SUPERNUMERARY TEETH

(26 YEARS RETROSPECTIVE STUDY) 

Introduction:

A Supernumerary Tooth is that tooth which is additional to the normal one.  It is an extra tooth, erupted or unerupted, resembling or unlike the other teeth in the group to which it belongs. Its presence may cause malposition of adjacent teeth or prevent their eruption. The condition is also known as Hyperdontia. Supernumerary teeth occur more frequently in the permanent dentition, and are rare in the primary dentition.

Etiology:

             The etiology of Supernumerary tooth is not completely understood.  Supernumerary or extra teeth result from disturbances during the initiation and proliferation stages of dental development.  This may lead to hyper genesis. Various theories exist for development of Supernumeraries.

One theory suggests that the Supernumerary Tooth is created as a result of a dichotomy of the tooth bud.

Another theory is the hyperactivity theory, which suggests that Supernumeraries are formed as a result of local, independent, conditioned hyperactivity of the dental lamina.

It is suggested that supernumerary teeth develop from a third tooth bud arising from the dental lamina near the permanent tooth bud or possibly from splitting the permanent tooth bud itself.

Classification:

Supernumerary teeth are classified according to morphology and location.

Morphologically, a supernumerary tooth may be:

1. Conical

2. Supplemental

3. Tuberculate (Fig.)

4. Odontome.

Location wise, a supernumerary tooth may be:

1. Mesiodens

2. Distodens

3. Paramolar (Fig.)

A Supernumerary tooth can have normal morphology and may resemble to the tooth with which it is associated. Such tooth is also called a supplemental tooth (Fig.). A Supplemental Tooth may be rudimentary in shape and smaller in size.

Mesiodens is a supernumerary tooth with a cone shaped crown and a short root. It is present in the midline, between Central Incisors.  Maxillary Mesiodens is the most common supernumerary tooth.

A Paramolar occurs in the molar region.

A Distodens or fourth molar is found distal to the third molar.

Aim of Study:

Main aim of this study is to analyze incidence and prevalence of Supernumerary Teeth in a Rural, Industrial Town of India.

Materials & Methods:

This is a retrospective study of 11,000 X-rays recorded in the Dental Clinic of KCC Hospital, Khetri Nagar, India from Feb.1983 to Aug. 2009.  These X-rays have been recorded over a period of more than 26 years. They include 10,335 Intra Oral Periapical and 665 Intra Oral Occlusal X-rays.

Register No. 01 to 10 are those of Periapical X-rays. Each Register from 01 to 10 has 1000 X-rays in chronological order. Register no.21, currently in use has a record of 335 Periapical X-rays till 17/08/2009.

Register No. 11 to 16 are those of the Occlusal X-Rays. Each Register from 11 to 16 has 100 X-rays in chronological order.  Register No.17, currently in use has a record of 65 X-rays till 06/08/2009.

In all, 204 Supernumerary Teeth are found recorded in these X-ray Registers. After deleting duplicate records, a total of 181 Supernumerary Teeth, in 153 patients, have been identified and studied.

Most of these X-rays are from family members and employees of Khetri Copper Complex, A Unit Of Hindustan Copper Limited, A Government of India Undertaking. Since all employees are codified, it has facilitated proper record keeping and authenticity of data is assured.

 Observations:

TABLE 1: TEETH-WISE

In a total of 181 Supernumerary Teeth, there are 146 Male Supernumerary Teeth and 35 Female Supernumerary Teeth. It shows that occurrence of Male Supernumerary Teeth is 04 times more than Female Supernumerary Teeth.

MALE TEETH	146
FEMALE TEETH	035
TOTAL TEETH	181

 

 

 TABLE 2: SEX-WISE

There are a total of 153 cases having a total of 181 Supernumerary Teeth. 153 cases consist of 121 males and 32 females. This shows that Sex wise Male Patients are 3.8 times more prone to Supernumeraries.

MALE PATIENTS	121
FEMALE PATIENTS	32
TOTAL PATIENTS	153

 

           

 TABLE 3: JAW-WISE

166 Supernumerary Teeth have been recorded in Maxillary Region alone whereas only 15 Supernumerary Teeth have been recorded in the Mandibular Region. This Jaw-wise table shows that occurrence of supernumeraries is 11.1 times more in Maxillary Region than in Mandibular Region.

MAXILLARY TEETH	166
MANDIBULAR TEETH	015

 

 TABLE 4: SIDE-WISE

Incidentally, Side-wise table presents equal incidence of Supernumerary Teeth on both sides. However 72 Maxillary Mesiodens present in the Midline, constitute the biggest group.  Maxillary Mesiodens are 39.8% of all Supernumerary Teeth. However, a very small number (03) Mesiodens have been recorded in Mandibular Region. This forms the smallest group with only 1.7% presence.

RIGHT SIDE	053
LEFT SIDE	053
MIDLINE (MESIODENS) Maxillary	072
MIDLINE (MESIODENS) Mandibular	003

 

 

   TABLE 5: REGION-WISE

INCISOR REGION (MAXILLARY)	137
INCISOR REGION (MANDIBULAR)	005
PREMOLAR REGION (MAXILL ARY)	010
PREMOLAR REGION (MANDIBULAR)	005
MOLAR REGION (MAXILLARY)	014
DISTO MOLAR REGION (MAXILLARY)	005
MOLAR REGION (MANDIBULAR)	005

 

 

 

 

Region-wise, Maxillary Incisor Region forms the largest group with 137 supernumeraries. This shows that 75.7 % of all Supernumerary Teeth are present in Maxillary Incisor Region alone.

This is followed by 14 Supernumerary Teeth in the Maxillary Molar Region, thus constituting 7.7 % of all Supernumerary Teeth.

There are 10 Supernumerary Teeth in the Maxillary Premolar Region. This shows that 5.5% of all Supernumerary Teeth are present in the Maxillary Premolar Region.

There are 05 Supernumerary Teeth in Disto Molar Region. These are also known as 4th. Molars. They form 2.8% of all Supernumeraries.

Maxillary region alone has a total of 166 Supernumerary Teeth. It thus has 91.7 % of all Supernumerary Teeth.

In Mandibular Region there are only 5 Supernumerary Teeth in Incisor Region, 5 Supernumerary Teeth in Premolar Region and also 5 Supernumerary Teeth in the Molar Region. Thus a total of only 15 Supernumerary Teeth are recorded in Mandibular Region, out of a total of 181 Supernumerary Teeth. This shows that Mandibular Region has only 8.3 % of all recorded Supernumerary Teeth.

Incisor Region (Both Maxillary and Mandibular Regions taken together) has 142 Supernumerary Teeth. This is 78.5 % of all Supernumerary Teeth.

Premolar Region (both Maxillary Region and Mandibular Region) has 15 Supernumerary Teeth. This is 8.3 % of all Supernumerary Teeth.

Molar Region (both Maxillary Region and Mandibular Region) has 24 Supernumerary Teeth. This is 13.3 % of all Supernumerary Teeth.

In the Molar Region alone, there are 05 Maxillary 4th Molars, (04 in Male Patients and only 01 in a Female Patient). Out of these, only 01 Male Patient had Bilateral Disto Molars or 4th Molar.

No Mandibular Disto Molars have been recorded so far.

TABLE 6: SOLITARY/ MULTIPLE

There are 126 cases having presence of a solitary Supernumerary Tooth. It forms 69.6 % of all Supernumerary Teeth.

55 Supernumerary Teeth i.e. 30.4 % of all Supernumerary Teeth are present in multiple numbers in a mouth.           

26 patients had 2 Supernumerary Teeth each (Fig. No. 03).

There is only 1 female patient having 03 supernumerary teeth in her mouth.

SINGLE TOOTH	126 CASES
TWO TEETH	026 CASES
THREE TEETH	001 CASE

 

 

TABLE 7:  PAIR OF SUPERNUMERARY TEETH IN A MOUTH.

REGION	MALE	FEMALE	TOTAL
MAXILLARY INCISOR	19	01	20
MAXILLARY PREMOLAR LEFT 1ST & 2ND.	00	01	01
MAXILLARY MOLAR BILATERAL BETWEEN1ST & 2ND. MOLARS	01	00	01
MAXILLARY MOLAR RIGHT 1ST & 2nd MOLAR	01	00	01
MAXILLARY DISTO MOLAR BILATERAL	01	00	01
MANDIBULAR INCISOR	01	00	01
MANDIBULAR MOLAR BILATERAL BETWEEN2ND.PREMOLARS & 1ST. MOLARS.	01	00	01

There are 26 patients with a pair of Supernumerary Teeth. Among these 26 patients, the findings were as follows:

• 19 Male patients and 01 Female patient had a pair of Supernumerary Teeth in the Maxillary Incisor Region. (Fig.) 

• 01 Female patient had a pair of Supernumerary Teeth in Left Maxillary 1st. and 2nd. Premolar Region.

• 01 Male patient had a pair of Supernumerary Teeth found on both sides between 1st and 2nd. Maxillary Molar Regions.

• 01 Male patient had a pair of Supernumerary Teeth in Maxillary 1st and 2nd. Molar Region.

• 01 Male patient had a pair of Supernumerary Teeth in Maxillary Distomolar Region, Bilaterally.

• 01 Male patient had a pair of Supernumerary Teeth in Mandibular Incisor Region.

• 01 Male patient had a pair of Supernumerary Teeth present between 2nd. Premolar and 1st. Molar, Bilaterally, in Mandibular Region.

Only 01 Female patient is recorded with 03 Supernumerary Teeth. One Tooth each was present in Maxillary 2nd Molar Region Bilaterally, while the 3rd Supernumerary was found in Maxillary Right Distomolar Region.

Discussions:

A Supernumerary Tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. The condition is also known as Hyperdontia. It is an extra tooth and may or may not resemble the other teeth in the group to which it belongs. It may erupt or remain impacted and may lead to malposition of adjacent teeth or prevent eruption of Permanent Tooth.  Supernumerary teeth generally occur in the Permanent Dentition, and they are rare in the Primary Dentition.

A total of 11,000 Dental X-Rays were recorded at the Dental OPD of KCC Hospital from 4th. Feb.1983 to 17th.Aug. 2009. Out of these 10335 X-Rays were Intra Oral Periapical and 665 were Intra Oral Occlusal X-Rays. After removing duplicity, a total of 181 Supernumerary Teeth have been identified and studied.

There are 146 teeth in Male patients and 35 in Female patients. It shows that incidence of Male Supernumerary Teeth is more than 04 times than that of Female Supernumerary Teeth.  

A total of 166 Maxillary and 15 Mandibular Supernumerary Teeth were found. This shows that occurrence of maxillary Supernumerary teeth is 11.1 times more common than Mandibular supernumerary teeth.

Side-wise there was no significant difference, but the largest number of Supernumerary Teeth was recorded in the Midline region. There are a total of 75 Mesiodens (72 Maxillary and 03 Mandibular). This shows that 46.6 % of all Supernumerary teeth are present in the Midline.

Region wise, 142 Teeth were seen in the Incisor region, followed by 24 Teeth in the Molar region and 15 Teeth in the Premolar region. This shows that out of 181 Supernumeraries, 78.5 % were present in the Incisor region only.

There are 125 Cases having presence of a Solitary Supernumerary Tooth. This presents 69.1 % of all Supernumeraries.

26 cases had 2 Supernumerary Teeth each: Out of these 26 Cases, 21 cases were those of a pair of Supernumerary Teeth, present in the Incisor Region. There was only one pair in Mandibular Incisor Region and the rest 19 Cases had pair of Supernumeraries in Maxillary Incisor Region.

There was one pair each in Maxillary Molar Regions, Mandibular Molar Regions, and Maxillary Distomolar Regions.  All these were bilaterally symmetrical.

One case, showing presence of 2 Supernumerary Teeth Unilaterally, one each, in relation to Maxillary Left 1st and 2nd Premolars has been recorded.

Another pair of Supernumeraries was recorded with presence of one Supernumerary Tooth each, in relation to Maxillary Right 1st. and Maxillary Right 2nd. Molar.

Only 01 Female patient had 03 Supernumerary Teeth. One Tooth each was present in: Maxillary 2nd Molar Region Bilaterally, while the 3rd Supernumerary was found in Maxillary Right Distomolar Region.

Heredity Role:

According to some authors, heredity also plays a role in the occurrence of this anomaly, though in my study of 181 Supernumeraries, I have come across only one case where a father and his son, both had one supernumerary tooth each. Father had a Mesiodens present between Maxillary Central Incisors while his son had a Supernumerary Tooth present between Maxillary Right Central and Lateral Incisors.

Interesting Case Reports:

A 17 years old boy had a partially erupted Maxillary Left Central Incisor with mobility and Periapical pathosis. Intra Oral Periapical X-ray revealed presence of an Impacted Supernumerary tooth, palatally, and a Dilacerated Maxillary Left Central Incisor (Fig09). Extraction of Supernumerary (Fig 08) along with Elective (intentional) Replantation of Maxillary Central Incisor was performed.

A 12 year old girl had an Upper Left Lateral Incisor, geminated with a Supernumerary Tooth (Fig.No.10.).  The patient was successfully treated through Elective (Intentional) Replantation of Maxillary Left Lateral Incisor after separation of Crown of geminated supernumerary tooth and Extra Oral endodontics in both roots (Fig.No.11).

A 20 yr old female had an irregular hard growth in Lower Left 2nd. Molar region. Radiograph revealed an Impacted Mandibular Left 2nd. Molar with an Odontome like structure (Fig. No.12) and a missing Left Mandibular 3rd.Molar. The Odontome was excised (Fig.No.13) and surgical Eruption of Left Mandibular 2nd. Molar facilitated.

Complications Due To Supernumeraries :

Presence of Supernumeraries may lead to:

1. Failure of Eruption: The presence of a supernumerary tooth is the most common cause for the failure of eruption of a maxillary central incisor. Supernumerary teeth in other locations may also cause failure of eruption of teeth in affected region.

2. Displacement: The presence of a supernumerary tooth may cause displacement of a permanent tooth. The degree of displacement may vary from a mild rotation to complete displacement. Presence of Mesiodens leads to Diastema.

3. Crowding: Erupted supplemental teeth most often cause crowding.  A supplemental incisor may cause crowding in the upper anterior region.

            4. Pathology: Dentigerous cyst formation is another problem that may be associated with impacted supernumerary teeth.  Resorption of roots, adjacent to a supernumerary tooth may occur.

Indications for Removal of Supernumeraries:

1. Spontaneous eruption of the supernumerary has occurred.

2. Aesthetic reason, Malocclusion, Crowding, etc.

3. Normal tooth eruption has been delayed or inhibited.

4. Altered eruption or displacement of tooth is evident.

5. There is associated pathology.

Indications for Monitoring Without Removal:

1. Satisfactory eruption of related teeth has occurred;

2. No active orthodontic treatment is planned;

3. There is no associated pathology;

4. Removal may affect the vitality of the related teeth.

Conclusion:

This is a retrospective study of 11,000 Dental X-rays recorded at the Dental OPD of KCC Hospital Khetri Nagar, India during the past 26 years (From Feb.1983 to Aug.2009). Out of these, 181 Supernumeraries were found in 153 patients.

The study shows that occurrence of Male Supernumerary Teeth is 04 times more than the Female Supernumerary Teeth and, Sex-Wise Male Patients are 3.8 times more prone to Supernumeraries.

Occurrence of Supernumeraries is 11.1 times more in Maxillary region than in Mandibular region.

Mesiodens alone (both upper and lower jaws) are 41.4% of the total Supernumerary Teeth. Maxillary Incisor Region forms the largest group with 137 Supernumeraries, followed by 014 in Maxillary Molar Region. Incisor region alone (Both Maxillary & Mandibular) has 78.5 % of all Supernumerary Teeth.

 There are 126 cases having presence of a Solitary Supernumerary Tooth.

There are 26 cases with 2 Supernumerary Teeth each and One Case with 3 Supernumeraries.

A few cases have been successfully treated through Elective (Intentional) Replantation.  

 

*****