Non syndromic supernumerary teeth: management of two clinical cases

Non syndromic supernumerary teeth: management of two clinical cases

Akram Belmehdi^1,&, Soukayna Bahbah², Karima El Harti², Wafaa El Wady²

 

¹The Department of Oral Surgery, Dental Center of Treatment and Diagnosis (Ibn Sina Hospital), Rabat, Morocco, ²The Oral Surgery Department, Faculty of Dentistry of Rabat, Mohammed V University, Morocco

 

 

^&Corresponding author
Akram Belmehdi, The Department of Oral Surgery, Dental Center of Treatment and Diagnosis (Ibn Sina Hospital), Rabat, Morocco

 

 

 

 

Supernumerary teeth (ST) or hyperdontia are uncommon alterations of development that may appear in either of the dental arches. While single tooth impaction is not uncommon, development of multiple impacted teeth is a rare condition and often found in association with syndromes or developmental anomalies such as cleidocranial dysplasia, Gardner's syndrome, trichorhino phalangic syndrome and cleft lip and palate [1]. Multiple ST in individuals with no other disease or syndrome is very rare [2]. In addition, they can occur unilaterally or bilaterally and can arise in the maxilla, mandible, or both [3]. Their overall prevalence ranges from 0.1% to 3.6%; however, it varies between the races [4]. Supernumerary teeth tend to adversely affect the neighboring dentition. They often hinder eruption and development of the permanent tooth related to them hence causing crowding, displacement, diastema, retention or delayed/ectopic eruption, root resorption, dental caries, periodontal lesions due to compression of adjacent roots and pulp necrosis and, in some cases, dentigerous cyst formation [5,6]. They cause delayed eruption or non-eruption of adjacent teeth and malformations of adjacent teeth at a rate of 21.6% [7]. The purpose of this paper is to present two cases of the patients who had supernumerary teeth without any associated syndrome or development anomaly.

 

 

Case 1: a 24-year-old female patient was referred to our department for the treatment of multiple impacted supernumerary teeth, which were detected on an orthopantomogram obtained at a dental clinic. An intraoral examination did not detect any abnormalities with regard to the size or shape of the patient's tooth crowns or the relationship between his dental age and chronological age, but a panoramic radiograph revealed three supernumerary teeth which were situated behind the 18, 48 and 38 (Figure 1). There was no any other specific oral finding and relevant familial history of dental abnormalities. The patient was educated about the presence of multiple supernumerary teeth and the extraction of the two mandibular supernumerary teeth was indicated before orthodontic treatment (Figure 2).

 

Case 2: a 19-year-old girl was referred to our department because of a recurrent pericoronitis relevant to the lower right third molar 48. General physical and extra oral examination did not show any abnormality and medical/family history was non-contributory. Orthopantomogram has revealed a presence of 3 supernumerary teeth which were situated behind the 18, 28 and 48 (Figure 3). Surgical removal of the right mandibular supernumerary tooth was planned with extraction of the 48 (Figure 4) and the others ST will remain under surveillance following the patient decision.

 

 

Supernumerary tooth in normal dentition is not an unusual phenomenon but the presence of multiple supernumerary teeth in individuals without any syndromic disorder is not common. Literature shows that single supernumerary tooth is the most common [3,8] and they frequently locate in the anterior maxilla, specifically the midline. In contrast, multiple supernumerary teeth have been found to occur more frequently in the premolar region [4,8]. The literature shows that 76 to 86% of non-syndromic cases involve only one supernumerary tooth and that 12 to 23% of cases present two ST [2,3,9,10]. Analysis of ST cases shows that the variation is small, with the presence of one or two ST being more frequent. A single ST occurs in 72 to 77% of cases, two occur in 18 to 27% and three in only 1 to 5% [2,3,11]. The incidence of ST is generally higher in men, affecting premolars in approximately 10% of cases and almost 75% of these cases occur in the mandible [2,12]. Only 1% of non syndromic cases present multiple ST, which occur more frequently in the area of the mandibular premolars and in the anterior region [13-15]. The precise etiology of supernumerary teeth remains unclear. However, several theories have been postulated to explain their presence. These theories include atavism (evolutionary throwback) or phylogenetic theory, tooth germ dichotomy, hyperactivity of the dental lamina and genetic and environmental factors [16].

 

Orthopantomogram has been the modality of choice for investigating the status of supernumerary teeth, but the introduction of cone-beam computed tomography (CBCT) to radiographic technology has proved as the most effective three dimensional means of examining dental and associated osseous structures [7]. In our cases, we used orthopantomogram which has shown us the anatomic situations of ST. Regarding management issues of supernumerary teeth, different management options are available for patients with multiple hyperdontia not associated with complex syndromes. If the teeth are asymptomatic with no radiographic evidences of any pathologies and not likely to interfere with orthodontic tooth movement, (location beyond teeth apices) they can be monitored with periodic radiographic examination. But if the patient does not want to risk any complications, considerations can be given to extraction. If associated with roots of permanent teeth, waiting till the completion of root development should be considered to minimize the chances of root damage. If the supernumerary teeth are associated with any sort of complications like cysts or tumors, obstruction to normal teeth eruption, hindrance to orthodontic tooth movement and unaesthetic appearance, extraction is a logical management in those cases [8,17]. In our cases, we have decided to extract supernumerary to optimize orthodontic treatment (case 1) and following third molar complication (case 2) and we agreed with the patients to keep the other supernumerary tooth and put it under periodic monitoring.

 

 

The key of a successful management of patients presented with supernumerary teeth requires a multidisciplinary approach and should form the part of a structured treatment plan in cooperation with pediatric dentistry, orthodontists and oral surgeons.

 

 

The authors declare no competing interests.

 

 

Akram Belmehdi did management of the first case report, research concept and design, collection and/or assembly of data, analysis of data and writing the article. Soukayna Bahbah did management of the second case report and Data analysis and interpretation. Karima El Harti did data analysis and interpretation, critical revision of the article and final approval of article. Wafaa El Wady did critical revision of the article and final approval of article.

 

 

I would like to express a deep sense of gratitude to my parents, who always stood by me like a pillar in times of need and to whom I owe my life for their constant love, encouragement, moral support and blessings.

 

 

Figure 1: orthopantomogram showing the presence of supernumerary teeth behind 18, 48 and 38

Figure 2: peroperative view showing the surgical management of the right mandibular ST

Figure 3: orthopantomogram showing the presence of supernumerary teeth behind 18, 48 and 38

Figure 4: peroperative view showing the surgical management of the right mandibular ST

 

 

1. Mali S, Karjodkar FR, Sontakke S, Sansare K. Supernumerary teeth in non-syndromic patients. Imaging Sci Dent. 2012 Mar; 42(1): 41-45. PubMed | Google Scholar


2. Santos TS, Erick Ricardo Silva ER, Faria AC, Filho FVM, Xavier SP. Multiple supernumerary teeth in a nonsyndromic 12-Year-Old female patient: a case report. Brazilian Dental Journal. 2014; 25(1): 79-82. PubMed | Google Scholar


3. Rajab LD, Hamdan MA. Supernumerary teeth: review of the literature and asurvey of 152 cases. Int J Paediatr Dent. 2002; 12(4): 244-54. PubMed | Google Scholar


4. Yusof WZ. Non-syndrome multiple supernumerary teeth: literature review. J Can Dent Assoc. 1990; 56(2): 147-9. PubMed | Google Scholar


5. Yeluri R, Hegde M, Baliga S, Munshi AK. Multiple supernumerary teeth associated with an impacted maxillary central incisor: Surgical and orthodontic management. Contemp Clin Dent. 2012; 3(2): 219-22. PubMed | Google Scholar


6. Sivapathasundharam B, Einstein A. Non-syndromic multiple supernumerary teeth: Report of a case with 14 supplemental teeth. Indian J Dent Res. 2007; 18(3): 144. PubMed | Google Scholar


7. Krishnan B, Narasimhan B, Nirupama C. Non syndromic multiple supernumerary teeth: a case report of 11 supernumerary teeth. J Indian Acad Oral Med Radiol. 2012; 24(4): 296-9. Google Scholar


8. Yan L, Yu LW, Bhandari K, Shan CL. Report of a case with 19 supernumerary teeth in a non-syndromic patient. Indian Journal of Dentistry. 2014; 5(2): 92-95. PubMed | Google Scholar


9. Diaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association. Med Oral Patol Oral Cir Bucal. 2009; 14(5): E229-E231. PubMed | Google Scholar


10. Fernandez Montenegro P, Valmaseda Castellon E, Berini Aytes L, Gay Escoda C. Retrospective study of 145 supernumerary teeth. Med Oral Patol Oral Cir Bucal. 2006; 11(4): E339-E344. PubMed | Google Scholar


11. Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three-dimensional evaluations of supernumerary teeth using cone-beam computed tomography for 487 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103(3): 403-411. PubMed | Google Scholar


12. Kawashita Y, Saito T. Nonsyndromic multiple mandibular supernumerary premolars: a case report. J Dent Child. 2010; 77(2): 99-101. PubMed | Google Scholar


13. Fardi A, Kondylidou-Sidira A, Bachour Z, Parisis N, Tsirlis A. Incidence of impacted and supernumerary teeth - a radiographic study in a North Greek population. Med Oral Patol Oral Cir Bucal. 2011; 16(1): E56-E61. PubMed | Google Scholar


14. Diaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association. Med Oral Patol Oral Cir Bucal. 2009; 14(5): E229-E231. PubMed | Google Scholar


15. Hyun HK, Lee SJ, Ahn BD, Lee ZH, Heo MS, Seo BM, Kim JW. Nonsyndromic multiple mandibular supernumerary premolars. J Oral Maxillofac Surg. 2008; 66(7): 1366-1369. PubMed | Google Scholar


16. Wang XP, Fan J. Molecular genetics of supernumerary tooth formation. Genesis. 2011; 49(4): 261-77. PubMed | Google Scholar


17. Shah A, Gill DS, Tredwin C, Naini FB. Diagnosis and management of supernumerary teeth. Dent Update. 2008; 35(8): 510e512, 514e6, 519e20. PubMed | Google Scholar