Case Report on Impacted Supernumerary Teeth

A CASE REPORT ON A CASE REPORT ON IMPACTED IMPACTED

TUBERCULATED TUBERCULATED SUPERNUMERARY SUPERNUMERARY

TEETHTEETHBY,BY,

DR.SRINIVAS.L.SDR.SRINIVAS.L.SPOST GRADUATE STUDENTPOST GRADUATE STUDENT

DR.SYAMALA REDDY DENTAL DR.SYAMALA REDDY DENTAL COLLEGE &HOSPITALCOLLEGE &HOSPITAL

BENGALURU BENGALURU

www.dentistpro.org to find more

SUPERNUMERARY TOOTHSUPERNUMERARY TOOTH(Hyperdontia)(Hyperdontia)

Supernumerary teeth -a developmental Supernumerary teeth -a developmental disturbance disturbance during odontogenesisduring odontogenesis

The first report of a supernumerary tooth appeared The first report of a supernumerary tooth appeared between between AD 23 and 79AD 23 and 79. . (1)(1)

Supernumerary teeth may be Supernumerary teeth may be Single or multiple, unilateral or bilateral,erupted or Single or multiple, unilateral or bilateral,erupted or

un un erupted ,one or both jaws.erupted ,one or both jaws. It can beIt can be

Eumorphic Heteromorphic/Dysmorphic(2)

ClassificationClassification

CClassification lassification position in the archposition in the arch shapeshape.(3).(3)

Position in the archPosition in the arch

in the midline-in the midline-MesiodensMesiodens

in the premolar regionin the premolar region--Para-premolarsPara-premolars

in the molar region-in the molar region-Para-Para-molarsmolars

distal to the molars-distal to the molars-Disto-molarsDisto-molars


According to According to shapeshape

MOLARIFORMMOLARIFORM

CONICAL

TUBERCULATE

MOLARIFORM

EpidemologyEpidemology Prevalence -Prevalence -0.1-3.8%0.1-3.8% Male to female ratio- 2:1. Male to female ratio- 2:1. (4)(4)

PREVELANCEPREVELANCE

MESIODENSMESIODENS

Male to female of 2:1. Male to female of 2:1. (5)(5)

PERMANENT 0.10-3.6%(4)

PRIMARY 0.02-1.9%

PERMANENT 0.15-3.8%(5)

PRIMARY 0-1.9%

EtiopathogenesisEtiopathogenesis Represents Represents Phylogenetic relicPhylogenetic relic

of extinct ancestors.of extinct ancestors.(6)(6)

DichotomyDichotomy -suggests that the -suggests that the tooth bud is split to create two tooth bud is split to create two teeth.teeth.(7)(7)

HyperactivityHyperactivity of the dental of the dental lamina (most widely supported).lamina (most widely supported).(8)(8)

Commonly associated withCommonly associated with

Cleidocranial dysplasiaCleidocranial dysplasiaGardners syndromeGardners syndromeAlso associated with Also associated with cleft lipcleft lip and and palatepalate

Clinical significanceClinical significance Interfere with normal Interfere with normal occlusion.occlusion. Interfere with Interfere with eruptioneruption of of

normal tooth.normal tooth. AestheticAesthetic Delayed eruptionDelayed eruption DisplacementDisplacement CrowdingCrowding Less commonly- Less commonly- odontogenic odontogenic

cystscysts & & resorptionresorption

CASE REPORTCASE REPORT A 11year old male A 11year old male

patient normal in his patient normal in his facial appearance, not facial appearance, not exhibiting any exhibiting any physical or skeletal physical or skeletal abnormality nor any abnormality nor any symptoms suggestive symptoms suggestive of any syndromic of any syndromic background.background.

His medical history His medical history was non contributorywas non contributory

Intra oral Intra oral examination examination revealed all the revealed all the teeth that are teeth that are expected in a expected in a 11year old 11year old child,except child,except maxillary left maxillary left central central incisor,which was incisor,which was missing.missing.

Diagnostic aidsDiagnostic aids

Patient was advised Patient was advised

an an OPGOPG

an an IOPARIOPAR

an an Occlusal radiographOcclusal radiograph

and and Diagnostic castDiagnostic cast was was

preparedprepared

OPGOPG

Diagnostic casts


Treatment planTreatment plan

Conclusions Conclusions of of radiographsradiographs, , and and clinical clinical examination.examination.

Localization -Localization -Clark’s shift Clark’s shift conecone technique.technique.

Surgical procedure Surgical procedure

Conical mesiodens Tuberculate mesiodens

7th day after surgery After suture removal

Pre operative, post operative IOPAR.IOPAR of tuberculate mesiodens

Extracted specimens The topmost specimen is barrel shaped with open apex.

The specimen below is conical in shape

Incompletely formed rootTubercle

After the extraction of the teeth,patient After the extraction of the teeth,patient is recalled at regular interval for the is recalled at regular interval for the followup regarding the impacted left followup regarding the impacted left central incisor .central incisor .

If needed surgical exposure followed If needed surgical exposure followed by orthodontic intervention has to be by orthodontic intervention has to be carried out.carried out.

The present case is unusual due to the The present case is unusual due to the presence of a two impacted mesiodens presence of a two impacted mesiodens with an unusual morphology in a with an unusual morphology in a nonsyndromic patient.nonsyndromic patient.

ReferencesReferences 1.Maya C, Ashok Kumar BR. Familial occurrence of mesiodens with unusual findings: Case report. 1.Maya C, Ashok Kumar BR. Familial occurrence of mesiodens with unusual findings: Case report.

Quintessence Int 1998;29:49-51. Quintessence Int 1998;29:49-51. 2.Sharma A. Familial occurrence of mesiodens: A case report. J Indian Soc Pedo Prev Dent 2003;21:2.2.Sharma A. Familial occurrence of mesiodens: A case report. J Indian Soc Pedo Prev Dent 2003;21:2. 3.RajabLD,Hamdan AM.Sypernumerary teeth .Review of the literature and a survey of 152 cases.Int J

Paediatr Dent 2002 ;12:244-54 4. Arathi R, Ashwini R. Supernumerary teeth: A case report. J Indian Soc Pedo Prev Dent 2005;23:103-4. Arathi R, Ashwini R. Supernumerary teeth: A case report. J Indian Soc Pedo Prev Dent 2005;23:103-

5. 5. 5. Shashikiran ND, Reddy VV, Mandroli P. Molariform supernumerary tooth: A case report. J Indian 5. Shashikiran ND, Reddy VV, Mandroli P. Molariform supernumerary tooth: A case report. J Indian

Soc Pedo Prev Dent 2000;18:18-20. Soc Pedo Prev Dent 2000;18:18-20. 6 . Rajendran R, Sivapathasundaram B. Shafer's textbook of oral pathology, 5 th ed. Elsevier: New 6 . Rajendran R, Sivapathasundaram B. Shafer's textbook of oral pathology, 5 th ed. Elsevier: New

Delhi, India; 2006. Delhi, India; 2006. 7. Prabhu NT, Rebecca J, Munshi AK. Mesiodens in the primary dentition: A case report. J Indian Soc 7. Prabhu NT, Rebecca J, Munshi AK. Mesiodens in the primary dentition: A case report. J Indian Soc

Pedo Prev Dent 1998;16:93-5. Pedo Prev Dent 1998;16:93-5. 8.von Arx T. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aus Dent J 8.von Arx T. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aus Dent J

1992;37:189-95. 1992;37:189-95. 9. Sedano HO, Gorlin RJ. Familial occurrence of mesiodens. Oral Surg Oral Med Oral Pathol 1969;27:360-9. Sedano HO, Gorlin RJ. Familial occurrence of mesiodens. Oral Surg Oral Med Oral Pathol 1969;27:360-

1. 1. [ [PUBMED] ] 10. Primosch RE. Anterior supernumerary teeth and surgical intervention in children. Pediatr Dent 10. Primosch RE. Anterior supernumerary teeth and surgical intervention in children. Pediatr Dent

1981;3:204-15. [PUBMED] 1981;3:204-15. [PUBMED] 11. Ersin NK, Candan U, Alpoz AR, Akay C. Mesiodens in primary, mixed and permanent dentitions: A 11. Ersin NK, Candan U, Alpoz AR, Akay C. Mesiodens in primary, mixed and permanent dentitions: A

clinical and radiographic study. J Clin Pediatr Dent 2004;28:295-8. [PUBMED]clinical and radiographic study. J Clin Pediatr Dent 2004;28:295-8. [PUBMED]12. Peter Heasmen;Restorative Dentistry,Paediatrric and Orthodontics.12. Peter Heasmen;Restorative Dentistry,Paediatrric and Orthodontics.13. 13. Eur J Paediatr Dent. 2004 Mar;5(1):35-40Eur J Paediatr Dent. 2004 Mar;5(1):35-40. [. [PUBMEDPUBMED]]


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Case Report on Impacted Supernumerary Teeth