ABSTRACT:

Supernumerary teeth are relatively frequent disorders of Odontogenic origion characterized by excess number of teeth with mesiodens being most common. The early diagnosis and treatment of mesiodens is essential for the normal development of individual’s dentition.

KEYWORD : Supernumerary teeth , Odontogenic, Mesiodens

INTRODUCTION
:
Supernumerary teeth are disorder of odontogenesis, characterized by
an excess number of teeth, which can cause dental problems. These teeth may remain impacted in alveolar bone or can erupt in oral cavity. The term mesiodens refers to the supernumerary teeth in midline of anterior maxillary region between central incisors(ref -1,2, ). It is two times more frequent in males than females (ref -3,4,5 ). Only 25% of all mesiodens spontaneously erupt in oral cavity (ref -5 ). In general they remain impacted ,asymptomatic and are more commonly discovered during routine radiographic examination.
This article represents guidelines for diagnosis and management of non syndromic supernumerary teeth.

DEVELOPMENT OF SUPERNUMERARY TEETH:

The most accepted theory for the development of supernumerary teeth is hyper activity of dental lamina. This theory describes that remnants of dental lamina or palatal or lingual offshoot of active dental lamina are induced to develop into an extra tooth bud, which result in supernumerary teeth. The less accepted theory is Dichotomy theory, which suggests that the tooth bud is split to create two teeth ,one of which is supernumerary tooth .

CLASSIFICATION OF SUPERNUMERARY TEETH BY MORPHOLOGY

1. Conical or peg shaped-most often lies between maxillary central incisors and may produce midline diastema, incisor rotation or failure of eruption of central incisor.
2. Tuberculate or barrel shaped- usually associated with unerupted central incisors.
3. Supplemental- resembles and lies adjacent to the last tooth of a series.
4. Odontome- may either be compound or complex.

ROLE IN ETIOLOGY OF MALOCCLUSION:

Most common complications of mesiodens are the delay /prevention of eruption or displacement/rotation of maxillary permanent incisors. Relatively less common complications include midline diastema, dilacerations of permanent teeth, cyst formation and eruption of supernumerary teeth in nasal cavity.(ref -5)

 

TREATMENT PLAN:

Treatment may vary from extraction of supernumerary teeth to extraction followed by orthodontic correction in order to establish a good occlusion.

DISSCUSION

Supernumerary teeth may be present in both permanent and primary dentitions but less frequent in primary dentition. Prevalence of supernumerary teeth ranges between 0.15%-1.9%.

Mesiodens can cause delayed or ectopic eruption of permanent incisors which can alter normal occlucion and esthetics of an individual. Mesiodens may present as rudimentary morphology with cone shaped crown generally smaller in size than adjacent normal teeth. It may also be found to mimic natural tooth shape. The root is often totally formed, may be curved/or globular(ref-6 ).

Mesiodens is frequently associated with several craniofacial disturbances including cleft lip or palate(ref-7 ) and cleidocranial dysotosis(ref -8)and to a lesser extent with gardener’s syndrome or chondorectodermal dysplasia. (ref-9).Early diagnosis enables dental surgeons to reduce the extent of surgery, orthodontic treatment and possible future complications.

CASE REPORT

An eight year old male patient reported to dental clinic with chief complaint of crooked teeth in upper front region. Medical & family history were insignificant.
Clinical Examination:
Intraoral examination showed the presence of a conical shaped tooth between maxillary central incisors and other tuberculate shaped tooth palatal to left maxillary central incisor.
Radiographic Examination:
Panoramic view and occlusal maxillary view were advised, which showed the presence of two supernumerary teeth ,one tooth between maxillary central incisors and other tooth which was present palatal to left maxillary central incisor, radiographs confirmed the correct number and position of teeth.
Extractions were done under local anesthesia. Patient was recalled after one week for check-up and advised to consult every six months, so that orthodontic treatment can be planned after suitable time-period.

Fig (1) Front view.	Fig (2) Intraoral view.
Fig (3) Occlusal Radiographic View.	Fig (4) Extracted teeth.

CONCLUSION

Early diagnosis and correct treatment planning of supernumerary teeth hold important position in preventing certain anomalies such as delayed eruption of permanent teeth, cyst formation around unerupted supernumerary teeth and malocclusions such as crowding, rotation of teeth , ectopic eruption of permanent teeth. REFRENCES:

1: Seddom R P, Johnstone S C, Smith P B. Mesiodentes in twins: a case report & review of literature. Int. J Pediatric Dent .1997;7:177-184.

2: Sefura JJ. Jimenez-Rubio A. Concomitant hypohyperdontia: Simultaneous occurance of mesiodens and agenesis of a maxillary lateral incisor. Oral Surg Oral Med Oral Patho Oral Radio Endod. 1998;86:473-475.

3: Sedano H O, Gorlin RJ. Familial occurance of mesiodens. Oral Surg Oral Med Oral Pathol. 1969;27:360-361.

4: Shafer M, Hine M, Levy B Textbook of Oral Pathology. Philedelphia: Saunders; 1983 Developmental disturbances of oral and paraoral structures pg. 47-49.

5: Hattab FN, Yarsin OM, Rawashdeh MA. Supernumerary teeth: report of 3 cases and review of literature. ASDC J Dent Child. 1994;61:382-393.

6: Giancotti A, Grazzini F, De Dominicis F, Romanini G, Arcuri C. Multidisciplinary evaluation & clinical management of mesiodens. J Clin Pediatric Dent 2002;26:235-37.

7: Bohn A. Dental anomalies in cleft lip & cleft palate. Acta Odontol Scand. 1963;21:1-14.

8: Richardson A, Deussen FF. Facial & dental anomalies in cleidocranial dysplasia: a study of 17 cases. Int J Pediatric. Dent 1994;4:225-231.

9: Gorlin R. Hennekam R. Syndromes of the head & neck. Oxford University Pres.2001.

AUTHORS
DR RAJEEV ANAND
(MDS, ORAL & MAXILLOFACIAL SURGERY)