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Table of Contents   
INVITED REVIEW  
Year : 2011  |  Volume : 14  |  Issue : 3  |  Page : 221-224
Management of supernumerary teeth


Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India

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Date of Submission13-Aug-2010
Date of Decision28-Feb-2011
Date of Acceptance14-Mar-2011
Date of Web Publication10-Oct-2011
 

   Abstract 

Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars)

Keywords: Paramolar, supernumerary teeth,conical teeth, distomolars

How to cite this article:
Parolia A, Kundabala M, Dahal M, Mohan M, Thomas MS. Management of supernumerary teeth. J Conserv Dent 2011;14:221-4

How to cite this URL:
Parolia A, Kundabala M, Dahal M, Mohan M, Thomas MS. Management of supernumerary teeth. J Conserv Dent [serial online] 2011 [cited 2016 Aug 24];14:221-4. Available from: http://www.jcd.org.in/text.asp?2011/14/3/221/85791

   Introduction Top


Supernumerary teeth are defined as those in addition to the normal series of deciduous or permanent dentition. They may occur anywhere in the mouth. They may appear as a single tooth or multiple teeth, unilaterally or bilaterally, erupted or impacted and in mandible/maxilla or both the jaws. The prevalence of supernumerary teeth varies between 0.1 and 3.8% and is more common in the permanent dentition. [1],[2],[3] The low prevalence of supernumerary teeth in primary dentition is because it is generally overlooked by the parents, is often of normal shape (supplemental type), erupt normally, and appear to be in proper alignment. [4] The incidence is considerably higher in the maxillary incisor region followed by maxillary third molar and mandibular molar, premolar, canine and lateral incisors. [5] Though there is no significant sex distribution in primary supernumerary teeth, males are affected approximately twice than females in the permanent dentition. [6],[7]


   Classification of Supernumerary Teeth Top


Supernumerary teeth can be classified according to chronology, location (topography), morphology and their orientation. Chronologically, they can be classified as pre-deciduous, similar to permanent teeth, and post permanent or complementary; morphologically as conical, tuberculate, supplemental (eumorphic) and odontome; topographically as mesiodens, paramolar, distomolar and parapremolar, and according to orientation as vertical, inverted and transverse [8] [Table 1], [Table 2] and [Table 3]. Paramolars are supernumerary molars, usually rudimentary (dysmorphic), situated buccally or lingually/palatally to the molar row. Mostly, they are situated between the second and third molars, while in very rare cases they can be found in between the first and second molars [Figure 1]. Distomolars are situated either directly distal or distolingually to the third molar and are usually rudimentary conical shape [Figure 2] and [Figure 3].
Figure 1: Presence of bilateral paramolars in between first and second molars

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Figure 2: Right side intraoral peri-apical radiograph showing carious maxillary right second molar (17), paramolar and distomolar

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Figure 3: Left side intraoral peri-apical radiograph showing carious maxillary left second molar (27), paramolar and distomolar

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Table 1: Supernumerary teeth based on location

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Table 2: Supernumerary teeth based on morphology

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Table 3: Supernumerary teeth based on eruption and orientation

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   Etiology Top


The exact etiology of the supernumerary teeth has not yet completely understood. Several theories have been suggested for their occurrence, such as the phylogenetic theory, [9] the dichotomy theory, [10] occurrence due to hyperactive dental lamina [11] and due to a combination of genetic and environmental factors. [12] Generally, multiple supernumerary teeth are associated with diseases or syndromes. [4] Supernumerary teeth show strong association with developmental disorders such as cleft lip and palate, cleidocranial dysostosis, Gardener syndrome and less commonly with  Ehlers-Danlos syndrome More Details, Fabry Anderson's syndrome, chondroectodermal dysplasia, incontinentia pigmenti and tricho rhino-phalangeal syndrome. [2],[5] Supernumerary teeth may erupt normally, remain impacted, appear inverted or assume an abnormal path of eruption.


   Complications Associated with Supernumerary Teeth Top


As such, supernumerary teeth do not cause any complication. However, these may lead to delay or failure of eruption of permanent teeth, displacement, crowding, root resorption, dilaceration, loss of vitality of adjacent teeth, subacute pericoronitis, gingival inflammation, periodontal abscesses, dental caries due to plaque retention in inaccessible areas, incomplete space closure during orthodontic treatment, and pathological problems such as dentigerous cyst formation, ameloblastomas, odontomas and fistulae. They may also interfere in alveolar bone grafting and implant placement.


   Diagnosis and Management Top


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 failure of eruption or ectopic eruption of permanent tooth, persistence of deciduous tooth, wide diastema and obvious presence of additional teeth. [13] An anterior occlusal or periapical radiograph [Figure 2] and [Figure 3] using paralleling technique and panaromic view (OrthoPantomoGraph) [Figure 4] are the most useful radiographic investigations to visualize supernumerary teeth. Recently, computed tomography has also been used to detect the presence of supernumerary teeth. [14],[15] 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 to 1. However, radiographs alone are not adequate for the definitive diagnosis. Their interpretation should always be conducted in conjunction with clinical findings. 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 [Figure 5] and [Figure 6]. Supernumerary teeth can be managed either by removal/endodontic therapy or by maintaining them in the arch and frequent observation [Figure 7]. Removal of the supernumerary teeth is recommended where [7]

  • 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 [Figure 1],
  • 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 esthetic and functional status.
Figure 4: OPG showing maxillary bilateral paramolars and distomolars

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Figure 5: Intraoral peri-apical radiograph showing completion of endodontic therapy in maxillary right second molar (17)

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Figure 6: Intraoral radiograph showing restoration in maxillary second molar

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Figure 7: Management of supernumerary teeth

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Extraction should be performed carefully to prevent damage to adjacent permanent teeth, which may cause ankylosis and maleruption of these teeth. The clinician should be careful to avoid complications such as damaging nerve and blood vessels during manipulation of the tooth, perforation of maxillary sinus, pterygomaxillary space, orbit and fracture of maxillary tuberosity. Clinicians must also be alert as sometimes supernumerary teeth are fused with the adjacent tooth structure at crown or root level, which may make the extraction difficult. [16],[17],[18] 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.


   Conclusions Top


Supernumerary teeth can present in any region of oral cavity. These may erupt or remain impacted and may lead to various complications. Though the occurrence of paramolars is rare, clinicians should be aware of their presence and associated problems in order to formulate a sound treatment plan after thorough clinical and radiographic investigations, to meet the challenges.

 
   References Top

1.Yusof WZ. Non-syndromal multiple supernumerary teeth: Literature review. J Can Dent Assoc 1990;56:147-9.  Back to cited text no. 1
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2.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. 2
    
3.Brook AH. Dental anomalies of number, form and size: Their prevalence in British school children. J Int Assoc Dent Child 1974;5:37-53.  Back to cited text no. 3
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4.Scheiner MA, Sampson WJ. Supernumerary teeth: A review of the literature and four case reports. Aus Dent J 1997;42:160-5.  Back to cited text no. 4
    
5.Grimanis GA, Kyriakides AT, Spyropoulos ND. A survey on supernumerary molars. Quintessence Int 1991;22:989-95.  Back to cited text no. 5
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6.Kinirons MJ. Unerupted premaxillary supernumerary teeth. A study of their occurrence in males and females. Br Dent J 1982;153:110.  Back to cited text no. 6
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7.Garvey MT, Barry HJ, Blake M. Supernumerary teeth- an overview of classification, diagnosis and management. J Can Dent Assoc 1999;65:612-6.  Back to cited text no. 7
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8.Shah A, Gill DS, Tredwin C, Naini FB. Diagnosis and management of supernumerary teeth. Dental Update 2008;35:510-20.  Back to cited text no. 8
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9.Smith JD. Hyperdontia: Report of a case. J Am Dent Assoc 1969;79:1191-2.  Back to cited text no. 9
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10.Liu JF. Characteristics of premaxillary supernumerary teeth: A survey of 112 cases. ASDC J Dent Child 1995;62:262-5.  Back to cited text no. 10
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11.Primosch RE. Anterior supernumerary teeth -assessment and surgical intervention in children. Pediatr Dent 1981;3:204-15.  Back to cited text no. 11
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12.Brook AH. A unifying etiological explanation for anomalies of human tooth number and size. Arch Oral Biol 1984;29:373-8.  Back to cited text no. 12
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13.Von Arx T. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aus Dent J 1992;37:189-95.  Back to cited text no. 13
    
14.Liu DG, Zhang WL, Zhang ZY, Wu YT, Ma XC. Three dimensional evaluations of supernumerary teeth using cone-beam computed tomography for 487 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:403-11.  Back to cited text no. 14
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15.Ballal S, Sachdeva GS, Kandaswamy D. Endodontic management of a fused mandibular second molar and premolar with the aid of spiral computed tomography: A case report. J Endod 2007;35:1247-51.   Back to cited text no. 15
    
16.Loh FC, Yeo JF. Paramolar with bifid crown. Oral Surg Oral Med Oral Pathol Oral Radiol 1993;76:257-8.  Back to cited text no. 16
    
17.Ghoddusi J, Zarei M, Jafarzadeh H. Endodontic treatment of a supernumerary tooth fused to a mandibular second molar: A case report. J Oral Sci 2006;48:39-41.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18.Nunes E, De Moraes IG, De Novaes PM, De Sousa SM. Bilateral fusion of mandibular second molars: A case report. Braz Dent J 2002;13:137-41.  Back to cited text no. 18
    

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Correspondence Address:
Abhishek Parolia
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Light House Hill Road, Mangalore, Karnataka - 575 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.85791

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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