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CASE REPORT
Year : 2010  |  Volume : 1  |  Issue : 1  |  Page : 45-46 Table of Contents     

Multiple supernumerary teeth and odontoma in the maxilla: A case report


1 Department of Pedodontics and Preventive Dentistry, ITS Centre for Dental Studies and Research, Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, ITS Centre for Dental Studies and Research, Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh, India
3 Department of Pathology and Microbiology, ITS Centre for Dental Studies and Research, Delhi-Meerut Road, Muradnagar, Ghaziabad, Uttar Pradesh, India

Date of Web Publication15-Apr-2010

Correspondence Address:
P B Sood
Department of Pedodontics and Preventive Dentistry, ITS Centre for Dental Studies and Research, Delhi-Meerut Road, Muradnagar, Ghaziabad - 201 206
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-237X.62528

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   Abstract 

Most supernumerary impacted teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. The detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the diagnostic problems associated with multiple supernumerary impacted teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity.

Keywords: Multiple supernumerary, nonsyndrome, odontoma, open apex, tooth malformation


How to cite this article:
Sood P B, Patil B, Godhi S, Shetty DC. Multiple supernumerary teeth and odontoma in the maxilla: A case report. Contemp Clin Dent 2010;1:45-6

How to cite this URL:
Sood P B, Patil B, Godhi S, Shetty DC. Multiple supernumerary teeth and odontoma in the maxilla: A case report. Contemp Clin Dent [serial online] 2010 [cited 2019 Jul 18];1:45-6. Available from: http://www.contempclindent.org/text.asp?2010/1/1/45/62528


   Introduction Top


Supernumerary teeth may be defined as any teeth or tooth substance in excess of the full complement of primary and permanent teeth. Multiple impacted supernumerary teeth are rare. Most cases are found in association with syndromes such as Gardner's syndrome, cleidocranial dysostosis, and cleft lip and palate. [1],[2],[3],[4] Supernumerary teeth may occur as single (76-86%), double (12-23%), or multiples (<1%) , unilaterally or bilaterally, and in one or both jaws. [5] They may occur in any region of the dental arch with a particular predilection for the premaxilla. The prevalence for nonsyndrome multiple supernumerary teeth is less than 1%, and the male-to-female ratio has been reported as 9:2. [3],[6],[7] Hyperdontia with one to four supernumerary teeth may be localized in the upper anterior and molar region. Supernumerary teeth may lead to delayed eruption or noneruption, displacement of permanent teeth, resorption or malformation of adjacent roots, and cystic formation (rarely). [4],[7] A single case of multiple supernumerary teeth and odontoma in the maxilla in a 12-year-old female child and its treatment and the 2-year follow-up is presented here.


   Case Report Top


A 12-year-old girl reported with a chief complaint of a missing tooth in the upper front region of the jaw. She had history of trauma at the age of one and a half months. Medical and family histories were noncontributory. The face appeared bilaterally symmetrical. Lymph nodes were not palpable. An intra-oral examination revealed a conical tooth in the position of the right central incisor; the left central incisor was missing [Figure 1]. On palpation, bulging of the maxillary left canine vestibular and palatal region was appreciable. Radiographs showed three irregular masses of calcified tissue resembling teeth-like structures in the palate; they were inverted and the structure resembled the tooth showing single pulp space and had dilacerated roots [Figure 2]. The erupted tooth in place of 11 had a wide-open apex. The radiographic diagnosis of odontoma/supernumerary teeth and 21 absent was made. The surgical removal of impacted supernumerary teeth or odontoma, followed by esthetic rehabilitation was planned.

The surgical removal of the multiple calcified tissues in the maxilla was carried out under general anesthesia. The surgical site was prepared; exposure of the desired site was carried out by raising the labial and palatal flap. All the impacted calcified tissues were removed by the bone guttering technique [Figure 3]. Wound toileting was done and the flap was closed with an interrupted vicryl 3-0 suture material with an interrupted suturing technique. The wound healing was normal. Tooth specimens were sent for histopathology. A histopathological examination revealed that one calcified structure showed features of multiple pulp spaces and areas of active mineralization, and was diagnosed as a compound composite odontoma; other two teeth had normal histological features of a tooth and were termed as supernumerary teeth [Figure 4]. The conical tooth was restored to the shape of a central incisor and the left central incisor was replaced with a removable partial denture. The case was followed up for 2 years which showed good bone formation radiographically.


   Discussion Top


It is rare to find multiple supernumerary teeth with no associated diseases or syndromes. Odontomas are classified under supernumerary according to the Howard classification. [8] Compound odontomas are more common and affect the anterior maxilla, and odontomas are associated mostly with permanent and rarely with deciduous teeth. [9] The etiology is not completely understood. Several theories proposed include trauma and infection. [10] Lopez Areal has concluded in his study that if injury occurs early in childhood it is more likely to form odontomas. [11] Odontomas may be associated with cystic changes. Odontomas are treated by surgical enucleation and there is little possibility of recurrence.


   Conclusion Top


As approximately 75% of supernumerary teeth are impacted and asymptomatic, most are diagnosed coincidentally during a radiographic examination. Early diagnosis is important to minimize the risk of complications resulting from supernumerary teeth.

 
   References Top

1.Golan I, Baumert U, Hrala BP, Mussig D. Early craniofacial signs of cleidocranial dysplasia. Int J Paediatr Dent 2004;14:49-53.  Back to cited text no. 1      
2.Atasu M, Dumlu A, Ozbayrak S. Multiple supernumerary teeth in association with cleidocranial dysplasia. J Clin Pediatr Dent 1996;21:85-91.  Back to cited text no. 2  [PUBMED]    
3.Yusof WZ. Non-syndrome multiple supernumerary teeth: Literature review. J Can Dent Assoc 1990;56:147-9.  Back to cited text no. 3  [PUBMED]    
4.Hattab FN, Yasin OM, Rawashdeh MA. Supernumerary teeth: Report of three cases and review of the literature. ASDC J Dent Child 1994;61:382-93.  Back to cited text no. 4      
5.So LL. Unusual supernumerary teeth. Angle Orthod 1990;60:289-92.  Back to cited text no. 5  [PUBMED]    
6.Manrique Mora MC, Bolanos Carmona MV, Briones Lujan MT. Molarization and development of multiple supernumerary teeth in the premolar region. J Dent Child (Chic) 2004;71:171-4.  Back to cited text no. 6      
7.Rajab LD, Hamdan MA. Supernumerary teeth: Review of the literature and a survey of 152 cases. Int J Pediatr Dent 2002;12:244-54.  Back to cited text no. 7      
8.Garvey MT, Barry HJ, Blake M. Supernumerary teeth: An overview of classification, diagnosis and management. J Can Dent Assoc 1999;65:12-6.   Back to cited text no. 8      
9.Philipsen HP, Reichart PA, Praetorius F. Mixed odentogenic tumors and odontomas: Consediration on interrelationship: Review of literature and presentation of 134 new cases of odontomas. Oral Oncol 1997;33:86-99.  Back to cited text no. 9  [PUBMED]    
10.Shafer WG, Hine MK, Levy BM. Cysts and tumors of odontogenic origin. A Text book of oral pathology 4 th ed. Philadelphia: WB Saunders; 1993. p. 258-317.  Back to cited text no. 10      
11.Lopez-Areal L, Silvestre Donat F, Gil Lozano J. Compound odontoma erupting in mouth: 4 year follow-up of a clinical case. J Oral Pathol Med 1992;21:285-8.  Back to cited text no. 11      


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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