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10.5005/jp-journals-10011-1317
Balaji Krishnan et al
ORIGINAL ARTICLE
Nonsyndromic Multiple Supernumerary Teeth:
A Case Report of 11 Supernumerary Teeth
Balaji Krishnan, Balaji Narasimhan, C Nirupama
ABSTRACT
Hyperdontia is an odontostomatologic anomaly characterized
by an excess in both erupted and non-erupted teeth number.
A 23-year-old female patient reported to us with a chief complaint
of malaligned teeth and inability to maintain oral hygiene.
Extraoral examination did not reveal any abnormality. Intraoral
examination revealed multiple supernumerary teeth in maxillary
and mandibular premolar region. The teeth present were: 11,
12, 13, 14, 16, 17, 18, 21, 22, 23, 24, 25, 26, 27, 28, 31, 32, 33,
34, 35, 36, 37, 38, 41, 42, 43, 44, 45, 46, 47, 48. Apart from
these teeth there were. One half erupted supernumerary tooth,
distal to 14, one supernumerary tooth palatal to 14, one supernumerary tooth buccal to 15, one supernumerary tooth lingual
to 34, one supernumerary tooth lingual to 36, one supernumerary
tooth mesio lingual to 45,1 supernumerary tooth distolingual to
45. The panoramic radiograph was taken to study the presence
of impacted teeth. It revealed: Two supernumerary teeth in 1st
quadrant, three supernumerary teeth in 2nd quadrant, three
supernumerary teeth in 3rd quadrant, one impacted mesial to
36, three supernumerary teeth in 4th quadrant, one impacted
mesial to 46. Whenever, supernumerary teeth are diagnosed ,
a proper decision regarding the appropriate management should
be made carefully. In our opinion, the management of
multiple supernumerary teeth poses a great challenge to
clinicians. Therefore, it vital to for an interdisciplinary approach
for the treatment.
Keywords: Hyperdontia, Gardner’s syndrome, Ectodermal
dysplasia.
How to cite this article: Krishnan B, Narasimhan B,
Nirupama C. Nonsyndromic Multiple Supernumerary Teeth: A
Case Report of 11 Supernumerary Teeth. J Indian Aca Oral
Med Radiol 2012;24(4):296-299.
Source of support: Nil
maxilla, palatal area of upper incisors, lower premolar area
and distal of the upper and lower third molars.9 The crowns
of supernumerary teeth may show either a normal
appearance or different atypical shapes and their roots may
be completely or incompletely developed.10 The most
frequent complication of having supernumerary teeth is the
dental malposition2-4 of teeth of the normal series (erupted
or not) which in turn leads to clinical consequences of
orthodontic and/or surgical nature; more rarely, impacted
supernumerary teeth are the cause of follicular cysts, neuralgic
manifestations, dysodontiasis of permanent teeth.2-4 The
etiology is unknown, although a number of theories have
been proposed: Atavism, tooth germ dichotomy, hyperactivity of the dental lamina, and genetic factors comprising
a dominant autosomal trait characterized by low
penetrance.11,12 Numerous hereditary syndromes have been
described in association with hyperdontia, such as
cleidocranial dysplasia, Crouzon syndrome, Ehlers-Danlos
syndrome, Gardner syndrome, Nance-Horan syndrome and
cleft lip and palate.13 Mutations in the genes RUN X2, APC
and NHS are associated with the etiology of cleidocranial
dysplasia, Gardner and Nance-Horan syndrome respectively.14
However, no mutations providing nonsyndromic supernumerary teeth have been discovered yet.15 The present
article highlights a case of multiple impacted supernumerary
teeth not associated with any disorder.
CASE REPORT
Conflict of interest: None declared
INTRODUCTION
Hyperdontia is an odontostomatologic anomaly
characterized by an excess in both erupted and nonerupted
teeth number. Supernumerary teeth are defined as any
supplementary tooth or tooth substance in addition to usual
configuration of 20 deciduous and 32 permanent teeth.1
It can be described as ‘real’ if determined by an increased
number of teeth, otherwise it is ‘false’ if caused by a delay
in shedding of primary dentition beyond the transition
period. 2-5 Hyperdontia is reported quite frequently
(males:females, around 2:1),3 and it seems to occur more
often in patients with hereditary factors concerning this
anomaly.6 The prevalence of multiple supernumerary teeth
ranges from 8 to 27% of cases. 7,8 The most frequent
locations for supernumerary teeth are: The midline of the
296
A 23-year-old female patient reported to us with a chief
complaint of misaligned teeth and inability to maintain oral
hygiene. Extraoral examination did not reveal any
abnormality. Intraoral examination revealed multiple
supernumerary teeth in maxillary and mandibular premolar
region. The teeth present were: 11, 12, 13, 14, 16, 17, 18,
21, 22, 23, 24, 25, 26, 27, 28, 31, 32, 33, 34, 35, 36, 37, 38,
41, 42, 43, 44, 45, 46, 47, 48. Apart from these teeth there
were (Figs 1 to 5):
1. One-half erupted supernumerary tooth, distal to 14
2. One supernumerary tooth palatal to 14
3. One supernumerary tooth buccal to 15
4. One supernumerary tooth lingual to 34
5. One supernumerary tooth lingual to 36
6. One supernumerary tooth mesiolingual to 45
7. One supernumerary tooth distolingual to 45.
JIAOMR
Nonsyndromic Multiple Supernumerary Teeth: A Case Report of 11 Supernumerary Teeth
The panoramic radiograph (Fig. 6) and the occlusal
radiographs (Figs 7 and 8) were taken to study the presence
of impacted teeth. It revealed:
1. Two supernumerary teeth in 1st quadrant.
2. Three supernumerary teeth in 2nd quadrant.
3. Three supernumerary teeth in 3rd quadrant, one impacted
mesial to 36.
4. Three supernumerary teeth in 4th quadrant, one impacted
mesial to 46.
The proposed treatment plan consists of extraction of
retained and erupted supernumerary teeth in order to initiate
orthodontic treatment. At present, the patient is under
orthodontic treatment and is under regular clinical and
radiological examinations.
DISCUSSION
Fig. 1: Misaligned upper and lower teeth
The etiology of supernumerary teeth remains unclear, but
several theories have been suggested for their incidence.
The localized and independent hyperactivity of the dental
lamina is the most accepted cause for the development of
supernumerary teeth. Some proposed that supernumerary
teeth are formed as a result of local, independent,
conditioned hyperactivity of the dental lamina.16-18 It also
seems that Asians are more affected with supernumeraries
than others.19-21 Supernumerary teeth may erupt normally
or remain impacted, but in either case their presence may
Fig. 2: First and second quadrant showing supernumerary teeth
Fig. 4: Maxillary arch showing supernumerary teeth
Fig. 3: Third and fourth quadrant showing supernumerary teeth
Fig. 5: Mandibular arch showing supernumerary teeth
Journal of Indian Academy of Oral Medicine and Radiology, October-December 2012;24(4):296-299
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Balaji Krishnan et al
lead to clinical problems. Most problems associated with
supernumeraries are because of their potential to interfere
with normal occlusal development or with orthodontic
mechanics such as crowding, separation, impaction, or
delayed eruption of permanent teeth, malocclusion,
rotations, retained deciduous teeth, palatally displaced
permanent canines, abnormal eruption sequence, and
compromised space closure. In addition to these, supernumerary teeth can also cause cystic formation or they can
erupt into the nasal cavity or in the maxillary sinus.17,22-27
The apparently morphologically normal finding of multiple
supernumerary teeth in the absence of an associated systemic
condition or syndrome is an uncommon phenomenon. In
our case, the most common site with supernumerary teeth
were mandibular premolar region, which is consistent with
findings of Yusof,28 who reviewed most of the published
cases in the English language literature and found that when
nonsyndromal multiple supernumerary teeth are present,29
the most common site affected is the mandibular premolar
region, followed by the molar and the anterior regions,
respectively. Solares and Romero17 found that 74% of
supernumerary teeth are located in the mandibular premolar
region. Recent case reports of multiple supernumerary teeth
confirm this finding.22,30 In our case there were 6 supernumerary teeth in the mandibular premolar region.
Review of literature shows only a few reported cases of
nonsyndromic multiple supernumerary teeth. Sivapathasundharam and Einstein (2005)31 have reported 12 impacted
supernumerary teeth similar to premolars in a 20-year-old
male. Srivatsan and Aravindha Babu (2007)32 have reported
occurrence of 10 supernumerary teeth. Leslie (1984)33
reported a case of nonsyndrome multiple impacted
supernumerary teeth that resembled regular mandibular
premolar teeth. It has been stated that in nonsyndromic cases,
mandibular premolar region is the preferred site of
occurrence.34 But in the case presented here, supernumerary
teeth were found in both right and left premolar region of
both maxilla and mandible.
Whenever, supernumerary teeth are diagnosed, a proper
decision regarding the appropriate management should be
Fig. 7: Maxillary occlusal view revealing
supernumerary teeth
Fig. 8: Mandibular occlusal view revealing
supernumerary teeth
made carefully. In our opinion, the management of multiple
supernumerary teeth poses a great challenge to clinicians.
Therefore, it is vital for an interdisciplinary approach for
the treatment.
Mostly, supernumerary teeth are managed surgically,
often due to retention of the permanent teeth in the region.35
Surgical removal of the teeth may cause damage to adjacent
structures.22 In patients with the supernumerary teeth not
causing alterations in the eruption, position or integrity of
the permanent dentition, a conservative approach is
preferred. 35 Each case must be therefore analyzed
individually concerning its management taking into account
untoward developments like malocclusion, retention of
permanent teeth or tendency for cyst formation, etc. Regular
clinical examination with periodic radiographic examination
is recommended.
REFERENCES
Fig. 6: Orthopantomograph showing multiple erupted and
impacted supernumerary teeth
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1. Schulze C. Developmental abnormalities of the teeth and jaws.
In: Gorlin RJ, Goldman HM (Eds). Thoma’s oral pathology. St
Louis: Mosby 1970:112-22.
2. Capozzi L, Gombos F, Masi P, Modica R, Valletta G. Patologia
speciale odontostomatologica. Firenze, Italy: USES Publisher 1987.
JIAOMR
Nonsyndromic Multiple Supernumerary Teeth: A Case Report of 11 Supernumerary Teeth
3. Cassetta M, Russomanno MR. L’iperdontia nei settori lateroposteriori; indagine epidemiologica su 20398 pazienti. Riv Ital
Stomatol 1994;63(11):565-73.
4. Orlando S, Bernardini UD. Sulle anomalie dentali numeriche
per eccesso. Riv Ital Stomatol 1966;21(12):1267-322.
5. Pezzoli M, Vercellino V, Borio PS. Considerazioni cliniche sulle
anomalie dentarie di numero, per eccesso, nella dentizione
permanente. Min Stomat 1969;18:524-34.
6. Mason C, Rule DC. Midline supernumeraries: A family affair.
Dent Update 1995;22(1):34-35.
7. Primosch RE. Anterior supernumerary teeth-assessment and
surgical intervention in children. Pediatr Dent 1981 Jun;3(2):
204-15.
8. von Arx T. Anterior maxillary supernumerary teeth: A clinical
and radiographic study. Aust Dent J 1992 Jun;37(3):189-95.
9. Hyun HK, Lee SJ, Ahn BD, Lee ZH, Heo MS, Seo BM, et al.
Nonsyndromic multiple mandibular supernumerary premolars.
J Oral Maxillofac Surg 2008 Jul;66(7):1366-69.
10. Garvey MT, Barry HJ, Blake M. Supernumerary teeth an
overview of the classification, diagnosis and treatment. J Canad
Dent Assoc 1999;65:612-16.
11. Gay Escoda C, Mateos Micas M, España Tost A, Gargallo
Albiol J. Otras inclusiones dentarias. Mesiodens y otros dientes
supernumerarios. Dientes temporales supernumerarios. Dientes
temporales incluidos. En: Gay Escoda C, Berini Aytés L, (Eds).
Tratado de Cirugía Bucal. Tomo I. Madrid: Ergon 2004;497-534.
12. Trull Gimbernat JM, Banchilleria Balaguer E, Vall-Llosera
Riera J, Gay Escoda C. Supernumerarios múltiples no
sindrómicos: Descripción de un caso. Av Odontoestomatol
1994;10:89-93.
13. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and
maxillofacial pathology (2nd ed). Philadelphia: WB Saunders
2002:69-73.
14. Bailleul-Forestier I, Berdal A, Vinckier F, De Ravel T, Fryns
JP, Verloes A, et al. The genetic basis of inherited anomalies of
the teeth.Part 1: Clinical and molecular aspects of non-syndromic
dental disorders. Eur J Med Genet 2008;51:273-91.
15. Bailleul-Forestier I, Molla M, Verloes A, Berdal A. The genetic
basis of inherited anomalies of the teeth. Part 2: Syndromes
with significant dental involvement. Eur J Med Genet
2008;51:383-408.
16. Primosch R. Anterior supernumerary teeth-assessment and
surgical intervention in children. Pediatr Dent 1981;3:204-15.
17. Solares R, Romero MI. Supernumerary premolars: A literature
review. Pediatr Dent 2004;26:450-58.
18. Liu JF. Characteristics of premaxillary supernumerary teeth: A
survey of 112 cases. ASDC J Dent Child 1995;62:262-65.
19. Zhu JF, Marcushamer M, King LD, Henry JR. Supernumerary
and congenitally absent teeth: A literature review. J Clin Pediatr
Dent 1996;20:87-95.
20. So LLY. Unusual supernumerary teeth. Angle Orthod 1990;
60:289-92.
21. Moore SR, Wilson DF, Kibble J. Sequential development of
multiple supernumerary teeth in the mandibular premolar
region—a radiographic case report. Int J Paediatr Dent 2002;12:
143-45.
22. Rajab LD, Hamdan MA. Supernumerary teeth: Review of the
literature and a survey of 152 cases. Int J Paediatr Dent
2002;12:244-54.
23. Hongstrum A, Andersson L. Complications related to surgical
removal of anterior supernumerary teeth in children. ASDC J
Dent Child 1987;54:341-43.
24. Kantor ML, Bailey CS, Burkes EJ. Duplication of the premolar
dentition. Oral Surg Oral Med Oral Pathol 1988;66:62-64.
25. Mason C, Rule DC, Hopper C. Multiple supernumeraries: The
importance of clinical and radiographic follow-up.
Dentomaxillofac Radiol 1996;25:109-13.
26. Pracy JP, Williams HO, Montgomery PQ. Nasal teeth. J
Laryngol Otol 1992;106:366-67.
27. Erkmen N, Olmez S, Onerci M. Supernumerary tooth in the
maxillary sinus: Case report. Aust Dent J 1998;43:385-86.
28. Yusof WZ. Non-syndromal multiple supernumerary teeth:
Literature review. J Can Dent Assoc 1990;56:147-49.
29. Umweni AA, Osunbor GE. Non-syndrome multiple supernumerary teeth in Nigerians. Odontostomatol Trop 2002;25:
43-48.
30. Scheiner MA, Sampson WJ. Supernumerary teeth: A review of
the literature and four case reports. Aust Dent J 1997; 42:160-65.
31. Sivapathasundharam B, Einstein A. Nonsyndromic multiple
supernumerary teeth: Report of a case with 14 supplemental
teeth. Indian J Dent Res 2005;18(3):144.
32. Srivatsan P, Aravindha Babu N. Mesiodens with an unusual
morphology and multiple impacted supernumerary teeth in a
non-syndromic patient. Indian J Dent Res 2007;18(3):138-40.
33. Leslie JC. Multiple supernumerary teeth. Oral Surg Oral Med
Oral Pathol 1984;57(4):463.
34. Açikgöz A, Açikgöz G, Tunga U, Otan F. Characteristics and
prevalence of nonsyndromic multiple supernumerary teeth:
A retrospective study. Dentomaxillofac Radiol 2006;35(3):
185-90.
35. Koch H, Schwartz O, Klausen B. Indications for surgical removal
of supernumerary teeth in the premaxilla. Int J Oral Maxillofac
Surg 1986;15:273-81.
ABOUT THE AUTHORS
Balaji Krishnan (Corresponding Author)
Professor, Department of Orthodontics and Dentofacial Orthopedics
Tagore Dental College and Hospital, Chennai, Tamil Nadu, India
Phone: 9840400990, e-mail: [email protected]
Balaji Narasimhan
Lecturer, Department of Oral Medicine and Radiology, Tagore Dental
College and Hospital, Chennai, Tamil Nadu, India
C Nirupama
Reader, Department of Orthodontics and Dentofacial Orthopedics
Karpaga Vinayaga Institute of Dental Sciences, Chennai
Tamil Nadu, India
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