TRANSPOSED SUPERNUMERARY PREMOLAR IN ALIGNMENT premolar and maxillary molar ... Supernumerary maxillary premolars have variable morphology
TRANSPOSED SUPERNUMERARY PREMOLAR IN ALIGNMENT premolar and maxillary molar ... Supernumerary maxillary premolars have variable morphology
TRANSPOSED SUPERNUMERARY PREMOLAR IN ALIGNMENT premolar and maxillary molar ... Supernumerary maxillary premolars have variable morphology
TRANSPOSED SUPERNUMERARY PREMOLAR IN ALIGNMENT premolar and maxillary molar ... Supernumerary maxillary premolars have variable morphology

TRANSPOSED SUPERNUMERARY PREMOLAR IN ALIGNMENT premolar and maxillary molar ... Supernumerary maxillary premolars have variable morphology

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    Ngeow we. Transposed supernumery premolar in alignment - a case re-port. Annals Dent Univ Malaya 1996; 3: 69-72

    ABSTRACTSupernumerarypremolars have been reported to occur in 0.29%of thegeneralpopulationand to represent about 9.1% of all supernumerary teeth. Most ofthe supernumerary teeth reported in the literature were detected by radio-graphsas most of them were unerupted or impacted.Asearch of the literaturerevealed not many cases of fully erupted and well aligned supernumerarypremolars being reported. A case of a unilateral transposed supernumerypremolarthat had erupted into alignment is presented here. The remarkablefeatureof this case is that the supernumery premolar is transposed betweenthe first and second permanent maxillary molars. The etiology ofsupernumeraryteeth is also reviewed.

    Key Words: alignment, premolar. supernumerary, supplemental, transposition.

    WeiCheong Ngeow. BDS (Mal).

    Tutor,Faculty of Dentistry,University of Malaya,59100, Kuala Lumpur,Malaysia.

    Address of correspondence:WeiCheong Ngeow,Faculty of Dentistry,University of Malaya,59100, Kuala Lumpur,Malaysia.

    IntroductionSupernumerary teeth have been found in all of the tooth-bearing areas of the dental arches and may occur in theprimary or permanent dentition(l). The prevalence ofsupernumeraries in the deciduous dentition has beenreported to be 0.8%(2) and that in the permanent dentitionas between 0.3% and 3.5%(3,4,5).Supernumerary teeth havea greater predilection for certain areas. The majority ofsupernumerary teeth occur in the maxilla with 90% locatedin the premaxillary region. This is followed by themandibular premolar and maxillary molar region(5.6.7.X),andmore rarely, in the canine region(9).

    Supernumerary teeth can be classified according totheir morphology. Various morphogical types have beendescribed: supplemental (or eumorphic), rudimentary(conical), tuberculate, or molariform. A supernumerarytooth that is similar morphologically and structurally to amember of the normal dentition is referred to as asupplemental tooth.

    The embyronic origin of these is not clearlyunderstood. A relationship to genetic patterns ofinheritance has not been established, although there is a2: I male to female ratio

  • 70 Annals of Dentistry, University of Malaya \1)1.3 fan 1996

    Figure I: Intraoral view showing the transposed supplementalpremolar in alignment between the maxillary molars.

    had competent lips and the ratio of his facial height waswithin normal range. His incisors were also of Class Irelationship with overjet of 2mm and overbite of 30%.However, there was a midline shift of the upper centralincisors of about 1mm to the right. There was mildmaxillary anterior teeth crowding.

    The patient was not aware of any family memberwho had supernumerary teeth. However, no relatives wereavailable for examination. The patient was only given oralhygiene instruction. He was also informed of thesupplemental tooth that was transposed and was inalignment. There appears to be no reason for extractionof the supplemental premolar.

    No radiographic examination was taken initially andwhen it was decided to present this case, the patient couldnot be contacted for further radiographic examination.

    DISCUSSIONSupernumerary premolars, especially in the maxillas,

    are unusual occurrences and third premolars which eruptwithout undue disturbance of the dental arch alignmentare very rare indeed. Supplemental premolars transposedand erupted into occlusion are not frequently reported inthe literature(l3.14.15.16). Most reported cases ofsupernumerary maxillary premolars were of the disfiguringor ectopic varieties, erupting buccal or lingual to thenatural dentition.

    Jasmin, Jonesco-Benaiche and Muller-Giamarchi(l7)presented a case of supernumerary mandibular thirdpremolar in a pair of twins. It is interesting to note thatthe pan tomographic examination revealed a mirror-imaging of three mandibular supernumerary premolars inboth children(17).

    (Lowry and MacCallum(lK), Fuller(19) and Lin(20)reported cases with supplemental teeth distal to themaxillary first permanent molars which were displacedbuccally and not in' occlussion. Barnett(21)reported a casewith supernumerary premolars between the first andsecond molars which was erupted buccally in the maxillaand lingually in the mandible. In addition, Van deVoorde(22)reported four fully erupted supernumerary leftmandibular premolars and three similar right premolarswhich were in reasonably good alignment and which werein occlusion with a partial denture in the upper arch.

    Vijayavergia and associates(13) were the first to report acase of transposed supernumerary premolar in occlusionwith natural dentition. Their case was two bilaterallyfunctioning supernumerary premolars located distal to thepermanent maxillary first molars. Their patient came witha complaint of pain at the maxillary right second and thirdmolars. Barkerll4) reported a similar occurrence and coinedthe nomenclature transposed third premolars in occlusion.A year later, Raphael(l5) reported the third case of suchoccurrence. The patient was, however, symptom free.

    Means and Tabeling(l6) were the first to report a caseof a unilateral transposed supernumerary premolar in oc-clusion. In their report, the patient complainted of painon the right retromolar pad region. They found that thepatient had a. supernumerary premolar in satisfactoryocclusion between the right maxillary first and secondmolar. The second molar was, however, supraerupted andimpinging on the retromolar pad during maximum closure.

    Most teeth erupted in their expected position in thedental arch. On rare occasions however, a tooth may bereversed in its site of eruption (such as a canine betweentwo premolars). This transposed tooth may bemisdiagnosed as a supernumerary tooth. Orthodontictreatment is not indicated to correct the transposition. Theuse of tooth masking procedures may the treatment ofchoice.

    Seventy-five percent of supernumerary premolars areunerupted(ll) and usually asymptomatic. However, in thereview of cases of transposed supernumerary premolar,two cases had signs and symptoms caused by theadditional teeth onto the dentition which led to thediscovery of the teeth(l3.16).The patient reported here wassymptom free and he was expected to remain so, providedhe maintained his good oral hygiene.

    The aetiology of supernumerary teeth has not yet beencompletely clarified. Various theories have been suggestedto explain this phenomenon(23). They are:

    a) Atavism or reversionb) Heredityc) Aberrations during embryologic formationd) Progress zonee) Unified etiologic explanation.

    a) Atavism or reversionThis hypothesis proposes a reversion to an ancestralhuman dentition which contained a larger number ofteeth(l24).It has been proposed that a supernumerarypremolar may be an atavistic reappearance of theextra premolar of the primitive dentition. However,this theory is not probable because if atavism isresponsible, both the maxilla and mandible should beequally affected.

    b) HereditySupernumerary teeth is theorirised to result frommutant genes. This is supported by the observationof a greater frequency of supernumerary teeth inpatients with maxillofacial anomalies such asCleidocranial Dysostosis(25), cleft lip or cleft palate(26),

  • Fabry's disease (angiokeratoma corporis diffusum)(27)and Gardner's syndrome(28). It has also been proposedthat autosomal iriharitence with lack of penetrationmight also give rise to supernumerary teeth(29).Thegreater frequency of supernumerary teeth in male thanin female indicates the possibility of a sex-linkedheredity(3().

    c) Aberrations during embryologic formation.There are several theories which are based onaberrations during embryologic formation. Theyinclude theory of epithelial remnants(3I), theory ofsupernumerary dental germs, theory of duplication bydichotomy of tooth germs, theory of additionalproliferation of the dental lamina(32), theory of thePrague school

  • 72 Annals of Dentistry, University of Malaya \i,l. 3 Jan 1996

    Dentomaxillofac Radiol 1978; 7: 15-78) Bodin I., Julin P, Thomsson M. Hyperdontia : IV. Supernumerary premolars. Dentomaxillofac Radiol 1981; 10:

    99-103.9) Davis PJ. Hypodontia and hyperdontia of permanent teeth in Hong Kong school children. Community Dent Oral

    Epidemiol 1987; 15:218-2010) Breckon n, Jones SP. Late forming supernumeraries in the mandibular premolar region. Br J Orthodont 1991;

    18:329-31.II) Stafne EC. Supernumerary teeth. Dent Cosmos 1932; 74: 653-912) Yusof WZ. Non syndrome multiple supernumerary teeth: Literature review. Canadian Dent Assoc J 1990; 56: 147-

    913) Vijayavergia NK, Dayal PK, Joshi MR. Bilateral functioning premolar-form supernumerary teeth distal to the

    maxillary permanent first molars. J Dent 1977; 5: 76-814) Barker BCW. Transposed third premolars in occlusion. Oral Surg 1977; 44: 16515) Raphael DM. Transposed supernumerary premolar. Oral Surg 1978; 46: 59816) Means DA, Tabeling n. Transposed supernumerary premolar in occlusion. Oral Surg Oral Med Oral Pathol 1984;

    58: 36717) Jasmin JR, Jonesco-Benaiche N, Muller-Giamarchi M. Supernumerary teetlf in twins. Oral Surg Oral Med Oral

    Pathol 1993; 76: 258-918) Lowry JC. MacCallum HR. Bilateral supernumerary teeth in the maxillary molar region. Br Dent J 1965; 118;390-I

    19) Fuller AC. Supernumerary teeth. Report of bilateral maxillary supernumerary. Br Dent J 1966; 121: 34020) Lin TY. Seven supernumerary premolars. Report of case Br Dent J 1967; 123: 437-821) Barnett BS. A case of multiple supernumerary teeth. Br J Orthod 1974; 1: 217-822) Van de Voorde HE. Functioning supernumerary mandibular premolars. Report of case. Dent Dig. 1971; 77: 392-523) Grimanis GA, Kyriak