Supernumerary teeth also known as hyperdontia, is the condition where more than normal number of teeth are present. When the extra tooth is present in deciduous dentition that is the primary dentition or in permanent dentition than these specific extra teeth are called as supernumerary teeth. By definition the supernumerary teeth are the extra teeth present in the oral cavity. These can be found in any region of the oral cavity.
There is no specific cause of the supernumerary teeth. Many theories are given to explain their presence. Some says that these are there because of the abnormal division of the tooth bud but another theory says that it is because of the hyperactivity of the dental lamina. Dental lamina is the dental tissue which forms the tooth buds to form the teeth. If the dental lamina shows hyperactivity then extra teeth are formed which are known as the supernumerary teeth. Hereditary is also considered to be one of the main cause of supernumerary teeth.
The incidence of supernumerary teeth is more common in adult permanent teeth as compared to deciduous teeth. It is 0.8% in deciduous teeth and 2.1% in permanent teeth. These can be unilaterally present or bilaterally. It can be single or multiple. Normally it is single but multiple supernumerary teeth are present in cases of cleft lip and palate, cleidocranial dysplasia or Gardner’s syndrome. The incidence of supernumerary teeth in cleft lip and palate cases is around 22%. While in cleidocranial dysplasia cases it is 22.2% in maxillary region and 5 % in molar region. The supernumerary teeth can be present in one jaw or both the jaws. In deciduous teeth the incidence of supernumerary teeth is equal in males and females but in case of permanent teeth the incidence of supernumerary teeth is twice in males as compared to the females.
Multiple supernumerary teeth present in cleidocranial dysplasia
Supernumerary teeth can be classified according to the location and the morphology. The supernumerary teeth present in the front teeth are called Mesiodens. The deciduous teeth are normally conical and straight but the permanent teeth can be differentiated into different shapes. They can be classified into four types according to the morphology. These are:
They are normally peg shaped and are present between the front teeth and are known as the Mesiodens. They develop ahead or with the formation of root but some times they are impacted and lie inverted in the palate. Rarely do they cause hindrance in the eruption of the permanent teeth but they can cause the rotation or the displacement of the permanent teeth.
X-ray showing inverted and conical Mesiodens
Tuberculate Supernumerary Teeth
As the name implies they have more than one cusp or tubercle and are mostly present palatally to the central upper incisors. Their root formation is delayed and they are usually paired. It is very rare that they erupt and they can cause the delayed eruption of the incisors.
Supplemental Supernumerary Teeth
It is the duplication of teeth in normal series. Mostly it is found in lateral incisor, molar and premolar region. Most of the deciduous teeth are supplemental and are never impacted.
It can be complex composite odontoma i.e. the diffuse mass of dental tissue which is totally disorganized. Other is compound composite odontoma which has some resemblance to the normal anatomical structures.
X-ray showing complex composite odontoma
Problems Encountered by Supernumerary Teeth
There are many problems associated with supernumerary teeth. The main problems with supernumerary teeth are listed below.
1. Movement of the teeth
The presence of the supernumerary teethcauses the displacement of the adjacent teeth. When they are removed the teeth come in to alignment.
2. Hindrance in the eruption of the teeth
Some times the supernumerary teeth are so placed that it causes the hindrance in the eruption of the normal teeth. The teeth fail to erupt. In such cases, when X-ray’s are taken to find the cause, the presence of supernumerary tooth is the cause and extraction of supernumerary tooth solves the problem.
3. Failure in eruption of front teeth
Supernumerary teeth can sometime become cause for failure of eruption of front teeth.
4. Crowding of the teeth
The supernumerary teeth also cause crowding as they are the extra tooth or teeth. When extracted this takes care of the crowding.
5. Development pathology in relation to Supernumerary teeth
Few pathological conditions are found in relation to the supernumerary teeth like cyst formation. Dentigerous cyst formation is the most common pathological condition found in case of supernumerary teeth.
Dentigerous cyst in relation to the supernumerary tooth
6. Alveolar bone grafting
If alveolar bone grafting has to be done and there is supernumerary tooth present then that has to be extracted and then one has to wait for healing. It causes problems where alveolar bone grafting has to be done like in case of cleft lip and palate where as such incidence of supernumerary teeth is very high.
7. Resorption of roots of adjacent teeth
Some times the position of the supernumerary teeth is such that it causes the Resorption of the roots of the adjacent teeth. In such cases the supernumerary teeth has to be extracted as soon as possible.
8. Implant site preparation
Some times when the site is being prepared for the implant and there is a supernumerary tooth present, it has to be extracted and bone grafting has to be done.
Diagnosis of the Supernumerary Teeth
Most of the times, the supernumerary teeth are asymptomatic. They are diagnosed by chance. But if some teeth are impacted or there is displacement of the teeth then anterior occlusal X-ray and the periapical X-ray is taken to diagnose the presence of the supernumerary teeth.
Treatment and Management of the Supernumerary Teeth
Management part depends upon the location of the supernumerary tooth and its affect on the teeth. If it is asymptomatic and is not causing any problem like there is no displacement of teeth. There is no hindrance in the eruption of the teeth and no pathology is involved then the supernumerary teeth are not extracted. But there are certain conditions where the supernumerary tooth has to be extracted.
Conditions where extraction of supernumerary tooth is indicated:
When the eruption of the teeth is delayed
Displacement of the teeth is there which cannot be explained.
When major orthodontic alignment of the teeth is planned like braces treatment has to be done. In such cases if any supernumerary tooth is present which is not visible or asymptomatic even then it is extracted.
Some alveolar bone grafting procedure is planned like in case of cleft lip and cleft palate.
When implant site has to be prepared for putting the implant.
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