IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 1020

Non-syndromic Supplemental Permanent Maxillary Lateral Incisor: A Rare Case Series

E Premkumar1, K Vijay Venkatesan2, Chitra Janardhanan Vejai Vekash3, M Sathyakumar4, A Pravindevaprasad5

1Senior Lecturer, Department of Conservative Dentistry & Endodontics, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India, 2Professor, Department of Conservative Dentistry & Endodontics, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India, 3Post Graduate Student, Department of Conservative Dentistry & Endodontics, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India, 4Reader, Department of Oral and Maxillofacial Pathology, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India, 5Reader, Department of Orthodontics, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India

Supernumerary teeth, or hyperdontia, are the additional teeth to the normal series and are seen in all quadrants of the jaw. They have been reported to occur in both primary and permanent dentition. The supplemental supernumerary refers to duplication of teeth in the normal series and is found at the end of the tooth series. The majority of supernumeraries found in primary dentition are of the supplemental type. It is rare and was overlooked because of their normal size and shape. Hereby, we report three cases of supplemental maxillary permanent lateral incisor which resulted in crowding and poor esthetics. This case series reports unilateral supplemental teeth and its management.

Keywords: Hyperdontia, Incisiform supplemental teeth, Supernumerary maxillary lateral incisor, Supernumerary tooth, Supplemental teeth

independent, conditioned hyperactivity of the dental lamina.2 Another theory states that the supernumerary tooth was formed because of a dichotomy of tooth bud.5 Hereditary, environmental factors are considered as etiological factors in the occurrence of supernumerary teeth. The autosomal dominant trait was also suggested.

Supernumerary teeth were classifi ed by position or shape.6 Positional variations include mesiodens, paramolars, disto molars, and para premolars. Supernumerary teeth of normal shape and size are termed as “supplemental,” whereas teeth of abnormal shape and smaller size are termed as “rudimentary” and include a “conical,” “tuberculate,” and “molariform” teeth.7

This case series describes the rare occurrence of unilateral supplemental teeth without any association with the syndrome and its management.

CASE REPORTS

Case 1A 21-year-old female patient reported to the clinic with the chief complaint of teeth missing in the anterior region of the lower jaw. The familial, medical, and dental histories were not relevant. The extra-oral examination did not reveal any abnormalities.

INTRODUCTION

Tome’s fi rst used the term supplemental tooth to describe an extra tooth that resembled a normal series of the dentition.1 Supplemental teeth were also described by the term “superlative.” It is also classifi ed as normal, incisiform, or eumorphic.2 Supplemental maxillary incisors are rare to occur than conical or tuberculate supernumerary teeth in this region.3

Multiple supernumerary teeth in individuals with no other associated diseases or syndromes are rare.2 Cleft lip and palate, Cleidocranial dysostosis, Gardner’s syndrome, Fabry Anderson’s syndrome, Chondroectodermal dysplasia, and Ehlers–Danlos syndrome are commonly seen with supernumerary teeth.4

The etiology of hyperdontia remains unclear. One theory suggests that these teeth were formed because of local,

Case Report DOI: 10.17354/cr/2016/203

Corresponding Author:Dr. E Premkumar, Department of Conservative Dentistry & Endodontics, SRM Kattankulathur Dental College & Hospital, Potheri, Kanchipuram, Tamil Nadu, India. Phone: +91-9443045450. E-mail: endoprem@gmail.com

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Month of Submission : 01-2016Month of Peer Review : 02-2016Month of Acceptance : 03-2016Month of Publishing : 03-2016

Premkumar, et al.: Supplemental Teeth

IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10 21

Intra-oral examination revealed an edentulous lower anterior region extending from 43 to 32. The left mandibular lateral incisor was rotated and lingually inclined.

In addition to this complaint, incidentally, there was a supernumerary tooth in the maxillary arch on the left side that was palatally placed. It resembled the permanent maxillary lateral incisor. The morphology and the size of the supernumerary teeth were similar to the permanent maxillary lateral incisor and were located between erupted 11 and 12 (Figure 1).

Intra-oral periapical radiograph (Figure 2) revealed the supplemental permanent maxillary lateral incisor with fully formed crown and root formation. There were no disturbance or changes in the adjacent teeth.

However, the supplemental lateral incisor was impinging on the left mandibular permanent lateral incisor that was interfering with occlusion for the construction of a fi xed partial denture. The patient was advised to extract the supplemental tooth for esthetic rehabilitation of lower denture.

Case 2A 58-year-old female patient reported to the clinic with the chief complaint of decay in the right upper front tooth region. There were no signifi cant familial, medical, and dental histories. The extra-oral examination did not reveal any abnormalities.

Intra-oral examination revealed a supplemental tooth of maxillary lateral incisor on the right side of the maxillary arch adjacent to the permanent maxillary lateral incisor. The morphology and the size of the supernumerary teeth were similar to the permanent maxillary lateral incisor and were present in between 12 and 13 (Figure 3).

The patient had class 1 molar occlusion and had no interference with occlusion in this case, and the decay was due to the loss of contact and food lodgement in between 12 and the supplemental tooth.

Intra-oral periapical radiograph (Figure 4) was taken which revealed the extra permanent maxillary lateral incisor with complete crown and root formation present in between the 12 and 13. There were no disturbance or changes in the adjacent teeth.

The management included the restoration of dental caries in the distal aspect of the permanent maxillary lateral incisor.

Case 3A 21-year-old female patient complained of pain in the upper front tooth region. The familial, medical, and dental histories were not relevant. The extra-oral examination did not reveal any abnormalities.

Intra-oral examination revealed decay on the palatal aspect of the permanent maxillary lateral incisor adjacent to the canine. In addition to this complaint, incidentally, there was a supernumerary tooth in the maxillary arch on the same side adjacent to the carious tooth. It resembled the maxillary lateral incisor. The morphology and the size of the supernumerary teeth were similar to the permanent maxillary lateral incisor (Figure 5a and b). The palatal

Figure 2: Intra-oral periapical radiograph reveals the supplemental teeth in between the permanent maxillary central incisor and the lateral incisor. The radiopaque shadow seen indicates the overlap of teeth due to its presence palatally

Figure 1: (a) Supplemental teeth is located palatally between the erupted maxillary central and the lateral incisor. (b) Palatal view showing the supplemental teeth (Red arrow)

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Figure 3: (a) Supplemental teeth similar to the permanent maxillary lateral incisor and was present in between the lateral incisor and the canine. (b) Palatal view showing the supplemental teeth (Red arrow)

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IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 1022

inclination and intrusion of the teeth made us conclude that the tooth with decay was considered as supplemental teeth.

Intra-oral periapical radiograph (Figure 6) revealed the supplemental permanent maxillary lateral incisor with complete crown and root formation. There were no disturbance or changes in the adjacent teeth. However, the supplemental lateral incisor showed no response to electric pulp tester and was diagnosed as non-vital teeth. The

management includes the treatment of the supplemental teeth using root canal treatment and restoring with permanent composite fi lling.

DISCUSSION

Supernumerary teeth are common in the maxilla as compared to that of the mandible, and the most aff ected area is the premaxilla.3 The prevalence rates of supernumerary teeth vary between 0.1% and 6.9% in the permanent dentition.8 However, males are more commonly aff ected than the females with a ratio of 1.1:1. The conditions commonly associated with supernumerary teeth include cleft lip and palate, Cleidocranial dysplasia, Gardner’s syndrome, Fabry Anderson’s syndrome, Chondroectodermal dysplasia, and Ehlers–Danlos syndrome.9 The presence of genetically determined syndrome can be arrived from the familial history from the patient.8 However, in our cases, there was no relevant positive familial history which made us conclude as non-syndromic.

Few cases have been reported in literature until date. If a supplemental tooth is present, it is most commonly seen in the anterior maxillary region in the permanent dentition which is in concurrence with our case.8 In most of the cases, erupted supplemental teeth is part of the normal dental series.10

The inheritance and environmental factors were considered as possible reasons for the etiology.11 Interference with the stage of initiation, atavism continued the proliferation of remnants of the dental lamina, producing a “third dentition,” and/or dichotomy of the tooth germ, and produces two or more separate units. The tooth bud splits into two parts of equal or unequal size resulting in two teeth of equal size or one normal and one abnormal tooth.12 The presentation of only one permanent supplemental tooth in all the three cases seems to further complicate the question of etiology in hyperdontia cases.8

Supernumerary teeth are detected as a chance fi nding during clinical or radiographic examinations and are mostly asymptomatic. It is essential to identify the supernumerary teeth clinically and radiographically, before a defi nitive diagnosis and a treatment plan can be formulated. This case series is rare, as it demonstrates unilateral supernumerary lateral incisors without any associated syndrome.9

Commonly encountered with supplemental teeth are clinical problems such as failure of eruption, displacement or rotation, crowding, abnormal diastema, dilacerations, cystic formation, and ectopic eruption in permanent dentition. Failure of eruption of adjacent permanent teeth is the most frequently occurring complication.13 However,

Figure 4: Intra-oral periapical radiograph reveals the supplemental teeth in between the permanent maxillary central incisor and the lateral incisor

Figure 6: Intra-oral periapical radiograph reveals the supplemental teeth in between the permanent maxillary central incisor and the lateral incisor

Figure 5: (a) Supplemental teeth similar to the permanent maxillary lateral incisor and was present in between the lateral incisor and the canine. (b) Palatal view showing the supplemental teeth (Red arrow)

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IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10 23

in both of our cases, the supplemental lateral incisor did not disturb the formation of adjacent teeth except for the displacement causing unesthetic appearance in case 1.

Clinical and radiographic evaluation of the supplemental teeth is necessary to draw a treatment plan. In our cases, case 1 had healthy teeth, but the displacement of supplemental teeth palatally was observed which required extraction as suggested in the literature for replacement with fi xed partial denture in the lower arch. Case 2 and 3 had supplemental teeth between the canine and the lateral incisor and did not pose any problems such as arch irregularity, caries, and malocclusion. So, treatment was deferred for case 2. Similarly, a supplemental tooth in case 3 was non-vital and hence required endodontic treatment.

CONCLUSION

The case series emphasizes the importance of treatment plan that can be carried out by careful diagnosis based on the clinical and radiographic picture. Extraction of supernumerary teeth is not always the rule as long as it does not aff ect the adjacent teeth or cause any malocclusion.

REFERENCES

1. Gupta S, Singla S, Marwah N, Du a S, Goel M. Synodontia between permanent maxillary lateral incisor and a supernumerary tooth: Surgical treatment perspective. J Oral Health Community Dent 2007;1:52-5.

2. Primosch RE. Anterior supernumerary teeth – assessment and

surgical intervention in children. Pediatr Dent 1981;3:204-15.3. Liu JF. Characteristics of premaxillary supernumerary teeth:

A survey of 112 cases. ASDC J Dent Child 1995;62:262-5.4. Zhu JF, Marcushamer M, King DL, Henry RJ. Supernumerary and

congenitally absent teeth: A literature review. J Clin Pediatr Dent 1996;20:87-95.

5. Humerfelt D, Hurlen B, Humerfelt S. Hyperdontia in children below four years of age: A radiographic study. ASDC J Dent Child 1985;52:121-4.

6. Mitchell L. Supernumerary teeth. Dent Update 1989;16:65-6, 68-9.7. Garvey MT, Barry HJ, Blake M. Supernumerary teeth – an overview

of classifi cation, diagnosis and management. J Can Dent Assoc 1999;65:612-6.

8. Gupta DK, Mi al S, Gupta M, Sharma H. Unilateral supplemental primary maxillary lateral incisor without a permanent supernumerary: A rare case report. Indian J Oral Sci 2012;3:45-8.

9. Nagpal A, Hans MK, She y S, Kaur N, Kumar S. Non-syndromic bilateral supplemental maxillary lateral incisors: A rare case. J Clin Diagn Res 2013;7:1812-3.

10. Anil P. Management of supplemental permanent maxillary lateral incisor: A rare case. J Dent Med Sci 2012;1:24-6.

11. Schmuckli R, Lipowsky C, Peltomäki T. Prevalence and morphology of supernumerary teeth in the population of a Swiss community. Short communication. Schweiz Monatsschr Zahnmed 2010;120:987-93.

12. Stellzig A, Basdra EK, Komposch G. Mesiodentes: Incidence, morphology, etiology. J Orofac Orthop 1997;58:144-53.

13. Nik-Hussein NN. Anterior maxillary supernumerary teeth: A clinical and radiographic study. Aust Orthod J 1990;11:247-50.

How to cite this article: Premkumar E, Venkatesan V, Vekash CJ, Sathyakumar M, Pravindevaprasad A. Non-syndromic Supplemental Permanent Maxillary Lateral Incisor: A Rare Case Series. IJSS Case Reports & Reviews. 2016;2(10):20-23.

Source of Support: Nil, Confl ict of Interest: None declared.