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| CASE REPORT |
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| Year : 2015 | Volume
: 5
| Issue : 2 | Page : 125-128 |
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Supernumerary tooth: Report of a case
M Nisha, B Sapna, DJ Veeresh, Brajesh Kumar
Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| Date of Web Publication | 10-Mar-2016 |
Correspondence Address:
Dr. M Nisha
Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2231-6027.178504
Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They may be single, multiple, unilateral or bilateral erupted or unerupted, and in one or both jaws. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in the lower arch. Multiple supernumerary teeth are usually associated with conditions such as cleft lip and palate or syndromes like cleidocranial dysplasia and Gardner's syndrome. They are of great concern to the dentists and patients because of the eruption, occlusal, and aesthetic problems they can cause. Early recognition and diagnosis of supernumerary teeth are important to prevent further complications in permanent dentition. Our case represents ten supernumerary teeth in permanent dentition, of which 8 were erupted and 2 were unerupted with no associated syndrome. Keywords: Classification, permanent teeth, supernumerary teeth
How to cite this article:
Nisha M, Sapna B, Veeresh D J, Kumar B. Supernumerary tooth: Report of a case. Int J Oral Health Sci 2015;5:125-8 |
| Introduction | |  |
Supernumerary teeth are defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Supernumerary teeth are more frequently observed in permanent dentition than in deciduous dentition with a predilection for the upper arch than lower arch in a proportion of 10:1.[1] The prevalence of supernumerary teeth is 0.15–1% in permanent dentition [1] and 0.3–0.6% in the primary dentition [2] with predilection of 2:1 for male sex.[3] A familial tendency has been demonstrated in 10 out of 23 cases,[4] but further research is warranted.[5]
Etiology of the development of supernumerary teeth is not clear. It may be due to dichotomy of the tooth bud [6] or due to hyperactivity theory, suggesting that they are formed as a result of local, independent, conditioned hyperactivity of dental lamina,[7] proliferation of the remains of the dental lamina, atavism (reversion to the ancestral human dentition), splitting of the tooth bud (dichotomy theory), and a combination of genetic and environmental factors.[8],[9] 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.[10] Multiple supernumerary teeth are usually associated with conditions such as cleft lip and palate or syndromes like cleidocranial dysplasia and Gardner's syndrome.
Supernumerary teeth may cause the delayed or impaired eruption of succedaneous teeth (26–52%), displacement or rotation of permanent teeth (28–63%), crowding, abnormal diastema, or premature space closure, dilaceration or abnormal root development of permanent teeth, cyst formation (4–9%), or eruption into nasal cavity.[3] Thus, early recognition and management are important as a preventive measure for permanent dentition.
| Case Report | | |
A 22 years male patient reported to a clinic with the chief complaint of pain in his lower right and left lower back teeth region since 1 month. History of present illness reveals that pain was insidious in onset, moderate in intensity, throbbing in nature, and localized to the left and right lower jaw region. Pain aggravates while having food and relieved by itself after 30 min. On extraoral examination, right and left submandibular lymph nodes were tender on palpation, roughly oval in shape, and mobile in all directions.
Intraoral examination revealed deep Class I dental caries present with respect to 37 and 47 and was tender on percussion. Hard tissue examination revealed a full complement of permanent teeth except 23. Multiple supernumerary teeth were evident in both maxillary and mandibular teeth region. Three supernumerary teeth present in the first quadrant, of which two were present on buccal aspect between 13–14 and 16–17 and one on palatal aspect between 15 and 16 [Figure 1]. Two supernumerary teeth on the second quadrant in the region of 23 and on buccal aspect between 26 and 27 [Figure 2]. Two supernumerary teeth on lingual aspect with respect to 34–35 and one supernumerary tooth between 44 and 45 in the fourth quadrant [Figure 3]. Initial Class I dental caries evident with respect to 17, 26, 27, 36, 46, and 48 on local examination of the lesion. | Figure 1: Intraoral view showing supernumerary teeth in the first quadrant
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 | Figure 2: Intraoral view showing supernumerary teeth in the second quadrant
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Radiographic findings
A panoramic survey of the teeth and jaws revealed a full complement of permanent teeth along with ten supernumerary teeth present in maxillary as well as a mandibular region all together. Impacted teeth present with respect to 23 and two impacted supernumerary teeth between 24–25 and 45–46 region. Radiographic evidence of eight other supernumerary teeth is evident in the region of 13–14, 15–16, 16–17, 23, 26–27, 34–35, 35–36, and 44–45 [Figure 4].
Based on above findings, a final diagnosis of chronic apical periodontitis with respect to 37 and 47 with multiple supernumerary teeth is given.
| Discussion | | |
Supernumerary teeth are those that are present in excess of the normal set of teeth and was first described between 23 and 79 AD.[4] They can also be denoted by term hyperdontia.[5]
A supernumerary tooth can be defined as one that is additional to the normal series and can be found in almost any region of the dental arch.[11],[12] Supernumerary teeth more frequently found in the premaxillary region, and approximately 90% present in the maxilla, with a strong predilection for the anterior region. The most common site is the maxillary incisor region, followed by maxillary fourth molars and mandibular fourth molars, premolars, canines, and lateral incisors.[13] It may have a normal morphology or may be rudimentary and miniature. Classification of supernumerary teeth may be on the basis of position or form.[14] Positional variations include the region of incisor (mesiodens), beside premolars (para-premolar), beside molars (paramolar), and distal to the last molar (distomolar). Variations in form consist of conical types (peg-shaped), tuberculate types (more than one cusp or tubercle or barrel shaped), supplemental teeth (duplication of normal series), and odontomes (disorganized, diffuse mass of dental tissue). Supernumerary teeth may, therefore, vary from a simple odontome, through a conical or tuberculate tooth to a supplemental tooth which closely resembles a normal tooth. Moreover, the site and number of supernumeraries can vary greatly.
Although most supernumerary teeth occur in the jaws, but few have been reported in the gingiva, maxillary tuberosity, soft palate, maxillary sinus, sphenomaxillary fissure, nasal cavity, and between the orbit and the brain have also been reported.[4] The eruption of accessory teeth is variable and dependent on the degree of space available; 75% of supernumerary teeth in the anterior maxilla fail to erupt. Unlike hypodontia, hyperdontia is positively correlated with macrodontia. Studies have shown that the teeth of individuals with hyperdontia tend to be larger than average, especially mesiodistal dimensions of crown region suggesting anomalies of tooth number and size have same etiologies.[15] Although most of the supernumerary teeth develop during the first two decades of life but can identified in older adults.[4] Occasionally, normal teeth may erupt into an inappropriate position. This pattern of abnormal eruption is called dental transposition. Such misplaced teeth have been confused with supernumerary teeth. The teeth involved most frequently in transposition are the maxillary canines and first premolars. Supernumerary teeth appearing after the loss of the permanent teeth are known as “Post Permanent dentition.” This is generally regarded as a rare event and believed to arise from the eventual eruption of previously impacted teeth.[4]
It is essential to enumerate and identify the teeth present clinically and radiographically before the formulation of definitive diagnosis and treatment plan regarding supernumerary teeth. Radiographs played an important role to rule out the presence of impacted supernumerary teeth or other associated anomalies and approximation with adjacent anatomic structures during surgical extractions. Traditional two-dimensional radiographs include a panoramic radiograph to evaluate the vertical position, an occlusal X-ray to evaluate the proximity to adjacent teeth, and periapical radiographs to determine the labiopalatal position serves as an essential criteria and helpful in defining an accurate position of a supernumerary tooth, either buccal or palatal,[15],[16] but volumetric three-dimensional images are obtained from cone beam computed tomography (CBCT) scan. Conventional radiographs are helpful in initial diagnosis but more detailed information about the position of the teeth, the presence or absence of root resorption, and treatment planning are provided with CBCT.[16]
In literature, there is no exact treatment protocol for the management of supernumerary teeth. Treatment options for supernumerary teeth include observation and extraction. Observation involves no treatment other than monitoring the patient clinically and radiologically when satisfactory eruption of related teeth has occurred; no active orthodontic treatment is envisaged; no associated pathology; removal would prejudice the vitality of the related teeth. Treatment may vary from just extraction of supernumerary teeth or extraction followed by an orthodontic correction to establish a good occlusion. Immediate removal of the supernumerary tooth is indicated if the eruption of the adjacent tooth has been delayed or inhibited, altered eruption or displacement of the adjacent tooth is evident, the supernumerary tooth interferes with active orthodontic treatment, there is associated pathology, or if the spontaneous eruption of the supernumerary has occurred. Where there is no adequate space for an impacted tooth to erupt following removal of the supernumerary, surgical exposure of the permanent tooth and orthodontic traction is usually required.[17] Munns [18] stated that the earlier the offending supernumerary tooth is removed, the better the prognosis.
Complications
The complications most often associated with the tooth itself are a nasal eruption and cystic degeneration. The eruption of supernumerary teeth into the nasal cavity occurs rarely. Several case reports are available which indicate that the inverted conical type is the most common offender.[19] Dentigerous (follicular) cyst formation is another problem associated with unerupted supernumerary teeth. Most problems associated with supernumerary teeth are due to their ability to interfere with normal eruption and position of the adjacent teeth. These problems include loss of vitality, diastema formation, displacement, and impaction.[19]
| Conclusion | | |
Supernumerary teeth are relatively common and present a variety of complications. The clinician should have a thorough knowledge of signs suggesting the presence of supernumerary teeth including non-or delayed eruption, alterations in the eruptive pattern, diastema formation, midline shift, and crowding. On appropriate diagnosis, early intervention is required in the form of surgical or orthodontic treatment and combination in order to minimize unwanted side effects to the developing dentition.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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