Occurrence of bilaterally impacted mandibular supernumerary teeth: A rare case report and review of literature

Pravesh Kumar Jhingta; Vinay Kumar Bhardwaj; Deepak Sharma; Nishant Negi; Sanjeev Vaid; Naresh Kumar

doi:10.4103/0976-433X.156217

CASE REPORT

Year : 2016 | Volume : 7 | Issue : 3 | Page : 198-201

Occurrence of bilaterally impacted mandibular supernumerary teeth: A rare case report and review of literature

Pravesh Kumar Jhingta¹, Vinay Kumar Bhardwaj², Deepak Sharma¹, Nishant Negi³, Sanjeev Vaid³, Naresh Kumar⁴
¹ Department of Periodontology, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
² Department of Public Health Dentistry, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
³ Department of Orthodontics and dentofacial orthopaedics, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
⁴ Department of Periodontology, Maharaja Ganga Singh Dental College and Research Centre, Sriganganagar, Rajasthan, India

Date of Web Publication

22-Aug-2016

Correspondence Address:
Pravesh Kumar Jhingta
Department of Periodontology, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh
India

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DOI: 10.4103/0976-433X.156217

Abstract

Supernumerary teeth are present in addition to the normal complement of teeth in permanent or deciduous dentitions. Incidence is high in a permanent dentition, affecting both the gender. They are more common in males, with the male to female ratio of 2:1. When the supernumerary teeth are causing problems such as, extensive resorption of adjacent teeth, hindering the eruption or malposition of permanent teeth, early surgical intervention is recommended. A case of bilaterally impacted supernumerary premolars was reported, when an orthopantomograph view was taken that revealed the presence of additional teeth impacted in relation to 35-36 and 45-46. Literature reports increased occurrence of the supernumeraries in the maxilla, but supernumerary premolars are more likely to develop in the mandible. Etiology of supernumerary teeth is ambiguous, and is due to the following conditions: Atavism or reversion, heredity, aberrations during embryologic formation, progress zone, and unified etiologic explanation.

Keywords: Impacted, mandibular arch, premolars, supernumerary

How to cite this article:
Jhingta PK, Bhardwaj VK, Sharma D, Negi N, Vaid S, Kumar N. Occurrence of bilaterally impacted mandibular supernumerary teeth: A rare case report and review of literature. SRM J Res Dent Sci 2016;7:198-201

How to cite this URL:
Jhingta PK, Bhardwaj VK, Sharma D, Negi N, Vaid S, Kumar N. Occurrence of bilaterally impacted mandibular supernumerary teeth: A rare case report and review of literature. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Jan 15];7:198-201. Available from: https://www.srmjrds.in/text.asp?2016/7/3/198/156217

Introduction

Supernumerary teeth are present in addition to the normal complement of teeth in permanent/deciduous dentitions.^[1] Their incidence is high in a permanent dentition, affecting both the gender, but is more common in males, with a male to female ratio of 2:1.^[2] These occur in 0.3-3.8% of the population, of which 90-98% are seen in the maxilla. These may be present singly or in multiples, unilaterally or bilaterally in the maxilla, the mandible or both and are commonly seen in the incisor region of the maxillary arch.^[3] Supernumerary premolars constitute 8%^[4] and 9.1%^[5] of all supernumerary teeth. They are more likely to develop in the mandible than in the maxilla. Supernumerary premolars occur 3 times more frequently in males than in females, indicating a sex linked inheritance, with the highest frequency of occurrence in the mandibular premolar region (74%). They are also the most common supernumerary teeth in the mandibular arch.^[6] Seventy five per-cent of these teeth are impacted, unerupted and generally asymptomatic; and the majority are of the supplemental type.^[2] Bodin, et al.^[7] reported that only 2% of the supernumerary premolars exhibited any pathological changes, and indicated that these teeth should be left untreated rather than risk surgical damage. Hopcraft, 1998; Cortes, et al., 2009.^[8],[9] Orhan, et al.,^[10] Bhardwaj et al., 2012^[11],[12] mentioned that supernumerary teeth can be observed as isolated or multiple cases, unilateral or bilateral and in mandible or maxilla. Removal of unerupted supernumeraries involves the risk of damage to the adjacent structures, and a decision should be made whether to remove or monitor them.^[13] Early surgical intervention is recommended, when the supernumerary is causing problems such as, extensive resorption of adjacent teeth, hindering the eruption or malposition of permanent teeth. This article reports a case of bilaterally impacted supernumerary premolars.

Case Report

A 29-year-old male patient reported to the Department of Periodontology, with a chief complaint of a hard and painless protuberance since the last 6 months on the tongue side of both sides of the back lower teeth. Family, medical and dental histories were non-contributory. Extra-oral examination was normal. On palpation, a hard, immobile, painless swelling was observed on the lingual aspect of the mandible between 34-35 and 44-45 [Figure 1]. Clinically, one of the supernumerary teeth had pierced through the lingual alveolar ridge [Figure 2]. Orthopantomograph revealed the presence of 4 additional teeth impacted in relation to 34-35 and 44-45 each [Figure 3]. After the clinical and radiographic evaluations, the condition was diagnosed as multiple impacted supernumerary teeth. The supernumerary teeth were extracted under local anesthesia, because they were causing resorption of the root of 34, 35 and the mesial root of 44 and 45.

Figure 1: Protuberances of the supernumerary teeth in left mandibular premolar area

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Figure 2: Erupted supernumerary tooth in the right premolar area

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Figure 3: Orthopantomogram showing bilateral impactions of four supernumerary teeth in the mandibular premolar region

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Discussion

Cases of bilateral supplemental premolar teeth are developing later than their counterparts have been reported in the literature.^{[3],[4],[5],[6]} Reports have demonstrated that supernumerary premolar teeth develop approximately, 7-11 years after normal development, and it appears likely that this case may be a similar example. Bhardwaj et al.^[11] reported a similar case in which the supernumerary premolar had led to the resorption of an adjacent tooth. Although the literature reports an increased occurrence of the supernumeraries in the maxilla,^[14] supernumerary premolars are more likely to develop in the mandible.^[15] The etiology of supernumerary teeth is ambiguous, with different factors giving rise to different types of supernumeraries and combined etiological factors responsible for same. Various theories have been suggested to explain this phenomenon,^[16] which are as follows:

Atavism or reversion ^[17]
heredity ^[18],[19]
aberrations during embryologic formation ^[20]
progress zone ^[21]
unified etiologic explanation.^[22]

Supernumerary teeth may be classified according to the Morphology: Rudimentary and supplemental. Rudimentary teeth are smaller and tuberculate in shape, whereas the supplemental teeth usually, resemble the teeth of a group with which they are associated, that is incisors, canines, premolars and molars.^[23],[24] They may be single or multiple. Based on the location in the oral cavity, they may be called as mesiodens, paramolar and distomolar.

Management

Occasionally, supernumerary teeth are asymptomatic, and may be detected as a chance finding during radiographic examination. Detailed history, clinical examination, thorough investigation, early diagnosis and appropriate treatment of supernumerary teeth are mandatory. Unerupted supernumerary may be found by chance during radiographic examination. Sometimes, clinicians may suspect the presence of supernumerary teeth, if there is a failure of eruption or ectopic eruption of permanent tooth, persistence of deciduous tooth, wide diastema and obvious presence of additional teeth.^[25] An anterior occlusal or periapical radiograph using paralleling technique and panaromic view (OrthoPentomoGraph) are the most useful radiographic investigations to visualize supernumerary teeth. Recently, computed tomography has also been used to detect the presence of supernumerary teeth.^[26],[27] A complete radiographic survey of the entire oral cavity is essential to identify the presence of all impacted supernumerary teeth, because the ratio of impacted to erupted supernumerary teeth ranges from 3:1. Treatment depends on the type and location of the supernumerary teeth, and on its potential effect on adjacent hard and soft tissue structures. Occasionally, supernumerary teeth may lead to complications such as deep caries in the adjacent teeth, which may require restoration or endodontic therapy of the adjacent teeth as well. Supernumerary teeth can be managed either by removal/endodontic therapy or by maintaining them in the arch and frequent observation. Removal of the supernumerary teeth is recommended, where there is associated pathology, permanent tooth eruption has been delayed due to the presence of supernumerary tooth, increased risk of caries due to the presence of supernumerary teeth, which makes the area inaccessible to maintain oral hygiene, altered eruption or displacement of adjacent tooth is evident, there are severely rotated teeth leading to further complication, orthodontic treatment needs to be carried out to align the teeth, its presence would compromise alveolar bone grafting and implant placement, and there is compromised aesthetic and functional status.^[28],[29]

Extraction should be performed carefully, to prevent damage to adjacent permanent teeth, anatomic structures and spaces. Supernumerary teeth can also be kept under observation without extraction, when satisfactory eruption of related teeth has occurred with no associated pathology and not causing any functional and esthetic interference.^[29]

Conclusion

Usually, supernumerary teeth are diagnosed as a routine clinical and radiological examination except in few cases, where they cause clinical symptoms. Supernumeraries generally cause problems of malocclusion of a local nature, like tipping of adjacent teeth, rotation, bodily displacement, delayed eruption or prevent eruption of the tooth of the normal series. Also, they may lead to the esthetic disharmony and the functional distortion.

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