ORIGINAL ARTICLE

Supernumerary teeth in a Turkish population

Elcin Esenlik,a M. Ozgur Sayın,b A. Onur Atilla,c Tuncer Ozen,d Ceyhan Altun,e and Feridun Basxakf

Isparta and Ankara, Turkey

Introduction: Our aim in this study was to investigate the frequency, distribution, sex differences, and char-acteristics of supernumerary teeth in a referred Turkish population. Methods: A total of 2599 patients’ pano-ramic radiographs (1360 girls, 1239 boys) were evaluated, including children in both the mixed and thepermanent dentitions. Their mean age was 8.6 6 0.23 years. Number, location, classification, side, and impac-tion of supernumerary teeth were evaluated. Furthermore, the development of these teeth was evaluated.Results: Eighty-four supernumerary teeth were found on 69 radiographs; 9 were deciduous and 75 were per-manent teeth. Most supernumerary teeth were in the premaxillary region (67%). Mesiodens (n 5 43) was themost frequent supernumerary tooth (51.2%). This was followed by the maxillary lateral incisor (15.5%), themandibular premolar (14.3%), the maxillary canine (9.5%), the maxillary premolar (6%), the mandibular lateralincisor (2.4%), and the mandibular canine (1.2%). Sixty-two (73.8%) supernumerary teeth were impacted. Themale-female ratio was 1.13:1, which was not statistically significant. Conclusions: The prevalence of super-numerary teeth in Turkish children was 2.7% in this study. (Am J Orthod Dentofacial Orthop 2009;136:848-52)

Supernumerary teeth are a developmental distur-bance encountered in the dental arches or jaws.These teeth are in excess of the normal series.1

Although this problem seems to be caused by geneticor environmental factors, the etiology is unknown.They can be found nearly anywhere in the dental archesor jaws. They can be single, double or multiple, unilat-eral or bilateral, and in 1 jaw or both jaws at the sametime. Supernumerary teeth might resemble normal teethor be amorphous. They are usually named according tothe region where they are situated and mainly classifiedas supplemental or rudimentary teeth according to theirmorphology.2 Supplemental teeth are of normal size andshape, and resemble the teeth with which they are asso-ciated. Rudimentary teeth are further classified as coni-cal, tuberculate, or molariform. There is also anodontoma type.

a Assistant professor, Department of Orthodontics, Faculty of Dentistry,

University of Suleyman Demirel, Isparta, Turkey.b Associate professor, Department of Orthodontics, Faculty of Dentistry,

University of Suleyman Demirel, Isparta, Turkey.c Research assistant, Department of Orthodontics, Faculty of Dentistry, Univer-

sity of Suleyman Demirel, Isparta, Turkey.d Associate professor, Department of Oral Diagnosis and Radiology, Dental

Sciences Center, Gulhane Medical Academy, Ankara, Turkey.e Assistant professor, Department of Pediatric Dentistry, Dental Sciences

Center, Gulhane Medical Academy, Ankara, Turkey.f Associate professor, Department of Pediatric Dentistry, Dental Sciences

Center, Gulhane Medical Academy, Ankara, Turkey.

The authors report no commercial, proprietary, or financial interest in the

products or companies described in this article.

Reprint requests to: M. Ozgur Sayın, Suleyman Demirel Universitesi

Disxhekimligi Fakultesi Ortodonti A.B.D, Cunur, Isparta, 32260, Turkey;

e-mail, drsayin@gmail.com.

Submitted, July 2007; revised and accepted, October 2007.

0889-5406/$36.00

Copyright � 2009 by the American Association of Orthodontists.

doi:10.1016/j.ajodo.2007.10.055

848

Supernumeraries have a predilection for the premax-illary region. The most common supernumerary tooth ismesiodens, which is usually small and conical, between2 maxillary incisors. This is generally followed by max-illary lateral incisor, maxillary fourth molar, and man-dibular third premolar supernumeraries. Maxillarypremolar, canine, and mandibular fourth molar are theleast common ones.3 Supernumeraries can appear inboth deciduous and permanent dentitions, but they areusually seen in the permanent dentition.4 The prevalenceof supernumerary teeth in the permanent dentition variesbetween 0.1% and 3.4% of the various groups studied.4-10

Their frequency in the deciduous dentition is 0.03% to1.9%.11,12 Although no sex differences in the deciduousdentition were reported, boys are affected approximatelytwice as often as girls in the permanent dentition.13

Supernumeraries can be impacted, erupt spontane-ously, or exhibit ectopic eruption.14 These teeth locatedespecially in the premaxilla can cause certain clinicalproblems such as failure to erupt, displacement of a per-manent tooth, crowding, or dentigerous cyst formation.4

On the other hand, sometimes supernumeraries areasymptomatic and are detected in radiographic exami-nations by coincidence.

Although studied in other groups, the frequency ofsupernumerary teeth in Turkish people is not well docu-mented in the literature. Therefore, we aimed to inves-tigate the frequency, distribution, sex differences, andcharacteristics of supernumerary teeth in a referredTurkish population.

MATERIAL AND METHODS

A total of 2599 patients’ panoramic radiographs(1360 girls, 1239 boys) referred to Gulhane Medical

Table I. Distribution of patients and supernumerary teeth by sex

Total examinedpatients

Affected patients(n, [%])

Supernumeraryteeth (n) Mean age (y)

Maxillaryteeth

Mandibularteeth

Permanentteeth

Deciduousteeth

Male 1239 35 (2.8) 42 9.1 6 0.36 37 5 39 3

Female 1360 34 (2.5) 42 8.2 6 0.26 32 10 36 6

Total 2599 69 (2.7) 84 8.6 6 0.23 69 15 75 9

American Journal of Orthodontics and Dentofacial Orthopedics Esenlik et al 849Volume 136, Number 6

Academy in Ankara, Turkey, between November2004 and March 2006 were evaluated in this study.These patients were referred to the Departments ofOral Diagnosis and Radiology, Pedodontics, and Or-thodontics with complaints of caries, crowding, anddelayed eruptions. This investigation included chil-dren in the mixed and permanent dentitions. Themean age of the sample was 9.90 6 2.85 years(range, 6-16 years), and the mean age of the affectedpatients was 8.6 6 0.23 years. These patiens werefrom the middle eastern regions of Turkey. Nonehad a significant medical history or had received pre-vious dental treatment including extractions. All pan-oramic radiographs were taken with the samemachine and inspected by the same author (C.A.) un-der optimal conditions. Number, location, classifica-tion, side, and impaction of supernumerary teethwere evaluated. Odontomas with supernumeraryteeth were also noted, but they were not consideredin the prevalence of supernumerary teeth. Conse-quences such as interference with the eruption of nor-mal teeth and pathologic conditions were alsorecorded. Furthermore, the development of the super-numerary teeth was evaluated visually and recordedas only crown formation, crown and partly root for-mation, or complete tooth formation.

The chi-square test was used to test for sex differ-ences.

RESULTS

In 69 of the 2599 patients (2.7%), 84 supernumeraryteeth were found. Seventy-five of these teeth were per-manent (89%), and 9 were deciduous (11%). The prev-alences of deciduous and permanent supernumeraryteeth were 0.4% and 2.3%, respectively. The male(n 5 35) to female (n 5 34) ratio was 1.13:1. Bothboys and girls had 42 supernumeraries (Table I). Thechi-square test showed no significant sex differences.Sixty-nine supernumeraries were in the maxilla, and15 in the mandible (4.6:1). Sixty-seven percent werein the premaxillary region (Table I).

Fifty-four patients had 1 supernumerary tooth, and15 patients had 2 supernumerary teeth. None hadmore than 2 supernumerary teeth. Double supernumer-

ary teeth were found in the right and left quadrantssymmetrically.

A detailed distribution of the supernumerary teeth isgiven in Table II. Mesiodens (n 5 43) was the most fre-quently seen supernumerary tooth (51.2%) followed bymaxillary lateral incisor (15.5%), mandibular premolar(14.3%), maxillary canine (9.5%), maxillary premolar(6%), mandibular lateral incisor (2.4%), and mandibularcanine (1.2%).

Twenty-two (26.2 %) of all supernumerary teethwere erupted, and 73.8% (n 5 62) were impacted. Allmaxillary and mandibular supernumerary premolarswere impacted. Mesiodens had an impaction rate of76.7%. On the other hand, only 4 of 13 mandibular lat-eral incisors were impacted.

Most supernumerary teeth were in a vertical posi-tion with varying degrees of inclination (69.1%).This was followed by mesioinclined (16.7%), inverselypositioned (7.1%), and distoinclined (7.1%) supernu-meraries. All inverted teeth were mesiodens. No super-numerary had a horizontal position.

The supernumeraries (n 5 84) included 42 conical,2 tuberculate, and 40 supplemental teeth; 39 of the 42conical and all tuberculate teeth were mesiodens.Only 2 of the 40 supplemental teeth were mesiodens,whereas all maxillary lateral incisors and all premolarswere supplemental.

Fifty-two supernumerary teeth (61.9%), 27 of whichwere mesiodens, had complete formation. Fifteen su-pernumerary teeth had partial root formation with com-plete crown formation. Seventeen supernumerary teethhad only crown formation. In 40 subjects (48 supernu-merary teeth), since both the supernumerary tooth andthe adjacent normal tooth had complete root formationat our examination, it was impossible to determinewhether the root development of the supernumerarytooth was delayed or advanced compared with the nor-mal adjacent tooth. It was possible to evaluate root de-velopment of 36 supernumerary teeth in 29 subjects.In 6 subjects, 6 supernumerary teeth had advancedroot development. In 17 subjects, 23 supernumararyteeth had delayed root development, and, in 6 subjects,6 supernumerary teeth had root development equal tothat of the normal adjacent tooth. All extra maxillarypremolars (n 5 5), most extra mandibular premolars

Table II. Distribution and characteristics of 84 supernumerary teeth in 69 affected subjects

MesiodensMax lateral

incisor Max canine Max premolarMand lateral

incisor Mand canine Mand premolar Total Percent

Male 22 6 4 5 1 — 4 35 2.8

Female 21 7 4 — 1 1 8 34 2.5

Deciduous 2 3 3 — — — 1* 9 10.7

Permanent 41 10 5 5 2 1 11 75 89.3

Erupted 10 9 1 — 2 — — 22 26.2

Unerupted 33 4 7 5 — 1 12 62 73.8

Single 31 13 4 1 2 1 2 54 64.3

Bilaterally 6 — 2 2 — — 5 30 35.7

Vertical 25 13 7 5 2 — 6 58 69.1

Mesioinclined 7 — — — — 1 6 14 16.7

Distoinclined 5 — 1 — — — — 6 7.1

Inverted 6 — — — — — — 6 7.1

Supplemental 2 13 6 5 1 1 12 40 47.62

Conical 39 — 2 — 1 — — 42 50

Tuberculate 2 — — — — — — 2 2.4

With odontoma: 3 — — — — — — 3 3.6

Compound 2 1 — — — — — 3 3.6

Complex — — — — — — — —

Only crown 4 — — 5 — — 8 17 20.2

Partial root 12 1 — — — — 2 15 17.9

Entire tooth 27 12 8 — 2 1 2 52 61.9

Right 19 10 4 3 — 1 7 44 52.4

Left 17 3 4 2 2 — 5 33 39.3

Midline 7 — — — — — — 7 8.3

Total 43 13 8 5 2 1 12 84

Percent 51.2 15.5 9.5 6 2.4 1.2 14.3

Max, Maxillary; Mand, mandibular.

*Deciduous supernumerary molar.

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(11 of 12), and some mesiodens (7 of 43) had delayedroot development.

In addition to these findings, we found that some su-pernumerary teeth interfered with the eruption of 18normal teeth. These normal teeth were impacted and in-cluded 1 mandibular right first premolar, 1 maxillaryright lateral incisor, and 16 maxillary central incisors.No supernumerary tooth had cystic transformation,but 6 supernumerary teeth with odontomas were foundin the premaxillary region.

DISCUSSION

In the literature, the frequency of supernumeraryteeth in various populations is between 0.1% and 3.4%.4,5,9,10,15-18 Ethnic background is an important factorin these varying results. A higher prevalence of supernu-merary teeth was reported for Chinese children than forwhite children.6 However, the prevelance of supernu-merary teeth is not well documented in Turkish people.

Several reports emphasize the importance of pano-ramic film examination for the accurate diagnosis of nu-meric anomalies.17,19-21 Supernumerary teeth cannot beconfirmed without a radiographic survey.3,17,22 In stud-

ies with only visual examination, supernumerary toothcan be overlooked.5 In accordance with our results, itwas previously reported that most supernumerary teethwere unerupted.14,16,22 Undoubtedly, it would be morevaluable if randomly selected patients were evaluatedwith panoramic radiographs. Since it is impossible forethical reasons, our study consisted of a referred popu-lation. Therefore, the frequency of supernumarary teeth(2.7%) in our study might not represent the generalTurkish population. However, this ratio was in the rangeof previous studies evaluating other groups. Parry andIyer8 evaluated 2000 Indian orthodontic patients and re-ported that 51 (2.5%) had supernumerary teeth. On theother hand, the lower frequencies of supernumeraryteeth in some studies that evaluated referred patientscould be due to ethnic differences.7,10

In most previous reports, supernumerary teeth werefound more frequently in the permanent dentition thanin the deciduous dentition.4,16,22,23 Probably, the fre-quency of deciduous supernumerary teeth has beenunderestimated because of exfoliation or extractions.23

It is necessary to consider a detailed dental history atthis point. In our study, although the age range of the pa-tients was 6 to 16 years, most subjects were between 7

and 9 years, when some deciduous teeth had exfoliated.Therefore, only 9 deciduous supernumerary teeth werefound, and they were not discriminated from permanentsupernumerary teeth when assessing the frequency.

In agreement with previous reports, most supernu-meraries were found in the premaxillary region as mesio-dens and rarely in the mandibular incisor region.3,5,24,25

Because of obvious complications, mesiodens can be di-agnosed more easily by the parents; this affects the num-ber of referrals. Although mandibular fourth molars andparamolars were reported to be more frequent, especiallyin the Japanese literature, these supernumeraries werenot found in this study.26,27 Unlike many previous stud-ies, all supernumeraries in our study were located mesi-ally to the first molars. A possible reason for this mightbe sample differences. Our sample was a referred popu-lation, and, because supernumerary molars do not gener-ally cause functional or esthetic consequences, patientsrarely seek advice regarding them.

Most previous studies reported that males were af-fected aproximately twice as often as females.3-5,

11,16,18,28,29 However, in a study of Chinese children,the male-to-female ratio was 6.5:1.6 These differencesmight be due to racial or sampling differences.16,24 Incontrast to the previous reports, in our study, no signif-icant sex diffences were found. This finding agrees withsome previous reports including patients at variousages.27,30,31

Several studies reported that, if a patient had a super-numerary tooth in the deciduous dentition, a succedane-ous permanent supernumerary tooth was expected ata rate of 30% to 63%.20,22,23,32-34 In this study, no per-manent extra tooth or germ was observed succeedinga deciduous supernumerary tooth. However, this doesnot mean that a permanent supernumerary teeth willnot occur later in life. A supernumerary teeth can occurafter the age of 8 or 9 years.17,22,31,35 Rubenstein et al36

stated that supernumerary premolars especially mightnot become radiographically visible until the age of12. Furthermore, some authors reported that, even afterthe extraction of a supernumerary tooth, a new onemight occur in the same location a few years later.21,37

Because of this possibility, patients should be checkedonce a year with a radiographic examination. Supernu-merary teeth in the deciduous and mixed dentitions cancause several problems in the permanent dentition.

Some investigators reported that supernumeraryteeth have delayed development compared with thenormal dentition.21,36,38-41 In our study, maxillary andmandibular extra premolars especially had less rootdevelopment compared with adjacent normal teeth, allof which were supplemental. Some mesiodens hadalso delayed root development. In addition, all teeth

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with delayed root development were unerupted. Severalreports indicated that extra premolars especially withdelayed development were unurepted.21,36,39,41 In con-trast, Humerfelt et al23 reported that most supernumer-ary teeth had normal development, but their studyincluded patients in the deciduous dentition.

This might explain why most supernumerary teethwere impacted. Probably, the supernumerary teeth arelate to erupt because of their slow root development.Therefore, they could not appear in the dental arch atthe right time, and they might be impacted due to re-stricted areas. For the same reason, deciduous supernu-merary teeth can erupt more easily because of thedeciduous spaces in the dentition.19,22 Another factorabout the impaction of supernumerary teeth might beodontomas accompanying them in some cases.6 Thesestructures can impede the eruption paths of supernumer-ary and normal teeth. A predecessor supernumerary de-ciduous tooth is not always present to guide the eruption.Therefore, supernumerary teeth can deviate in any direc-tion in the jaw—eg, horizontal or inverted. In this study,no supernumerary teeth were in a horizontal position.

Since it is rare to find a supernumerary tooth in thedeciduous dentition, the problems are mainly encoun-tered in the permanent dentition and require orthodontictreatment. Failure of eruption of adjacent permanentteeth is the most frequent complication, occurring in20% to 60% of patients.4,16,25,42-45 Mesiodens espe-cially caused the most problems in our study, in accor-dance with previous reports.16,22,25,38 We found thiscomplication in subjects aged 6 to 8 years. Therefore,clinicians should not overlook the delayed eruption ofa central or lateral incisor at an early age.

CONCLUSIONS

1. The frequency of supernumarary teeth (2.7%) inour study was similar to previous reports evaluatingother populations.

2. Since some supernumeraries cause several clinicalproblems, clinicians should take appropriate mea-sures even at early ages. This might reduce theneed for further orthodontic treatment.

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December 2009