|Year : 2012 | Volume
| Issue : 1 | Page : 45-48
Unilateral supplemental primary maxillary lateral incisor without a permanent supernumerary: A rare case report
Deepak Kumar Gupta1, Sanjeev Mittal2, Mona Gupta3, Harmesh Sharma4
1 Department of Orthodontics & Dentofacial Orthopedics, MM College of Dental Sciences & Research, Mullana, India
2 Department of Prosthodontics, MM College of Dental Sciences & Research, Mullana, India
3 Private practitioner, Govt. Dental College & Hospital, Patiala, India
4 Department of Periodontics, Govt. Dental College & Hospital, Patiala, India
|Date of Web Publication||27-Sep-2012|
Deepak Kumar Gupta
House No 910 FF Sector 9, Panchkula- 134109
Source of Support: None, Conflict of Interest: None
Supernumerary teeth occur frequently in permanent dentition, but they are less prevalent in primary dentition. Supernumerary teeth of orthodox shape and size that resemble normal dentition are called 'supplemental teeth.' Supplemental teeth are less common than supernumerary teeth and are often overlooked because of their normal shape and size. Supplemental teeth may cause esthetic problems, delayed eruption and crowding, and they require early diagnosis and treatment to prevent complications. Deciduous supernumerary teeth are often accompanied by corresponding permanent supernumerary usually in the same area. The present case is a rare exception, in which no permanent supernumerary was found anywhere in the arch.
Keywords: Hyperdontia, lateral incisor, primary dentition, supernumerary teeth, supplemental teeth
|How to cite this article:|
Gupta DK, Mittal S, Gupta M, Sharma H. Unilateral supplemental primary maxillary lateral incisor without a permanent supernumerary: A rare case report. Indian J Oral Sci 2012;3:45-8
|How to cite this URL:|
Gupta DK, Mittal S, Gupta M, Sharma H. Unilateral supplemental primary maxillary lateral incisor without a permanent supernumerary: A rare case report. Indian J Oral Sci [serial online] 2012 [cited 2017 Sep 26];3:45-8. Available from: http://www.indjos.com/text.asp?2012/3/1/45/101677
| Introduction|| |
Supernumerary teeth are defined as those that appear in addition to the normal series. The occurrence of supernumerary teeth in the primary dentition is a less common finding, and it is almost one-fifth of that seen in the permanent dentition. The prevalence rates of supernumerary teeth, reported in the literature, vary between 0.1% and 6.9% in the permanent dentition and 0.4%-0.8% in deciduous teeth. ,,,, Interestingly, 35%-50% of supernumerary teeth in primary dentition are superseded by extra teeth in the same location in the permanent dentition. ,
Marinelli et al, in a recent study concluded that anomalies in primary dentition are associated with an increased likelihood of anomalies of the succedaneous permanent, and same observation has been reported earlier in literature.  Radiographic studies has also reported that children with primary supernumeraries exhibits a greater chance of hyperdontia in the permanent dentition than do the others. , These observations made us to believe that our case is a rare one, as in present case, the primary supernumerary was not associated with permanent supernumerary and further supported by the finding that the anomaly of hyperdontia is more common in males than in females. ,,,
Supernumerary teeth can be classified on the basis of position or shape.  Positional variations include mesiodens, paramolars, distomolars, and parapremolars. Primosch  classifies supernumerary teeth into two types according to shape. Supernumerary teeth of normal shape and size are termed 'supplemental,' whereas teeth of abnormal shape and smaller size are termed 'rudimentary' and include 'conical', 'tuberculate,' and 'molariform' teeth. 
Sexual dimorphism has also been reported by most authors, with males being more commonly affected i.e. between 1.1:1 and 6.5:1, depending on the respective population. ,, Supernumerary teeth are estimated to occur in the maxilla 8.2 to 10 times as frequently as in the mandible, and most commonly affected area is premaxilla.  Supplemental teeth in both primary and permanent dentition are most commonly located in the anterior maxillary region.
| Case Report|| |
A 2 year 9 months old female child reported to orthodontic OPD for routine dental examination. The patient, though being very young, was very cooperative and well-behaved. Intraoral examination showed presence of a supplemental tooth resembling primary maxillary lateral incisor in upper right quadrant. [Figure 1],[Figure 2] and [Figure 3] There was no significant medical history and no history of trauma. Patient intraoral periapical X-ray and Orthopantomogram [Figure 4] and [Figure 5] confirmed presence of supplemental tooth resembling primary maxillary right lateral incisor with no other supernumerary teeth present anywhere in Upper and lower arch. Intraorally, patient had no other disease process in terms of caries or other dental problem. Further, the clinical examination of both the parents did not reveal any supernumerary or supplemental tooth, which only suggested (without confirmation) absence of any genetic predisposition. The parents were cautioned that this supplemental tooth might cause future problems in terms of delayed/ectopic eruption of underlying permanent teeth, crowding, and might need to be extracted if it does not exfoliate by itself. The patient was advised to maintain good oral hygiene and to get periodic check-up after every six months. The future plan would be once the child is of manageable age at around 7-8 years or when deciduous incisors has started exfoliating then the case can be reevaluated and if need be the supplemental tooth in question can be extracted if it is causing above-mentioned problems.
|Figure 1: Intraoral photographs showing presence of supplemental tooth distal to primary maxillary right lateral incisor|
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|Figure 2: Intraoral photographs showing presence of supplemental tooth distal to primary maxillary right lateral incisor|
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|Figure 3: Intraoral photographs showing presence of supplemental tooth distal to primary maxillary right lateral incisor|
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|Figure 4: IOPA X-ray showing no extra tooth bud in the immediate vicinity of primary maxillary right lateral incisor|
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|Figure 5: OPG X-ray showing absence of any extra tooth bud in both upper and lower Jaw|
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| Discussion|| |
According to the literature, supernumerary teeth are rarely observed in deciduous dentition. Supernumerary teeth in primary dentition is often overlooked because the additional teeth are of normal shape and often erupt in proper alignment as the spacing frequently encountered in the deciduous dentition may be utilized to allow the supernumerary tooth to erupt with reasonable alignment. This might be the reason for their less detection by parents. Further, many children have an initial dental examination following eruption of the permanent anterior teeth, so anterior deciduous supernumerary teeth, which have erupted and exfoliated normally, would not be detected.
Distinguishing between a normal tooth and its supplemental 'twin' may be difficult. A supplemental tooth may exhibit deep palatal pith and coronal invagination. Supplemental teeth, as the name implies, refer to teeth that are duplications of teeth in the normal series.
The presence of supernumerary teeth may be part of developmental disorders. The most common syndromes that show a significant incidence of multiple supernumerary teeth are cleft lip and palate (16.7% of patients), Gardner's syndrome, and cleidocranial dysostosis. , A careful check for a family history of supernumerary teeth could point to the presence of a genetically determined syndrome.
Children with clefts show a higher incidence of supernumerary lateral incisors when the cleft occurs as a cleft lip. These supernumerary lateral incisors occur more frequently in the primary than in the permanent dentition. Meadors  reported a case in which fusion occurred between a primary lateral incisor and a supernumerary primary lateral incisor in the area of a cleft lip. A succedaneous supernumerary incisor was also present. Bilateral supplemental maxillary lateral incisors were also reported in both primary and permanent dentition. 
The cause of hyperdontia is unclear, but it is believed to result from atavism (i.e. reversion to a more primitive type of dentition); continued proliferation of remnants of the dental lamina, producing a "third dentition," and/ or dichotomy of the tooth germ, which produces two or more separate units. According to the dichotomy theory, which seems the most plausible, the tooth bud splits into two parts of equal or unequal size. This results in two teeth of equal size or one normal and one abnormal tooth.  Heredity may also play a role because supernumeraries are more common in the relatives of affected children than in the general population.  The significance of the present case lies in the fact that the presence of supplemental deciduous maxillary lateral incisor was not accompanied by permanent supernumerary/ supplemental tooth, which is in contrast to usual finding that anomalies in primary dentition are associated with an increased likelihood of anomalies of the succedaneous permanent. ,,, The presence of only one, that too deciduous supplemental tooth seems to further complicate the question of etiology in hyperdontia cases.
Most cases of supernumerary teeth does not give clinical symptoms, and they are usually detected during radiographic examination. Supernumerary teeth may erupt regularly in the oral cavity or be retained in the jaw. Eruption frequency is reported to vary between 15% and 34% in the permanent dentition while in the primary dentition, about two-thirds of the supernumeraries erupt. , In our patient, supernumerary primary maxillary lateral incisor was erupted. It does not give any clinical problem at this time. Supernumerary teeth may cause various clinical problems (failure of eruption, displacement or rotation, crowding, abnormal diastema, dilacerations, cystic formation, and ectopic eruption) in permanent dentition. Failure of eruption of adjacent permanent teeth is the most frequently occurring complication and occurs in 30% to 60% of cases. ,
In the permanent dentition, with regard to the possible complications and as a rule, it is advisable to remove supernumerary teeth, including those not erupted. In cases of normal eruption of supernumerary teeth, when they do not cause disturbances of the arc regularity, it is possible to desist from this rule. The final decision about the need to remove should be undertaken by the attending dentist, after clinical and radiographic consideration.
Hyperdontia observed in primary dentition should alert the clinician to the possibility of hyperdontia in the permanent dentition. A careful radiographic survey of both dental arches will provide the clinician and the parents with a preview of any potential problems likely to develop during the course of the child's growth and development. In case of our patient, supplemental teeth in the primary dentition were not superseded by supplemental teeth in the same location in the permanent dentition.
Although no treatment of supernumerary teeth is recommended in the primary dentition, the parents should be informed of the range of possible consequences to the permanent dentition, even in the absence of radiographs of the affected area. Intraoral radiographs should be taken as soon as possible to allow the dentist to plan for treatment at the appropriate time.
It is essential to clinically and radiographically enumerate and identify supernumerary teeth before development of a treatment plan. If a supplemental tooth is present and erupted, it may be difficult to determine which tooth is supplemental and which is part of the normal dental series. In these circumstances, if both teeth are healthy, it is logical to extract the tooth that is most displaced from the line of the arch, so as to relieve crowding. Orthodontic problems associated with supernumerary teeth can be avoided by early detection and management, which are necessary aspects of preventive dentistry.
| Conclusion|| |
The decision on proceeding with the treatment of supernumerary teeth should be based on the full clinical picture, interview and past dental history. Early detection of supernumerary teeth and treatment should be done to avoid or reduce potential complications. The future research can be aimed at evaluating the arch length in patients with supernumerary teeth so as to see and confirm the effect of number of teeth on the development of jaw bone.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]