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Year : 2016  |  Volume : 7  |  Issue : 2  |  Page : 118-120

Esthetic management of early childhood caries in primary maxillary anterior teeth comprising a supplemental tooth

Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication19-May-2016

Correspondence Address:
Namratha Tharay
Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore - 524 003, Andhra Pradesh
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DOI: 10.4103/0976-433X.182666

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Early childhood caries (ECC) is a severe problem in the children that necessities the pulpal and/or esthetic restorative management. Primary supplemental teeth associated with its succedaneous permanent teeth is a rare dental anomaly. Both the ECC and supplemental teeth predispose for the early intervention that influence the esthetic, physiological, and psychological factors. Hence, the present paper reports a 2 years 10 months boy with severe ECC and the presence of primary maxillary supplemental tooth associated with its succedaneous tooth, symptomatically and esthetically managed with wire posts and strip crowns. The present paper also discusses a brief review of supernumerary teeth regarding its prevalence, theories and management of the same.

Keywords: Early childhood caries, strip crowns, supplemental tooth

How to cite this article:
Tharay N, Nuvvula S. Esthetic management of early childhood caries in primary maxillary anterior teeth comprising a supplemental tooth. SRM J Res Dent Sci 2016;7:118-20

How to cite this URL:
Tharay N, Nuvvula S. Esthetic management of early childhood caries in primary maxillary anterior teeth comprising a supplemental tooth. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Jul 31];7:118-20. Available from:

  Introduction Top

Dental anomalies may be observed either as a change in tooth size, shape or in number that are influenced by a complex interplay of genetic and environmental variables.[1],[2] Supernumerary teeth (ST) are one of the most widely reported and significant anomaly affecting the permanent as well as primary dentition. “Supernumerary teeth” or “hyperdontia” refers to a developmental dental anomaly describing the aberrations in the normal number of teeth.

ST may exist either in maxilla, mandible, or both arches (bimaxillary), may be single or multiple, present unilaterally or bilaterally, eumorphic (supplemental) or dysmorphic (rudimentary), straight or inverted in position and may be either erupted or impacted. We report a case of toddler with primary supplemental incisor showing the radiographical presence of permanent successor, along with the aesthetic management of four maxillary incisors and supplemental incisor with deep caries and pulp involvement.

  Case Report Top

A South Indian boy aged 2 years 10 months accompanied by his grandparent came to the Department of Pedodontics and Preventive Dentistry with the chief complaint of broken, discolored upper front teeth. The child was physically healthy, with no other remarkable features in his past medical history. He had a history of bottle feeding, 3-4 times during night time with sugar added to milk from the past 1-year.

On examination, extra-orally, there were no observable abnormalities. Intra-orally, the child was in the primary dentition stage of development with a complete set of 20 primary teeth.

A supplemental tooth was observed in the right maxillary quadrant between the lateral incisor and canine (5S). The child had dental caries with pulpal involvement 51, 52, 61, 62 as well as the supplemental tooth with the loss of maximum crown structure [Figure 1]a. Dental caries without pulpal involvement was evident in 54, 64, 74, and 84. The supernumerary tooth was morphologically undistinguishable due to grossly destructed crown onto the cervical line. A maxillary anterior occlusal radiograph was advised for further evaluation, which revealed the presence of supernumerary primary tooth with complete root development associated with permanent supplemental tooth with crown completion in the maxillary right quadrant [Figure 1]b. Based on root canal anatomy, the supernumerary can be identified as a supplemental primary maxillary lateral incisor. The treatment planned was pulpectomy with metapex ® (Meta Biomed Co. Ltd., Chunocheongbuk-do, Korea), followed by placement of strip crowns for 51, 52, 5S, 61 and 62 and restoration of all the decayed teeth conservatively. During the second appointment, restorations were made with dycal ® base (Dentsply Caulk, Milford, USA), and light cure glass ionomer cement (GC Gold Label, GC Corporation, Japan) on 54, 64, 74 and 75.
Figure 1: Initial appearance of primary maxillary anteriors (a); anterior occlusal radiograph (b); radiographic appearance of wire post in tooth number 51 (c); clinical appearance of wire posts in the pulpectomy treated teeth (d), and posttreatment appearance (e)

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In the subsequent appointments, pulpectomy with metapex ® as obturating material was done 51, 52, 5S, 61, and 62. In further appointments loops made of A. J. Wilcock Australian special plus wire (A. J. Wilcock, Whittlesea, Victoria, Australia) in the form of letter gamma (γ) used as retentive posts were inserted into the root canals [Figure 1]c unto a length of 2-3 mm, not extending beyond 5 mm and cemented with light cure glass ionomer cement [Figure 1]d, followed by placement of strip crowns 51, 52, 5S, 61 and 62 with the composite restoration [Figure 1]e. A. J. Wilcock Australian wire was used due to its advantages such as, higher tensile strength, good flexibility, toughness, and greater working range such that the posts can be easily inserted into the root canal, compared with the stainless steel wire. The grandparent was advised to bring the child for regular follow-up visits unto the completion of early mixed dentition stage in order to plan the treatment for the succedaneous permanent ST.

  Discussion Top

ST are more common in permanent teeth, compared with primary teeth. The prevalence of permanent ST varies depending on geographic locations and ranges from 0.5% to 5.3%[3] with increased predilection to the mongoloid race.[4] The prevalence of ST in the permanent dentition is 1-3%[5] whereas in primary dentition, it is 0.3-0.6%[1] with a prevalence of 1.2% in permanent dentition in Indian population.[6]

The reported lower prevalence of ST in primary dentition can be, due to unreported cases in spaced primary dentition, that leads to normal alignment of teeth without any crowding and also overlooked as they occur mostly as supplemental form.[2] The most common type of supernumerary in the permanent dentition is mesiodens which account for 90-98%[1] whereas in primary dentition, it is maxillary supplemental lateral incisors. A primary ST is followed by a supernumerary permanent successor in 35-60% cases.[7]

Males are affected more commonly than females, approximately 2:1 to as high as 5.5-6.5:1 in Asians [3] including Indian population at a frequency of 1.7:1.[8] ST has a predilection for the maxilla, approximately 8:1 times, with the most common site in the maxillary arch being the premaxillary region.[6] The overall prevalence of premaxillary ST in primary and mixed dentition is 1.9%.[8] Multiple ST is frequently found in the mandibular premolar area.[9]

Various theories have been suggested to describe the etiology of ST, which include the atavism theory, dichotomy theory and dental lamina hyperactivity theory. But, the exact etiology for the development of ST is unknown. Most of the literature on ST supports the dental lamina hyperactivity theory which suggests localized, independent, and conditioned hyperactivity of the dental lamina.[9]

Based on the shape of ST, Primosch [1] classified supernumeraries into two types: Supplemental and rudimentary. Supplemental or eumorphic denotes the ST of normal shape and size, and may also be labeled as incisiform. Rudimentary or dysmorphic teeth will have an abnormal shape and smaller size, and includes conical, tuberculate, and molariform types.

Supplemental teeth are less common, compared to other ST and are often overlooked due to their normal shape and size. According to dental lamina hyperactivity theory; a supplemental form would develop from the lingual extension of an accessory tooth bud whereas a rudimentary form would develop from the proliferation of epithelial remnants of the dental lamina.[9] Supplemental teeth may cause esthetic problems, delayed eruption, and crowding, and require early diagnosis and management to prevent complications.[10]

Regarding treatment for ST, many controversies and opinions exist, particularly relating to the timing of the removal. Munns [11] recommends the removal of the supernumerary as soon as it has been discovered and ideally before the age of 5 years according to Rotberg and Kopel.[12] However, the immediate removal of supernumeraries is not necessary if underlying pathology do not exist, as said by Koch et al.[5] Högström and Andersson [13] suggested two options which include removal of the supernumerary as soon as it has been diagnosed or the supernumerary could be left until the completion of root development in the adjacent teeth. Omer et al.[14] proposed a treatment option for surgical removal of the ST based on Demirjian's tooth stages. Ideally, ST should be surgically removed at Demirijian stage C (4-5 years old) as it exhibits minimal complications.[14] Surgical removal should not extend beyond 6-7 years old after which more complications are expected. According to Nuvvula et al.[15] ST has to be extracted in the early mixed dentition stage to allow spontaneous eruption and alignment of permanent teeth that minimizes the intervention, midline shift, and space loss.

In the present case, the proposed follow-up is to allow natural exfoliation/timely extraction of primary supplemental lateral incisor, while monitoring the development of normal series lateral incisor and permanent supernumerary lateral incisor, which require extraction in the future. The subsequent need for orthodontic treatment is assessed after the completion of mixed dentition stage.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Primosch RE. Anterior supernumerary teeth — assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 1
Shanmugha Devi G, Arangannal P, Muthu MS, Nirmal L. Supernumerary teeth associated with primary and permanent teeth: A case report. J Indian Soc Pedod Prev Dent 2002;20:104-6.  Back to cited text no. 2
Toureno L, Park JH, Cederberg RA, Hwang EH, Shin JW. Identification of supernumerary teeth in 2D and 3D: Review of literature and a proposal. J Dent Educ 2013;77:43-50.  Back to cited text no. 3
Davis PJ. Hypodontia and hyperdontia of permanent teeth in Hong Kong schoolchildren. Community Dent Oral Epidemiol 1987;15:218-20.  Back to cited text no. 4
Koch H, Schwartz O, Klausen B. Indications for surgical removal of supernumerary teeth in the premaxilla. Int J Oral Maxillofac Surg 1986;15:273-81.  Back to cited text no. 5
Shimizu T, Miyamoto M, Arai Y, Maeda T. Supernumerary tooth in the primary molar region: A case report. J Dent Child (Chic) 2007;74:151-3.  Back to cited text no. 6
Patil S, Doni B, Kaswan S, Rahman F. Prevalence of dental anomalies in Indian population. J Clin Exp Dent 2013;5:e183-6.  Back to cited text no. 7
Shekhar MG. Characteristics of premaxillary supernumerary teeth in primary and mixed dentitions: A retrospective analysis of 212 cases. J Investig Clin Dent 2012;3:221-4.  Back to cited text no. 8
Amarlal D, Muthu MS. Supernumerary teeth: Review of literature and decision support system. Indian J Dent Res 2013;24:117-22.  Back to cited text no. 9
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Bahadure RN, Thosar N, Jain ES, Kharabe V, Gaikwad R. Supernumerary teeth in primary dentition and early intervention: A series of case reports. Case Rep Dent 2012;2012:614652.  Back to cited text no. 10
Munns D. A case of partial anodontia and supernumerary tooth present in the same jaw. Dent Pract Dent Rec 1967;18:34-7.  Back to cited text no. 11
Rotberg S, Kopel HM. Early vs late removal of mesiodens: A clinical study of 375 children. Compend Contin Educ Dent 1984;5:115-9.  Back to cited text no. 12
Högström A, Andersson L. Complications related to surgical removal of anterior supernumerary teeth in children. ASDC J Dent Child 1987;54:341-3.  Back to cited text no. 13
Omer RS, Anthonappa RP, King NM. Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth. Pediatr Dent 2010;32:14-20.  Back to cited text no. 14
Nuvvula S, Melkote TH, Mohapatra A, Nirmala SV. Impacted mandibular permanent incisors related to supernumerary teeth: A rare condition. Pediatr Dent 2012;34:70-3.  Back to cited text no. 15


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