Supernumerary teeth diagnosis and treatment approach. Six case reports

Supernumerary teeth are relatively common in the general population, affecting the primary and the permanent dentition and have been reported in many genetic syndromes. They are classified according to form and shape. Seven different examples of hyperodontia are presented to highlight the numerical and morphological variation in dental abnormalities manifestations, empathising the importance of thorough clinical and radiological examination and of a correct therapeutic approach. The patients presented single or multiple hyperodontia, with particular interest for a 12 supernumerary teeth case. The clinical problems linked to supernumerary teeth were: impaction or ectopic eruption, crowding, possible root resorption of adjacent teeth. The therapeutical approach of supernumerary teeth varied on the position of the element in excess and on the complexity of the clinical case. In some cases the single extraction of the supernumerary tooth was indicated, while in other cases the extraction of the tooth was needed in addition to orthodontic treatment to gain sufficient space for the tooth with delayed eruption.     

Multi-lobed mesiodens with a palatal talon cusp: a rare case report

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch and the talon cusp is a rare dental developmental anomaly seen on the lingual surface of anterior teeth. This paper presents a rare clinical case of development of talon cusp in a mesiodens with multiple lobes, which interfered with both occlusion and appearance of an 11-year-old patient. During clinical interview, the patient reported difficulty on mastication. Clinical and radiographic examination revealed that a supernumerary tooth with completely formed root was causing an occlusal interference. The supernumerary tooth was diagnosed as multi-lobed mesiodens associated with a palatal talon cusp. The treatment plan consisted in the extraction of the supernumerary tooth followed by orthodontic treatment for diastema closure and tooth alignment.     

A premaxilla with a supernumerary tooth indicating a developmental region with a variety of dental abnormalities: a report of nine cases

The aim of this study was to elucidate whether a premaxilla with a supernumerary tooth has additional dental abnormalities. The study does not include premaxillas with a mesiodens, only premaxillas with parasagittally located supernumerary teeth. Radiographs from eight children, followed from 1 year and 5 months to 11 years and 5 months in the municipal dental health service in Denmark, were analyzed. One patient was seen only once. Dental abnormalities recorded included: invaginations on permanent incisors, resorption of roots of incisors, curved roots of incisors, delayed eruption, and delayed formation of roots. The study shows that there are dental abnormalities within the premaxillary region where the supernumerary tooth is located. This indicates that, apart from the supernumerary tooth, a more widespread deviation from normal conditions including tooth malformation, arrested eruption, and root resorption occur within the premaxillary region. The most important outcome of this study is that in the region with a supernumerary tooth the adjacent incisor shows delayed eruption after surgical removal of the supernumerary tooth. The deviations in root morphology, including root resorption, are not limited to patients who have had orthodontic treatment, but patients who did not receive orthodontic treatment also revealed deviations in root morphology. Therefore the treatment outcome can be different from the expected outcome.     

A premaxilla with a supernumerary tooth indicating a developmental region with a variety of dental abnormalities: a report of nine cases

The aim of this study was to elucidate whether a premaxilla with a supernumerary tooth has additional dental abnormalities. The study does not include premaxillas with a mesiodens, only premaxillas with parasagittally located supernumerary teeth. Radiographs from eight children, followed from 1 year and 5 months to 11 years and 5 months in the municipal dental health service in Denmark, were analyzed. One patient was seen only once. Dental abnormalities recorded included: invaginations on permanent incisors, resorption of roots of incisors, curved roots of incisors, delayed eruption, and delayed formation of roots. The study shows that there are dental abnormalities within the premaxillary region where the supernumerary tooth is located. This indicates that, apart from the supernumerary tooth, a more widespread deviation from normal conditions including tooth malformation, arrested eruption, and root resorption occur within the premaxillary region. The most important outcome of this study is that in the region with a supernumerary tooth the adjacent incisor shows delayed eruption after surgical removal of the supernumerary tooth. The deviations in root morphology, including root resorption, are not limited to patients who have had orthodontic treatment, but patients who did not receive orthodontic treatment also revealed deviations in root morphology. Therefore the treatment outcome can be different from the expected outcome.     

Fusion of Central Incisors with Supernumerary Teeth: A 10-year Follow-up of Multidisciplinary Treatment

Introduction

Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and may cause clinical problems such as tooth crowding and esthetic problems. Preliminary planning and careful management are often required by a dental team comprising an orthodontist, an endodontist, a prosthodontist, and an oral surgeon. A multidisciplinary treatment approach in a case with fused teeth is presented.

Methods

A 9-year-old girl presented with macrodontia of a left maxillary central incisor. The patient was referred to the orthodontic department because of a large central incisor as a result of fusion with an unspecific supernumerary tooth. The surgical procedure included sectioning off the mesial segment as far as possible, both apically and subgingivally, and extracting 1 of the fused supernumerary teeth. During the sectioning procedure, the pulp of the remaining tooth was exposed at the middle third of the root. Direct pulp capping was performed by an endodontist using mineral trioxide aggregate. Twelve weeks later, orthodontic treatment was commenced, and finally after a 26-month orthodontic treatment period, the central incisors' crown was restored using composite material.

Results

A 10-year clinical and radiographic follow-up revealed that the remaining resected central incisor kept its vitality, and the patient was pleased with the esthetic result.

Conclusions

Proper interdisciplinary treatment planning of complicated cases such as anomalous teeth, which involve fusion to a supernumerary tooth, may lead to minimal invasive conservative procedures that maintain tooth vitality and result in a pleasing esthetic result.     

Tuberculate and odontoma type supernumerary teeth

An 8-and-a-half-year-old girl with supernumerary teeth of tuberculate and odontoma type is described. Treatment of the patient is carried out on conventional lines with a combination of surgical and orthodontic methods. The upper tuberculate type supernumerary teeth were extracted and, after surgical exposure, the upper permanent first incisors were aligned with removable appliances. After secondary dentition was completed, the lower odontoma type supernumerary tooth was removed surgically, and also the maxillary and mandibular first premolars were extracted because of severe crowding, and fixed orthodontic appliances were used to align the permanent dentition. Early diagnosis and treatment of this anomaly is necessary to avoid more serious consequences and to prevent severe orthodontic disturbances.     

Conservative adjunct to esthetic orthodontic treatment in young patients

The esthetic effect of orthodontic treatment in young patients may sometimes be incomplete without performing additional procedures related to the form and texture of the anterior teeth. Six young patients, aged 7 to 21 years, presented for orthodontic treatment to improve their dental esthetics. The problems of tooth staining, mutilation, congenitally missing teeth, tooth size/arch length discrepancy, and sequellae of dental trauma neccessitated a combined orthodontic-prosthodontic treatment. Changing morphology and texture by conservative prosthetic procedures proved to be a successful complement to orthodontic treatment.     

A Survey of Malocclusion and the Need for Orthodontic Treatment in a Shropshire School Population

Abstract

Occlusal features and the need for orthodontic treatment are difficult to assess objectively. Methods of assessment which have been devised for public health purposes are different from those which are needed for clinical purposes.

A study was carried out on 1000 children, aged 11 to 12 years, to assess certain occlusal features and the need for orthodontic treatment in clinical terms, and to determine which occlusal features brought about the need for treatment. The criteria for assessment are defined.

The population was found to have a high prevalence of dental arch crowding and of Class 2 dental arch relationship. The features were each present in more than half the population. Other findings regarding occlusal features are outlined.

There was little difference between the sexes for the occlusal and aetiological features studied.

No orthodontic treatment was found to be necessary in 40·1 per cent of the population. Treatment by planned extraction of teeth only was necessary in 22·0 per cent, and active tooth movement with appliances, either with or without extraction of teeth, in 37·9 per cent.

Crowding of the dentition and Class 2 dental arch relationship were found to be the main cause of the need for orthodontic treatment. In this population, more than 50 per cent of the necessary appliance treatment would be involved in treating Class 2 Division 1 occlusion.

There were no significant differences between the sexes in the need for orthodontic treatment.     

单侧完全性唇腭裂术后患者牙弓间宽度不调的矫治

目的　通过对单侧完全性唇腭裂术后患者上下颌间牙弓宽度不调的研究及对患者正畸治疗的临床观察 ,总结该类患者正畸治疗的特点。方法　对 4 8例单侧完全性唇腭裂术后患者进行临床检查 ,记录其上下牙弓间的宽度关系 ;根据患者错情况制定不同的治疗方案进行临床治疗。结果　 (1)单侧完全性唇腭裂术后患者中出现上下颌牙弓宽度不调的比率为 6 0 .4 % ,双侧后牙反为 33.3% ,单侧后牙反为 16 .7%。男女之间差异无显著性。 (2 )宽度不调以双尖牙区为重 ,上尖牙区是扩弓治疗的重点。 (3)磨牙区牙弓宽度的不协调常较轻微 ,一些患者甚至上颌最后磨牙区略宽 ,对 5例患者 (占 10 4 % )进行了上颌磨牙的腭向移动。结论　单侧完全性唇腭裂患者正畸治疗中上颌多需扩弓 ,且扩弓潜力较大。对于严重拥挤的患者 ,拔牙决定应在扩弓后作出。扩弓治疗应在牙槽突植骨前进行 ,扩弓后需延长保持时间     

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report

Abstract – The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio‐distal trimming was performed and the defects were restored with anterior resin composites in order to re‐establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow‐up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.     

Multidisciplinary management of impacted central incisors due to supernumerary teeth and an associated dentigerous cyst

Supernumerary teeth are the most common developmental dental anomaly resulting from hyperactivity of dental lamina, dichotomy, environmental factor, or polygenetic process of atavism. Supernumerary teeth present classical oral complication such as impaction of adjacent teeth, crowding, diastema formation, rotation, displacement of teeth, and occlusal interference. A dentigerous cyst associated with anterior supernumerary teeth (mesiodens) is rare and accounts for 5% of all dentigerous cysts. The present case reports describe the successful management of the impacted permanent maxillary central incisor positioned high in the vestibule. A combination of surgical and orthodontic techniques was employed to improve treatment outcome with greater hard and soft tissue preservation and to prevent psychological problems. In the surgical phase, supernumerary teeth and dentigerous cyst were removed. Subsequently traction was employed by bonding bracket on the labial surface using closed and open eruption techniques. Successively, fixed orthodontic treatment was started to align permanent maxillary central incisors in an occlusal plane. Thus, combination of surgical and orthodontic method can be the treatment of choice over surgical extraction, implant placement, and surgical repositioning.     

159例矫治前后牙弓测量结果分析

探讨和分析不同治疗方法不对病例矫治前后牙弓变化的规律。方法。对使用固定矫治器进行治疗的三组１５９例治疗前后研究模型进行牙弓测量。结果１治疗后,扩弓组６－６宽度增加;关隙组３－３长度,牙弓长度、３－３宽度减少;拔牙组３－３长度增加而牙弓长度,基骨长度减少,６－６宽度减少而基骨宽度增加。２治疗前基骨宽度关隙组〉扩弓组〉拔牙组;治疗后３－３长度关隙组〈扩弓组〈拔牙组和３－３宽度三组间无显著性差异。结论：     

Traction--a surgical/orthodontic procedure.

Maxillary crowding may cause failure of eruption of the canine. The teeth so displaced are directed buccally or palatally. In both cases, surgical intervention is indicated after space has been made in the arch. Palatally displaced canines are treated by surgical excision of palatal mucosa to promote eruption. Wide excision is indicated to prevent the healing process from covering the exposed tooth crown. Because of the anatomy of the buccal mucosa, however, surgical excision of the crowns of buccally displaced canine frequently results in periodontal problems. An alternative technique is therefore presented; this involves the surgical exposure of the crowns of buccally displaced teeth to allow the attachment of a wire traction hook. The crown is then recovered. The traction hook provides a point of attachment, so that orthodontic forces may be applied to the unerupted tooth to guide its eruption. The preservation of the mucosal flap ensures a normal epithelial attachment develops on the buccal surface of the tooth, and the normal gingival anatomy of the buccal mucosa is maintained. The procedure may also be used in cases where upper incisors have been prevented from erupting because of the presence of supernumerary teeth. Even after surgical removal of the supernumerary teeth, the permanent incisors often fail to erupt. In such cases, the placement of traction hooks will enable the orthodontist to bring the unerupted teeth into their correct positions in the arch.     

螺旋CT牙体表面成像对骨内埋伏牙的定位及临床应用

目的：建立牙齿立体表面形态图像并探讨用于术前检查骨内埋伏牙的效果。方法：应用三维螺旋ＣＴ的图像处理功能,在牙颌骨表面重建图像的基础上,采用图像处理表面遮盖法,消除周围骨组织的影像,获得单纯牙体表面图像。应用该方法检查９例患的骨内埋伏多生牙和阻生牙。结果：能清楚显示上颌骨埋伏多生牙的畸形形态、在牙列唇侧或腭侧的位置及与牙列牙根的关系;上颌埋伏恒尖牙萌出方向与正畸牵引方向的角度;阻生智齿与第二磨牙的     

Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up

AIM: To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.     

Hemisection of a fused tooth

Fusion is a developmental anomaly which occurs due to a union of 1 or more adjacent teeth during morphodifferentiation of the dental germs. The present case report presents the hemisection of a maxillary central incisor fused with a supernumerary tooth. A 10-year-old boy was referred to clinic with the chief complaint of the presence of a large anterior tooth. Intraoral and radiographic investigations indicated fusion between the left central incisor and a supernumerary tooth. The fused tooth was separated with a diamond bur, and the supernumerary tooth was extracted. The left central incisor was restored with composite resin and the diastema between the maxillary central incisors was closed with orthodontic treatment. The left central incisor was still healthy after a follow-up examination period of 24 months. An ideal overjet and overbite relation was achieved at the end of the orthodontic treatment. Hemisection can be considered as an appropriate treatment alternative for a permanent tooth fused with a supernumerary tooth.     

Initial tooth movement: force application and pain--a relationship?

Initial dental casts of 24 patients, who had previously completed a discomfort index card for the first 16 days following placement of a fixed appliance, were examined. A method is described whereby the anterior and overall crowding in the relevant dental arch was measured as a tooth/arch discrepancy index using the reflex metrograph. The crowding was measured in three dimensions as the discrepancy between the sum of the anatomic mesiodistal widths of the teeth and the actual mean arch shape canine to canine (3 to 3) and first molar to first molar (6 to 6) inclusive. An additional two-dimensional method using the best "goodness of fit" (least variance) of a parabolic arch shape for the mean arch length in the 6 to 6 crowding measurement is also described. The measurement accuracy of the reflex plotter was less than 0.12 mm. The method error for the crowding measurements expressed as root mean square (RMS) values was 0.97 mm for the anterior tooth/arch, 1.45 mm for the overall tooth/arch discrepancies, and 1.35 mm for the tooth/arch discrepancy based on the best fit of a parabolic curve. It is proposed that since the same bracket width and fully engaged arch wire type were used in every case, some relationship between the initial crowding that reflected the forces applied and the discomfort experienced by the patients might be expected. This was not found to be true. There was no correlation between the total discomfort experienced and the crowding measurements 3 to 3 or 6 to 6.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of a fused central incisor in association with a macrodont lateral incisor: a case report

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.     

Late-developing supernumerary mandibular premolar: a case report

This report presents a case of a patient who developed a supernumerary mandibular premolar during the course of orthodontic treatment. Evidence of this tooth comes from consecutive panoramic radiographs. It is not routine practice to screen for developing supernumerary teeth during orthodontic treatment. Therefore, the possibility of supernumerary tooth interference with occlusal development or orthodontic treatment should always be kept in mind. A brief review of literature concerning the late formation of supernumerary teeth is included.     

Disturbance of dentoalveolar arch formation in the front part of the maxilla due to 11, 21 teeth retention. Treatment

The cause of disturbance of dentoalveolar arch formation in the front part of the maxilla in one patient was the maxillary central incisors eruption delay due to retention of supernumerary teeth situated in the region of upper central incisors. A positive result of the treatment was achieved with the use of surgical and orthodontic methods. The distinctive feature of the orthodontic method was retained tooth displacement (by traction) into the dentition.