : 2017 | Volume
| Issue : 1 | Page : 41-43
Nonsyndromic multiple impacted supernumerary teeth
A Shilpa, Ranjani Shetty, S Shivaprasad, L Ashok
Department of Oral Medicine and Radiology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Web Publication||3-Jul-2017|
Department of Oral Medicine and Radiology, Bapuji Dental College and Hospital, Davangere, Karnataka
Source of Support: None, Conflict of Interest: None
Supernumerary teeth are defined as the existence of an excessive number of teeth in relation to the normal dental formula and they may develop at any location in either upper or lower dental arch. Hyperdontia or supernumerary teeth without associated syndrome is a rare phenomenon, as supernumerary teeth are usually associated with cleft lip and palate or other syndromes such as Gardner's syndrome and cleidocranial dysplasia. Here, we report a case of supernumerary teeth in a nonsyndromic patient.
Keywords: Multiple impacted, nonsyndromic, supernumerary teeth
|How to cite this article:|
Shilpa A, Shetty R, Shivaprasad S, Ashok L. Nonsyndromic multiple impacted supernumerary teeth. Int J Oral Health Sci 2017;7:41-3
| Introduction|| |
A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. Supernumerary teeth which are well aligned in the arch and resemble the normal anatomy of adjacent teeth are called supplementary teeth. There are evidences of occurrence of supplementary premolars and molars (fourth molar/distomolar/paramolar) in the prehistoric human. The term mesiodens denotes a supernumerary tooth located between the maxillary central incisors. Their reported prevalence ranges between 0.3% and 0.8% in the primary dentition and 0.1 − 3.8% in the permanent dentition. Supernumerary teeth can occur as singles, multiples, unilaterally, or bilaterally and in the maxilla, mandible, or both. Supernumerary teeth are estimated to occur in the maxilla 8.2–10 times more frequently than the mandible and most commonly affect the premaxilla.
| Case Report|| |
A 21-year-old female [Figure 1] reported to our department with a chief complaint of pain in the lower left back teeth region for 4 days. Pain was intermittent, aggravated on having food, and she also had a history of restoration in relation to that tooth in private clinic 1 week back. Intraorally, there was missing 28 and restored 37. Provisional diagnosis of chronic apical periodontitis in relation to 37 was considered. Intraoral periapical radiography was taken in relation to 37 which revealed loss in the continuity of the lamina dura and widening periodontal ligament space in the apical 1/3rd, coronal radiopacity involving enamel, dentin coronal radiolucency involving enamel dentin and pulp suggestive of chronic apical periodontitis with restorative material coronally, and also an impacted tooth was incidentally present apical to 36 [Figure 2]. Orthopantomogram was taken to rule out any other impacted tooth which revealed a full complement of teeth with impacted supernumerary teeth apical to 35, interradicularly in relation to 34 and 35, and apical to 36, 45, 46, 14, 15, 25, and 26 [Figure 3].
|Figure 3: A dental panoramic radiograph revealing a multiple impacted supernumerary tooth|
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| Discussion|| |
A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. The etiology of supernumerary teeth is not completely understood. Various theories exist for the different types of supernumerary teeth. One theory suggests that the supernumerary tooth is created as a result of a dichotomy of the tooth bud.
Another theory, well supported in the literature, is the hyperactivity theory, which suggests that supernumeraries are formed as a result of local, independent, conditioned hyperactivity of the dental lamina. Heredity may also play a role in the occurrence of this anomaly, as supernumeraries are more common in the relatives of affected children than in the general population. However, the anomaly does not follow a simple Mendelian pattern.
The prevalence of supernumerary teeth in deciduous dentition is 0.3%–0.8% and 1.5%–3.5% in permanent dentition. A meta-analytic study has shown that the value obtained for prevalence depends directly on the diagnostic tools used, panoramic radiography being the most effective diagnostic method. Supernumerary teeth are more prevalent among men than women in a proportion of 2:1, although some authors report this proportion to range from 1.7:1 to 3.1:1. The upper maxilla presents supernumerary teeth more frequently than the mandible. A study by Liu et al. of 487 patients and 626 supernumerary teeth found that they were located in the upper maxilla in 92% of the patients. In another study of 283 supernumerary teeth, they were situated in the upper maxilla in 95% of cases, while Mahabob et al. analyzed 2216 patients with 27 supernumerary teeth, 67% of which were situated in the upper maxilla. In a study 303 supernumerary teeth in 200 patients observing that 88% were situated in the upper maxilla. However, another study of 393 supernumerary teeth found almost the same frequency in the two jaws.
Classification of supernumerary teeth
Supernumerary teeth can be classified according to chronology, location, morphology, and orientation. Garvey et al. classified them as single or multiple. Single supernumerary teeth are classified on the basis of their morphology as conical, tuberculate, supplementary, and odontomas, the latter being composite or complex. Primosch  classified supernumerary teeth as two types according to shape: supplementary or rudimentary; supplementary or eumorphic are those that have a normal shape and size and rudimentary or dysmorphic have an abnormal shape and smaller size and maybe conical, tuberculate, or molariform.
According to the location of supernumerary teeth, they can be classified as mesiodens (situated at the midline), paramolar (situated vestibularly between the second and third molars), and distomolar (situated distal of the third molar). They may show vertical, inverted, or transversal orientations.
Clinical features of supernumerary teeth
Supernumerary teeth may erupt normally, remain impacted, appear inverted, or assume an abnormal path of eruption. Supernumerary teeth with a normal orientation will usually erupt. However, only 13%−34% of all permanent supernumerary teeth are erupted, compared with 73% of primary supernumerary teeth. Complications associated with supernumerary teeth are prevention or delay of eruption of associated permanent teeth, displacement or rotation of permanent teeth, crowding, incomplete space closure during orthodontic treatment, lacerations, delayed or abnormal root development of associated permanent teeth, root resorption of the adjacent teeth, complication with supernumerary teeth itself, and late-forming supernumerary teeth. Medical conditions associated with supernumerary teeth such as developmental disorders that show an association with multiple supernumerary teeth include cleft lip and palate, cleidocranial dysostosis, and Gardner's syndrome. Less common disorders include Fabry–Anderson's syndrome, Ehlers–Danlos syndrome, incontinentia pigmenti, and Trico–Rhino–Phalangeal syndrome.
The radiographic features of supernumerary teeth are variable. They may appear entirely normal in size and shape, but they may also be similar in size compared with adjacent normal dentition or have a conical shape. In extreme cases, the supernumerary teeth may appear grossly deformed. Most are isolated events, although some may be familial and others may be syndrome associated with Gardner's syndrome and cleidocranial dysplasia. In addition to periapical radiography, occlusal radiographs may aid in determining the location and number of unerupted supernumerary teeth. Care should be taken to review panoramic radiographs for supernumerary teeth. Cone beam computed tomography precisely determines the location of each supernumerary tooth.
Management of supernumeraries
Treatment depends on the type and position of the supernumerary tooth and on its effect or potential effect on adjacent teeth. The management of a supernumerary tooth should form part of a comprehensive treatment plan and should not be considered in isolation.
| Conclusion|| |
Supernumerary teeth may cause a variety of complications including impaction, delayed eruption, ectopic eruption, dental overcrowding, teeth spatial disorders, and the formation of follicular cysts. In our case, supernumerary teeth are impacted. To date, there is no clear consensus as to the best time to surgically extract an unerupted supernumerary tooth.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]